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Biomedical subjects

T Silverstone

Publications and source records attributed to T Silverstone.

At least 37 records · Page 2Linked to original sources
PubMed1995

Is there a seasonal pattern of relapse in bipolar affective disorders? A dual northern and southern hemisphere cohort study.

BACKGROUND: Admission statistics for mania frequently show an increase in the summer. The present two-centre study was designed to test the hypothesis, in a representative sample of bipolar patients, that manic and depressive relapses show a seasonal pattern. METHOD: Two cohorts of bipolar I patients, one in London, England (n = 86), the other in Dunedin, New Zealand (n = 58), were tracked retrospectively during 1985-88 and prospectively during 1989-91, with the onset of all relapses being carefully dated. RESULTS: In the London cohort there were 221 episodes of mania and 76 of depression; in the Dunedin cohort there were 201 of mania and 61 of depression. No consistent seasonal pattern of mania was detected in either centre. There was an autumn preponderance of depressive episodes in both centres. CONCLUSIONS: Relapse of bipolar depression, but not of mania, appears to be determined in part by seasonal factors.

Adult↗
PubMed1993

The incidence of mania in two areas in the United Kingdom.

The incidence of mania in an inner-city area was estimated by both a casenote search with later interview and a prospective interview method. The incidence was found to be twice as high as that in a more rural area, as estimated by the casenote-based method. Though a high proportion of the inner-city population were from ethnic minorities, particularly Afro-Caribbean, this could not explain the discrepancy. It is suggested that the incidence of mania is related to the mobility of the local population.

Adult↗
PubMed1993

Ritanserin attenuates anorectic, endocrine and thermic responses to d-fenfluramine in human volunteers.

This study investigated the role of the 5-HT2/1C receptor antagonist ritanserin on d-fenfluramine (d-FF) induced changes in food intake, prolactin (PRL) secretion and oral temperature in 12 healthy male volunteers. The study was double blind and placebo controlled. Food intake was measured using an automated food dispenser. d-FF (30 mg) significantly reduced fat intake. While ritanserin (5 mg) had no effect when given alone it abolished the d-FF induced reduction in fat intake. In addition, ritanserin abolished the d-FF induced rise in PRL and oral temperature. The results suggest that 5-HT2 or 5-HT1C receptors mediate the effects of d-fenfluramine on appetite, prolactin secretion and temperature in humans.

Adult↗
PubMed1993

Moclobemide--placebo-controlled trials.

In this paper, three placebo-controlled trials of moclobemide, and four three-way comparison trials of moclobemide, placebo and one of the standard tricyclic antidepressants, imipramine, clomipramine, or amitriptyline, are reviewed. The results of the placebo-controlled trials indicate that about twice as many of the patients receiving moclobemide showed a marked improvement during a four-week treatment period, as compared with patients receiving placebo. Of the three-way trials, two studies indicated that the efficacy of moclobemide was significantly greater than that of placebo and similar to that of other antidepressants (imipramine or amitriptyline). Tolerance of moclobemide was good and better than that of the tricyclic antidepressants. In the other three-way comparison trials, the differences in efficacy between the placebo, moclobemide, and the tricyclic antidepressant were not significant.

Adolescent↗
PubMed1993

The prolactin response to d- and l-fenfluramine and to d-amphetamine in human subjects.

Twelve normal male volunteers took part in a double-blind placebo-controlled study to measure the effects of d- and l-fenfluramine singly and in combination with d-amphetamine on plasma prolactin levels. Both isomers of fenfluramine were found to differ significantly in their effects from d-amphetamine, and from placebo, causing prolactin levels to rise. d-Fenfluramine produced the greatest change. There were minor differences between the level of activity of the two drugs when given in conjunction with d-amphetamine. d-Amphetamine produced a non-significant reduction in prolactin secretion. The neurochemical basis for the experimental findings reported is considered, with special reference to the use of d-fenfluramine as a specific serotonergic probe.

Adult↗
PubMed1993

Depot antipsychotics in bipolar affective disorder.

The effect of prophylactic treatment with depot antipsychotic drugs was examined in 16 patients with bipolar affective disorder. The frequency and duration of illness episodes occurring during depot treatment was compared to that which occurred when these patients were treated with other agents over a corresponding time period. Treatment with depot antipsychotics was associated with a significant decrease in the frequency and duration of manic episodes, but not depressive episodes. Thus prophylactic treatment with depot antipsychotic drugs is likely to be of benefit in patients with bipolar illness who experience frequent manic episodes despite treatment with lithium and/or carbamazepine.

Adult↗
PubMed1993

The effects of d- and l-fenfluramine (and their interactions with d-amphetamine) on cortisol secretion.

Twelve normal weight healthy male volunteers participated in a double-blind, placebo-controlled trial of the effects of d- and l-fenfluramine, d-amphetamine, and the interactions between the two isomers of fenfluramine with amphetamine, on cortisol secretion. d-Fenfluramine and d-amphetamine in combination produced the greatest cortisolaemic effect, suggesting that they act by differing neurochemical pathways. d-Fenfluramine produced a significant effect, but l-fenfluramine produced little effect, suggesting that the cortisol-releasing properties of racemic fenfluramine reside in the d-isomer.

Adult↗
PubMed1992

A comparison of the effects of d- and l-fenfluramine and d-amphetamine on energy and macronutrient intake in human subjects.

