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Biomedical subjects

U Halbreich

Publications and source records attributed to U Halbreich.

At least 55 records · Page 3Linked to original sources
PubMed1996

Sertraline in the treatment of premenstrual dysphoric disorder.

It is estimated that 2 to 9 percent of women suffer from premenstrual dysphoric disorder (PMDD). Despite decades of research, effective treatments for the condition have eluded investigators. Research criteria for (PMDD) were established to promote investigation into the treatment and psychobiology of severe, dysphoric premenstrual symptomatology. Application of these new criteria to clinical trials adds needed rigor to research in this area and justifies the identification of effective treatments. In this study, rigorous criteria were utilized in a 12-center trial investigating the efficacy of the serotonin reuptake inhibitor sertraline in the treatment of PMDD. The study was completed and data was available for 162 women. A preliminary analysis demonstrated a positive response (very much improved or much improved) in 68 percent of patients treated with sertraline, compared with only 40 percent of patients treated with placebo (p < .01). This preliminary analysis provides strong support for the efficacy of sertraline as a treatment of severe premenstrual dysphoria.

1-Naphthylamine↗
PubMed1995

Estrogen augments serotonergic activity in postmenopausal women.

To investigate the influence of estrogen replacement on serotonergic activity in postmenopausal women, the serotonin agonist meta-chlorophenylpiperazine (m-CPP) (0.5 mg/kg) was given orally to 18 normal postmenopausal women, 11 of whom were also tested following 30 days' treatment with estrogen transdermal patches (estraderm 0.1 mg). Fifteen normal, healthy women of reproductive status served as a control group. Cortisol and prolactin responses to m-CPP were measured. Without estrogen, the prolactin and cortisol responses of postmenopausal women to m-CPP were blunted compared to those of reproductive women. Estrogen replacement increased the hormonal responses. It is suggested that decreased serotonergic activity in postmenopausal women might contribute to their vulnerability to affective disorders. Estrogen replacement therapy might decrease this vulnerability and might add to the efficacy of serotonergic antidepressants when warranted.

Administration, Cutaneous↗
PubMed1995

Menstrually related disorders: what we do know, what we only believe that we know, and what we know that we do not know.

Menstrually related disorders (MRD) are quite prevalent. Attention is mostly focused upon the premenstrual syndromes (PMS), which are a subject of controversy tinted by opinions, beliefs, and biases. Recently, substantial progress has occurred in the diagnosis, evaluation, and treatment of MRD, but their etiology and pathophysiology are still unknown and are a matter for several hypotheses. Data on MRDs were recently extensively cataloged and reviewed elsewhere. Here the emphasis is on some opinions from the departure point that: (1) The existence of MRD is undoubtful if beliefs and biases are put aside, and (2) symptoms of MRD are diversified and the dysphoric ones are associated with other dysphoric disorders and states. The biology of MRDs should be elucidated by emphasizing the multidimensional interactional processes involving the hypothalamic-pituitary-gonadal (HPG) system, neurotransmitters, and other hormonal axes, as well as other biological systems and circuits. The biological systems are interwoven with environmental and psychological inputs. Much of the available data can be understood within a model of dynamically evolving, diversified vulnerabilities, which may be expressed as symptoms when a trigger is applied. That trigger is probably related to ovulation and/or the HPG system but might also be related to another stress- or state-related mechanism. Treatment of MRD might be targeted at the symptoms or vulnerability variables (as is the case with antidepressants) or at the ovulation-related trigger (as is the case with ovulation suppressors). Knowledge about MRD will be enhanced by studies of the mechanisms of interaction between environment and hormonal and brain systems, by studies of processes of homeostasis and its dysregulation, and by an in-depth evaluation of the mechanisms of treatment response and nonresponse.

Female↗
PubMed1994

Teaching normal and abnormal behavior to primary care physicians.

OBJECTIVE: This article delineates the framework for a curriculum on psychiatry, normal and abnormal human behavior for primary care physicians (PCPs). METHODS: Curricula have been surveyed. Members of the Education Committee of the Association of Medicine and Psychiatry, as well as Family Physicians and General Internists involved in education have been consulted. Their recommendations are integrated. RESULTS AND CONCLUSIONS: The curriculum should be developed according to the needs of PCPs and from their perspective. Patient and problem-oriented, its content can be divided into: a) personal skills that should be developed; and b) knowledge of symptoms, their differential diagnosis (DDX) and management within the PCP's, facilities and abilities.

Curriculum↗
PubMed1993

Increased imidazoline and alpha 2 adrenergic binding in platelets of women with dysphoric premenstrual syndromes.

