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Biomedical subjects

Z Kronfol

Publications and source records attributed to Z Kronfol.

At least 37 records · Page 2Linked to original sources
PubMed1984

Hypothalamic-pituitary-adrenocortical activity in patients with diabetes mellitus.

Several clinical and physiologic associations between depression and diabetes mellitus have been reported. In this study, a potential neuroendocrine association was studied by measuring hypothalamic-pituitary-adrenocortical (HPA) axis activity in patients with diabetes mellitus. Plasma cortisol levels and response to dexamethasone administration were determined in 54 diabetics. Twenty-three (55%) of forty-two 1-mg dexamethasone suppression tests (DSTs) performed in 34 subjects, with eight repeated tests, and two (10%) of twenty 2-mg DSTs demonstrated a blunting of normal suppression. None of a variety of potential demographic, physiologic, or mood factors predicted nonsuppression. This study replicates prior findings that HPA dysfunction occurs in association with diabetes, and invalidates the use of the 1-mg DST as a diagnostic marker for melancholia in patients with diabetes.

Adult↗
PubMed1984

Leukocyte regulation in depression and schizophrenia.

The distribution of leukocytes in the blood stream is affected by levels of circulatory glucocorticoids. Elevated concentrations of cortisol are usually associated with an increase in the number of neutrophils and a decrease in the number of lymphocytes. Since primary depressive illness is often associated with hypercortisolemia, we hypothesized that similar changes in the blood stream of depressive patients may occur. To test this hypothesis, we retrospectively compared leukocyte counts in 177 untreated depressive patients and 178 untreated schizophrenic controls. We found a significant increase in the absolute and relative numbers of neutrophils and a significant decrease in the absolute and relative numbers of lymphocytes in the depressive group. Furthermore, when compared to normative values from the general population, depressed patients showed higher frequencies of both neutrophilia and lymphopenia than the schizophrenic group. These results indicate differences in the regulation of leukocytes in depression and schizophrenia consistent with the effects of higher levels of plasma cortisol in the depressive group.

Adult↗
PubMed1984

Nortriptyline capacity-limited metabolism: a case report.

A case report of a 62-year-old patient is presented with apparent dose-dependent kinetics for nortriptyline following the administration of therapeutic doses of the drug. Twelve-hour measurements of total plasma nortriptyline following steady state administration of the drug at 10 mg every other day, 10 mg daily, and 25 mg daily were 38, 86, and 647 ng/ml and while free plasma nortriptyline concentrations were 0.37, 0.9, and 6.6 ng/ml, respectively. Half-lives calculated from samples collected at 12, 24, and 36 hours status after administration of steady state 10 mg every other day, 10 mg daily, and 25 mg daily maintenance doses were 30.4, 36.7, and 64 hours, respectively. Toxicity did not occur despite excessive total plasma tricyclic antidepressant concentrations as a result of abnormally increased plasma protein binding of nortriptyline. The case is contrasted to the usual pharmacokinetic characteristics for the tricyclic antidepressants.

Blood Proteins↗
PubMed1983

Impaired lymphocyte function in depressive illness.

Mood states and immunity may be related. To investigate the immune status of patients with primary depressive illness, we compared in-vitro lymphocytic responses to three different mitogens in 26 drug-free depressed patients and 20 normal controls of comparable age and sex. We observed a generalized and marked decrease in the lymphocyte mitogenic activity among the depressive group. This defect in lymphocyte function may be indicative of an impairment in cell-mediated immunity in patients with primary depressive illness.

Adult↗
PubMed1983

Dexamethasone suppression tests in antidepressant treatment of melancholia. The process of normalization and test-retest reproducibility.

Pilot studies suggest that changes in response to the dexamethasone suppression test (DST) in melancholic patients receiving antidepressants might represent a laboratory marker of clinical progress. We performed weekly DSTs in 31 hospitalized patients with major depressive disorder, primary and endogenous subtypes, during drug-free and subsequent treatment periods. Most nonsuppressors had progressive normalization of DST responses in conjunction with clinical improvement, DST normalization usually preceded or coincided with good clinical response, and failure to normalize was often associated with poorer clinical outcome. Occasional patients with baseline dexamethasone suppression become nonsuppressive after withdrawal from medication, but the DST has no apparent value as a serial marker in patients with well-documented normal DST findings. Our results extend the construct validity of the DST as a state-related marker in nonsuppressors and suggest future clinical applications.

Adult↗
PubMed1983

Antidepressant withdrawal syndromes: evidence supporting the cholinergic overdrive hypothesis.

The authors present case examples of the various antidepressant withdrawal syndromes. Substantial evidence supports the contention that these syndromes result from cholinergic overdrive; thus, they may have a common pathophysiological basis. Even paradoxical reactions on antidepressant withdrawal, such as mania, are consistent with the cholinergic overdrive hypothesis. If the cholinergic overdrive hypothesis of affective illness. The cholinergic overdrive hypothesis is both of considerable heuristic value and is further testable by the study of the tonic and phasic aspects of sleep and neuroendocrine parameters in the withdrawal state.

Acetylcholine↗
PubMed1983

Imipramine-induced tremor: effects of a beta-adrenergic blocking agent.

