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Biomedical subjects

J F Neil

Publications and source records attributed to J F Neil.

At least 19 recordsLinked to original sources
PubMed1986

Response of energy and suicidal ideation to ECT.

The mean suicidal ideation scores of 37 patients receiving ECT improved significantly earlier than energy items. However, caution is recommended in prematurely dismissing clinical wisdom regarding suicidal risk during treatment for depression.

Depressive Disorder↗
PubMed1986

ECT response in psychotic versus nonpsychotic unipolar depressives.

Thirty primary unipolar depressives were studied to determine whether depressed patients with psychotic symptoms respond better to ECT than those without such symptoms. Psychotic (N = 9) and nonpsychotic (N = 21) patients showed equal therapeutic benefit in similar periods of time. Thus, the presence of psychotic symptoms did not enhance the degree of response to ECT in patients with primary unipolar major depression.

Delusions↗
PubMed1985

Evaluation of depression in a general hospital: utility and limitations of the dexamethasone suppression test.

Use of the DST was studied in medically hospitalized, depressed patients. Although complicating medical factors necessarily excluded nearly 60% of referrals, post-dexamethasone plasma cortisol values were significantly higher in 14 major depressives appropriate for the DST as compared to 12 patients with milder, subsyndromal depressive conditions. Using a plasma cortisol criterion of greater than 7 micrograms/dl, the DST identified major depression with 57% sensitivity and 92% specificity in this subsample (p less than 0.005). While limited by a high exclusion rate, the DST may be useful for confirmation of major depression in carefully screened general hospital patients. Implications for research and practice are discussed.

Depressive Disorder↗
PubMed1985

A pharmacokinetic approach to the study of cell membrane lithium transport in vivo.

Although many previous investigations have focused on in vitro studies of lithium transport by erythrocytes (RBCs) of psychiatric patients, the extent to which such studies actually reflect the transport of this drug by other types of cells in vivo is unknown. To study lithium transport in vivo, pharmacokinetic analysis of plasma lithium concentration data was performed in four subjects who were given single oral doses of lithium carbonate (600 mg). The data were analyzed according to a two-compartment model, consisting of a central compartment (extracellular, including plasma) and a peripheral (intracellular) compartment. Rate constants for the transfer of lithium into (ki) and out of (ko) the intracellular compartment were calculated. In RBCs from the same subjects, lithium transport in vitro was also directly measured. Rate constants were determined for phloretin-sensitive transport (ks), which corresponds to Na+-Li+ countertransport activity, and residual passive "leak" diffusion (kr). In RBCs, these two pathways account for major components of lithium efflux and influx, respectively. To compare the in vivo and in vitro rate constant data, the ratios ko/ki and ks/kr were also calculated. There was a significant correlation between these two rate-constant ratios (r = 0.96, p less than 0.05), although the values observed in vitro were higher than those found in vivo. Because the in vivo rate constants reflect lithium transport by many types of cells in the peripheral compartment, this finding supports the idea that the RBC may provide a useful model for studying lithium transport processes that are also operative in other types of cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Membrane Permeability↗
PubMed1985

The pharmacological treatment of delusional depression.

The authors investigated the pharmacological treatment of delusional depression by assigning patients on a random double-blind basis to amitriptyline alone, perphenazine alone, or a combination of the two. Fourteen (78%) of the 18 patients assigned to amitriptyline plus perphenazine were responders, compared with seven (41%) of 17 patients treated with amitriptyline alone and three (19%) of the 16 patients treated with perphenazine alone. The combination of amitriptyline and perphenazine was clearly superior (p less than .01).

Adolescent↗
PubMed1984

The efficiency of ECT: I. Response rate in depressive episodes.

A great deal of variation in opinion and practice remains regarding the most efficient use of electroconvulsive therapy (ECT) in treating depression. In this study we used an estimate of maximal improvement point to look at the rate of response to conventional ECT (one seizure per session, three times per week) in 66 patients with depressive episodes. Of the variables examined, increasing age was found to be significantly associated with slower response rate. Comparison of our results with studies of the multiple seizure technique suggests that giving multiple seizures per session does not speed response rate. We therefore conclude that within the limits of current clinical practice age is probably more important than number of frequency of seizures in determining the rate at which depression responds to ECT.

Adult↗
PubMed1984

DSM-III, RDC, and ECT: depressive subtypes and immediate response.

The usefulness of RDC and DSM-III diagnostic subtypes as predictors of response to ECT was examined in a multi-observer, multi-factorial study of 44 depressed patients. Most of the patients met criteria for "endogenous" and/or "melancholic" subtypes of major depressive disorders. None of the RDC or DSM-III subtypes (reactive, secondary, nonpsychotic) identified the least responsive patients. Thus, the presence of "reactive" factors, the absence of psychotic symptoms, or the presence of other illnesses did not reduce the likelihood or degree of immediate response to ECT in patients with major depression.

Adult↗
PubMed1982

Prevalence of sleep apnea and nocturnal myoclonus in major affective disorders: clinical and polysomnographic findings.

