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Biomedical subjects

C M Mazure

Publications and source records attributed to C M Mazure.

At least 55 records · Page 3Linked to original sources
PubMed1995

Desipramine treatment of major depression in patients over 75 years of age.

The authors investigated the relationship of desipramine concentrations in plasma to response, side effects, and dose in depressed patients over 75 years of age to determine if these "very old" patients were unusually sensitive to treatment. Thirty-four elderly patients consecutively hospitalized for nonpsychotic, unipolar major depression were treated with a fixed dose desipramine regimen for 4 weeks. Twelve nonresponding patients received a second trial at an increased dose. Comparisons were made with data from younger patients previously published by the authors. At comparable doses, steady-state desipramine concentrations in plasma in the elderly patients did not differ from those observed in younger patients. Response at levels in blood < 115 ng/ml was low, only 6 (21%) of 28 patient trials resulted in response. At levels > or = 115 ng/ml, 6 (46%) of 13 patient trials were effective. These rates were not significantly different. Inspection of the data revealed that a concentration in plasma of 105 ng/ml significantly separated responders and nonresponders (chi 2 = 3.93, df = 1, p < 0.05), but even at levels > or = 105 ng/ml, the response rate was still low relative to rates in prior studies of younger patients treated for a similar duration. The serious adverse reaction rate, 7 of 34, was similar to that previously observed in younger patients. This sample of "very old" elderly was not unusually "sensitive" to antidepressant drug treatment. In fact, the low rate of response observed at usually adequate levels in blood suggested "resistance" to treatment. The findings underscore the need for more effective drug treatments in the depressed elderly.

Aged↗
PubMed1995

Assessment of extrapyramidal symptoms during acute neuroleptic treatment.

BACKGROUND: Acute administration of traditional neuroleptic drugs is often accompanied by the emergence of extrapyramidal symptoms (EPS). The use of a standardized scale to measure EPS can assist the clinician in assessing the occurrence and severity of these adverse reactions. The current work presents the interrater reliability and validity of the Yale Extrapyramidal Symptom Scale (YESS)--an eight-item, easy-to-administer scale for assessing emergence, severity, and type of side effects that commonly occur during acute treatment. METHOD: Interrater reliability (Study 1) and validity (Study 2) of the scale were studied using two independent samples of acutely psychotic patients treated with neuroleptic drugs. Study 1: Interrater reliability was assessed by comparing the YESS ratings of two clinicians blind to the other's rating and to the patient's drug regimen and dose. Study 2: Validity was studied by examining whether YESS items correlated with other EPS measures (convergent validity) but not with psychotic symptoms that may be confused with EPS (discriminant validity). RESULTS: Interrater agreement between clinicians was good to excellent. YESS items correlated with assessments used to measure symptoms of Parkinson's disease and akathisia and generally showed low nonsignificant correlations with ratings of symptoms of psychosis. CONCLUSION: The current work presents a brief EPS scale for the assessment of commonly occurring neuroleptic-induced extrapyramidal side effects. It was demonstrated that the YESS could be used reliably across clinician raters and that the YESS is a valid measure for assessing EPS during acute treatment.

Acute Disease↗
PubMed1994

Elevated plasma monoamine metabolites in eating disorders.

Mean fasting plasma homovanillic acid (HVA) levels were elevated in females hospitalized with eating disorders (both anorexia and bulimia nervosa) compared with females hospitalized with adjustment disorder. Fasting plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) was elevated in anorectic patients only. Five patients with eating disorder and psychosis had higher values for HVA and MHPG than the remainder of the patients with eating disorder.

Adolescent↗
PubMed1994

Characteristics of desipramine-refractory depression.

BACKGROUND: To determine the predictors of desipramine-refractory depression, the authors examined the outcome in patients with major depression who were admitted to a general hospital and treated with desipramine adjusted to an adequate blood level. METHOD: Sixty-eight consecutive inpatients with DSM-III nonpsychotic unipolar major depression who had failed to respond to 1 week of hospitalization without drug treatment were studied. Outcome was assessed with the Yale Depression Inventory after a 4-week desipramine trial in which 24-hour plasma concentrations were used to rapidly achieve a therapeutic desipramine level. RESULTS: Poor response to a therapeutic desipramine trial, which occurred in 15 of 50 patients, was significantly associated with definite personality disorder, prior treatment failure, near delusional status, age < or = 35 years, duration of depressive episode, recurrence of depression, dysthymia, and secondary depression. The first four items remained significantly correlated with poor response when the presence of the other items was accounted for using multiple regression. Drug response was not predicted by the diagnosis of melancholia (DSM-III and DSM-III-R) or initial severity of the depressive episode. CONCLUSION: The four strongest correlates of outcome were highly predictive of drug response. In patients with two or more predictors, only 25% (4 of 16) responded, while in those with one or no predictors, 91% (31 of 34) responded.

