The mood-lowering effect of tryptophan depletion: possible explanation for discrepant findings.
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Affect↗
Biomedical subjects
A J Van der Does
Publications and source records attributed to A J Van der Does.
Tryptophan depletion in SSRI-recovered depressed outpatients.
RATIONALE: Recently, a number of studies have challenged the finding that acute tryptophan depletion (TD) increases depressive symptoms in medicated, formerly depressed patients. The present study examined the effects of acute nutritional TD on remitted depressed patients currently treated with selective serotonin reuptake inhibitors. In an attempt to clarify conflicting earlier findings, the effects of a number of clinical variables on outcome were also investigated. METHODS: Ten patients underwent TD in a double-blind, controlled, balanced crossover fashion. The control session followed the procedure of Krahn et al. (1996 Neuropsychopharmacology 15:325-328). Sessions were 5-8 days apart. RESULTS: TD was significantly related to increased scores on clinician-rated depression and anxiety scales, and on self-rated depression, anxiety, and somatic symptoms. The control challenge had no effect, despite the fact that the reductions in plasma tryptophan during the control session were unexpectedly high. Some evidence was found for a threshold in the relationship between reduction of plasma tryptophan and mood response. CONCLUSIONS: The mood effect of TD in medicated, formerly depressed patients was confirmed. A threshold may exist for mood effects following TD, implying that recent negative findings may have been caused by insufficient depletion. No other predicting or mediating factors were identified, although the variable "history of response pattern to medication" deserves further study.
Adolescent↗
The effects of tryptophan depletion on mood and psychiatric symptoms.
BACKGROUND: The number of studies using tryptophan depletion (TD) challenge has increased markedly in the past few years. Recently, a number of negative results have been published, implicating that the effect of TD on mood may be less consistent than previously thought. METHODS: The literature on the mood effects of TD in psychiatric patients and healthy volunteers was reviewed. RESULTS: TD has a mood-lowering effect in subgroups of recovered depressed patients, patients with seasonal affective disorder and vulnerable healthy subjects. The mood effect in former patients is of a different quality, however, than the effect in healthy subjects. Some recent negative studies in depression might be explained by insufficient lowering of plasma tryptophan levels. Preliminary evidence exists for an effect of TD on bulimia nervosa, autism, aggression and substance dependence. CONCLUSIONS: The effects of TD on mood may be more consistent than suggested by a number of recent negative studies. Response to TD in recovered depressed patients is associated with prior treatment. However, even in SSRI-treated patients the relapse rates are not higher than 50-60%, which needs to be explained. The clinical usefulness of the response to TD in recovered patients (prediction of relapse after treatment discontinuation) and in symptomatic patients (prediction of treatment refractoriness) deserves more research attention. Further suggestions for future research include the cognitive effects of TD in recovered depressed patients and the effect of dietary habits on response to TD.
Anorexia Nervosa↗
Cognitive change following cognitive behavioural therapy for non-cardiac chest pain.
BACKGROUND: Seventeen to 43% of patients with non-cardiac chest pain suffer from anxiety/panic disorders. Cognitive behavioural therapy (CBT) is effective in reducing non-cardiac chest pain. However, no data are available indicating that pain reduction following CBT may be cognitively mediated or whether success of CBT is dependent on the presence of panic. The aim of the study was threefold: (1) does CBT have a differential effect on cognitive measures; (2) does a relationship exist between improvement in non-cardiac chest pain and changes in cognitive measures, and (3) can panic be established as a moderator of the effect of treatment? METHODS: Sixty-five patients with non-cardiac chest pain completed a randomised trial comparing study CBT with 'care as usual'. Dependent measures were: frequency of chest pain, anxiety, the fear of bodily sensations, attributions and catastrophic cognitions. RESULTS: CBT had a differential effect on most of the cognitive measures. Pain reduction was associated with the development of more adequate cognitions with respect to chest pain, independent of anxiety reduction. Although panic patients reported higher baseline scores on the cognitive measures, no differences in treatment results were found between panic and no-panic patients. CONCLUSIONS: Pain reduction following CBT may be cognitively mediated. The presence of panic did not affect the outcome of treatment, implying a broad applicability of the cognitive model for treatment of patients with non-cardiac chest pain.