We performed screening polysomnography on 86 inpatients with affective disorders and found that 13 (15.1 per cent) had sleep apnea and one had nocturnal myoclonus. The apnea tended to be extremely mild, with an average of 27.8 episodes per patient and with a mean duration of 15.0 seconds. No clinically significant cardiac arrhythmia accompanied the apnea. The apnea was predominantly obstructive or mixed, not central. Only four patients (4.7 per cent) had apnea indices greater than five, and even here the total apnea was considered mild. Much of the apnea (68.3 per cent) occurred during rapid eye movement sleep. While there was no association of apnea with gender or with type of sleep-wake complaint, a significant relationship with age emerged. On the basis of these data, we suggest that routine polysomnographic screening for sleep apnea and nocturnal myoclonus in affective disorders is not indicated. On occasion, however, both an affective disorder and a sleep-apnea syndrome co-exist in the same patient. In such cases, the sleep-wake complaint is usually very prominent and/or long-standing in relation to other psychopathology and requires appropriate polysomnographic evaluation.

Adult↗
PubMed1981

When a schizoaffective diagnosis has meaning.

Recently, there has been a flurry of studies showing that schizoaffective patients, diagnosed using acute symptom complexes, usually turn out to have affective disorders if they are rediagnosed applying more reliable longitudinal parameters. However, Occam's razor cuts both ways. This investigation shows that if schizoaffective illness is diagnosed using the nonacute parameter "presence of interepisodic thought disorder," it looks more like schizophrenia. Schizoaffectives diagnosed this way have earlier onset of illness, tend to remain unmarried, usually do not abuse alcohol or sedatives, have a worse response to psychopharmacological treatments, relapse more frequently, and tend to deteriorate.

Acute Disease↗
PubMed1981

Sleep and treatment prediction in endogenous depression.

The prediction of clinical response in depression has been based primarily on clinical symptoms and history. Recently, psychobiologic measures have been used to increase the accuracy of clinical prediction. In 34 drug-free patients with primary endogenous depression treated with amitriptyline, the application of EEG-monitored sleep criteria alone was more significant than clinical status alone in the prediction of clinical response. Prolonged REM latency and reduced difficulty in sleep onset following the administration of amitriptyline were the main sleep variables contributing to this prediction equation. These data suggest a strong relationship between clinical outcome and psychobiologic profile in patients with endogenous depression after a "pharmacologic probe" with a tricyclic antidepressant.

Adult↗
PubMed1981

Neuropsychological assessment and EEG sleep in affective disorders.

The neuropsychological test performance of 76 hospitalized, depressed patients meeting RDC for the presence of affective disorder was assessed as part of a protocol involving amitryptyline (n = 53) or placebo (n = 23). Tests included the Trail-making Test (TMT), the Benton Visual Retention Test, and the Shipley-Hartford Scale. Clinical ratings and data concerning the characteristics of EEG sleep were also obtained. Analysis of data collected after a drug-free period of 2 weeks and again at the end of the protocol yielded the following conclusions. Base-line performance was inferior to norms for these tests, but for the TMT, scores were not as poor as that expected for brain-damaged patients. Poor performance was often associated with older age, the presence of psychotic features, and prolonged sleep latencies. Baseline Hamilton Rating Scale (HRS) was predicted best by TMT part B. However, this association was not as strong as that between HRS and poor sleep efficiency. Treatment with drug or placebo had little differential effect upon test performance over the course of the protocol. It is suggested that further research should utilize tests which have specificity in localizing cerebral lesions, so that any focal deficits in brain function in depression might be identified.

Adult↗
PubMed1981

Anergic depression accompanied by increased intracellular sodium and lithium.

This report describes a patient who experienced chronic retarded depression punctuated by precipitous worsening of mood with hyperphagia or by intermittent euphoric episodes. Ratings of depressive symptom severity changed in close association with intracellular sodium content. Intracellular sodium was highly correlated with intracellular lithium. Difficulties that were encountered in the clinical management of this patient are discussed.

Adult↗
PubMed1980

Transmembrane distribution of lithium and sodium in erythrocytes of depressed patients.

In this investigation the intracellular: extracellular distribution of lithium across the erythrocyte membrane (RBC lithium distribution) was studied in vitro and in vivo. The in vitro studies were conducted by incubating cells from drug-free subjects in lithium-containing physiologic media. The in vivo studies consisted of measurements of plasma and erythrocyte (RBC) lithium and sodium concentrations during lithium carbonate treatment. Previous observations of a correlation between in vitro and in vivo RBC lithium distribution values were verified, and it was found that addition of 0.1 mM ouabain to the in vitro incubation media abolished this correlation. To examine the relationship between RBC lithium distribution and specific clinical features of depression, in vitro studies were conducted with RBCs from 20 depressed patients and 14 nondepressed control subjects. The patients were categorized as having bipolar (manic-depressive), unipolar, or secondary depressive disorders. After in vitro incubation with lithium for 48 h, the RBCs from bipolar patients had lithium distribution values that were similar to those observed in ouabain-treated cells. It appears that the lithium transport characteristics of RBCs of bipolar patients may differ from those of other depressed patients or nondepressed subjects.

Depression↗