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Biomedical subjects

C F Reynolds

Publications and source records attributed to C F Reynolds.

At least 19 recordsLinked to original sources
PubMed1992

Diminished nocturnal penile tumescence in depression: a replication study.

A descriptive study was conducted in a new sample of 51 men with DSM-III-R research diagnostic criteria (RDC) major depression in order to replicate earlier observations that measures of nocturnal penile tumescence (NPT) and penile rigidity are disturbed in depressive states. When compared to both the age-equated patient (n = 34) and normal control (n = 28) groups reported in our 1988 study, the new sample manifested significant abnormalities of NPT and diminished penile rigidity. Such disturbances were not, however, significantly correlated with psychobiological indicators of severe or endogenous depression.

Adult↗
PubMed1992

Early return to REM sleep after nocturnal awakening in depression.

Sixteen male outpatients with major depression and 20 age-equated healthy controls were awakened from rapid eye movement (REM) sleep between 1:30 and 3:30 AM, and the rapidity of return to REM sleep was determined. The time it took to return to REM sleep was reduced in depressives compared with controls: 61.6 (17.9 SD) min versus 80.6 (24.9 SD) min, respectively (p = 0.01). The time elapsed until the return to REM sleep was significantly correlated with baseline REM latency in controls (but not depressives). In contrast, return to REM time was significantly correlated with depression severity scores in depressives (but not controls). There was no evidence to support the hypothesis that the more rapid return to REM sleep in depression was caused by a slow wave sleep deficit. The mechanism underlying the rapid return of REM sleep in depression thus may be related to a severity-linked disturbance, such as a proposed increase in REM "pressure."

Adult↗
PubMed1992

Electroencephalographic sleep in spousal bereavement and bereavement-related depression of late life.

Although spousal bereavement in late life is common and frequently leads to major depression, the boundary between bereavement without a depressive syndrome and bereavement-related depression has been insufficiently studied from a physiological perspective. Because other forms of depression are associated with physiological changes, including sleep, we have attempted to clarify the relationship of bereavement and bereavement-related depression by investigating electroencephalographic (EEG) sleep in 31 elderly volunteers with recent spousal bereavement, stratified by the presence (n = 15) or the absence (n = 16) of major depression (Research Diagnostic Criteria). Entry into the study was limited to volunteers without a personal history of psychiatric disorder. As hypothesized, bereaved subjects with major depression had significantly lower sleep efficiency, more early morning awakening, shorter rapid eye movement (REM) latency, greater REM sleep percent, and lower rates of delta wave generation in the first nonREM (NREM) period, compared with bereaved subjects without depression. Furthermore, the sleep of bereaved subjects with single-episode major depression resembled that of elderly patients with recurrent unipolar major depression (n = 15) on measures noted above. Sleep in bereavement without depression was similar to that of 15 healthy control subjects (neither bereaved nor depressed). These findings suggest that the current DSM-III-R concept of uncomplicated bereavement is not confirmed, as the sleep patterns of subjects who develop a depressive syndrome in the context of bereavement, many of whom might be considered to have "uncomplicated bereavement" by DSM-III-R standards, are identical to sleep patterns found in major depressive episodes. To our knowledge, this is the first study of EEG sleep in spousal bereavement with and without major depression.

Aged↗
PubMed1992

Neuropsychiatric correlates of cerebral white-matter radiolucencies in probable Alzheimer's disease.

We evaluated the neuropsychological functions, rate of disease progression, and psychiatric characteristics of 22 patients with probable Alzheimer's disease in whom periventricular white-matter radiolucencies (PWMRs) were seen on the computed tomographic scan of the brain and compared them with 22 matched patients with Alzheimer's disease without PWMRs. Executive/attention, lexical/semantic, memory/learning, and visuospatial functions did not differ between the two groups at baseline or at the 1-year follow-up examination. The frequency of major depression, delusions, and hallucinations did not differ between the groups. However, patients with PWMRs had significantly higher Hachinski Rating scores at both visits and were more likely to develop cerebrovascular disease during follow-up than were controls with Alzheimer's disease. These preliminary results suggest that the presence of PWMRs is not associated with specific cognitive and psychiatric features or with an altered rate of progression of Alzheimer's disease but does predict the development of clinically significant cerebrovascular disease.

Aged↗
PubMed1992

Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale.

