Biomedical subjects

U Halbreich

Publications and source records attributed to U Halbreich.

At least 37 records · Page 2Linked to original sources

PubMed1998

Hormonal treatments for premenstrual syndrome.

Ovarian function appears to play a fundamental role in premenstrual syndrome (PMS). Accordingly, treatment strategies designed to suppress ovulation have generally been found to be effective for treatment of menstrually related syndromes and symptoms. GnRH agonists and Danazol(R) are probably inferior to estrogen, due to their unfavorable side effects profile. In addition, it is worthwhile to emphasize that in spite of the publicity of progesterone treatment for PMS, in most well-controlled studies it has not been shown to be more effective than placebo for the treatment of these syndromes. The efficacy of hormonal treatments that do not suppress ovulation is still controversial.

Journal Article↗

PubMed1998

Evaluation of women's mental health: delineation of the field, and needs and steps toward a consensus.

Mental health studies that investigate the behavior, mood, perception, cognition, and biology associated with specific conditions of women or with situations characterized by substantial gender differences are proliferating in number and progressing in quality, depth, and scope. To solidify the field, there is a need for a consensus on definitions and diagnostic criteria, standardized clinical assessment procedures, and large-scale interdisciplinary collaborative efforts to effectively study and illuminate the diversified aspects of women's mental health. Under a professional services contract with the National Institute of Mental Health, researchers who investigate women's mental health met during the American Psychiatric Association (APA) meeting in San Diego, California, on May 19, 1997. The 18 participants discussed key clinical and biological assessments and subsequently submitted papers reflecting scientific conclusions and recommendations for standardizing these assessments. It was agreed that a unified assessment instrument would be beneficial, but due to the widespread requirements and numerous factors that are critical in assessing all areas of women's health, situation-specific forms are often needed. The background, rationale, and process of the meeting are described here, whereas the details and recommendations are described in individual position papers.

Female↗

PubMed1998

Premenstrual syndromes.

Premenstrual syndromes (PMS) are a group of menstrually related, chronic, cyclical disorders manifested by emotional and physical symptoms in the second half of the menstrual cycle. A diagnosis of PMS is based on the timing and symptom pattern observed in daily symptom reports maintained by the patient. The etiology is unknown but is believed to involve genetic and dynamically evolving vulnerability, reproductive hormones, and neurotransmitters, as well as other brain processes. Effective medications have been identified for acute hormonal and symptomatic treatment of the disorder, but the time course and frequency of relapse and recurrence remain poorly understood. Further studies of PMS in all areas--etiology, pathobiology, diagnosis, course of illness, and treatment efficacy--are needed to increase the body of information about the menstrual cycle's effects on women's health and mood disorders.

Female↗

PubMed1998

Future directions for studies of women's mental health.

Women's mental health is increasingly recognized as a major field with an impact on the well-being of individuals, their families, and society. It is also recognized that this field is in its infancy and needs to be well delineated: Definitions and assessment procedures for the various topics need to be developed; the pathobiologies are as yet unknown; and time course, variations, and treatment outcome of most of the entities included are unknown or not confirmed. Also, interactions among phenomena, biology, environment, and sociopsychological aspects have not been well studied. A group of investigators whose focus is on various aspects of women's mental health, especially reproduction-related dysphorias, met and discussed their respective priorities for studies in the field. Mechanisms and operational vehicles to effectively achieve the expressed goals and to conduct the proposed studies are presented.

Female↗

PubMed1997

Symptomatic improvement of premenstrual dysphoric disorder with sertraline treatment. A randomized controlled trial. Sertraline Premenstrual Dysphoric Collaborative Study Group.

CONTEXT: Premenstrual dysphoric disorder is an important cause of symptoms and functional impairment in menstruating women. OBJECTIVE: To evaluate the efficacy of sertraline hydrochloride for treatment of premenstrual dysphoria by measuring changes in symptom expression and functional impairment. DESIGN: Two screening cycles followed by 1 single-blind placebo cycle and 3 cycles of randomized, double-blind, placebo treatment. SETTING: Twelve university-affiliated outpatient psychiatry and gynecology clinics. PATIENTS: Of the 447 women who requested participation, 243 met criteria for premenstrual dysphoric disorder and were randomized; 200 women completed the study. INTERVENTION: A flexible (50-150 mg) daily dose of sertraline hydrochloride. MAIN OUTCOME MEASURES: The Daily Record of Severity of Problems, Hamilton Rating Scale for Depression, Clinical Global Impression Scale, and Social Adjustment Scale. RESULTS: Mean (+/-SD) total daily symptom scores decreased significantly (P<.001) in the sertraline-treated (64+/-22 to 44+/-19) compared with the placebo-treated (62+/-22 to 54+/-24) groups. Significant improvement (P<.05) was found for all clinically derived symptom clusters (depressive, physical, and anger/irritability symptoms). Hamilton Rating Scale for Depression scores decreased by 44% and 29% in the sertraline and placebo groups, respectively (P<.002). End-point global ratings showed much or very much improvement in 62% of the active treatment group and 34% of the placebo treatment group (P<.001). Reported functional impairment was substantial at baseline. Improvement in psychosocial functioning with treatment was similar to what is found in studies of major depression. CONCLUSIONS: Sertraline was significantly better than placebo for treatment of premenstrual dysphoria as reflected by symptomatic improvement and change in reported functional impairment. Serotonin reuptake inhibitors such as sertraline are useful therapeutic options for women with premenstrual dysphoria.

