Biomedical subjects

C F Reynolds

Publications and source records attributed to C F Reynolds.

At least 127 records · Page 7Linked to original sources

PubMed1997

Psychiatric correlates of MR deep white matter lesions in probable Alzheimer's disease.

The authors examined the relationship between psychiatric symptoms and the presence of of MR deep white matter lesions (DWMLs) in 28 probable Alzheimer's disease (AD) patients with mild to moderate dementia. The difference in frequency of psychiatric symptoms between patients with and without DWMLs was not statistically significant. However, MR global scores of severity correlated with the presence of ideational disturbances (such as low self-esteem and suicidal ideation). Analysis of specific cerebral regions indicated that the highest correlation occurred in the frontal white matter. Thus, DWMLs are correlated with specific symptoms of depression in AD. Whether DWMLs are etiologically related to these symptoms remains to be determined.

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PubMed1997

Psychoeducational workshops for elderly patients with recurrent major depression and their families.

OBJECTIVE: This report details an extension of the use of psychoeducational workshops with psychiatric patients and their families to families of elderly patients with recurrent unipolar late-life depression. METHODS: Subjects were 132 participants in a study of maintenance therapies for late-life depression and their 182 family members and significant others who accepted invitations to single-session family workshops. Participants provided feedback on their satisfaction with the content and quality of the workshops. Associations between workshop attendance, preworkshop demographic and clinical characteristics, treatment adherence, and outcome were explored through comparisons between 108 patients who attended workshops and 24 patients who declined the workshop invitation. RESULTS: Favorable feedback from participants suggested that the extension of the workshops to families of elderly patients with depression was successful. Workshop attendance was associated with a lower rate of dropout during continuation treatment. CONCLUSIONS: Results associating workshop refusal and treatment dropout, as well as the overall treatment compliance and retention rates in this randomized clinical trial involving geriatric patients, support the need for further study of factors relating to elderly patients' willingness to engage in family-centered interventions.

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PubMed1997

Differences over the life span in daily life-style regularity.

A diary-based instrument-the Social Rhythm Metric (SRM)-was used to assess the level of stability of daily social and behavioral rhythms in a group of 239 healthy subjects (112 male, 127 female) ranging in age from 20 to 89 years. Each subject completed the instrument for two consecutive weeks, which were averaged to yield one measure (SRM score) of life-style regularity [range 0 (least regular) to 7 (most regular)] and another of activity level index (ALI), corresponding to the number of (diary listed) activities done per week (max. = 119). SRM score increased reliably with age group at an average rate of 0.018 units per year. ALI showed an "inverted U"-shaped function with a maximum at about 50 years. SRM changes appeared not to be related to demographic differences between the age groups, although ALI differences may have been so related. No main effects or interactions were found with gender. Life-style regularity appears to increase over the life span in response to both biological and psychosocial changes and may represent an adaptation to age-related changes in the circadian system's sensitivity to entraining agents. Regular behavioral rhythms may be conducive to continued good health and well-being.

Activities of Daily Living↗

PubMed1997

Does lorazepam impair the antidepressant response to nortriptyline and psychotherapy?

BACKGROUND: This analysis sought to determine whether lorazepam influences time to response or rate of response in elderly depressed patients receiving nortriptyline and psychotherapy and to examine clinical and polysomnographic correlates of lorazepam treatment. METHOD: Patients with recurrent major depressive disorder (N = 119; mean +/- SD age = 68.0 +/- 6.1 years; diagnosis defined by Research Diagnostic Criteria) received acute treatment with nortriptyline and interpersonal psychotherapy. Thirty-five patients received open-label adjunctive lorazepam for anxiety or insomnia symptoms (LZ+) and 84 did not. Statistical analyses were conducted between the LZ+ group and a group of 35 patients who received no lorazepam (LZ-) and were matched for anxiety level. Patients had polysomnographic studies prior to treatment and after remission of depressive symptoms. RESULTS: The LZ+ group reported more anxiety on the Brief Symptom Inventory (p = .04) compared with the remaining 84 patients. The LZ+ group had a greater proportion of endogenous depression subtype than the anxiety-matched LZ- group, in addition to more abnormal EEG sleep (higher percentage of REM sleep, shorter REM latency, lower delta sleep ratio). Mean time to initial antidepressant response was no different between groups. However, a significantly greater proportion of LZ+ than LZ- patients responded to acute treatment (91.4% vs. 71.4%; p < .03). CONCLUSION: Adjunctive lorazepam does not slow the antidepressant response to combined antidepressant/psychotherapy treatment in elderly depressed patients, and it is associated with a greater likelihood of antidepressant response. A greater percentage of patients treated with lorazepam have endogenous depression subtype and abnormal sleep findings (EEG) than those who are not treated with lorazepam. Adjunctive lorazepam is useful for treating anxiety in elderly depressed patients.