Adult↗
PubMed1992

Lithium in combination with perphenazine: effect on plasma monoamine metabolites.

The addition of lithium to perphenazine altered the pattern of plasma homovanillic acid (HVA) during the course of treatment for acute psychosis. In the perphenazine-treated group plasma HVA declined significantly by days 7-9 of treatment, whereas in the perphenazine-plus-lithium group plasma HVA tended to increase. The pattern for plasma methoxyhydroxyphenethyl-glycol (MHPG) was not significantly different for the two groups. The addition of lithium to a neuroleptic may enhance the metabolism of dopamine.

Adult↗
PubMed1992

Drug-responsive symptoms during early neuroleptic treatment.

Identification of symptoms that are directly responsive to neuroleptic drugs at progressive phases of treatment is important for monitoring drug response and understanding the relationship between neurochemical mechanisms of drug action and disordered behavior. Using multiple regression analyses that controlled for pretreatment severity, we identified those symptoms that improved in direct relation to serum concentrations of perphenazine after 10 days of treatment. Improvement in two positive symptoms of psychosis--hallucinations and conceptual disorganization--appears to be related to perphenazine level and useful for assessment of early drug response.

Adult↗
PubMed1992

Comparison of ovarian response in the same women with the same or different lots of human menopausal gonadotropin.

A variation in the bioactivity of different production lots of human menopausal gonadotropin (hMG) has been suggested. Therefore, we evaluated ovarian response to hMG in 14 women during three separate IVF cycles. The first two cycles were performed with the same lot (#03310027; Cycles A1 and A2); the third cycle utilized different lots of hMG (Cycle B). In all cycles, hMG was administered 3 ampules/day beginning cycle Day 3 and continued for at least 6 days. Estradiol and ultrasound evaluations were performed on Day 3, and then daily, beginning on cycle Day 8. Fourteen women completed all three cycles. There were no significant differences in baseline estradiol and ultrasound. Estradiol levels on Day 8 (A1, 754 +/- 130; A2, 700 +/- 107; B, 520 +/- 80 pg/ml, analysis of variance p greater than 0.5) and on Day 9 (A1, 1051 +/- 144; A2, 1140 +/- 155; B, 840 +/- 124 pg/ml, p greater than 0.05) were similar as well. The number of small (1.0-1.4 cm) follicles, large (greater than or equal to 1.5 cm) follicles, and total follicles (Day 8: total A1, 5.5 +/- 0.9; A2, 4.0 +/- 0.7; B, 4.5 +/- 0.9, p greater than 0.05; Day 9: total A1, 6.7 +/- 0.9; A2, 6.9 +/- 0.8; B, 6.9 +/- 0.9, p greater than 0.05) in all three cycles were also similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Estradiol↗
PubMed1991

Plasma free homovanillic acid (HVA) as a predictor of clinical response in acute psychosis.

The relationship of plasma free homovanillic acid (HVA) and methoxyhydroxyphenylglycol (MHPG) to early clinical response was prospectively studied in a new series of acutely psychotic inpatients given a fixed dose of perphenazine elixir for 10 days. Elevated pretreatment plasma HVA but not MHPG was significantly associated with good response. Change in HVA was correlated with a favorable response and a significant decline in MHPG was found in responders. Results suggest that HVA can provide a useful clinical predictor of response, and that both dopamine metabolism and noradrenergic functioning, as measured by plasma HVA and MHPG, are reduced in effective neuroleptic treatment.

Acute Disease↗
PubMed1991

A preliminary, open study of the combination of fluoxetine and desipramine for rapid treatment of major depression.