1-Naphthylamine↗

PubMed1997

Premenstrual dysphoric disorders: a diversified cluster of vulnerability traits to depression.

Some biological factors which have been shown to be abnormal in subgroups of women with dysphoric premenstrual syndromes (PMS) have not been limited to the symptomatic late luteal phase of the menstrual cycle, but also existed during the non-symptomatic mid-follicular phase of the cycle. Personality, cognitive functions, alpha 2 and imidazoline binding, sensitivity to inducement of panic attacks, relative hypothyroidism, and some but not all serotonergic functions of women with dysphoric PMS differ from those with no PMS, and also differ during a non-symptomatic phase of the cycle. It is suggested that premenstrual symptoms are an expression of vulnerability traits that might surface in response to a trigger. Such traits are probably diverse, and the nature of the symptoms might depend upon the underlying trait. It is postulated-that some vulnerability traits to specific premenstrual syndromes might also be vulnerability traits to depression or anxiety in general.

Anxiety Disorders↗

PubMed1997

Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: psychosocial outcomes.

OBJECTIVE: The purpose of this study was to determine the effects of antidepressant pharmacotherapy on mood symptoms and psychosocial outcomes in dysthymia. METHOD: In a multicenter, double-blind, parallel-group trial, 416 patients with a diagnosis of early-onset primary dysthymia (DSM-III-R) of at least 5 years' duration without concurrent major depression were randomly assigned to 12 weeks of acute-phase therapy with sertraline, imipramine, or placebo. The psychosocial outcome measures used in the study were the Global Assessment of Functioning Scale, the Social Adjustment Scale, the Longitudinal Interval Follow-up Evaluation psychosocial ratings, and the Quality of Life Enjoyment and Satisfaction Questionnaire. RESULTS: Sertraline and imipramine were significantly better than placebo in improving psychosocial outcomes as measured by the first three instruments. The Quality of Life Enjoyment and Satisfaction Questionnaire scores demonstrated significant improvements from baseline, and both active treatments produced significantly greater improvements than placebo. Significantly fewer patients discontinued sertraline (6.0%) than discontinued imipramine (18.4%) because of adverse events. CONCLUSIONS: Pharmacotherapy is an effective treatment for dysthymia in terms of psychosocial functioning as well as depressive symptoms, even when the dysthymia is long-standing.

1-Naphthylamine↗

PubMed1997

Menstrually related disorders--towards interdisciplinary international diagnostic criteria.

Premenstrual and catamenial disorders are prevalent, diversified and involve various body systems. The mechanisms and management of the menstrually related disorders (MRDs) are hampered by a fragmented approach because each cluster of symptoms is studied and treated by specialists in a number of related disciplines. The apparent common denominator of MRDs, an association with the menstrual cycle, also carries with it associations with ovulation and ovulation-related hormonal and cyclic biological changes. To achieve progress in understanding and treating MRD, an interdisciplinary nomenclature and diagnostic system are needed. Criteria based on temporal occurrences and not on phenomenology have been developed after interdisciplinary discussions and are herein proposed.

Diagnosis, Differential↗

PubMed1997

Role of estrogen in postmenopausal depression.

Estrogen has been reported to improve the cognitive functioning of postmenopausal women. It is suggested that estrogen replacement therapy (ERT) might be beneficial for improvement of mood and cognition in menopausal women. We have shown that this improvement is selective and is probably more apparent in complex integrative functions. We have also shown that estrogen can augment serotonergic activity as well as some norepinephrine-related processes in postmenopausal women. Because of its effects on mood-related neurotransmitter processes, ERT might decrease vulnerability to depression and be effective as an adjunct therapy to prevent treatment nonresponse to conventional antidepressants.

Biogenic Monoamines↗

PubMed1997

The undertreatment of dysthymia.

