Request for more information about study of rapid cycling in affective disorders.
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Bipolar Disorder↗
Biomedical subjects
R W Lam
Publications and source records attributed to R W Lam.
Seasonal affective disorder presenting as chronic fatigue syndrome.
Although operational criteria have been recently proposed to better define chronic fatigue syndrome (CFS), it remains a controversial diagnosis. There are many overlapping symptoms between CFS and major depression. The author presents two patients with seasonal affective disorder, who responded to phototherapy and had previously been diagnosed as CFS. Because of the consequences of treatment, seasonal and non seasonal depression need to be ruled out in patients with chronic fatigue symptoms.
Diagnosis, Differential↗
Ontogeny of thyrotropin releasing hormone and precursor peptide in the rat.
Thyrotropin releasing hormone (TRH) and its precursor peptide pGlu-His-Pro-Gly (TRH-Gly) were measured in serum and in a variety of tissues of developing rats using specific RIA. TRH and TRH-Gly immunoreactivities were detected in most tissues. TRH concentrations were highest in pancreas, in which mean (+/- SEM) TRH concentrations were 138 +/- 20 pmol/g wet tissue 2 d before birth and 644 +/- 80 and 586 +/- 86 pmol/g, respectively, 2 and 5 d after birth. Hypothalamic TRH levels gradually increased from 4 d before birth (12 +/- 2.5 pmol/g) to 77 d of postnatal age (348 +/- 33 pmol/g). Hypothalamic concentrations were lower than levels in pancreas until 13 d of age. The mean serum TRH level at 2 d was 80 +/- 20 pmol/L and fell to the adult range by 21 d. TRH-Gly concentrations were highest in small gut (371 +/- 64 pmol/g) during the neonatal period, falling gradually to adult levels (33 +/- 4.8 pmol/g) by 35 d. Mean hypothalamic TRH-Gly concentrations increased to a peak of 62 +/- 4.5 pmol/g at 13 d, falling thereafter. High TRH-Gly concentrations (greater than 100 pmol/g) also were observed in pancreas (at d 2), kidney, and pituitary gland (at d 21). Serum TRH-Gly concentrations were highest (mean 417 +/- 26 pmol/L) on the 2nd postnatal day and gradually decreased to the adult level by 35 d. Changes in the TRH-Gly/TRH ratio were inversely correlated with tissue TRH concentrations in hypothalamus, pancreas, and liver.(ABSTRACT TRUNCATED AT 250 WORDS)
Age Factors↗
Ultraviolet versus non-ultraviolet light therapy for seasonal affective disorder.
Although light therapy has been shown to be effective in the treatment of seasonal affective disorder (SAD), little research has been done to determine which light wavelengths affect treatment outcome. In this triple crossover study the authors compared 1 week of light therapy in which bright (2500 lux), full-spectrum fluorescent light, with and without blockade of the ultraviolet (UV) spectrum, was used with a dim (500 lux) light control in 11 SAD patients. The dim light condition had no significant antidepressant effects as measured by the Hamilton Rating Scale for Depression (HAM-D), the Beck Depression Inventory (BDI), and an atypical depressive symptom (ATYP) score. The UV-light condition significantly reduced HAM-D, BDI, and ATYP scores, whereas the UV-blocked condition significantly reduced only the ATYP score. These results suggest that the UV-spectrum in light therapy may have a differential effect on typical and atypical symptoms in SAD.
Depressive Disorder↗
Melatonin suppression in bipolar and unipolar mood disorders.
Nocturnal melatonin suppression to 500 lux light was studied during an acute episode of illness in 8 patients with bipolar disorder, 7 patients with unipolar depression, and 15 age-, sex-, and season-matched normal controls. Unipolar patients did not differ from controls in melatonin suppression. In contrast to previous studies, controls showed greater melatonin suppression than bipolar patients. Baseline melatonin concentration, however, was significantly lower in the bipolar group compared to the unipolar and control groups.