Age Factors↗

PubMed1997

Effect of sertraline on plasma nortriptyline levels in depressed elderly.

BACKGROUND: Several serotonin selective reuptake inhibitors have been reported to be inhibitors of the cytochrome P450 2D6 (CYP2D6). Thus, they may increase the plasma level of secondary amine tricyclic antidepressants, which are predominantly metabolized through this enzyme. Except for a few case reports, no clinical data document the degree of this drug-drug interaction in elderly depressed patients. METHOD: We systematically examined this interaction by determining the change in plasma nortriptyline levels in 14 elderly depressed patients in whom sertraline was added to nortriptyline. RESULTS: After addition of 50 mg/day of sertraline, the median increase in plasma nortriptyline level over baseline was 2% (range, -26% to 117%; p = .30). In 2 patients (14%), there was an increase of 50% or more. For patients taking higher sertraline doses (N = 7; 100 or 150 mg/day), the median increase in plasma nortriptyline level over baseline was 40% (range, -12% to 239%; p = .08). CONCLUSION: Overall, a modest effect of sertraline was observed on nortriptyline metabolism in these elderly depressed patients. This is consistent with prior reports of a weak inhibition of CYP2D6 by sertraline in vitro and in young healthy volunteers. However, some patients showed a change in plasma nortriptyline level that would be considered clinically significant. Thus, careful monitoring of plasma nortriptyline levels is recommended in all patients treated with a combination of nortriptyline and sertraline.

1-Naphthylamine↗

PubMed1997

The posttreatment illness course of depression in bereaved elders. High relapse/recurrence rates.

Losing close attachments through death in late life is common and can lead to depression. Previous work has shown the clinical benefits of treating these depressions. This article describes the 2-year course of 53 elderly subjects with bereavement-related depression after responding to various treatments. Forty-six patients experienced a full response to acute treatment, but 36% experienced relapse or recurrence. This finding suggests that the treatment response in depressed bereaved older patients is more brittle than expected.

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PubMed1997

Suicidal ideation in elderly bereaved: the role of complicated grief.

This study examined whether symptoms of complicated grief at baseline predicted suicidal ideation during a depressive episode in elderly bereaved individuals. Over a 17-month period, serial ratings of suicidal ideation, hopelessness, and symptoms of depression, anxiety, and complicated grief were obtained from 130 elderly participants who had lost their spouses within the past 2 years. Groups of active and passive suicidal ideators, as well as nonideator controls, were compared via analysis of variance (ANOVA) with respect to levels of complicated grief, depression, and anxiety. Elderly bereaved with both active and passive suicidal ideation were found to have higher symptomatic levels of depression, hopelessness, complicated grief, and anxiety, as well as lower levels of perceived social support, than nonideators at study entry. Fifty-seven percent of the patients with high complicated grief scores were found to be ideators during the follow-up versus 24% of the patients with low complicated grief scores. Patients with any suicidal ideation had higher symptom levels of depression, anxiety, and complicated grief when they were ideators as compared with periods when they denied ideation. Fifteen out of the 39 ideators had recurrent depressive episodes versus 5 of the 91 nonideators. Patients with a history of suicide attempts were more likely to be ideators after loss than other bereaved. Thus, the condition of having high levels of complicated grief symptoms and depressive symptoms appears to make bereaved individuals vulnerable to suicidal ideation. Detection of high levels of complicated grief could help clinicians identify patients who may be at heightened risk for suicide.

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PubMed1997

Using interpersonal psychotherapy (IPT) in a combined psychotherapy/medication research protocol with depressed elders. A descriptive report with case vignettes.