Prompted by a recent study suggesting that the combination of desipramine hydrochloride and fluoxetine down-regulates beta-adrenergic receptors more rapidly than either drug alone, we administered both desipramine and fluoxetine to 14 inpatients with major depression in an open, 4-week trial. Desipramine plasma levels drawn 24 hours after an initial standardized dose were used to rapidly adjust desipramine dosage and compensate for the interactive effects of fluoxetine on desipramine levels in the blood. Responses were retrospectively compared with those of 52 inpatients who were descriptively similar and previously treated in the same setting with desipramine alone. Response was significantly more rapid in the group that received both drugs. One week after treatment began, the mean change in Hamilton Depression Rating Scale scores was 42% in the group that received both drugs and 20% in the group that received desipramine alone (Mann-Whitney U test, P = .007). Two weeks after administration of the drugs, the mean change in scores of the group that received both drugs was 60%, while a 30% change was noted in the patients treated with desipramine alone (P = .001). Ten (71%) of the 14 patients in the group that received both drugs completely remitted (change in Hamilton Depression Rating Scale score of greater than 75%, and final score of less than 7) within 4 weeks, while few patients treated with desipramine alone met these criteria within 4 weeks. This preliminary study suggests that treatment with both desipramine and fluoxetine is a rapid and effective strategy for treatment of major depression, and supports recent hypotheses of noradrenergic-serotonergic synergism.

Adult↗
PubMed1990

Does melancholia predict response in major depression?

We examined the value of the melancholic distinction for predicting response to 1 week of hospitalization without antidepressant drugs and to a 4-week fixed plasma level desipramine (DMI) trial in patients with unipolar non-psychotic major depression. Both DSM-III and III-R criteria were tested. Response to hospitalization (HDRS less than or equal to 12) was much less common in DSM-III melancholic than in non-melancholic patients (1 of 19 vs. 18 of 37, chi 2 = 8.69, df = 1, P less than 0.001) and severity did not account for this association. DSM-III-R melancholia criteria were also associated with poor hospital response but slightly less predictive. Melancholic patients, however, diagnosed with either set of criteria, were not more likely to respond to drug treatment on any of the measures examined.

Adult↗
PubMed1990

Predictors of hospital outcome without antidepressants in major depression.

Fifty-two consecutive inpatients with nonpsychotic unipolar major depression were assessed for response to 1 week of hospitalization without antidepressants. Each was rated at admission and at 1 week using the Hamilton Rating Scale for Depression (HRSD). Fifteen of 52 responded (HRSD score less than or equal to 12), 10 of whom improved by greater than or equal to 50% change in the HRSD score. Five variables were correlated with lack of hospital response: DSM-III melancholia, panic disorder, the DSM-III-R item "absence of personality disorder," admission severity, and age. Multiple regression showed an independent association between hospital outcome and the first three variables. Response to 1 week of hospitalization was found in 70% (14 of 20) of the patients who had none of the three identified predictors: melancholia, panic, and absence of personality disorder. In patients with one or more of these predictors, only 3% (1 of 32) responded.

Adult↗
PubMed1990

Psychotogenic drug use and neuroleptic response.

When fixed doses of haloperidol or perphenazine were used in two separate studies, we found that psychotic males with a prior history of psychotogenic drug use had a poorer early neuroleptic response even in the early stages of their psychotic disorder than psychotic males who had not previously used significant amounts of psychotogenic drugs. Relative neuroleptic refractoriness may be characteristic of some dual diagnosis patients at the beginning of their illness. Antecedent psychotogenic drug use may contribute to the development of psychosis and to relative neuroleptic refractoriness by means of effects upon dopaminergic mechanisms.

Adolescent↗
PubMed1990

Value of the DST for predicting response of patients with major depression to hospitalization and desipramine.

The authors examined the value of the dexamethasone suppression test (DST) for predicting response of patients with unipolar, nonpsychotic major depression to 1 week of hospitalization without antidepressant drugs and to a 4-week trial of desipramine at a fixed plasma level. The rates of response to hospitalization without drug treatment (defined as a score of 12 or less on the Hamilton Rating Scale for Depression) were not significantly different for the patients with a positive DST and those with a negative DST. This finding differs from those of prior studies of the DST and response to placebo. The responses of the DST-positive and DST-negative patients to desipramine also did not differ, a finding that replicates those in some prior reports.

Adult↗