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J F Greden

Publications and source records attributed to J F Greden.

At least 127 records · Page 7Linked to original sources
PubMed1982

Biological markers of melancholia and reclassification of depressive disorders.

Pathophysiological markers of melancholia are being developed in four major areas: 1) neuroendocrine; 2) sleep; 3) psychomotor and 4) biochemical. Neuroendocrine markers include a failure of suppress plasma cortisol secretion in the dexamethasone suppression test (DST), diminished thyrotrophin (TSH) response to thyrotrophin releasing hormone (TRH stimulation test), and blunted growth hormone response to a variety of stimulating agents such as d-amphetamine, methylamphetamine, clonidine, L-dopa and insulin (growth hormone test). Of these, the DST is the best standardized. It is a highly specific laboratory marker with documented value in diagnosis, assessing prognosis and monitoring treatment progress. Sleep EEG abnormalities include reduced REM latency, increased REM density, reduction in delta sleep and impaired sleep efficiency. Sleep EEGs are pragmatically difficult, but results are quite specific. Elongated speech pause time (SPT) during "automatic speech" is a promising marker of psychomotor regulation. This simple, non-invasive measure may have special value in reducing clinical subjectivity and in monitoring treatment progress. Biochemical markers include: 1) platelet monoamine oxidase (MAO) activity; 2) in vitro lithium RBC transport and 3) urinary MHPG levels. Standardizations of biochemical tests are still lacking. Most biological tests for melancholia operate by indirectly "marking" CNS limbic system dysfunction. For wide acceptance, a test must be safe, moderately sensitive, highly specific, practical, relatively inexpensive and not significantly altered by common anti-depressant treatments. The DST best meets these criteria at this time. Proper utilization of test results requires knowledge of baseline prevalence rates and of the concepts of sensitivity (true-positive rate), specificity (true negative rate) and positive and negative predictive values (diagnostic confidence). No single marker will meet all clinical needs. Combinations or serial use of tests will hopefully enhance their already considerable usefulness.

Depressive Disorder↗
PubMed1982

EEG studies of sleep in the diagnosis of depression.

Psychiatric diagnoses have traditionally been made on the basis of clinical criteria, including current phenomenology and historical information. This traditional procedure presents several problems, including standardization of data gathering and interpretation. Biological criteria have been shown to be useful aids to diagnosis, but the same problems of standardization must be overcome. We present here the derivation of discriminant functions (DFs) using sleep EEG data to separate depressed from normal subjects. More important, we have cross-validated these DFs in a separate group of patients, using them to separate endogenous (ED) from nonendogenous depressed (ND) patients. ADF using the sleep variables REM latency and REM density can make this discrimination with sensitivity = 0.61 and specificity = 0.93. We also present our preliminary findings in support of the earlier conclusion that the sleep of unipolar ED patients is more disturbed than that of bipolar ED patients.

Adult↗
PubMed1981

A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility.

Four hundred thirty-eight subjects underwent an overnight dexamethasone suppression test (DST) to standardize the test for the diagnosis of melancholia (endogenous depression). Abnormal plasma cortisol concentrations within 24 hours after dexamethasone administration occurred almost exclusively in melancholic patients. The best plasma cortisol criterion concentration, above which a DST result may be considered abnormal, was 5 microgram/dL. The optimal dose of dexamethasone was 1 rather than 2 mg. Two blood samples obtained at 4 and 11 PM after dexamethasone administration detected 98% of the abnormal test results. This version of the DST identified melancholic patients with a sensitivity of 67% and a specificity of 96%. Baseline nocturnal plasma cortisol concentrations were not useful. Abnormal DST results were found with similar frequency among outpatients and inpatients with melancholia; but they were not related to age, sex, recent use of psychotropic drugs, or severity of depressive symptoms. Extensive evidence validates this practical test for the diagnosis of melancholia.

Adolescent↗
PubMed1981

Platelet alpha 2-adrenergic receptors in major depressive disorder. Binding of tritiated clonidine before and after tricyclic antidepressant drug treatment.

