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Biomedical subjects

I M Lesser

Publications and source records attributed to I M Lesser.

At least 55 records · Page 3Linked to original sources
PubMed1987

Neuroendocrine aspects of primary endogenous depression--IV. Pituitary-thyroid axis activity in patients and matched control subjects.

In order to ascertain the extent of hypothalamo--pituitary--thyroid (HPT) axis dysfunction in endogenous depression, we determined nocturnal serum thyrotropin (TSH) concentrations, TSH responses to thyrotropin releasing hormone (TRH) administration, and serum triiodothyronine (T3) and thyroxine (T4) concentrations in 40 Research Diagnostic Criteria primary, definite endogenous depressives and 40 individually matched normal control subjects. We also examined the relationships of the HPT measures to pre- and post-dexamethasone (DEX) serum and urine cortisol measures and, in the patients, to subject characteristics, the diagnosis of endogenous/melancholic depression by different systems, and the overall severity and specific dimensions of depressive symptomatology. Compared to their matched controls, the patients showed significant reductions in nocturnal serum TSH and serum T3 concentrations. Neither the TSH responses to TRH nor serum T4 concentrations were significantly different between the two groups of subjects. In the patients, none of the subject characteristics, diagnostic schemes for endogenous/melancholic depression or specific aspects of depressive symptomatology were significantly related to HPT activity. The measures of HPT activity were unrelated to measures of hypothalamo--pituitary--adrenal cortical (HPA) axis activity in both groups of subjects.

Adult↗
PubMed1987

Neuroendocrine aspects of primary endogenous depression. III. Cortisol secretion in relation to diagnosis and symptom patterns.

In order to ascertain the extent of hypothalamo-pituitary-adrenal cortical (HPA) hyperactivity in endogenous depression, we determined circadian serum cortisol patterns, cortisol responses to dexamethasone (DEX) administration, and urine free cortisol excretion before and after DEX administration in 40 definite endogenous depressives diagnosed with the Research Diagnostic Criteria. The cortisol measures ranged from normal to clearly elevated. To elucidate the clinical correlates of these hormone measures in the patients, we examined the relationships of the pre- and post-DEX cortisol measures to the diagnosis of endogenous/melancholic depression by different systems and to the overall severity and specific dimensions of depressive symptomatology. In this group of endogenous depressives, none of the diagnostic schemes for endogenous/melancholic depression which we studied was significantly related to the pre- or post-DEX cortisol measures. Of the other subject and symptom variables, only age and the agitation/anxiety factor of the Hamilton depression scale shown consistent relationships with the cortisol measures. Both were positively correlated, to a moderate degree, with the hormone measures, and they were not correlated with each other. Together they explained approximately 20% of the variance in the cortisol measures. Thus, within a group of moderately to severely ill endogenous depressives, the older and the more agitated anxious patients have a significantly greater likelihood of showing increased HPA activity. These findings indicate that age should be controlled in studies of the HPA axis and that the subjective experience of anxiety may contribute to HPA hyperactivity in endogenous depression.

Adult↗
PubMed1987

Past and current thyroid function in subjects with panic disorder.

Disturbances in thyroid function can result in symptoms similar to those occurring in patients with anxiety disorders, especially panic disorder. An association between thyroid illness and panic and phobic disorders has been suggested, but few studies have directly investigated this issue. To assess this possible relationship, the authors measured indices of thyroid function in 165 subjects who had a current DSM-III diagnosis of panic disorder, either with or without phobic avoidance. These subjects reported a higher prevalence of thyroid illness by history compared with the prevalence of thyroid illness in the general population; however, less than 1% of all subjects had current thyroid dysfunction. The presence of a major depressive episode (MDE) was unrelated to current thyroid function, although subjects with MDE reported a higher prevalence of thyroid disease by history. Indices of thyroid function were not correlated with the severity of panic attacks or phobias.

Adult↗
PubMed1986

Ethnicity and psychopharmacology.

In clinical studies and cross-national surveys, cultural or ethnic factors have been found to be significant determinants in patients' responses to psychotropic medication. Dosage requirements and the potential for toxic reactions might differ amongst racial and ethnic groups. In this paper, the authors review the relevant literature and examine pharmacodynamic, pharmacokinetic and cultural-psychological factors, all of which could be responsible for such ethnic variations.

Anti-Anxiety Agents↗
PubMed1986

Diagnostic considerations in panic disorders.

Approaches to the classification and treatment of anxiety have been lacking because of the unclear borders between pathologic and normal anxiety and the heterogeneity of patients called "anxious." The differentiation of panic from other anxiety states is a recent development in psychiatric nosology. The diagnosis of panic disorder and agoraphobia and their demarcation from other psychiatric and medical disorders are reviewed. Proposals to revise DSM-III criteria to provide concordance with current etiologic theories are discussed, and an overall treatment strategy that takes into account the multiple manifestations of the illness is outlined.

Agoraphobia↗
PubMed1985

A modified dexamethasone suppression test for endogenous depression.

