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Biomedical subjects

S B Patten

Publications and source records attributed to S B Patten.

13 recordsLinked to original sources
PubMed1992

The comparative efficacy of trazodone and imipramine in the treatment of depression.

OBJECTIVE: To review published clinical trials comparing the efficacy of trazodone with that of tricyclic antidepressant medication. DATA SOURCES: MEDLINE was searched for relevant articles published from 1983 to 1991. The bibliography of a review article was searched for further references. STUDY SELECTION: In all, 25 clinical trials were found. Six of these met the methodologic assessment criteria (adapted from the McMaster guidelines for the evaluation of clinical trials), which included the stipulation of a score of 18 or more on the Hamilton depression rating scale and a 50% reduction in that score as an outcome measure. DATA EXTRACTION: All six studies compared trazodone with imipramine. Data describing response to the treatments were extracted, and post-hoc power estimates were calculated. The analysis also involved statistical tests of a modified null hypothesis, the generation of confidence intervals (CIs) and a meta-analysis. DATA SYNTHESIS: All the studies found no significant difference in the efficacy of trazodone and imipramine. However, the statistical power of most of them was less than 50% and often less than 10%; thus there was a low probability that differences would be detected. The results of statistical tests of the modified null hypothesis, inspection of the CIs and the results of the meta-analysis all suggested that trazodone, and imipramine are equally efficacious. CONCLUSION: The application of various techniques for the analysis of equivalence data suggests that trazodone and imipramine are of approximately equivalent efficacy. The data are compatible with small differences in efficacy, but the differences are of a magnitude such that they are unlikely to be of clinical significance.

Clinical Trials as Topic↗
PubMed1992

Pharmacologic management of refractory depression.

OBJECTIVE: To review published clinical trials of the pharmacologic management of refractory depression. DATA SOURCES: MEDLINE was searched for relevant articles published from 1983 to 1990. The bibliographies of review articles were searched for additional references. Studies of nonpharmacologic treatments, such as electroconvulsive therapy, were not included. STUDY SELECTION: Eleven studies were found that did not contain obvious digressions from several methodologic assessment criteria (adapted from the McMaster guidelines for the evaluation of clinical trials). Further scrutiny by a nonblind reviewer resulted in the selection of four reports that were considered acceptable. An assessment by a second reviewer, blind as to author, results and journal name, confirmed this judgement. DATA EXTRACTION: Data describing response to the treatments were extracted by a single (nonblind) reviewer. Post-hoc power estimates and 95% confidence intervals were calculated whenever possible. DATA SYNTHESIS: The efficacy of augmenting an antidepressant regimen with lithium carbonate, triiodothyronine or reserpine was not supported by findings from the clinical trials reviewed. However, many trials with negative results lacked adequate statistical power to exclude the possibility of the drug's efficacy. The use of a monoamine oxidase inhibitor was supported by the one study that met the review's methodologic criteria. However, this study was not conducted under double-blind conditions. CONCLUSION: The generally recommended strategies for the pharmacologic treatment of refractory depression are not supported by methodologically sound studies.

Antidepressive Agents↗
PubMed1992

Delayed sleep phase disorder after traumatic brain injury.

Sleep-wake schedule disorder is defined by DSM-III-R as a mismatch between the normal sleep-wake schedule for a person's environment and his or her circadian sleep-wake pattern. The authors report a case in which a sleep-wake schedule disorder arose after a closed head injury. Sleep-wake schedule disorder has not been described as an outcome of closed head injury. As patients with sleep-wake schedule disorders may present with insomnia, this case suggests the possibility that some of the insomnia that frequently follows closed head injury may represent sleep-wake schedule disorders.

Adolescent↗
PubMed1992

Can drug-induced depressions be identified by their clinical features?

Drug-induced depression is classified by the DSM-III-R as an organic mood syndrome of the depressed type. Because drugs have specific pharmacological effects and mechanisms of action, depressive syndromes induced by specific drugs may have characteristic clinical features. An awareness of such features would be valuable for clinical purposes. This review is an attempt to summarize the information on clinical features of drug-induced depressions. The review determined that no unique clinical features have been identified for depressive syndromes associated with most drugs. However, the literature did suggest that depressions associated with oral contraceptive agents may differ significantly from non organic major depressive episodes.

Adrenergic beta-Antagonists↗
PubMed1991

Evaluation of the Modified Mini-Mental State Examination in a general psychiatric population.

Studies of clinical cognitive screening tests began in the 1960s, and ten instruments have been reported in the English literature. In this study, we have compared the widely used Mini-Mental State Examination developed by Folstein with a reportedly enhanced version, the Modified Mini-Mental State Examination devised by Teng, using a sample of 250 patients (inpatients, outpatients, emergency). We have come to the conclusion that the modifications brought about by Teng result in a minor improvement of the validity of the Mini-Mental State Examination in a psychiatric patients in a general hospital.

Emergency Services, Psychiatric↗
PubMed1991

The loss of a parent during childhood as a risk factor for depression.