BACKGROUND: Dysthymia is a chronic depressive condition that is quite prevalent. This condition can exact a significant toll on the general health and quality of life in the affected individual. Despite the frequency and consequences of dysthymia, however, the condition is often not diagnosed or treated. We present data on prior treatment from 410 patients with DSM-III-R dysthymia, primary type, early onset without concurrent major depression. METHOD: Axis I and II diagnoses were made by using the Structured Clinical Interviews for DSM-III-R, Patient Version (SCID-P) and SCID II for Personality Disorders. The Hamilton Rating Scale for Depression and the Clinical Global Impressions scale were also completed. Prior treatment was assessed, with special attention paid to previous antidepressant drug therapy and psychotherapy. RESULTS: Although the mean duration of dysthymia was about 30 years and almost half of the patients had previous episodes of major depression, only 41.3% had been treated with antidepressants and 56.1% with psychotherapy. A past history of major depression increased the frequency of prior antidepressant pharmacotherapy (45.7%) and psychotherapy (59.4%) compared with no history of major depression (36.8% and 40.9%, respectively). Comorbid personality disorder increased the likelihood of prior psychotherapy (70.7% vs. 49.6%) while having no effect on past pharmacotherapy. A history of substance abuse did not affect the history of antidepressant or psychotherapy treatment. In this study, dysthymia and psychosocial outcomes improved with sertraline and imipramine treatment. CONCLUSION: Dysthymic patients in this sample were significantly undertreated. Newer antidepressant agents may alter the potential for pharmacotherapy interventions in this vulnerable population.

1-Naphthylamine↗

PubMed1997

Intermittent luteal phase sertraline treatment of dysphoric premenstrual syndrome.

BACKGROUND: Dysphoric premenstrual syndrome (PMS) has been associated with serotonergic dysregulation, and serotonergic medications have been reported to alleviate the symptoms of PMS. We investigated the effects of the serotonin reuptake inhibitor sertraline given during only the luteal phase in women with dysphoric PMS. METHOD: After baseline ratings were obtained during two menstrual cycles, 15 women with dysphoric PMS who also met DSM-IV criteria for premenstrual dysphoric disorder (PMDD) entered single-blind treatment with sertraline 100 mg/day for one full menstrual cycle. Women who responded to this treatment were randomly assigned to a four-cycle double-blind placebo-controlled crossover study in which sertraline 100 mg/day or placebo was each given only during luteal phases of two consecutive menstrual cycles. RESULTS: Eleven (79%) of fourteen women responded to single-blind full-cycle treatment with sertraline and were randomly assigned to the double-blind crossover study. Three patients dropped out of the study while taking placebo owing to nonresponse. For the remaining patients, sertraline given during the luteal phase produced significant improvements in depression, impairment, and global ratings compared with placebo and was equivalent in efficacy to sertraline given during the entire menstrual cycle. CONCLUSION: Women with dysphoric PMS who responded to continuous sertraline treatment responded equally well to sertraline treatment that was restricted to the luteal phase. Luteal phase treatment may have advantages in side effect burden and costs. Larger controlled trials are warranted to confirm this finding.

1-Naphthylamine↗

PubMed1997

The influence of estrogen on monoamine oxidase activity.

The enzyme monoamine oxidase (MAO) has generated considerable interest as a biological marker. The serendipitous discovery that iproniazid was a weak MAO inhibitor (MAOI) led to the development and widespread use of MAOIs as antidepressants in the early 1950s. The-discovery of the two isoenzymes of MAO has led to the development of selective MAOIs that may have a more favorable side-effect profile. The regulation of MAO is multifactorial, and there is evidence that it involves estrogens. Improvement in mood and cognition reported in women on estrogen replacement therapy may also involve changes in MAO activity. The literature in this regard is reviewed here, and possible implications of the effects of estrogens on MAO activity are discussed.

Alzheimer Disease↗

PubMed1997

Hormonal interventions with psychopharmacological potential: an overview.

The better understanding of how hormones modulate cognition and behavior is associated with the application of hormones as psychotropic medications. Several natural and synthetic hormones are used as adjuncts to antidepressant medications or as treatments in their own right. We discuss pharmacotherapeutical aspects of estrogen, thyroid hormones, cortisol suppressors, and melatonin as examples of current trends in the field. In addition to the putative roles of these hormones in the treatment of affective disorders, estrogen might also be used as a cognition-enhancer, and both estrogen and thyroid hormones might have roles as mood stabilizers. The psychotropic effects of melatonin have recently received significant attention, but the exact role of that hormone still needs to be clarified.

Estrogens↗

PubMed1997

State and trait serotonergic abnormalities in women with dysphoric premenstrual syndromes.

Three to eight percent of women of reproductive age suffer from dysphoric premenstrual disorder (PMS). Although the exact pathophysiology of this disorder is not known, serotonergic dysregulation appears to be involved. In this article, we review and summarize the current data on changes in serotonergic parameters in women with dysphoric PMS and emphasize the distinction between state-related abnormalities which are present only during the symptomatic late-luteal phase and trait abnormalities which are present even during non-symptomatic phases of the menstrual cycle. The notion of diversified serotonergic systems that are selectively affected by fluctuations in gonadal hormones is discussed in the context of PMS as well as other dysphorias.