Reliable quantitative ratings of chronic medical illness burden have proved to be difficult in geropsychiatric practice and research. Thus, the purpose of the study was to demonstrate the feasibility and reliability of a modified version of the Cumulative Illness Rating Scale (CIRS; Linn et al., 1968) in providing quantitative ratings of chronic illness burden. The modified CIRS was operationalized with a manual of guidelines geared toward the geriatric patient and for clarity was designated the CIRS(G). A total of 141 elderly outpatient subjects (two medical clinic groups of 20 each, 45 recurrent depressed subjects, 21 spousally bereaved subjects, and 35 healthy controls) received comprehensive physical examinations, reviews of symptoms, and laboratory testing. These data were then used by nurse practitioners, physician's assistants, and geriatric psychiatrists to compute CIRS(G) ratings of chronic illness burden. As hypothesized, analysis of variance demonstrated significant differences among groups with respect to total medical illness burden, which was highest among medical clinic patients and lowest in control subjects. Good interrater reliability (i.e., intraclass correlations of 0.78 and 0.88 in a subsample of 10 outpatients and a separate group of 10 inpatients, respectively) was achieved for CIRS(G) total scores. Among medical clinic patients, a significant correlation was found, as expected, between CIRS(G) chronic illness burden and capability as quantified by the Older Americans Activities of Daily Living Scale; and between CIRS(G) scores and physicians' global estimates of medical burden. Finally, with repeated measures of illness burden approximately 1 year from symptom baseline, significant rises were detected, as expected. The current data suggest that the CIRS(G) can be successfully applied in medically and psychiatrically impaired elderly subjects, with good interrater reliability and face validity (credibility).

Activities of Daily Living↗
PubMed1992

Plasma cholinesterase isozymes and REM latency in schizophrenia.

The relation between electroencephalographic sleep parameters and plasma cholinesterase isozymes was examined in a group of 19 unmedicated schizophrenic patients. Rapid eye movement (REM) latency was found to be significantly inversely correlated with isozyme 3 (mainly acetylcholinesterase). The results are discussed in relation to cholinergic involvement in the regulation of REM sleep and in the pathophysiology of schizophrenia.

Adult↗
PubMed1992

Sleep in spousally bereaved elders with subsyndromal depressive symptoms.

Spousal bereavement in late life frequently leads to major depression. However, many people suffer from "minor" depressive symptoms that entail considerable suffering even in the absence of syndromal major depression. We describe longitudinal electroencephalographic (EEG) sleep and clinical evaluations in 14 elderly, recently spousally bereaved subjects who were experiencing subsyndromal depressive symptoms. While subjects did not meet diagnostic criteria for syndromal major depression, they did have mildly elevated scores on the Hamilton Rating Scale for Depression (mean = 10.6, range = 8-16) at the time of initial sleep studies (T1), which were carried out, on average, 5.5 months after loss of the spouse. Entry into the study was limited to volunteers who did not have a personal history of major depression or psychiatric disorder. Twelve subjects underwent followup clinical and EEG sleep evaluations (T2), 9.9 months after spousal loss. Fifty percent continued to show depressive symptoms at 6-month followup. Test-retest comparisons of sleep and clinical measures were made with a group of sex- and age-matched control subjects who were neither bereaved nor depressed. EEG sleep measures did not significantly correlate with time from loss of spouse, severity of depressive symptoms, or subjective sleep quality. Analysis of variance with repeated measures detected a significant group X time interaction effect for delta sleep ratio (decreasing in controls but increasing in the bereaved).

Aged↗
PubMed1992

Shifts in affective balance during cognitive therapy of major depression.

Thirty-two outpatient depressives were treated by experienced therapists during a 16- to 20-week, 20- to 24-session cognitive-behavioral therapy (CBT) protocol. Patients were classified as CBT responders (n = 22) or nonresponders (n = 10) on the basis of independent clinical ratings of Hamilton (1960) depression severity. Point and confidence interval estimation procedures yielded results consistent with hypotheses derived from the states-of-mind (SOM; Schwartz & Garamoni, 1986) model. At posttreatment, CBT responders shifted the balance of positivity and negativity to the optimal range, whereas nonresponders remained in a predominantly negative SOM. Response status was related more strongly to change in positivity than in negativity. Findings support the view that clinical response to CBT depends on reducing negativity and increasing positivity until an optimal balance is achieved.

Adaptation, Psychological↗
PubMed1992

Rhythmic vs homeostatic influences on mood, activation, and performance in young and old men.