One hundred eighty subjects at least 60 years of age with recurrent unipolar major depression were recruited to participate in a depression treatment protocol. All patients received drug therapy with nortriptyline (NT) and interpersonal psychotherapy (IPT) with an experienced clinician. Acutely, 81% of subjects showed a full response to combined treatment. In the initial 127 subjects, the most common problem areas in therapy were role transition (41%), interpersonal disputes (34.5%), and grief (23%). Case vignettes are presented and discussed. The combination of IPT and NT showed a powerful antidepressant effect. IPT was readily adaptable to the needs of depressed elders.

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PubMed1997

Is life stress more likely to provoke depressive episodes in women than in men?

One of the most consistent findings in psychiatric research is that rates of major depression are at least twofold higher among women than among men. Although there is considerable agreement in the literature that life events play a role in producing, triggering, or maintaining episodes of depression, less is known about the relationship among gender, life events, and depression. In the present study, we compared the rates, focus ("interpersonal" vs. "non-interpersonal"), and timing of stressful life experiences reported in rigorous interviews of male and female patients with unipolar recurrent depression and nondepressed contrast subjects. Consistent with hypotheses, female patients were more likely to experience stressful life experiences than their male counterparts; rates of stressful life experiences did not differ between female and male controls. Unexpectedly, rates of interpersonal stress did not differ among males and females regardless of patient or control status. We also found no significant differences in the timing of pre-onset events: stressful events were generally concentrated in the period immediately preceding onset for both men and women. Thus, although these data suggest that life stress may play a larger role in the provocation of recurrent episodes of depression for women than for men, there do not seem to be sex differences in the extent to which interpersonal vs. noninterpersonal events and difficulties are associated with depression onset or in the temporal distribution of events. Implications of these results are discussed in the context of research on other putative factors contributing to gender differences in rates of depression.

Adult↗

PubMed1997

Intrusive thoughts and avoidance behaviors are associated with sleep disturbances in bereavement-related depression.

Cognitive arousal has been associated with disrupted sleep in individuals with insomnia and may be one mechanism underlying sleep disturbances in depression. We evaluated the relationship of sleep to bereavement-related intrusive thoughts and avoidance behaviors in 40 men and women with major depression consequent to bereavement. Mean subject age was 65 years, 25% of the same was male, and median time since loss was 7.4 months. Levels of intrusive thoughts and avoidance behaviors were similar to samples seeking treatment for stress response syndromes, including post-traumatic stress disorder. After controlling for the effects of age, time since loss, and depression severity, greater frequency of bereavement-related intrusive thoughts and avoidance behaviors was associated with longer sleep latency and lower delta sleep ratio (P values < .01). Intrusive thoughts and avoidance behaviors were not strongly related to gender, time since loss, depression severity, or subjective sleep quality. These results suggest that intrusive thoughts and avoidance behaviors affect sleep in bereavement-related depression and may therefore be related to the clinical course of depression.

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PubMed1997

Accelerating response in geriatric depression: a pilot study combining sleep deprivation and paroxetine.

Elderly depressed patients often require an average of 12 weeks of pharmacotherapy before attaining remission. The delay between treatment initiation and remission may decrease compliance and prolongs suffering; hence, interventions that decrease the time to onset of antidepressant activity are needed. Our objective was to evaluate, in an open trial, the use of one night of total sleep deprivation combined with paroxetine to accelerate antidepressant response in elderly patients. Thirteen elderly patients with major depression were sleep-deprived for one night and started paroxetine on the night of recovery sleep. Patients were followed for twelve weeks, and clinical improvement was rated using the 17-item Hamilton Depression Rating Scale and a version of the Hamilton modified for sleep deprivation studies. 8/13 (62%) patients experienced significant improvement of depressive symptoms by 2 weeks. Within 12 weeks 11/13 (85%) patients responded to the combination of sleep deprivation and paroxetine. Median response time was 2 weeks. Clinical response at 12 weeks was correlated with changes in Sleep Deprivation Depression Rating Scale Scores between baseline and recovery sleep. In an open trial, the combined use of total sleep deprivation and paroxetine appears to be an effective method for speeding the onset of clinical antidepressant activity in geriatric depression and for improving early recognition of non-response.