While the loss of a parent during childhood may put a person at risk for depression, many studies have failed to confirm the importance of this risk factor. Nevertheless, the relationship between the loss of a parent and depression is of clinical importance. This paper reviews studies of the loss of a parent as a risk factor for depression. In addition, relevant data from these studies were pooled using meta-analytic techniques. It was found that for females there was a significant association between the loss of one's mother before age 11 and depression, and that losing one's mother during early childhood may double their risk of depression.

Adolescent↗
PubMed1991

Are the Brown and Harris "vulnerability factors" risk factors for depression?

The Brown and Harris model of depression holds that certain "vulnerability factors"--namely early maternal loss, lack of a confiding relationship, greater than three children under the age of 14 at home and unemployment--can interact with "provoking agents" to increase the risk of depression. The validity of this model has been widely debated, with most of the discussion concerning the interactive nature of the model. There has been relatively little attention paid to the possibility that the "vulnerability factors" may be risk factors for depression. The purpose of this paper is to determine whether the four Brown and Harris "vulnerability factors" are associated with an elevated risk of depression, irrespective of whether they may interact with provoking agents. The analysis contained in this paper utilizes power analyses and confidence intervals. The findings suggest that the lack of a confiding relationship is strongly associated with depression, and that all four of the "vulnerability factors" may be associated with an increased risk of depression.

Depressive Disorder↗
PubMed1990

Propranolol and depression: evidence from the antihypertensive trials.

The relationship between propranolol and depression is a subject of controversy. Numerous case reports suggest that propranolol can cause depression, but two small prospective trials have failed to confirm this. The contemporary psychiatric literature is divided as to whether propranolol can cause depression. This study addresses this issue by re-analyzing side effect data from clinical trials of propranolol as an antihypertensive agent. A literature review was carried out and the data were analyzed using meta-analytic statistical techniques. Propranolol was found to cause depression as a side effect with a statistically greater frequency than the control medications used in these trials. As other side effects of propranolol include fatigue, diminished energy, decreased libido, anorexia and poor concentration, it is suggested that propranolol is a cause of organic mood disorder, depressed type.

Clinical Trials as Topic↗
PubMed1990

Non-psychiatric therapeutic medications in the etiology of organic depression.

Medication-induced depression is classified by DSM-IIIR as organic mood disorder of the depressed type. Unfortunately, there is little consensus in the psychiatric literature regarding which medications are capable of inducing an organic mood disorder. Nor do estimates exist for the prevalence of organic mood disorders. In fact, the existing literature about medication induced depression consists mostly of case reports. Nevertheless, the etiology of organic depression is an important clinical issue, and one deserving of systematic study. In this paper, some of the methodologic issues related to research in this area are reviewed. Meta-analysis is proposed as a useful strategy for the study of some aspects of organic depression. The application of meta-analysis is illustrated with studies investigating the relationship between propranolol, methyldopa, clonidine and depression.

Depressive Disorder↗
PubMed1989

Dysgraphia.

Explore the source record for details and available documents.

Agraphia↗
PubMed1989

Organic mania induced by phenytoin: a case report.

Organic Mood Disorder of the manic type is a syndrome which resembles a manic episode but is due to a specific organic factor. Organic mania may be associated with a variety of physical illnesses such as temporal lobe epilepsy, multiple sclerosis, neoplasms and hyperthyroidism. In addition, organic mania can be associated with drugs including L-dopa, decongestants, sympathomimetics, steroids, baclofen withdrawal, cimetidine, and possibly captopril. This report describes a case of a 74 year old female who presented with a full syndrome of mania soon after being started on phenytoin. Neither the clinical picture, Mini-mental state score, nor EEG findings were suggestive of delirium. The syndrome resolved soon after the phenytoin was discontinued. This case suggests that phenytoin should be added to the list of medications capable of producing Organic Mood Syndrome, manic type.

Aged↗
PubMed1989

The face-hand test: a useful addition to the psychiatric physical examination.

The Face-Hand Test is a quick and simple neurological test which can be used to detect organic mental disorders. It is based on the principle that when light touch stimuli are simultaneously applied to the cheek and the hand, patients with organic mental disorders frequently report only the face stimulus. In other words, the hand stimulus is frequently extinguished. The test is conducted with the patient's eyes closed. For clinical purposes, ten consecutive face-hand (e.g., left cheek, right hand) combinations are applied and one point is awarded for each time the patient correctly localizes both stimuli. A score of six or less is considered a positive test. In this study, the Face-Hand Test was performed, by a blind tester, to eighty five admissions to psychiatric inpatient units at the Calgary General Hospital. Subsequently, a chart review was done, by a reviewer unaware of the test scores, and the presence or absence of an organic mental disorder was ascertained. In this sample, the sensitivity of the test for the detection of organic disorders was 87% and the specificity was 84%. The negative predictive value of the test was 97%, indicating that the test may be quite useful for the purpose of ruling out organic mental disorders among psychiatric admissions.

Humans↗