Assessment of an elderly depressed patient with an imipramine-induced tremor led to the conclusions that imipramine tremor (1) can be severe and incapacitating, (2) is most pronounced early in the treatment, (3) does not seem to be dose-related, and (4) is readily reversible with a beta-adrenergic blocking agent.

Depressive Disorder↗
PubMed1982

Subtypes of drug abuse with psychosis. Demographic characteristics, clinical features, and family history.

Hospital records of 72 drug abusers with psychoses (DAP) were analyzed to clarify the relationship between drug abuse and psychosis. Comparison groups included schizophrenics and atypical schizophrenics without drug abuse and drug abusers without psychoses (DA). Compared with DAP in whom psychoses lasted less than six months before admission (DAP-short), drug abusers with psychoses of a longer duration (DAP-long) had more symptoms, more premorbid personality disorders, and greater familial risks of schizophrenia and affective disorder. The DAP-long group resembled atypical schizophrenia for clinical features and family history, whereas the DAP-short group resembled DA for some clinical features and family history. The results indicate that there are several subgroups of DAP. The importance of clinical features and family history in identifying subgroups of DAP was stressed.

Adolescent↗
PubMed1982

Application of biological markers in depression secondary to thyrotoxicosis.

Biological markers of affective disorders have not been studied intensively in patients with secondary depression. An elderly woman with severe delusional depression secondary to thyrotoxicosis was monitored with weekly dexamethasone suppression tests (DSTs) and three sleep electroencephalography (EEG) evaluations. She received treatment only for her thyrotoxicosis, but her depression resolved completely. The serial DSTs were normal throughout her depression, consistent with the specificity of this test for primary endogenous depression. The sleep EEG erroneously suggested a diagnosis of primary depression but effectively monitored clinical improvement. Biological markers may have applicability in evaluating and monitoring patients with secondary depression.

Aged↗
PubMed1981

A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility.

Four hundred thirty-eight subjects underwent an overnight dexamethasone suppression test (DST) to standardize the test for the diagnosis of melancholia (endogenous depression). Abnormal plasma cortisol concentrations within 24 hours after dexamethasone administration occurred almost exclusively in melancholic patients. The best plasma cortisol criterion concentration, above which a DST result may be considered abnormal, was 5 microgram/dL. The optimal dose of dexamethasone was 1 rather than 2 mg. Two blood samples obtained at 4 and 11 PM after dexamethasone administration detected 98% of the abnormal test results. This version of the DST identified melancholic patients with a sensitivity of 67% and a specificity of 96%. Baseline nocturnal plasma cortisol concentrations were not useful. Abnormal DST results were found with similar frequency among outpatients and inpatients with melancholia; but they were not related to age, sex, recent use of psychotropic drugs, or severity of depressive symptoms. Extensive evidence validates this practical test for the diagnosis of melancholia.

Adolescent↗
PubMed1981

Dexamethasone suppression test and selection of antidepressant medications.

Endogenous depressives with abnormal dexamethasone suppression tests (DSTs) respond better to somatic antidepressant treatments than those with normal DSTs. Whether the DST also aids in the selection of specific antidepressants has not been determined. A pilot report suggested that patients with abnormal DSTs might be noradrenaline-deficient and respond preferentially to imipramine or desipramine, whereas those with normal DSTs might be serotonin-deficient and respond best to amitriptyline or clomipramine. Attempting to replicate this observation, we studied 26 patients diagnosed with Research Diagnostic Criteria as major depressive disorder, endogenous subtype, and with DSM-III as having melancholia. All were drug-free during baseline evaluation. All had abnormal DST results, with post-dexamethasone plasma cortisol levels exceeding 5 microgram/dl. We treated subjects with either imipramine or amitriptyline and compared clinical response with weekly Hamilton Depression Rating Scales, completed by raters blind to both DST results and the research question. Thereapeutic plasma levels were documented. We found no significant differences in treatment response between the subgroups. Twenty of the 26 subjects did well. The imipramine-treatment group failed to have either earlier response or better final outcome. These data fail to replicate suggestions that DST results assist in the selection of either imipramine or amitriptyline.

Amitriptyline↗
PubMed1978

Depression and hemispheric functions: changes associated with unilateral ECT.

Nine depressed patients received ECT to the dominant (left) side along with nine matched depressed patients who received ECT to the non-dominant (right) side. Neuropsychological tests showed that the right hemispheric functions were more frequently abnormal as compared to left hemispheric (dominant) functions in the pre-ECT tests. ECTs delivered to either the right or left side improved right hemispheric functions when the depression was ameliorated. This study indicates that in depression right hemispheric functions are initially disturbed and ECT, instead of being deleterious to these functions, tends to improve them.

Depression↗
PubMed1977

Catatonia and systemic lupus erythematosus.

Catatonia has generally been assumed by many physicians to be a subtype of schizophrenia. Numerous cases have been reported in the literature associating catatonia with other psychiatric and also medical illnesses. The present report describes a patient with Systemic Lupus Erythematosus (SLE) who presented in a catatonic state. A brief differential diagnosis of catatonia is also included.

Adult↗