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Biomedical subjects

C B Qualls

Publications and source records attributed to C B Qualls.

11 recordsLinked to original sources
PubMed1985

The dexamethasone suppression test and pituitary-adrenocortical function.

The dexamethasone suppression test (DST) as now commonly carried out in psychiatric settings yields "abnormal" results in many conditions including the healthy state. To determine whether the DST accurately identifies patients with physiologically meaningful increases in pituitary-adrenocortical activity, we compared DST results to baseline urinary cortisol level. Thirty-four psychiatric inpatients underwent a 24-hour urine collection and then a DST using 1 or 2 mg of dexamethasone. With the common 1-mg DST, 24-hour urinary cortisol levels in nonsuppressors and suppressors did not differ. With the 2-mg DST, however, nonsuppressors had significantly higher urinary cortisol levels than suppressors, and all nonsuppressors had urinary cortisol levels above the normal range. Thus, the 1-mg DST may not identify the heuristically important subgroup of psychiatric patients who have a pathophysiologically meaningful alteration in pituitary-adrenal regulation.

Adolescent↗
PubMed1985

Diagnostic heterogeneity and the DST in consecutive psychiatric admissions.

There is uncertainty about the clinical usefulness of the dexamethasone suppression test (DST). It is also unclear whether there are advantages to a 1-mg or 2-mg DST. Eighty-three consecutive psychiatric inpatients were randomly given a 1-mg or 2-mg DST within the first week of admission. Sensitivity, specificity, and diagnostic confidence are reported for this group, and also in combination with those for 119 semi-consecutive psychiatric admissions. Although rates of nonsuppression were consistently higher in patients with affective disorders than in patients with other diagnoses, the diagnostic confidence of the DST for major depression in a diverse and unselected patient population was not greater than the prevalence of the disorder. The DST does not appear to be useful for clinical diagnostic decision-making. Nonetheless, the DST may still be an important biological marker in neuroendocrine psychiatric research.

Adult↗
PubMed1984

A comparison of structural patterns of sexual arousal in male and female homosexuals.

Patterns of sexual arousal were examined for eight male and eight female homosexuals. Comparisons were made in terms of physiological and subjective arousal. The results indicate that for each group there exists very distinct arousal responses, with each group showing the greatest response to same-gender homosexual activity. Results are discussed in relationship to establishing normative data for assessment and clinical function.

Adult↗
PubMed1982

Lithium and chlorpromazine in psychotic inpatients.

A sample of recently hospitalized psychotic patients was assigned to treatment with lithium or chlorpromazine in a double-blind drug trial. Several diagnostic systems were used to characterize the patients. No relationship was found, regardless of criterion system used, between diagnosis and differences in drug effectiveness; specifically, the presence of "schizophrenic" symptoms did not predict a poor response to lithium. Among patients with physical overactivity, those treated with lithium terminated earlier and had poorer outcome than those treated with chlorpromazine. In patients who were not overactive, the two drugs were equally effective, and chronically psychotic patients had poorer outcomes regardless of drug. Lithium may be an effective treatment for acutely psychotic patients who are not overactive. The use of a lithium trial as a diagnostic tool may be unwarranted.

Adult↗
PubMed1982

Pituitary-adrenal regulation over multiple depressive episodes.

Pituitary-adrenal activity was evaluated with the dexamethasone suppression test in 11 patients over their multiple hospitalizations for major depression. All six patients who were suppressors during their index admission had one subsequent admission over the period of study during which they were again suppressors. Of five patients who were nonsuppressors during their index admission, three had one subsequent admission and two had three subsequent admissions. Four of these patients were again nonsuppressors during a subsequent admission. For patients who were nonsuppressors during some but not all admissions for depression, pituitary-adrenal activity appeared related to the persistence of the depressive episodes.

Adult↗
PubMed1982

Predicting pharmacotherapy outcome by subjective response.

Subjective response to the initial 24-hour dosage of psychoactive medication was evaluated as a predictor of clinical outcome in 33 drug-free patients with DSM-III diagnoses of functional psychoses. Pretreatment evaluation included measures of symptom severity, role functioning and attitude towards treatment. Clinical improvement after 8-21 days was significantly correlated with subjective response. The author suggests that inquiry regarding a patient's early subjective response to prescribe chemotherapy can help to identify ultimate drug refusal and clinical unresponsiveness.

Adult↗
PubMed1981

Pituitary-adrenal disinhibition in depression: marker of a subtype with characteristic clinical features and response to treatment?

The data from a series of studies in different patient samples are consistent in showing that resistance to dexamethasone suppression is selectively associated with primary major depressive disorder. In addition, nonsuppressors appear to have more depressive episodes, show greater improvement during hospitalization, tend to be older than suppressors, and may have a specific disturbance in cognitive function. Preliminary data suggest that nonsuppressors and suppressors respond preferentially to different antidepressants. These data raise the possibility that pituitary-adrenal disinhibition, as assessed by the dexamethasone suppression test, is associated with a depressive subtype having a distinctive pathophysiology, clinical course, and treatment response.

Adult↗
PubMed1979

Racing thoughts in depressed patients.

Patients with racing thoughts and depression may have atypical features that suggest a schizophrenic or borderline state and make diagnosis problematic; clinical management may be difficult because of failure to respond to standard treatments. These patients may have variants of affective illness; and may respond favorably to lithium carbonate.

Acute Disease↗