Bipolar Disorder↗
Distribution and ontogeny of thyrotropin-releasing hormone degrading enzymes in rats.
The distribution and ontogeny of tissue prolyl endopeptidase and pyroglutamyl peptidase I activities were studied in the rat from the 7th day before birth to adulthood. While low levels of prolyl endopeptidase activity were demonstrable in many fetal tissues, activity in brain cortex, hypothalamus, lung, and kidney increased dramatically during the 2 wk after birth, gradually returning to adult levels. In adult rats, levels of tissue prolyl endopeptidase activity were highest in kidney, when compared with the intermediate levels in brain cortex, hypothalamus, and liver. Pyroglutamyl peptidase activity was widely distributed in adult rat tissues with high levels in kidney and liver that exceeded intermediate levels in brain cortex and hypothalamus. Pyroglutamyl peptidase activities in fetal gut, brain, and lung tissue were elevated above adult values. In contrast to the development changes in prolyl endopeptidase activities, pyroglutamyl peptidase activity remained elevated above adult levels only during the first week of life. These results indicate that both prolyl endopeptidase and pyroglutamyl peptidase activities in the rat are developmentally regulated.
Aging↗
Treatment of depression in patients with dementia.
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Antidepressive Agents↗
A psychiatric fellowship in the United States.
The development of subspecialty fields in psychiatry will likely motivate many new graduates of Canadian psychiatric residency programs to seek additional fellowship training. There is little information to guide psychiatric residents interested in arranging a fellowship year. This article discusses the experience of three Canadian psychiatrists who recently completed a fellowship year in a well known academic centre in the United States. The reasons for considering an additional year of training are discussed. The practical aspects of finding and funding a fellowship year are also addressed. The individual experiences of the authors as fellows in consultation-liaison psychiatry, psychopharmacology and psychobiology, and sleep disorders medicine are described. Finally, personal stresses which appeared to be commonly experienced by psychiatric fellows are explored.
Canada↗
Distribution of thyrotropin-releasing hormone (TRH) and precursor peptide (TRH-Gly) in adult rat tissues.
TRH (pGlu-His-Pro-NH2) arises from the post-translational processing of a larger precursor peptide containing multiple copies of the TRH progenitor sequence, Gln-His-Pro-Gly. Concentrations of TRH and its precursor peptide (TRH-Gly) were determined in serum and a variety of tissues of the rat using specific RIA systems. TRH and TRH-Gly immunoreactivities were detectable in almost all tissues studied. TRH was distributed mainly in neural tissues, with the highest mean concentration (126 pg/mg tissue) in hypothalamus. In extra-neural tissues, mean TRH levels ranged from 0.6-4.8 pg/mg tissue; the mean serum concentration was 12.4 pg/ml. In contrast to the distribution of TRH, relatively higher mean TRH-Gly concentrations were observed in serum (76.5 pg/ml) and in extraneural tissues, including prostate (83.3 pg/mg tissue), spleen (19.0 pg/mg), adrenal (16.2 pg/mg), kidney (13.3 pg/mg), and gastrointestinal tract (6.3-19.8 pg/mg). Among brain tissues, the TRH-Gly concentration was highest in pituitary gland (13.1 pg/mg). The mean ratio of TRH-Gly/TRH concentrations was less than 1 in neural tissues and pancreas. The lowest ratio (0.04) was observed in hypothalamus, and the highest ratio (66) in prostate gland. Assuming that tissue TRH-Gly levels reflect TRH synthesis, these results suggest that 1) the processing of TRH-Gly to TRH varies among tissues, 2) TRH-Gly to TRH conversion occurs most efficiently in neural tissues, and 3) TRH-Gly to TRH conversion may be a rate-limiting step in TRH biosynthesis.
Animals↗
Light therapy for seasonal bulimia.
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Adult↗
Phototherapy for depressive disorders: a review.