An association between dysphoric premenstrual syndromes (PMS) and a lifetime history of major depressive disorders has previously been documented. Other studies have demonstrated an increase in the binding of radiolabeled imidazoline compounds to platelets of depressed patients. Clonidine and related imidazoline compounds interact with alpha 2 adrenoceptors to inhibit neuronal noradrenergic activity and in higher concentrations, they stimulate noradrenergic activity through their interaction with imidazoline receptors. Here we report increased 3H para-aminoclonidine binding to high affinity alpha 2 adrenoceptor sites as well as to nonadrenergic imidazoline binding sites in platelets of women with dysphoric PMS. This higher binding was most pronounced during the late-luteal-symptomatic phase of the menstrual cycle and, to a lesser degree, during the non-symptomatic mid-follicular phase. Binding to the imidazoline site distinguished women with dysphoric PMS from women with no such symptoms, was highly positively correlated with the severity of symptoms, and was negatively correlated with plasma levels of progesterone. These findings suggest that platelet imidazoline binding sites might be a biological marker for dysphoric states in PMS or for the vulnerability to develop them. These findings also point to a possible biological link between dysphoric PMS and major depressive disorders.

Adrenergic alpha-Agonists↗
PubMed1993

Menstrually Related Disorders: points of consensus, debate, and disagreement.

It seems that during the past decade we have been witnessing an evolution of a consensus on the phenomenology and time course of various types of MRDs. We are in a stage in which definitions and diagnostic criteria can be developed, but their broad acceptance is still not assured. The etiology and pathophysiology are still fiercely debated, but reasonable and feasible methods for scientific elucidation of the various hypotheses are in place and are followed by solid groups. Despite the uncertainty concerning the etiology of MRDs, reasonably efficient treatment modalities do exist, and most sufferers of MRDs should expect an eventual alleviation of their symptoms if they are treated in a specialized, established, and up-to-date program.

Female↗
PubMed1993

Special aspects of neuropsychiatric illness in women: with a focus on depression.

Many depressive disorders predominate in women. Other psychiatric disorders more prevalent in women than men often occur concomitantly with depression. A variety of these disorders show a premenstrual patterning of symptoms and are responsive to antidepressants. Migraine headaches are also more common in women, show a premenstrual patterning, and are responsive to antidepressants. Other neuropsychiatric and endocrine-related disorders predominating in women are discussed in this review. Greater attention to the special aspects of neuropsychiatric disorders in women may improve diagnosis and treatment.

Antidepressive Agents↗
PubMed1993

Altered serotonergic activity in women with dysphoric premenstrual syndromes.

OBJECTIVE: Dysphoric Premenstrual Syndromes (PMS) are quite prevalent and in some women they are severe enough to warrant treatment. Their pathophysiology is still unknown, despite increased interest and research. Here we review the possible role of serotonin in the multidimensional interactive pathophysiology of PMS. METHOD: Over 170 articles are reviewed. An extensive library search has been conducted and articles are included because of their relevance to: 1) the phenomenology of PMS; 2) the putative association of serotonergic (5-HT) activity with syndromes that occur premenstrually; 3) changes in 5-HT activity along the menstrual cycle, especially the late luteal phase; 4) influence of gonadal hormones on serotonergic functions; 5) endocrine strategies for assessment of 5-HT abnormalities; and 6) treatment studies of PMS with serotonergic agonists. RESULTS AND CONCLUSIONS: The data presented here suggest that post-synaptic serotonergic responsivity might be altered during the late-luteal-premenstrual phase of the menstrual cycle. Some serotonergic functions of women with PMS might be altered during the entire cycle and be associated with a vulnerability trait. It is hypothesized that gonadal hormones might cause changes in levels of activity of 5-HT systems as part of a multidimensional interactive system. Strategies to evaluate 5-HT activities in the context of the menstrual cycle are discussed--leading to the conclusion that the most promising approach is active stimulation with specific post-synaptic serotonin agonists. Treatment outcome studies of some imperfect compounds that are currently applied as a symptomatic treatment of PMS support the notion that 5-HT is involved in the pathophysiology of these syndromes.

Depressive Disorder↗
PubMed1991

Depression, natural killer cell activity, and cortisol secretion.

Natural killer (NK) cell activity was evaluated in 34 ambulatory patients with Major Depressive Disorder (MDD) and 21 healthy controls. No mean differences between the groups were found. However, female depressives (n = 19) exhibited higher NK activity than female controls (n = 14). The relationship between cortisol secretion and NK activity was examined using an integrated cortisol value derived from multiple blood samples taken between 1:00 and 4:00 PM. This comprehensive assessment of cortisol secretion circumvents spurious "single stick" cortisol values and provides a more accurate determination of hypercortisolemia than the dexamethasone suppression test. NK activity in depressives with cortisol hypersecretion (greater than 11 micrograms/dl) (n = 7) was no different than NK activity in depressives and controls with normal cortisol secretion. Furthermore, there was no correlation between cortisol secretion and NK activity in any of the groups. These results indicate that decreased NK activity is not a consistent finding in MDD and cannot be predicted by the presence of hypercortisolemia in these patients.

