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Biomedical subjects

D J Kupfer

Publications and source records attributed to D J Kupfer.

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

Polysomnographic characteristics of young manic patients. Comparison with unipolar depressed patients and normal control subjects.

Although sleep disturbance is a prominent feature of mania, its polysomnographic (PSG) features have received little study. To investigate more systematically the PSG characteristics of sleep in mania, all-night PSG evaluations were performed for two to four consecutive nights in 19 young manic patients (age range, 18 to 36 years), 19 age-matched patients with major depression, and 19 age-matched normal control subjects. Manic and depressed patients displayed nearly identical profiles of PSG abnormalities compared with normal control subjects, including disturbed sleep continuity, increased percentage of stage 1 sleep, shortened rapid eye movement latency, and increased rapid eye movement density. These results are similar to those reported in previous studies of major depression, and they are consistent with the possibility that the sleep disturbance in mania and major depression is caused by the same mechanism.

Adolescent↗
PubMed1992

Five-year outcome for maintenance therapies in recurrent depression.

After conducting a randomized, 3-year maintenance trial in 128 patients with recurrent depression who had responded to combined short-term and continuation treatment with imipramine hydrochloride and interpersonal psychotherapy, we asked those individuals who survived the 3-year trial receiving active medication (with or without psychotherapy) to continue in a 2-year additional randomized trial of active medication vs placebo. The question was whether maintaining antidepressant medication at the dosage used to treat the acute episode beyond 3 years would continue to provide a significant prophylactic effect compared with medication discontinuation after the 3 years of effective maintenance treatment. Survival analysis demonstrated a highly significant continued prophylactic effect for active imipramine hydrochloride treatment maintained at an average dose of 200 mg. We conclude that active imipramine treatment is an effective means of preventing recurrence beyond 3 years and that patients with previous episodes less than 2 1/2 years apart, therefore, merit continued prophylaxis for at least 5 years.

Adult↗
PubMed1992

Maintenance treatment and psychobiologic correlates of endogenous subtypes.

Although the endogenous subtype in depression has long been thought to have prognostic significance, to date no long-term maintenance treatment trial has examined the relative risk of recurrence in patients meeting criteria for this subtype. Following our analysis of the primary hypotheses regarding the relationship between treatment assignment and outcome [Frank et al. (1990) Arch. Gen. Psychiatry 47, 1093-1099], we now examine psychobiologic and maintenance treatment correlates for these recurrent unipolar patients grouped according to melancholic, endogenous but not melancholic, and non-endogenous subtype at index presentation. No differences were observed among the three groups in overall survival time; however, in the 52 patients who received psychotherapy without active medication during the maintenance phase, length of survival was inversely related to endogeneity. Interestingly, no differences were found among the three groups in EEG sleep parameters when studied either at baseline or following recovery.

Adult↗
PubMed1992

Imipramine and weight gain during the long-term treatment of recurrent depression.

The recently completed long-term maintenance trial of full-dose imipramine for recurrent unipolar disorder provided an opportunity to examine the extent to which such doses (200-300 mg daily) are associated with persistent and adverse side effects, particularly weight change. In 115 patients we monitored weight change during the three-year maintenance treatment phase to the point of trial completion, recurrence or termination. No differences were noted between individuals receiving active medication (average gain of 5.8 lbs. during an average treatment period of 725 days) versus those randomized to the 'no-drug' cells (average gain of 2.8 lbs. during an average treatment period of 422 days). Numerous other factors such as body mass index, previous weight gain and gender did not play a differential role in establishing why some individuals gained weight during long-term treatment of depression regardless of specific treatment.

Adult↗
PubMed1992

Electroencephalographic sleep abnormalities in depressed children: a hypothesis.

Although most studies on sleep in child and adolescent depression have indicated that sleep is relatively unaffected, abnormalities have been found. We hypothesized that discrepancies occur because family history of depression and sleep abnormalities in a parent have not been taken into account. In a group of parents and offspring with a family history of depression, 57% of parents had evidence of abnormal sleep. Sleep continuity and sleep architecture were correlated, and the magnitude of these correlations increased between parents with abnormal sleep and their offspring. Abnormal sleep may be expressed at a younger age when there is familial evidence for depression and abnormal sleep in a parent.