The specific binding of tritiated (3H)-clonidine, an alpha 2-adrenergic receptor agonist, to platelet membranes was measured in normal subjects and in patients with major depressive disorder. The number of platelet alpha 2-adrenergic receptors from the depressed group was significantly higher than that found in platelets obtained from the control population. Treatment with tricyclic antidepressant drugs led to significant decreases in the number of platelet alpha 2-adrenergic receptors. These results support the hypothesis that the depressive syndrome is related to an alpha 2-adrenergic receptor supersensitivity and that the clinical effectiveness of tricyclic antidepressant drugs is associated with a decrease in the number of these receptors.

Adolescent↗
PubMed1981

Dexamethasone suppression test and selection of antidepressant medications.

Endogenous depressives with abnormal dexamethasone suppression tests (DSTs) respond better to somatic antidepressant treatments than those with normal DSTs. Whether the DST also aids in the selection of specific antidepressants has not been determined. A pilot report suggested that patients with abnormal DSTs might be noradrenaline-deficient and respond preferentially to imipramine or desipramine, whereas those with normal DSTs might be serotonin-deficient and respond best to amitriptyline or clomipramine. Attempting to replicate this observation, we studied 26 patients diagnosed with Research Diagnostic Criteria as major depressive disorder, endogenous subtype, and with DSM-III as having melancholia. All were drug-free during baseline evaluation. All had abnormal DST results, with post-dexamethasone plasma cortisol levels exceeding 5 microgram/dl. We treated subjects with either imipramine or amitriptyline and compared clinical response with weekly Hamilton Depression Rating Scales, completed by raters blind to both DST results and the research question. Thereapeutic plasma levels were documented. We found no significant differences in treatment response between the subgroups. Twenty of the 26 subjects did well. The imipramine-treatment group failed to have either earlier response or better final outcome. These data fail to replicate suggestions that DST results assist in the selection of either imipramine or amitriptyline.

Amitriptyline↗
PubMed1981

Psychomotor function in affective disorders: an overview of new monitoring techniques.

Clinicians and researchers lack accuracy in assessing psychomotor functions of patients. Several objective monitoring techniques have recently been proposed with the goal of compiling accurate determinations. These include electromyographic determinations of facial expressions of emotion, measurement of speech phonation and pause times, and use of movement-activated recording monitors to quantify motility. Objective psychomotor assessments may improve classification, longitudinal monitoring, treatment selection, and prediction of outcome for patients with depression and mania.

Bipolar Disorder↗
PubMed1981

The Carroll rating scale for depression. I. Development, reliability and validation.

The Carroll rating scales (CRS) was developed as a self rating instrument for depression, closely matching the information content and specific items of the Hamilton rating scales (HRS). The CRS was found to have acceptable face validity and reliability. The concurrent validity of the CRS was acceptable, based on comparisons with the HRS and the Beck Depression Inventory (BDI). The internal consistency of the CRS was very similar to that of the HRS. The CRS contained information about HRS scores beyond what could be predicted from BDI scores, but the BDI did not predict HRS scores beyond what could be predicted from CRS scores. The CRS and BDI scores were strongly correlated and both had access to a subjective dimension of depression that could not be predicted from HRS scores. The complementary uses of self ratings and observer ratings are evident from these results. The CRS may be a useful alternative to the BDI as a self rating scale, with the additional advantage of closer correspondence to the HRS.

Adult↗
PubMed1981

Somatic manifestations of caffeinism.

Caffeine affects most physiological systems. Few studies, however, have attempted to document which somatic symptoms are commonly associated with caffeinism. To answer this question, the authors evaluated 124 general hospital patients, and compared reported somatic symptoms among low, moderate and high caffeine users. Diuresis, insomnia, withdrawal headache, diarrhea, anxiety, tachycardia and tremulousness were most commonly reported, in descending order of frequency. Differences among high, moderate and low users were common, and some dose-response associations were apparent. Most symptoms were explainable by caffeine's known CNS neuropharmacological effects or peripheral pharmacological actions.

Adult↗
PubMed1981

Changes in serial dexamethasone suppression tests among unipolar depressive receiving electroconvulsive treatment.