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PubMed1997

Low-level serum anticholinergicity as a source of baseline cognitive heterogeneity in geriatric depressed patients.

Depressed geriatric patients show substantial intersubject variability in cognitive performance, which complicates attempts to evaluate the cognitive effects of depression and of antidepressant therapy. This variability may reflect the multiple medications older patients take, many of which have anticholinergic effects. This study examined whether serum anticholinergicity (SA) explained some of the variability in depressed geriatric patients' memory performance. Before starting antidepressant treatment, 36 elderly depressed subjects were given a verbal learning test. At the same time, a blood sample was taken and analyzed by radioreceptor binding assay to determine their SA level. Nineteen of the subjects had detectable levels (mean = 0.28 pmole atropine equivalent). Subjects with an SA of zero showed significantly better delayed recall than did those with a positive SA level. Thus, even very low SA may produce subtle decrements in memory performance, an area of cognition known to be highly sensitive to anticholinergic effects.

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PubMed1996

Quality of life in elderly patients with recurrent major depression: a factor analysis of the General Life Functioning Scale.

Quality of life profiles measured by the General Life Functioning (GLF) Scale were examined in elderly patients with recurrent major depression, before and during combined treatment with nortriptyline and interpersonal psychotherapy. The study group included 110 patients, 91 recovered and 19 nonrecovered, aged 60 to 80 years, suffering from at least their second lifetime episode of major depression. Repeated measures analysis of covariance (with Hamilton and Beck depression scores as time-dependent covariates) was used to compare the temporal course of overall GLF scores for the recovered and the nonrecovered groups. Factor analysis was used to examine whether the GLF Scale yielded an overall score and measured specific aspects of well-being and coping. There were significant differences in the overall GLF scores between recovered and nonrecovered patients, with the differences increasing from week 8 of treatment onward. Analysis revealed significant improvements in quality of life, as measured by overall GLF scores, over the course of treatment in both recovered and nonrecovered patients. Even when changes in Hamilton and Beck depression ratings were controlled for in the statistical analysis, improvements in GLF scores were found to be greater in recovered than in nonrecovered patients. Thus, the GLF measures more than change in level of depression. Its overall score also has high internal reliability.

Adaptation, Psychological↗

PubMed1996

Social rhythm stability following late-life spousal bereavement: associations with depression and sleep impairment.

The aim of this study was to investigate changes in social rhythm stability and sleep in spousally bereaved subjects (n = 94) and in nonbereaved elderly control subjects (n = 45). Social rhythm stability and activity level were measured with a diary-like instrument, the Social Rhythm Metric (SRM). We observed that spousal bereavement, per se, was not associated with a lower social rhythm stability or activity level except in the presence of a major depressive episode. We also observed an inverse correlation between severity of depression and social rhythm stability, and a positive correlation between depression and both subjective and objective measures of sleep impairment. Higher social rhythm stability was correlated with better sleep in subjects with high activity levels, but not in subjects with low activity levels. Longitudinal data, including pre-bereavement assessment of social rhythm stability, are necessary to ascertain directional effects, i.e., whether loss of spouse occasions disruption of social rhythms or whether such disruption precedes sleep impairment and depression.

Adjustment Disorders↗

PubMed1996

A longitudinal study of EEG sleep in schizophrenia.

Several abnormalities in sleep architecture have been described in schizophrenia. However, the question of whether sleep electroencephalographic (EEG) changes are influenced by treatment and phase of illness remains unclear. To examine the longitudinal stability of sleep data, we compared baseline sleep measures with measures obtained approximately 4 weeks and 1 year after the beginning of treatment in a series of schizophrenic patients. At the 4-week assessment, sleep continuity measures improved significantly; a modest increase in rapid eye movement (REM) latency was seen, but no other changes were found in sleep architecture. At the 1-year assessment, REM latency, REM time, and average automated REM counts increased. No significant changes were seen for slow-wave sleep (SWS) parameters at 1-year follow-up. These findings suggest that SWS parameters are relatively stable during follow-up, while REM parameters seem to change, perhaps in relation to phase of illness and treatment. SWS alterations may, at least in part, reflect more invariant, perhaps trait-related alterations in schizophrenia.