Adult↗
PubMed1992

Electroencephalographic sleep studies in depressed outpatients treated with interpersonal psychotherapy: I. Baseline studies in responders and nonresponders.

Electroencephalographic (EEG) sleep measures have been examined as predictors of therapeutic response in patients with major depression. Although some studies have reported that EEG sleep measures are predictive of a favorable outcome with medications, two recent studies found no differences in the baseline sleep characteristics of responders and nonresponders to psychotherapy. To clarify this issue, we compared baseline EEG sleep in a group of patients with recurrent depression who responded to interpersonal psychotherapy (n = 19) and a comparable group who did not respond (n = 18). Baseline ratings of depression severity did not differ in the groups, but some differences in baseline sleep were noted. Psychotherapy nonresponders had longer sleep latencies, lower sleep efficiency, and increased automated measures of phasic rapid eye movement (REM) activity. In addition, the two groups had different EEG sleep adaptation patterns for REM latency and phasic REM density measures across the two study nights. These preliminary results suggest that baseline EEG sleep patterns, as well as the pattern of laboratory adaptation, may differ for depressed patients who respond to psychotherapy and those who do not.

Adolescent↗
PubMed1992

Electroencephalographic sleep studies in depressed outpatients treated with interpersonal psychotherapy: II. Longitudinal studies at baseline and recovery.

Electroencephalographic (EEG) sleep studies may help to identify persistent versus episodic biological characteristics of major depressive disorder. This report examines longitudinal EEG sleep studies in depressed patients treated with psychotherapy alone. Nineteen patients were studied during a symptomatic baseline period and again during early remission after treatment with interpersonal psychotherapy (IPT). EEG sleep findings at baseline were not markedly abnormal, but they were similar to those in other published studies of young adult outpatients. No changes were found in visually scored EEG sleep measures between depression and early remission. Automated measures of delta sleep and rapid eye movement (REM) activity showed small state-related changes, with delta activity increasing from baseline to remission, and automated REM measures decreasing. Strong baseline-remission correlations were noted for most sleep measures, including slow wave sleep, phasic REM activity, and automated delta EEG counts; measures of sleep continuity and tonic REM sleep were not strongly correlated. Consistent adaptation effects across nights were observed for sleep continuity and REM measures during each clinical phase. These findings support the hypothesis that most visually scored EEG sleep measures, as well as the sleep adaptation process, are stable through the acute episode of depression, at least into early symptomatic remission. They also suggest that finer-grained automated analyses of delta and REM activity may provide more sensitive tools for examining state-related changes.

Adolescent↗
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

The effect of SRIF on the EEG sleep of normal men.

The aim of this investigation was to evaluate EEG sleep, especially measures of delta-wave sleep, during and after the administration of somatostatin (SRIF). Eleven normal men, ages 22-37 yr, were administered saline or SRIF (0.1 microgram/kg/min IV) over 160 min at bedtime. SRIF delayed sleep-related growth hormone (GH) secretion without altering the amount of GH available during the entire night of sleep. No changes in delta-wave sleep occurred during either the first 100 min of sleep or the remainder of the night. Furthermore, all major EEG sleep variables were not significantly different between the saline and SRIF infusion night. It would not appear that the peripheral administration of this dose of SRIF or the subsequent delay of GH release has quantitative effects on EEG measures of all-night sleep.

Adult↗
PubMed1992

Life stress and treatment course of recurrent depression: 1. Response during index episode.

Research on treatment course and outcome in depression is mixed with respect to the implications of life stress. Several concerns are addressed in a prospective study of 91 individuals treated for recurrent depression. Specific forms of stress occurring before treatment entry predicted a poor clinical response both after 16 weeks and after a more extended intervention period. Specific forms of stress occurring during the 1st 6 weeks of treatment also predicted poor response after 16 weeks and after the extended intervention period. Severe stress occurring early in treatment predicted a longer time to attain relief for treatment responders. Concepts underlying the idea that stress-related disorders have a better clinical outcome are discussed, and it is proposed that life stress has different implications for individuals with and without recurrent depression.

Adjustment Disorders↗
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

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↗