Female↗

PubMed1996

A placebo-controlled, randomized clinical trial comparing sertraline and imipramine for the treatment of dysthymia.

BACKGROUND: Despite the high prevalence of dysthymia and its associated morbidity, few controlled trials have evaluated the efficacy of antidepressant medication for this disorder. A 12-week, double-blind, placebo-controlled, randomized, multicenter trial was performed to evaluate the safety and efficacy of sertraline hydrochloride and imipramine hydrochloride in treating dysthymia. METHODS: A total of 416 outpatients (271 women and 145 men) aged 25 to 65 years with DSM-III-R-defined, early-onset, primary dysthymia without concurrent major depression were randomized to 12 weeks of treatment with sertraline, imipramine, or placebo. RESULTS: Both active treatments resulted in significantly reduced scores on the 17-item Hamilton Rating Scale for Depression (P = .04 and P = .01 for sertraline and imipramine vs placebo, respectively), the Montgomery-Asberg Depression Rating Scale (P = .01 and P = .003 vs placebo, respectively), Hopkins Symptom Checklist (P < .05), and the self-rated version of the Inventory of Depressive Symptoms (P < .05). With the use of a Clinical Global impressions improvement score of 1 or 2 (very much or much improved) to define response, response rates were 59% for sertraline, 64% for imipramine, and 44% for placebo (P = .02 for sertraline vs placebo and P < .001 for imipramine vs placebo). A significantly greater proportion of patients receiving imipramine than those receiving sertraline or placebo discontinued treatment because of adverse events (P = .001 and P < .001, respectively). CONCLUSIONS: Pharmacotherapy provides considerable relief from the symptoms of dysthymia in patients suffering from this chronic affective disorder, with both sertraline and imipramine being more effective than placebo. The greater tolerability of sertraline is an important consideration because of the chronicity of dysthymia, which may require prolonged treatment with antidepressant medication.

1-Naphthylamine↗

PubMed1996

Accelerated osteoporosis in psychiatric patients: possible pathophysiological processes.

Osteoporosis, a very prevalent, potentially debilitating disease, is characterized by decreased bone mineral density (BMD). Decreased BMD has recently been reported in patients suffering from several mental disorders, including schizophrenia and major depression. In these patients the accelerated decrease in BMD can be attributed to drug-induced decreases in levels of estrogen and testosterone, to polydipsia and decreased calcium to smoking and alcoholism, and to increased activity of several interleukins as well as to hyperprolactinemia and hypercortisolemia. Several of these processes may be prevented or altered in order to prevent or delay decreased BMD.

Antipsychotic Agents↗

PubMed1996

Are chronic psychiatric patients at increased risk for developing breast cancer?

OBJECTIVE: The authors' goal was to assess the incidence of breast cancer among chronic psychiatric patients. METHOD: They reviewed mammograms and charts of 275 female patients over the age of 40 in a state psychiatric hospital and 928 women of comparable age at a general hospital radiology clinic. RESULTS: The incidence of breast cancer documented by pathology reports among the psychiatric patients was more than 3.5 times higher than that of patients at the general hospital and 9.5 times higher than the reported incidence in the general population. CONCLUSIONS: If confirmed, the suspected higher incidence of breast cancer among the psychiatric patients might be due to medications and further underscores the need for screening mammograms for breast cancer in these patients.

Adult↗

PubMed1996

Low plasma gamma-aminobutyric acid levels during the late luteal phase of women with premenstrual dysphoric disorder.

OBJECTIVE: Plasma gamma-aminobutyric acid (GABA) levels have been reported to be low in some patients with major depressive disorder. Premenstrual dysphoric disorder is often associated with major depressive disorder. Therefore, the authors sought to determine whether women with premenstrual dysphoric disorder with or without prior major depressive disorder also had low plasma GABA levels. METHOD: Plasma GABA levels were measured in 27 women with premenstrual dysphoric disorder and 21 comparison women during the the mid-follicular and late luteal phases of the menstrual cycle. RESULTS: In comparison women, plasma GABA levels increased from the mid-follicular to the late luteal phase. Women with premenstrual dysphoric disorder and a past history of major depressive disorder had low plasma GABA levels during both phases. In women with premenstrual dysphoric disorder but no past major depressive disorder, plasma GABA levels decreased from the nonsymptomatic, mid-follicular phase to the symptomatic, late luteal phase. CONCLUSIONS: Decreased GABA function may represent a common biological link between subtypes of depressive and premenstrual dysphoric disorders. A trait in major depressive disorder and a state-dependent decrease in premenstrual dysphoric disorder might imply a possible continuum between the two disorders.

Adult↗