Biomedical subjects

A M Ritenour

Publications and source records attributed to A M Ritenour.

4 recordsLinked to original sources

PubMed1997

Bipolar depression: an underestimated treatment challenge.

We sought to determine whether depressive and mixed/cycling episodes were as responsive to standardized pharmacotherapeutic interventions as were manic episodes in bipolar 1 patients. As part of the Maintenance Therapies in Bipolar Disorder (MH29618, E. Frank, PI) study, forty-two acutely ill bipolar 1 patients who had been randomly assigned to one of two preliminary phase non-pharmacologic treatment strategies (interpersonal and social rhythm therapy [IPSRT] or a standard medication clinic approach) were treated according to a standardized pharmacotherapeutic protocol. Symptom severity was measured weekly with the Hamilton Depression Rating Scale and the Bech-Rafaelsen Mania Scale in order to assess symptomatic remission. Survival analysis with the proportional hazards model was performed on time to remission. Manic patients were significantly more likely to achieve clinical remission than the depressed patients (100 vs. 59%) and did so significantly more rapidly. The difference in proportion remitting and time to remission between the depressed and mixed/cycling groups was not statistically significant. No significant effect for non-pharmacologic treatment assignment was found. These results point to the need to develop more effective treatments for bipolar depression. They also suggest that psychotherapy has a limited impact in the acute phase treatment of bipolar episodes.

Adult↗

PubMed1994

Nocturnal and circadian body temperatures of depressed outpatients during symptomatic and recovered states.

Forty-one recurrent unipolar depressed outpatients were studied at baseline (symptomatic period) and at recovery. Rectal temperatures were measured continuously between 1800h and 0600h on 2 successive nights at each time point. In those 24 patients who recovered after receiving interpersonal psychotherapy (IPT) alone ("psychotherapy responders") and who thus remained drug-free throughout, there was no difference in nocturnal body temperatures between baseline and recovery time points. Moreover, nocturnal temperature patterns appeared to be very similar to those of a healthy contrast group (n = 17). The contrast group was not matched for age and gender with the patient group, though, so the comparison was only suggestive. At baseline, those recovering after psychotherapy alone (n = 24) did not differ from those eventually failing to respond to IPT and requiring medications to achieve recovery ("medication responders") (n = 17). Medication responders did show some baseline versus recovery differences in nocturnal temperatures, but these may possibly have been a function of the medications used. At recovery, a subset of 19 psychotherapy responders and 13 medication responders underwent an "unmasking" experiment involving 36 hours of wakeful bedrest. In the resulting endogenous temperature rhythms, there was no evidence of any reliable differences between the psychotherapy responder and medication responder patient groups. Both groups showed rhythms that were very similar to those of a healthy contrast group (n = 17), although, again, the contrast group was not matched for age or gender with the patient group. In conclusion, in measures of body temperature, at least, there appeared to be little evidence of circadian dysfunction in this group of recurrent outpatient depressives.

Adult↗

PubMed1994

The Pittsburgh Sleep Diary.

Increasingly, there is a need in both research and clinical practice to document and quantify sleep and waking behaviors in a comprehensive manner. The Pittsburgh Sleep Diary (PghSD) is an instrument with separate components to be completed at bedtime and waketime. Bedtime components relate to the events of the day preceding the sleep, waketime components to the sleep period just completed. Two-week PghSD data is presented from 234 different subjects, comprising 96 healthy young middle-aged controls, 37 older men, 44 older women, 29 young adult controls and 28 sleep disorders patients in order to demonstrate the usefulness, validity and reliability of various measures from the instrument. Comparisons are made with polysomnographic and actigraphic sleep measures, as well as personality and circadian type questionnaires. The instrument was shown to have sensitivity in detecting differences due to weekends, age, gender, personality and circadian type, and validity in agreeing with actigraphic estimates of sleep timing and quality. Over a 12-31 month delay, PghSD measures of both sleep timing and sleep quality showed correlations between 0.56 and 0.81 (n = 39, P < 0.001).

Activities of Daily Living↗

PubMed1991

The Social Rhythm Metric (SRM): measuring daily social rhythms over 12 weeks.

A "Social Rhythm Metric" (SRM) of daily rhythmic behavior (developed previously) was given to 20 treated depressives (in remission) and 15 day-working control subjects for a continuous 12-week period. Long-term use of the SRM appeared feasible with no evidence of a deterioration in scores over the 12 weeks. Comparisons were made between intersubject and intrasubject variability, as well as a study of overall trends in SRM during the 12 weeks. Two further measures from the instrument--the Activity Level Index (ALI) and Other Person Involvement--were developed and shown to be useful adjuncts to the SRM. Although no simple differences in absolute SRM score emerged between patients and controls, there were significant differences in intersubject vs. intrasubject variability between the two groups. The patients showed more intrasubject variability and required more weeks of sampling to achieve a stable "trait" measure. Patients' social rhythms also appeared to be more "other person" prompted than those of controls.

Adult↗