The use of bright light (phototherapy) for psychiatric disorders has recently generated much interest among researchers and the lay population. The authors review the treatment studies of phototherapy for seasonal and non-seasonal depressive disorders, and the empirical evidence for theories of the psychophysiology of phototherapy. Although its mechanism of action remains to be explained, phototherapy appears to be a safe and effective treatment for seasonal depression and a promising treatment for non-seasonal depression. Further questions and future research directions are presented.
Depressive Disorder↗
Ovine fetal and adult atrial natriuretic factor metabolism.
Studies were conducted to quantify ovine fetal and adult atrial natriuretic factor (ANF) metabolism. A total of 14 pregnant ewes with singleton fetuses were prepared with vascular catheters. In protocol 1, six fetuses (mean gestation, 131 +/- 1 days) received intravenous infusions of synthetic human ANF (hANF, 100 ng.min-1.kg-1) for 60 min. Mean basal fetal plasma ANF levels increased from 180 +/- 44 pg/ml to a steady-state level of 1,233 +/- 192 pg/ml. In protocol 2, five fetuses (mean gestation, 130 +/- 1 days) received successive 40-min infusions of hANF at 5, 25, and 100 ng.min-1.kg-1. Although basal fetal plasma ANF levels (522 +/- 135 pg/ml) were greater than those observed in protocol 1, fetal plasma ANF levels increased to 1,580 +/- 295 pg/ml at the highest infusion rate. In both protocols 1 and 2, basal fetal plasma ANF levels were three- to fourfold greater than maternal levels. The fetal plasma ANF clearance rates calculated from protocol 1 and from the 25- and 100-ng.min-1.kg-1 infusions from protocol 2 were similar (89 +/- 10, 120 +/- 31, and 116 +/- 38 ml.min-1.kg-1, respectively) and were combined to yield a mean estimated fetal plasma ANF clearance rate of 102 +/- 11 ml.min-1.kg-1. In protocol 3, adult plasma ANF levels increased from 137 +/- 36 to 4,142 +/- 776 pg/ml in response to ANF infusion at 200 ng.min-1.kg-1. The mean plasma ANF clearance rate calculated for the adult animals was 59 +/- 12 ml.min-1.kg-1.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Catecholamine and endorphin responses to delivery in term and preterm lambs.
A marked increase in catecholamines and endorphins at birth has been described in animals and man. Because the factors which regulate catecholamine secretion are incompletely understood and because it has been suggested that endogenous opiates are important in the regulation of catecholamine secretion, we designed studies to compare changes in plasma catecholamines at birth with simultaneously measured endorphins. Catecholamines and beta-endorphin-like immunoreactivity (beta-ELI) were measured at birth in term (145 days) and preterm (130 days) lambs. Preterm lambs were given natural sheep surfactant intratracheally to prevent respiration failure. Following umbilical cord cutting, there was a marked increase in circulating norepinephrine (NE) and epinephrine (E) levels. The peak preterm NE (2.2 +/- 0.3 ng/ml at 1 h) was greater than the peak term NE (1.0 +/- 0.2 ng/ml at 5 min). The peak preterm E occurred later and also was greater than the peak term E (4.0 +/- 0.5 ng/ml at 1 h vs. 1.3 +/- 0.4 ng/ml at 15 min, respectively, p less than 0.01). Baseline beta-ELI in term animals (767 +/- 15 pg/ml) was greater than preterm (456 +/- 12 pg/ml). Following cord cutting peak beta-ELI in term animals rose to 867 +/- 201 pg/ml compared to a peak beta-ELI in preterm animals of 1,866 +/- 450 pg/ml. These results and their significance for neonatal adaptation to extrauterine life are discussed.
Animals↗
The clinical use of EEG in a general psychiatric setting.