Adult↗

PubMed1996

Abnormal electroencephalographic sleep profiles in major depression: association with response to cognitive behavior therapy.

BACKGROUND: To test the hypothesis that depressed patients with selected neurobiologic disturbances are less responsive to psychotherapy, we examined responses to cognitive behavior therapy in relation to electroencephalographic sleep profiles. METHODS: Under a prospective, case-control design, 90 outpatients with probable or definite endogenous major depression (Schedule for Affective Disorders and Schizophrenia and Research Diagnostic Criteria) were stratified into abnormal and normal sleep subgroups (on the basis of an empirically validated electroencephalographic sleep profile) and more severe and less severe depression subgroups (on the basis of pretreatment Hamilton scores). Response to 16 weeks of treatment was analyzed for both intention-to-treat and completers (n = 82) samples. Outcomes during a 36-month prospective follow-up were assessed with survival analyses. RESULTS: Abnormal sleep profiles and higher pretreatment depression severity were independently associated with poorer outcomes on several analyses. The association between sleep abnormality and cognitive behavior therapy response was not significant in the completers analyses, however, largely because of differential attrition. During follow-up, pretreatment depression severity was predictive of relapse and a lower recovery rate, whereas sleep abnormality was predictive of a lower recovery rate and a higher risk of recurrence. CONCLUSIONS: Depressed patients characterized by higher severity and/or an abnormal electroencephalographic sleep profile were relatively less responsive to cognitive behavior therapy. These associations are hypothesized to result from a constellation of neurophysiologic disturbances that interfere with the acquisition, application, and implementation of the skills emphasized in cognitive behavior therapy.

Adult↗

PubMed1996

Electroencephalographic sleep profiles during depression. Effects of episode duration and other clinical and psychosocial factors in older adults.

BACKGROUND: Limited evidence suggests that polysomnographic alterations may be more prominent early in a depressive episode. Whether the effects of episode duration extend beyond middle age and appear in late-life depression as well has important implications for treatment decisions and for understanding depressive illness across the life span. Furthermore, the impact of episode duration on sleep has not been examined in the context of other factors related to clinical history and psychosocial status. METHODS: Eighty-three persons aged 60 years or older with recurrent depression were studied: 34 had been depressed for 2 to 16 weeks and 49 for longer periods. An age- and gender-matched group of 48 persons with no history of major depression served as controls. Initial univariate analyses examined duration effects on electroencephalographic (EEG) sleep measurements. Multivariate analyses considered the combined effects of episode duration, clinical variables, and psychosocial variables on EEG sleep profile. RESULTS: Episode duration was strongly associated with sleep continuity, architecture, and rapid eye movement: subjects who were earlier in their depressive episodes had their sleep impaired more than those later in their episodes, who, in turn, were more impaired than controls. Moreover, clinical characteristics of subjects' depressive illness, demographic variables, and psychosocial stressors and supports had unique effects on the EEG sleep profile. CONCLUSION: Episode duration appears to be a potent factor to consider when evaluating sleep during depression. The additional contribution of clinical and psychosocial characteristics to the prediction of the EEG sleep profile demonstrates the importance of incorporating these variables into models of the psychobiologic characteristics of depression. The results are relevant to the timing and focus of therapeutic interventions.

Age Factors↗

PubMed1996

Anxiety among widowed elders: is it distinct from depression and grief?

The purpose of this study was to test the validity and utility of distinguishing symptoms of anxiety from those of depression and grief in recently spousally bereaved elders. We also examined pathways from baseline (six months or less post-spousal death) to follow-up (12 and 18 months post-death) levels of anxiety, depression and grief-related symptoms. Baseline and follow-up data were available from 56 recently widowed elderly subjects recruited for an investigation of physiological changes in bereavement. Confirmatory factor analyses indicated that a model in which anxiety was specified as a third factor, apart from depression and grief factors, fit the data well and significantly better than either the one or two factor models. Path analyses revealed that both baseline severity of grief and anxiety had significant lagged effects and predicted follow-up severity of depression. Symptoms of anxiety appeared distinct from those of depression and grief, and the anxiety, depression and grief factors differentially predicted subsequent symptomatology. These findings suggest a need for more specific identification and treatment of anxiety, depression and grief symptoms within the context of late-life spousal bereavement.

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