An abnormal dexamethasone suppression test (DST) identifies endogenous depressive with 95% confidence. The DST normalizes with successful treatment. Serial DSTs throughout treatment could provide useful information on (i) whether they biologically monitor clinical response, (ii) when DST normalization does occur, and (iii) whether early normalization predicts clinical outcome. We studied six inpatients who had abnormal DSTs on admission and serial DSTs during and after a course of ECT. All were diagnosed as unipolar major depressive disorder, endogenous (RDC). Clinical improvement was monitored with weekly Hamilton Rating Scales. Five of six abnormal DST patients converted to a normal test and showed significant clinical improvement. On patient failed to normalize and also had a poor outcome. All DST normalizations occurred by the fourth to sixth ECT. Additional ECTs resulted in further reduction in DST plasma cortisol values. All normalizers experienced progressive clinical improvement, and the DST successfully monitored these changes. DST conversion occurred early in treatment. Early DST normalization may have predictive value for good treatment response.

Depressive Disorder↗
PubMed1981

Speech pause time: a marker of psychomotor retardation among endogenous depressives.

Speech pause time (SPT)-the silent interval between phonations during automatic speech-is elongated during depressive episodes among endogenous depressives. Phonation time is unchanged. To follow up and expand earlier small-scale studies of these psychomotor findings we conducted a prospective determination of SPT among 24 unipolar (UP) depressives, 12 bipolar (BP) depressives, and 19 nondepressed controls. SPT was lengthened among both UP and BP depressives during their episodes. This elongation disappeared with clinical improvement. Nondepressed controls did not have longer SPT. During states of clinical remission, depressives and controls had comparable SPT values. Replications are required, but the measurement of SPT appears to be a useful, objective technique for identifying and monitoring psychomotor deceleration among depressives.

Bipolar Disorder↗
PubMed1980

Headache.

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Caffeine↗
PubMed1980

Diagnosis of endogenous depression. Comparison of clinical, research and neuroendocrine criteria.

Eighty-nine depressed outpatients were studied by clinical criteria, Research Diagnostic Criteria (RDC), and the dexamethasone suppression test (DST) of neuroendocrine regulation. A simple outpatient version of the DST, requiring only one blood sample, correctly identified 40% of patients diagnosed clinically as endogenous depression (ED), with a specificity of 98% and a diagnostic confidence of 95%. Differences in age, sex, or severity of symptoms between endogenous and non-endogenous depressives did not account for these results. By comparison, the diagnostic performance of the DST was weaker for the RDC categories Major Depressive Disorder (MDD) and primary MDD. These were less selective and more heterogeneous than the clinical category ED. The clinical diagnoses of ED were supported in 98% of cases by the RDC, but 22% of RDC endogenous MDD diagnoses were not supported by the clinical diagnoses. Abnormal DST results were found only in patients with both the clinical diagnosis of ED and the RDC diagnosis of endogenous MDD. Patients with definite endogenous MDD had a significantly higher frequency of abnormal DST results (42%) than those with probable endogenous MDD (14%), or those with other RDC diagnoses (3%). A significant association was found between positive DST results and a positive family history of depression. These results support other evidence for use of a positive DST result as an external validating criterion for ED. The category MDD contained all cases diagnosed clinically as ED, but was diluted by cases diagnosed clinically as non-endogenous depression who had no neuroendocrine disturbance. The results also confirmed that the endogenous/non-endogenous and primary/secondary classifications of depression are not identical. We conclude: (1) that the DST can be used in the differential diagnosis of depressed outpatients as well as inpatients; (2) that the RDC category primary MDD and the Washington University category primary depression are more heterogeneous and probably less valid than the clinical category ED; (3) that the RDC for endogenous MDD have only moderate validity; (4) that RDC diagnoses cannot substitute for careful clinical diagnoses in research studies; (5) that the best use of the RDC is to support clinical diagnoses, but not to generate diagnoses independently as a free-standing system; (6) that the concept of endogenous or endogenomorphic depression has validity and should be retained in research studies of depression.

Adult↗