In order to simplify the dexamethasone suppression test (DST), we have administered a lower dosage of dexamethasone (DEX) and shortened the sampling time to a single morning blood sample. DEX (in dosage increments from 0.125 to 1.0 mg, p.o.) was administered at 2300 h to normal volunteers in a double-blind randomized fashion, and blood samples were taken at 0700 h the following morning. While significant cortisol suppression occurred after the 0.375 mg, 0.5 mg, and 1.0 mg doses of DEX, the 0.5 mg dose was the smallest that clearly suppressed cortisol in all eight subjects. This dose then was used to test the feedback sensitivity of the central nervous system (CNS)-pituitary-adrenal axis in endogenously depressed patients. Twenty endogenously depressed patients and 20 normal volunteers were given both the standard 1.0 mg DST, with post-DEX serum cortisol determined at 1500 h, and the simplified 0.5 mg DST, with post-DEX serum cortisol determined at 0700 h. Four patients (20%) and one control (5%) were nonsuppressors after the 1.0 mg DST, and nine patients (45%) and one control (5%) were nonsuppressors after the 0.5 mg DST. In addition, nine patients with major depression (nonendogenous subtype) and 15 patients with panic attacks also were studied using the 0.5 mg DST. Only 2 of these 24 patients (8%) were nonsuppressors. The results suggest that the single-sample 0.5 mg DST is more sensitive than the standard 1.0 mg DST, and the specificity of the modified test appears comparable to the standard form of the test.

Adult↗
PubMed1985

Electroencephalographic study of nighttime panic attacks.

A woman whose condition was diagnosed as agoraphobia with panic attacks participated in an all-night polysomnographic study. During the night she experienced a panic attack that was phenomenologically similar to her daytime attacks. The attack occurred suddenly, arising from stage 3-4 (delta) sleep. There was no disruption of sleep architecture immediately before awakening. The occurrence of this panic attack during sleep is discussed in the context of other nighttime sleep disorders.

Adult↗
PubMed1985

A critique of contributions to the alexithymia symposium.

This paper reviews the contributions of Paulson, Demers-Desrosiers and Freyberger et al. to the symposium on alexithymia. Two of these papers discuss strategies for measurement of alexithymia, using established instruments as well as a recently introduced projective test designed to measure one's ability to symbolize. The third paper discusses a treatment approach which is based upon psychodynamic principles, yet has novel and practical modifications in technique. The papers are discussed as clinical contributions to alexithymia research and are critically reviewed in regard to methodology. I contend that much research in alexithymia has not given sufficient attention to research design, thus confusing our understanding and application of the concept.

Affective Symptoms↗
PubMed1983

Situational depression and the dexamethasone suppression test.

Neither baseline integrated 24 hr cortisol concentrations nor cortisol escape from dexamethasone suppression were able to distinguish a group of endogenously depressed patients who experienced precipitating events prior to their depression (situational) from a group of endogenously depressed patients with no discernible precipitating events (non-situational). Symptom severity, features of psychosis, and family history also were similar between the two groups. These results highlight the inadequacy of using the presence or absence of precipitating events for subtyping endogenous depression.

Adjustment Disorders↗
PubMed1983

Alexithymia: examining the development of a psychological concept.

Alexithymia is a clinically derived concept that refers to difficulty patients have with verbal expression of emotions and with fantasy elaborations. Since its recent introduction into the literature, it has been discussed in various contexts and has been considered by some to be a useful concept in integrating data from a variety of disciplines. The authors contend that many of the speculations about alexithymia are based on an inadequately researched data base and that its application in some areas is premature. They recommend careful investigation of any newly introduced psychological concept to avoid either its premature rejection or its reification.

Affective Symptoms↗
PubMed1981

A review of the alexithymia concept.

Alexithymia is a term meaning "no words for mood." It has been applied to patients who have marked difficulty in verbal expression of emotions and limited ability to use fantasy. These patients often have psychosomatic illnesses and tend to do poorly in traditional dynamic psychotherapy. The concept is discussed from an historical perspective and its current status in the understanding of psychosomatic illness is assessed. The alexithymia literature is critically reviewed with a focus on definition, measurement, etiological speculations, and the relevance of alexithymia to the psychotherapeutic process. The alexithymic concept has much to offer heuristically, but most of the literature to date has been anecdotal and theoretical, with few research investigations. Suggestions are made for future research that could serve to validate the concept and provide answers to questions regarding symptom formation and psychological problems.

Adult↗
PubMed1981

Attitudes toward medication change among chronically impaired psychiatric patients.

As the hazards of long-term use of psychotropic drugs become more apparent, drug holidays and medication discontinuance are increasingly being implemented. Chronically ill patients are often reluctant to cooperate with such treatment recommendations. The authors questioned 52 chronically impaired patients taking neuroleptics about their attitudes toward medication changes and their fantasies about the results of discontinuing their medication. Although they were seemingly compliant, the majority of the patients anticipated severe negative consequences.

Adult↗
PubMed1980

A combined crisis-outpatient clinic: a better system for delivery of psychiatric care?

The successful merger of a crisis clinic with an adult outpatient clinic suggests that the traditional splitting of crisis and outpatient care in American psychiatry may not optimal. In the combined clinic more patients were seen, staff time was utilized more efficiently, staff morale was increased, and educational needs were more easily satisfied. Patient care was not compromised in any way.

Adult↗