Adult↗
Accurate heartbeat perception in panic disorder: fact and artefact.
The hypothesis was investigated that more accurate perception of heartbeats by patients with panic disorder is an artefact of arousal. Twenty-three patients with panic disorder, 16 patients with a mood disorder and 21 normal controls were tested. There were more panic patients who accurately perceived their heart rates (N = 7) than depressed patients (N = 0) or normals (N = 2). The nine accurate perceivers had higher scores on questionnaires measuring the cognitions associated with panic. For non-accurate perceivers, perceived heart rates were unrelated to actual heart rates, unrelated to cognitive factors, but significantly related to arousal. It is concluded that the accurate perception of heartbeats by patients with panic disorder is both fact and artefact: some patients are accurate perceivers, but the majority are not.
Adult↗
Patient attributes and expressed emotion as risk factors for psychotic relapse.
In the context of a prospective, controlled treatment study, contrasting family interventions with individual treatment, the role of expressed emotion (EE) as a predictor of relapse was examined in patients with recent-onset schizophrenia and related disorders (n = 97). EE was compared with 13 predictor variables. The variables, taken from EE and family intervention studies, related to demography, premorbid functioning, present and past illness history, and comorbid substance abuse. Psychotic relapse was operationalized with a conservatively measured relapse criterion, composed of monthly ratings based on the Brief Psychiatric Rating Scale and on clinical judgment during the 12 months of outpatient treatment. Of the 14 predictor variables entered in stepwise survival analyses, 6 variables had probable predictive power on the conservative relapse criterion. These variables were entered in a Cox regression model. EE turned out to be the major predictor of relapse in the overall sample (hazard ratio [HR] 4.90; confidence interval [CI] 1.05-22.92). This finding remained when only patients with a first psychotic episode (p = 0.02) and patients in the individual treatment condition (p = 0.001) were examined. Cannabis abuse was the major predictor of relapse in patients with high-EE families (HR 4.27; CI 1.12-16.29).
Adolescent↗
Parental communication deviance: its stability and the effect of family treatment in recent-onset schizophrenia.
The influence of a behavioural family treatment on parental communication deviance (CD) was investigated in a longitudinal treatment study. Subjects were the parents of young patients with recent-onset schizophrenia or related disorders. Parents and patients were randomly assigned to one of two treatment conditions: individual out-patient treatment or a combination of individual out-patient and family treatment. Parental CD was assessed with the Thematic Apperception Test (TAT) both at the start of the out-patient treatment and after completion of treatment 1 year later. Most families had high levels of CD, a finding which is in agreement with previous CD studies. These high CD levels remained stable over the 12-month period. Family treatment was not effective in influencing the level of CD. The findings suggest that high CD is a stable trait-marker of parents, and they support the notion that high levels of CD may precede the onset of serious psychotic disorders. Studies with more chronic patients are needed to replicate the findings.
Adult↗
The relationships between expressed emotion, affective style and communication deviance in recent-onset schizophrenia.
The relationships between expressed emotion (EE), affective style (AS) and communication deviance (CD) were studied during hospitalization and after discharge. EE was measured with both the Camberwell Family Interview (CFI) and the Five-Minutes Speech Sample (FMSS). The study subjects were patients with recent-onset schizophrenia and related disorders, who were consecutively admitted to an in-patient unit for adolescents, and their parents. The results revealed that CFI/EE was significantly correlated with AS criticism scores during hospitalization, but did not predict AS scores after discharge. FMSS/EE correlated significantly with AS criticism when both measures were administered after discharge. During hospitalization, FMSS/EE was not significantly correlated with AS. No consistent relationship was found between CD and both affective factors (EE and AS). It is concluded that EE and AS overlap with regard to level of criticism when both measures are administered over a short period of time and independent of the time of assessment. In addition, the results indicate that affective and communication factors identify independent family attributes.
Adolescent↗
Association of anxiety with perception of histamine induced bronchoconstriction in patients with asthma.
