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Biomedical subjects

G Keitner

Publications and source records attributed to G Keitner.

7 recordsLinked to original sources
PubMed2001

Effectiveness of St John's wort in major depression: a randomized controlled trial.

CONTEXT: Extracts of St John's wort are widely used to treat depression. Although more than 2 dozen clinical trials have been conducted with St John's wort, most have significant flaws in design and do not enable meaningful interpretation. OBJECTIVE: To compare the efficacy and safety of a standardized extract of St John's wort with placebo in outpatients with major depression. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled clinical trial conducted between November 1998 and January 2000 in 11 academic medical centers in the United States. PARTICIPANTS: Two hundred adult outpatients (mean age, 42.4 years; 67.0% female; 85.9% white) diagnosed as having major depression and having a baseline Hamilton Rating Scale for Depression (HAM-D) score of at least 20. INTERVENTION: Participants completed a 1-week, single-blind run-in of placebo, then were randomly assigned to receive either St John's wort extract (n = 98; 900 mg/d for 4 weeks, increased to 1200 mg/d in the absence of an adequate response thereafter) or placebo (n = 102) for 8 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was rate of change on the HAM-D over the treatment period. Secondary measures included the Beck Depression Inventory (BDI), Hamilton Rating Scale for Anxiety (HAM-A), the Global Assessment of Function (GAF) scale, and the Clinical Global Impression-Severity and -Improvement scales (CGI-S and CGI-I). RESULTS: The random coefficient analyses for the HAM-D, HAM-A, CGI-S, and CGI-I all showed significant effects for time but not for treatment or time-by-treatment interaction (for HAM-D scores, P<.001, P =.16, and P =.58, respectively). Analysis of covariance showed nonsignificant effects for BDI and GAF scores. The proportion of participants achieving an a priori definition of response did not differ between groups. The number reaching remission of illness was significantly higher with St John's wort than with placebo (P =.02), but the rates were very low in the full intention-to-treat analysis (14/98 [14.3%] vs 5/102 [4.9%], respectively). St John's wort was safe and well tolerated. Headache was the only adverse event that occurred with greater frequency with St John's wort than placebo (39/95 [41%] vs 25/100 [25%], respectively). CONCLUSION: In this study, St John's wort was not effective for treatment of major depression.

Adult↗
PubMed2000

The relationship between quality of interpersonal relationships and major depressive disorder: findings from the National Comorbidity Survey.

BACKGROUND: The current study compared the quality of interpersonal relationships in individuals with major depressive disorder to individuals with dysthymia, comorbid depression, nonaffective disorders, and no psychiatric disorders. METHODS: Using data from the National Comorbidity Study, a series of logistic regressions, controlling for demographic variables, were conducted to examine the strength of the association between a major depressive disorder and interpersonal dysfunction (positive and negative interactions) in contrast to other psychiatric disorders. RESULTS: Respondents with current major depressive disorder reported significantly fewer positive interactions and more negative interactions with their spouse or live-in partner than those with nonaffective disorders, and than those with no psychiatric disorders. There were no significant differences in quality of interpersonal relationships between respondents with major depressive disorder and those with dysthymia. Among those with major depressive disorder, comorbidity or treatment-seeking behavior did not significantly contribute to degree of interpersonal difficulties. The strength of the association between interpersonal dysfunction and depression were, in general, comparable for men and women with major depressive disorder. LIMITATIONS: The cross-sectional design of this report precludes inferences regarding causality between quality of interpersonal relationship and current major depressive disorder. CONCLUSIONS: The results of this study indicate that, relative to psychiatric illness in general, poor intimate relationships are characteristic of a current major depressive disorder.

Adolescent↗
PubMed2000

Increases in manic symptoms after life events involving goal attainment.

Bipolar disorder has been conceptualized as an outcome of dysregulation in the behavioral activation system (BAS), a brain system that regulates goal-directed activity. On the basis of the BAS model, the authors hypothesized that life events involving goal attainment would promote manic symptoms in bipolar individuals. The authors followed 43 bipolar I individuals monthly with standardized symptom severity assessments (the Modified Hamilton Rating Scale for Depression and the Bech-Rafaelsen Mania Rating Scale). Life events were assessed using the Goal Attainment and Positivity scales of the Life Events and Difficulties Schedule. As hypothesized, manic symptoms increased in the 2 months following goal-attainment events, but depressed symptoms were not changed following goal-attainment events. These results are congruent with a series of recent polarity-specific findings.

Achievement↗
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↗
PubMed1981

Sexual and emotional intimacy between psychiatric inpatients: formulating a policy.

The management of sexual and emotional intimacy among inpatients is a prominent concern on psychiatric units. A survey of psychiatrists on 70 psychiatric units throughout Ontario shows that the percentage of units that separated the involved patients was roughly the same as the percentage that supported the relationships; however, the largest percentage reported using other methods. None of the units had a written policy for approaching these situations. The authors describe how two such relationships were handled on their own unit, and outline variables--pertaining to the involved patients, the milieu, and the treating psychiatrist--to consider in handling such relationships. They believe a general policy can be formulated that will ensure a consistent, as well as flexible, approach to patient intimacy.

Adult↗
PubMed1980

Long-term lithium treatment and the kidney. Interim report on fifty patients.

This is a report on the first part of our study of the effects of long-term lithium treatment on the kidney. Creatinine clearance, maximum urinary osmolality and 24 hour urine volume have been tested in 50 affectively ill patients who have been on long-term lithium for more than one year. These findings have been compared with norms and with values of the same tests from screening prior to lithium, available for most of our patients. No evidence was found for any reduction of glomerular filtration during lithium treatment. Low clearance values found in several patients could be accounted for by their age and their pre-lithium values. Urinary concentration defect appeared frequent but the extent of the impairment is difficult to assess because of the uncertainty about the norms applicable to this group of patients. The concentration defect appeared reversible, at least in part. Polyuria above 3 litres/24 hours was found in 10% of patients. An attempt is made to draw practical conclusions from the preliminary findings.

Adult↗