Nine healthy old (80+ years) men were compared with nine healthy young (20-30 years) men in a protocol that required 36 hours of continuous wakeful bedrest. Body temperature rhythm measurement confirmed that the old had as robust an endogenous circadian (approximately 24 hours) rhythm generation mechanism as the young. However, in measures of affect, activation, visual search speed, verbal reasoning speed, manual dexterity, and vigilance hit rate, the old showed a linear decline over the 36 hours of the vigil, with little of the superimposed 24-hour rhythmicity that was apparent in the young. Thus, separate from the endogenous rhythm generation processes, there appeared to be some attenuation with advanced age, which led to the relative absence of rhythmic expression in these mood and performance variables. Such attenuation might contribute to some of the sleep and performance problems reported by elderly adults.

Adult↗
PubMed1992

Cognitive slowing in Alzheimer's disease and geriatric depression.

Response slowing on psychological tasks is found both in Alzheimer's disease and depression. However, the underlying cause for this slowing may be different in the two disorders. This research examined whether the behavioral slowing found in Alzheimer patients results from a reduction in their rate of cognitive processing, whereas the slowing in depressed geriatric patients reflects a purely motor retardation. This hypothesis was tested using a task in which subjects had simply to determine the number of dots present in an array (i.e., enumeration). In all four subject groups (Alzheimer patients, depressed geriatric patients, healthy old controls, and healthy young controls), response time increased linearly with array size. The slope of this linear function (reflecting rate of enumeration) was the same in the normal and depressed patients, but was significantly greater in the Alzheimer patients, suggesting the presence of a cognitive slowing in Alzheimer's disease, but not in depression.

Aged↗
PubMed1992

Daily social rhythms in the elderly and their relation to objectively recorded sleep.

This study tested the hypothesis that the impaired sleep of healthy 71-91 year olds might be due to circadian dysfunction stemming from irregularity of life-style. Twenty-five old women, 20 old men and 21 young controls (19-28 years old) were studied in relation to 1) objective sleep as measured in the laboratory, 2) subjective sleep quality as measured by the Pittsburgh sleep quality index (PSQI) and 3) the social rhythm metric (SRM), an instrument to quantify the daily rhythms of life. Contrary to prediction, the SRM scales revealed that the older group had just as many activities completed and just as much other-person involvement as the young. Moreover, they showed a significantly greater regularity in daily life-style than the young, despite showing reliably impaired subjective and objective sleep. This suggests either that these seniors have always been regular in their life-style and that this has been protective of their health and vigor, or that their regularity has been developed as an adaptive response to age-related changes in the circadian system.

Aged↗
PubMed1992

Concordance between habitual sleep times and laboratory recording schedules.

The validity of laboratory-based studies of sleep depends, in part, upon good concordance between habitual sleep schedule and laboratory recording schedule. Without good concordance, error variance due to the circadian misplacement of sleep and to different amounts of time in bed is probable. In an assessment of scheduling concordance in 1,762 research patient nights over two time intervals, we observed good concordance (< 30-minute discrepancy) in 71.2-77.3% of bedtimes and waketimes, discrepancy (difference of > or = 30 minutes) in 14.9-24.2% of bedtimes and waketimes, and missing data in 4.6-7.5% of times. Waketime differences were consistently in the direction of earlier laboratory than habitual waketimes, whereas differences in bedtime were about equally divided between earlier and later (laboratory vs. habitual). Subjects with schedule discordance averaged 19.5 minutes less time in bed during laboratory sessions as compared with their habitual sleep schedule, whereas subjects with schedule concordance averaged only 3.6 minutes less (p < 0.001). Our experience suggests that it may be more difficult to achieve higher rates of concordance among young adult and middle-aged subjects than among elders and that patient requests related to external constraints on scheduling were a frequent reason for discrepancy. We strongly recommend a policy of routinely including data on laboratory versus habitual sleep times in peer-reviewed publications.

Adult↗
PubMed1992

Napping and 24-hour sleep/wake patterns in healthy elderly and young adults.