BACKGROUND: The perception of bronchoconstriction varies among patients with asthma and this perception may be related to the covariation of sensory and affective aspects of dyspnoea. A study was performed to evaluate whether there are differences in the perception of histamine induced bronchoconstriction between anxious and non-anxious perceivers and whether anxious perception of bronchoconstriction can be predicted by higher levels of baseline anxiety. METHODS: Seventy eight asthmatic subjects referred for a histamine challenge test undertook baseline measures for anxiety symptomatology and forced expiratory volume in one second (FEV1) followed by perceived breathlessness (Borg scale), anxiety (SUDS), and FEV1 measurement before and during induced bronchoconstriction. Based on the correlation between Borg and SUDS scores, the patients were divided into anxious and non-anxious perceivers. RESULTS: Forty one patients reported no anxiety during the challenge test. The anxious perceivers (n = 20) had higher levels of perceived breathlessness and anxiety at 20% fall in FEV1 and were more accurate in their perception of airways obstruction than non-anxious perceivers (n = 58). However, they did not report higher baseline levels of anxiety symptomatology. CONCLUSIONS: Anxiety experienced during bronchial challenge testing may result from the accurate perception of physiological changes and further direct attention to airways obstruction.
Adult↗
Is there a specific relationship between asthma and panic disorder?
The objective of the present study was three-fold: (1) to assess the prevalence of PD in asthmatic patients in comparison with non-asthmatic patients; (2) to investigate possible differences in pulmonary function and anxiety symptomatology between asthmatic patients with PD and those without; and (3) to evaluate possible differences in symptom perception during histamine-induced bronchoconstriction between asthmatic patients with PD versus asthmatic controls without PD matched for age, sex and bronchial responsiveness to histamine (PC20). The study was performed on 123 consecutive patients referred to the lung function laboratory of a university hospital for a histamine challenge test. Firstly, baseline measures for FEV1, anxiety (ADIS-R, ACQ, BSQ, and STAI) and depression (SDS) were collected. Subsequently, before and during induced bronchoconstriction FEV1, perceived breathlessness (Borg scale), subjective anxiety (SUDS), and somatic panic symptoms (PAQ) were assessed. The prevalence of PD in asthmatic patients, although higher than in the general population, was very similar to the rate observed in non-asthmatic patients. Baseline level of FEV1 and bronchial responsiveness to histamine (PC20) were also not significantly different between asthmatic patients with and without PD. Moreover, in comparison with matched controls, PD cases reported significantly higher levels of perceived breathlessness during induced bronchoconstriction, although their mean fall in FEV1 was very comparable. It is concluded that the higher prevalence of PD in asthma is non-specific and probably due to selection bias.
Adult↗
Symptoms, cognitive and social functioning in recent-onset schizophrenia: a longitudinal study.
The relationships among symptoms, cognitive functioning and social functioning were investigated in patients with schizophrenia over a period of 15 months. Patients with a mood disorder, a normal control group and a sample of parents of the schizophrenic patients also completed the cognitive tests. In the schizophrenia sample, only disorganisation was correlated with cognitive performance, which was interpreted as further evidence that disorganisation is a separate symptom dimension of schizophrenia. Against expectations, with two of three measurements no significant correlations were found between negative symptoms and cognitive performance. With these two measurements, however, a curvilinear association between negative symptoms and cognitive performance was observed, suggesting that negative symptoms are not a unitary concept. Finally, tentative evidence could be obtained for speed of information processing and selective attention as markers for vulnerability, although the latter is not specific for schizophrenia.
Adult↗
The prevalence of respiratory disorders in panic disorder, major depressive disorder and V-code patients.
Point prevalence and lifetime prevalence of respiratory disorders were assessed in 100 panic disorder (PD), 100 major depressive disorder (DD) and 100 V-code (VC) patients. Both current and past frequency of respiratory diseases were significantly higher in PD patients in comparison to VC patients, while no significant differences in point and lifetime prevalence between PD and DD or DD and VC patients were observed. It is hypothesized that a disturbed respiratory physiology may have differential effects depending upon the nature of the disorder and the appraisal by the patient.