The anorectic activity of the d and l isomers of d-fenfluramine (d-FF) (l-FF) were compared with d-amphetamine (d-amp) when given separately and together in 12 healthy male volunteers. The study was double blind and placebo controlled. Food intake was measured using an automated food dispenser. Anorectic activity was examined using a) total energy intake b) nutrient selection c) selection of foods categorised by nonsweet/sweet taste. Total energy intake was significantly reduced by d-FF (17%) d-amp (26%) d-FF + d-amp (36%) and l-FF + d-amp (31%). d-Amp and both combinations significantly reduced energy intake from all macronutrients in the total food. d-FF reduced carbohydrate but not fat or protein intake derived from all foods. When nonsweet and sweet tasting foods were examined separately, l-FF also significantly reduced energy (by 19%), fat and carbohydrate intake from nonsweet food. Neither d-FF nor l-FF reduced protein from nonsweet food. No anorectic drug given alone reduced sweet food intake, only d-amp given with d-FF had this effect. In contrast to nonsweet food, d-FF did not reduce carbohydrate from sweet foods. The results are in agreement with previous work that d-FF spares protein consumption but suggest that d-FF does not selectively reduce carbohydrate intake per se.

Adult↗
PubMed1992

Life events and relapse in bipolar affective disorder.

In a 2 year study of life events and relapse in a cohort of 62 patients with bipolar affective disorder, an excess of events was found during the month immediately preceding relapse. Of 52 relapses 19% were preceded by a severe event in the previous month, compared to a background rate of 5% of patients experiencing a severe event each month at other times. The rate of life events prior to relapse was not apparently different between manic and depressive relapse, though the number of depressive episodes was small.

Adult↗
PubMed1992

Centrally acting anorectic drugs: a clinical perspective.

This paper reviews the anorectic activity and effectiveness of catecholamine and serotoninergic anorectic drugs in the management of obesity. It discusses the clinical implications of the experimental findings and suggests prescribing strategies for effective long-term therapeutic benefit. The authors advocate that there is a role for the recently developed serotonin-mediated anorectic compounds in the treatment of obesity, particularly in those individuals with abnormal glucose tolerance or who are hypertensive.

Appetite Depressants↗
PubMed1992

The effects of lithium on body weight and food intake in normal subjects--a pilot study.

The possibility of lithium increasing hunger and food intake was examined in an open, pilot study involving five healthy male volunteers each of whom took lithium for 1 month at a dose to give mean 12 h serum lithium level of 0.5-0.8 mmol/l. Before starting lithium, after the first dose and again after 1 and 4 weeks on lithium, subjects attended the unit at lunch time. They were starting lithium, after the first dose and again after 1 and 4 weeks on lithium, subjects attended the unit at lunch time. They were weighed and ate their lunch time meal from a food dispenser similar to those in canteens. Subjective rating scales were completed before and after eating. No change in weight was seen. Food intake was slightly increased at the end of the month on lithium compared with the start but had fluctuated during the intervening weeks. There was no relationship between food intake and weight change.

Adult↗
PubMed1992

New aspects in the treatment of depression.

Because of the limitations in efficacy and safety of the older tricyclic antidepressants (TCA) and monoamine oxidase inhibitors (MAOI) a number of new approaches have been made in recent years to the treatment of depression to obtain more effective, more rapidly acting, better tolerated and safer drugs. One tactic has been to develop compounds with greater neuropharmacological selectivity in inhibiting the neuronal reuptake of 5-HT. Most of these are as effective as TCA but with fewer side-effects and greater safety. Another development has been 'reversible' MAOI which reduce the risk of interaction with tyramine-containing foods. For resistant depression the addition of lithium (and/or tryptophan) may be effective, possibly through promoting 5-HT neurotransmission. Continuous treatment with a selective 5-HT reuptake inhibitor can reduce the relapse rate in patients with recurrent depression. Unfortunately, these new approaches, despite their advantages in terms of side-effects and safety, have thus far not proved to be more effective or faster acting than the standard TCA. That remains a challenge for the future.

Depressive Disorder↗
PubMed1992

Carbamazepine versus lithium in the prophylaxis of bipolar affective disorder.

A 12-month double-blind trial of carbamazepine vs lithium, given as sole treatment for the prophylaxis of bipolar affective disorder, was carried out in 31 patients. All were previously stable on lithium; 15 were switched over to carbamazepine and 16 remained on lithium. Although the overall relapse rate was similar in the 2 groups (6 on carbamazepine, 8 on lithium), nearly all the relapses in carbamazepine occurred in the first month, probably precipitated by lithium withdrawal. Two patients on carbamazepine developed a rash and were withdrawn. More side effects were noted during the early stages on carbamazepine. Patients on lithium tended to gain weight (+4 kg) compared with carbamazepine (-3.1 kg). It is concluded that carbamazepine is as effective as lithium in the prophylaxis of bipolar affective disorder; changeover from lithium to carbamazepine should be done slowly.

Adult↗
PubMed1992

Season and manic relapse.

The episodes of mania occurring in a cohort of 86 patients with bipolar affective disorder were recorded over a 6-year period. Of the 54 patients who had at least 2 episodes, 8 (15%) met our criteria for a seasonal pattern of relapse. There was no particular season in which these relapses clustered. Overall, the time of year of the first recorded episode during the 6-year period did not predict the timing of subsequent episodes.

Bipolar Disorder↗