In a university teaching hospital, the charts of 150 psychiatric inpatients consecutively referred for EEG were reviewed to survey the clinical use of the EEG by psychiatrists. Individual psychiatrists referred between 18 and 31 percent of their caseloads, and 11.3 percent of the EEGs were abnormal. The only clinical indications significantly associated with an abnormal EEG were a history of epilepsy and suspicion of a recent seizure. The presence of an organic factor, which was previously identified in the history, mental status examination, or physical examination of 58 percent of the patients, was significantly associated with an abnormal EEG. However, none of the abnormal EEGs helped identify an organic etiology that was not already diagnosed, and in three cases clinicians appeared to ignore abnormal EEG results. Based on these data, the authors discourage the routine use of the EEG for psychiatric patients, recommending that an EEG be considered only when the clinical history and findings suggest an underlying organic disorder.
Adolescent↗
The lateralization of atypical facial pain.
Various theories have been proposed to explain the reported predominance of left-sided symptoms in patients with conversion disorders, psychogenic symptoms, and chronic pain. In a population of 110 patients with atypical facial pain (AFP), there were no significant differences in the side of pain or lateralization of pain between psychiatric and non-psychiatric patients. A non-significant trend to left-sided pain in psychiatric patients was found if only those patients with lateralized pain were examined. The significance of these results to etiological theories of chronic pain lateralization is discussed.
Conversion Disorder↗
ECT in the treatment of mixed depression and dementia.
Recent work has demonstrated the coexistence of depressive illness in some patients with dementing disorders. Two cases of mixed depression and dementia showed behavioural and mood improvement after treatment with ECT, but without improvement in cognition. The role of ECT in the treatment of affective symptoms in dementia is discussed.
Aged↗
Fetal atrial natriuretic factor and arginine vasopressin responses to hyperosmolality and hypervolemia.
Atrial natriuretic factor (ANF) is a class of diuretic and natriuretic peptides secreted by mammalian cardiac atria. Although basal plasma ANF levels in the ovine fetus are elevated relative to the adult, fetal secretion of ANF increases in response to intravascular isotonic saline infusion. Recent in vitro and in vivo studies indicate that ANF secretion also may be stimulated by increased plasma osmolality and/or sodium concentration. The present studies were conducted to determine if volume expansion associated with increased plasma osmolality would further augment ANF secretion in the ovine fetus. In response to successive 30-min intravenous infusions of 3% saline at 0.5 and 1.0 ml/kg/min fetal plasma ANF significantly increased from a basal level of 98 +/- 31 pg/ml to a peak of 439 +/- 42 pg/ml (p less than 0.05). During a 30-min postinfusion recovery period, fetal plasma ANF significantly decreased from peak values to 224 +/- 10 pg/ml (p less than 0.05), although remaining above basal levels. Fetal plasma osmolality significantly increased from 300 +/- 2 mosmol to 325 +/- 3 mosmol (p less than 0.05) whereas fetal plasma arginine vasopressin increased from 1.9 +/- 0.4 to 10.9 +/- 7.0 pg/ml (p less than 0.05) at the conclusion of the 3% saline infusion. During the saline infusion a significant increase in fetal heart rate and decrease in fetal hematocrit were noted. Fetal blood pressure and maternal plasma ANF and arginine vasopressin concentrations remained unchanged. Despite the potential stimulatory effects of hyperosmolality, increased plasma arginine vasopressin, and intravascular volume expansion, the increase in fetal plasma ANF in the present study did not exceed that induced by isotonic saline alone.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Antidepressant drug studies in the elderly.
This article reviews the literature on antidepressant drug trials conducted in elderly populations. Only 27 studies of cyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and psychostimulants deal specifically with subjects that were over age 60. Methodologic problems were found in many studies, including lack of diagnostic criteria and inadequate controlling for cognitive impairment, concurrent medical illnesses, and nonpsychotropic medications. Most studies compared second-generation antidepressants against placebo or tricyclic antidepressants (TCAs). Antidepressant drugs are effective treatments for geriatric depression, and limiting side effects are comparable with those seen in younger populations.
Aged↗