Adult↗
PubMed1991

Influence of age, sex and diurnal variability on imipramine receptor binding and serotonin uptake in platelets of normal subjects.

Imipramine (IMI) binding and serotonin (5-HT) uptake were determined in platelets of 98 healthy volunteers; and their association with age, sex and circadian rhythm were evaluated. A large interindividual variability was found for both IMI and 5-HT parameters. There was a negative correlation of IMI affinity constant (Kd) and binding (Bmax) with age, but no such correlation of 5-HT affinity constant (Km) or uptake (Vmax). Significant age-related diurnal variability was found for 5-HT Km in the whole group as well as for IMI Kd in males, but not in females. There was no significant correlation between 5-HT Vmax and IMI Bmax. Our results underscore a cautious approach to the interpretation of platelet serotonergic studies. In light of the multiple variables influencing the results, the usefulness of IMI or 5-HT as clinical markers should be re-evaluated.

Adult↗
PubMed1991

Imipramine receptor binding and serotonin uptake in platelets of women with premenstrual changes.

Gonadal hormones are believed to be involved in the pathophysiology of premenstrual changes (PMC) possibly through their interaction with neurotransmitter systems in the brain. The serotonergic system, an important central modulator of mood and behavior which is involved in the pathophysiology of affective disorders has been suggested to play a role in the genesis of dysphoric PMC. Blood platelet serotonin (5-HT) uptake and imipramine (IMI) binding have been shown to share similarities with serotonergic mechanisms in the brain thus enabling the study of serotonergic mechanisms. In this study, we report on platelet 5-HT uptake and IMI receptor binding which were simultaneously studied in women with PMC. Subjects with PMC showed a large interindividual variability with no consistent typical pattern or change during the late symptomatic as compared to the early nonsymptomatic luteal phase. Their IMI receptor binding, however, was lower compared to controls already during the early luteal phase before they developed symptoms and was similar during the symptomatic phase. This might suggest a preexistent vulnerability to the development of dysphoric PMC that might be related to impaired gonadal hormone modulation of the serotonergic system.

Adult↗
PubMed1991

Elimination of ovulation and menstrual cyclicity (with danazol) improves dysphoric premenstrual syndromes.

OBJECTIVE: To assess whether the therapeutic effect of danazol on premenstrual syndromes (PMS) is associated with suppression of ovulation. DESIGN: After 1 month on placebo, we administered 200 mg/d of danazol for 90 days to 24 women with dysphoric PMS. Symptoms during ovulatory cycles were compared with anovulatory periods. SETTING: Outpatient PMS program in a general hospital. PATIENTS: Twenty-four women who had dysphoric PMS and otherwise were physically and mentally healthy. INTERVENTIONS: None (except the oral medication). MAIN OUTCOME MEASURE: Prospective daily monitoring of symptoms with the Daily Rating Form, before, during, and after treatment. RESULTS: Twenty of 23 anovulatory periods were symptom-free versus 6 of 32 ovulatory periods (chi 2 = 15.63, P = 0.0002). CONCLUSION: The beneficial effect of danazol as treatment depends mostly on achieving an an-ovulatory state and elimination of hormonal cyclicity and not on the drug per se.

Adult↗
PubMed1991

Menstrual irregularities associated with bupropion treatment.

The authors report two cases of menstrual irregularities associated with bupropion treatment. This is the first report of such an association, and it is supported by data collected by the Burroughs Wellcome Co. Since the mode of action of this effective new antidepressant is basically unknown and does not operate through any of the putative mechanisms of the classical antidepressants, its side effect profile is of heuristic as well as practical importance.

Adult↗
PubMed1991

Prevalence and severity of premenstrual changes after tubal sterilization.

Many women report an association between tubal sterilization and the premenstrual syndrome. While early reports suggested such a linkage, more recent studies failed to confirm this association. In an attempt to elucidate the alleged association of tubal sterilization with premenstrual changes, we compared the severity of symptoms and their possible correlates with hormonal levels in 78 sterilized and nonsterilized women with prospectively confirmed premenstrual syndrome. No significant difference could be demonstrated between the groups in both the retrospective and prospective evaluation of the severity of premenstrual syndrome symptoms as well as in luteal hormonal levels. Our data confirm that premenstrual symptoms probably are not associated with tubal sterilization.

Adult↗