OBJECTIVE: To examine differences between healthy elderly and young adults in daytime napping, nocturnal sleep, and 24-hour sleep/wake patterns. A second objective was to determine whether elderly subjects with more and less frequent naps differed in their clinical features or nocturnal sleep. DESIGN: Survey by sleep/wake logs and polysomnography. Comparison by age. SETTING: Sleep/wake logs were completed in the subjects' homes. Polysomnographic studies were conducted on an outpatient basis in a sleep and chronobiology research laboratory. SUBJECTS: Convenience samples of forty-five healthy subjects over 78 years of age (21M, 24F) and 33 healthy adults between 20 and 30 years of age (20M, 13F). MAIN OUTCOME MEASURES: Using self-reports, we estimated the frequency and timing of daytime naps; timing, duration, and quality of nocturnal sleep; and 24-hour patterns of sleep and wakefulness. Also polysomnographic sleep measures. RESULTS: Compared to young adults, elderly subjects reported a greater mean number of daytime naps (P = .004), shorter nocturnal sleep with more wakefulness and earlier sleep hours (P less than .003 for each), and a trend for a shorter 24-hour sleep fraction. Among the elderly, more-frequent and less-frequent nappers did not differ in clinical ratings, self-report sleep measures, or polysomnographic measures. There was a trend for more sleep-disordered breathing and periodic limb movements in more frequent nappers. CONCLUSIONS: These findings are consistent with an age-related decrease in amplitude of the circadian sleep propensity rhythm, or with the expression of a semi-circadian (12-hour) sleepiness rhythm. However, we cannot exclude the additional possibility that napping results from lifestyle factors and nocturnal sleep pathologies in a subset of the elderly.

Adult↗
PubMed1992

Combined pharmacotherapy and psychotherapy in the acute and continuation treatment of elderly patients with recurrent major depression: a preliminary report.

OBJECTIVE: The authors examined the rate of response to the combination of nortriptyline and interpersonal psychotherapy for acute and continuation treatment of elderly patients with recurrent major depression. METHOD: The subjects were 73 elderly patients, 61 of whom completed treatment. Nortriptyline steady-state blood levels were maintained at 80-120 ng/ml, and interpersonal psychotherapy was administered weekly for 9.1 weeks (medium) of acute therapy and was decreased from biweekly to triweekly during 16 weeks of continuation therapy. During acute treatment nonresponding patients also received brief adjunctive pharmacotherapy with lithium or perphenazine. RESULTS: Of the 61 subjects given adequate trials of nortriptyline and interpersonal psychotherapy, 48 (78.7%) achieved full remission (Hamilton depression rating of 10 or lower over 16 weeks of continuation therapy), 10 patients (16.4%) did not respond (Hamilton rating never below 15), and three achieved only partial remission (Hamilton rating of 11-14). Early versus late onset was not associated with a difference in response rate. During the placebo-controlled, double-blind transition to maintenance therapy, 19 (76.0%) of the 25 patients randomly assigned to placebo maintenance conditions showed continued recovery and six relapsed. None of the 24 patients assigned to nortriptyline conditions relapsed. CONCLUSIONS: Use of nortriptyline plus interpersonal psychotherapy for 9.1 weeks (median) of acute and 16 weeks of continuation therapy appears to be associated with good response and relatively low attrition but about a 25% chance of relapse during double-blind discontinuation of nortriptyline. These data require confirmation in a controlled clinical trial of acute and continuation therapy.

Age Factors↗
PubMed1992

Training directors' opinions about the psychiatry resident in-training examination (PRITE).

OBJECTIVE: The American College of Psychiatrists conducted research to validate the content outline of the Psychiatry Resident In-Training Examination (PRITE) and to assess what residency training directors think about the examination. METHOD: A mail survey was sent to the 218 psychiatry residency training directors who subscribe to the PRITE. RESULTS: The survey response rate was 70%. A majority of the respondents indicated agreement with the relative emphasis given to each content area in the PRITE (range = 52%-80% agreement). Eighty-one percent of the respondents were strongly in favor of continuing the practice of releasing the examination and the correct responses each year after the examinations have been scored. The majority of the respondents use results on the PRITE for individual resident evaluation and program evaluation (90% and 94%, respectively). Very few respondents use the PRITE results as the sole measure for assessing residents' cognitive competence or use it for marketing their residency programs. CONCLUSIONS: The survey provided strong support for the content areas covered in the PRITE and their relative emphases. The current practice of releasing PRITE items and answers (a main difference between the PRITE and the certification examination of the American Board of Psychiatry and Neurology) was well supported by the survey results. The stated purpose of the PRITE, to provide educationally useful feedback for individuals and groups in the form of comparisons with peers in specific areas of knowledge, was supported by a large majority of the respondents.

Attitude of Health Personnel↗