Adult↗
Relapse criteria in schizophrenic disorders: different perspectives.
Relapse and exacerbation of psychotic symptoms were investigated in a prospective study of 88 patients with recent-onset schizophrenia and related disorders. Relapse definitions were derived from expressed emotion and family intervention studies and based on the Brief Psychiatric Rating Scale (BPRS), the Present State Examination, and clinical judgment. Results indicate that research and clinical criteria represent different perspectives on relapse. Clinical criteria provide a validity check that can verify BPRS-rated changes in partially remitted patients.
Adolescent↗
Symptom dimensions and cognitive and social functioning in recent-onset schizophrenia.
The relationships among symptoms, cognitive functioning and social functioning were investigated in 60 patients with recent-onset schizophrenia. Positive symptoms were unrelated to cognitive measures. Disorganization and depressive symptoms were correlated significantly with Card Sorting performance. Furthermore, only negative symptoms were correlated significantly with social functioning. These results replicate earlier studies with chronic and mixed samples, and support the validity of disorganization as a separate symptom dimension. In contrast to most previous studies, no significant correlations were found between negative symptoms and cognitive measures. However, some evidence was found for a non-linear association between negative symptoms had several cognitive measures. The variation explained by a curvilinear model was not high, but for some cognitive measures this model was clearly superior to a linear model. If replicated, this finding supports the position that cross-sectionally measured negative symptoms cannot be viewed as a unitary concept.
Adolescent↗
A dimensional and categorical approach to the symptomatology of recent-onset schizophrenia.
Sixty-five patients with recent-onset schizophrenia were assessed with two widely used symptom scales, the Brief Psychiatric Rating Scale-Expanded (BPRS-E) and the Psychiatric Assessment Scale (Manchester scale). Principal components analysis of the BPRS-E scores yielded a four-dimensional structure: positive symptoms, negative symptoms, disorganization, and depression. With the Psychiatric Assessment Scale, three dimensions were found: the positive symptoms (delusions, hallucinations) and disorganization (incoherence) appeared in one dimension. A categorical analysis resulted in predominantly positive, negative, and disorganized clusters, but more than half of the sample could not be allocated to any of these groups.
Adolescent↗
Does hypnosis contribute to the care of burn patients? Review of the evidence.
In burn treatment, hypnosis has been used for the alleviation of pain, the prevention and treatment of anxiety and depression, and the acceleration of wound healing. The successful application of hypnosis decreases the extensive medication needed. Furthermore, it provides a tool to patients with which they may experience more control in situations that are often experienced as overwhelming. Notwithstanding these important applications and the very positive terms with which the results of studies are generally described, hypnosis has mostly been neglected as a tool to help burn patients. This article reviews the clinical and experimental evidence of the usefulness of hypnosis in the management of burns. Pain reduction and crisis intervention are promising applications. However, due to a lack of systematic and controlled research, more specific conclusions are precluded. In the controversial area of wound healing, claims for the effectiveness of hypnosis have been made on the basis of slim evidence and inconclusive studies. This hypothesis needs to be addressed in controlled experiments. In summary, systematic investigations are needed to confirm and supplement available clinical evidence. Recommendations for future research are given.
Burns↗
Hypnosis and pain in patients with severe burns: a pilot study.
This report presents a pilot study on the effectiveness of hypnosis in the control of pain during dressing changes of burn patients. Eight patients were treated, and all evaluated the interventions as beneficial. The treatment of four patients was more closely analysed by obtaining pain and anxiety ratings daily. Results show a 50-64 per cent decrease in reported pain level for three patients and a 52 per cent increase of pain for one patient. The mean decrease for these four patients was 30 per cent (for overall as well as worst pain during dressing changes). A 30 per cent reduction of anxiety level and a modest reduction of medication use were achieved concurrently. It is concluded that hypnosis is of potential value during dressing changes of burn patients. Comparison of global evaluations and daily pain ratings shows that systematic research in some cases leads to conclusions opposite from clinical observations or follow-up evaluations. Limitations of this study are discussed and recommendations for future studies are given.
Adolescent↗