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Biomedical subjects

J F Rosenbaum

Publications and source records attributed to J F Rosenbaum.

At least 19 recordsLinked to original sources
PubMed1992

Subsyndromal symptoms in bipolar disorder. A comparison of standard and low serum levels of lithium.

Ninety-four patients with bipolar disorder participating in a random-assignment, double-blind, prospective maintenance trial of standard- (0.8 to 1.0 mmol/L) vs low-range (0.4 to 0.6 mmol/L) serum lithium levels were assessed to determine the presence and significance of subsyndromal symptoms during periods of remission and recovery. A significant relationship was found between prescribed serum lithium level and the probability of major affective relapse and the occurrence of subsyndromal symptoms. Patients given lithium carbonate to achieve low-range levels had 2.6 times the risk of major affective relapse as those given lithium for standard-range levels and nearly twice the risk of developing subsyndromal symptoms. Patients given the low-range therapy showed a greater variance in weekly Psychiatric Status Rating measures, and their symptoms were more likely to worsen at any time than were symptoms in their standard-level group counterparts. The first occurrence of subsyndromal symptoms increased the risk of major affective relapse fourfold. Following the onset of subsyndromal symptoms, the patients originally randomized to receive standard-range lithium therapy were still better protected from relapse than were patients randomized to receive low-range lithium treatment. Patients were two times more likely to develop depressive than hypomanic symptoms between acute episodes of illness. However, onset of hypomanic symptoms predicted subsequent major affective relapse twice as strongly as did depressive symptoms. Seventy-six percent of patients who became hypomanic had a major affective relapse, compared with 39% of patients who were subclinically depressed.

Adolescent↗
PubMed1992

Alcohol dependence in panic disorder patients.

The present study examined the prevalence of alcohol dependence among panic disorder patients. Twenty-four of 100 patients had a history of alcohol dependence according to DSM-III-R criteria; only one patient met criteria for current alcohol dependence. The lifetime prevalence obtained for this clinic sample exceeded that for the general population, and appeared to be due primarily to higher than expected rates among women. A childhood history of anxiety disorders and co-morbid diagnoses of social phobia and major depression were each associated with relatively higher rates of alcohol dependence. The clinical implications of these findings are discussed.

Adult↗
PubMed1992

High-dose fluoxetine in the treatment of depressed patients not responsive to a standard dose of fluoxetine.

In a four-week, open label study of major depression, 15 patients who had failed to respond to a trial of fluoxetine 20 mg/day of 8-12 weeks duration were then treated with fluoxetine 40 mg/day for one week and then, if tolerated, with either 60 or 80 mg/day. The mean HAM-D-17 and CGIS scores of these 15 patients decreased significantly at the end of 4 weeks on a higher dosage of fluoxetine (60 or 80 mg/day) with respect to the beginning of the four-week study. No significant side-effects were noted.

Adolescent↗
PubMed1992

Stable behavioral inhibition and its association with anxiety disorder.

"Behavioral inhibition to the unfamiliar" is a temperamental construct reflecting the tendency to be shy, timid, and constrained in novel situations. Previous work has suggested that it may be associated with anxiety disorders in children. Psychopathology was assessed in children from a nonclinical sample originally identified as behaviorally inhibited or uninhibited at 21 months and followed through 7 1/2 years. Children who remained inhibited at 4, 5 1/2 and 7 1/2 years (Stable Inhibited) had higher rates of anxiety disorders than children who were not consistently inhibited. Their parents had higher rates of multiple childhood anxiety disorders and of continuing anxiety disorder. These results suggest that the association between behavioral inhibition and anxiety disorder is accounted for by children who have stable behavioral inhibition.

Anxiety Disorders↗
PubMed1992

The thyrotropin response to thyrotropin-releasing hormone as a predictor of response to treatment in depressed outpatients.

We evaluated the predictive value of the thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) in 32 depressed outpatients completing a double-blind placebo-controlled trial of s-adenosyl-l-methionine (SAMe), which failed to show any significant difference between SAMe and placebo. Treatment response was defined as the change in Hamilton Rating Scale for Depression (HRSD-24) score between baseline and the end of the six-week trial. Subjects with TSH response outside the normal range (7-25 uU/ml) had a significantly greater response than patients with a normal response. There was also a significant correlation between absolute deviations from the mean TSH response (16 uU/ml) and changes in HRSD-24 scores.

Adolescent↗
PubMed1992

Accumulation of fluoxetine and norfluoxetine in human brain during therapeutic administration.

In vivo 19fluorine nuclear magnetic resonance spectroscopy was used to measure the brain concentration of fluoxetine and norfluoxetine in five patients with obsessive-compulsive disorder and three with major depression. The mean brain:plasma ratio of the parent drug plus the metabolite was significantly elevated to 2.6 (SD = 1.0) (95% confidence interval = 1.9-3.3). This accumulation may have implications for understanding both the therapeutic and the toxic effects of fluoxetine.

Adult↗
PubMed1992

Comorbidity of parental anxiety disorders as risk for childhood-onset anxiety in inhibited children.

OBJECTIVE: Previous work suggested that children of parents with panic disorder and agoraphobia were likely to be classified as behaviorally inhibited and that behaviorally inhibited children were likely to develop anxiety disorders. However, the factors determining which inhibited children were at risk for childhood onset of anxiety disorders remained unknown. The authors of this study hypothesized that greater anxiety loading in parents would increase the risk for anxiety disorders in children with behavioral inhibition. METHOD: Using DSM-III structured interviews, the authors examined patterns of aggregation of anxiety disorders in parents of two existing cohorts of children, one cross-sectional and clinically derived (31 children, 60 parents) and the other epidemiologically derived and longitudinal (40 children, 75 parents). Within each cohort, parents were stratified into three groups based on the presence (behavioral inhibition and anxiety) or absence (behavioral inhibition only, no behavioral inhibition and no anxiety) of behavioral inhibition and two or more anxiety disorders in their child. RESULTS: Parents of children with behavioral inhibition and anxiety, from both the clinical and nonclinical cohorts, had significantly higher rates of two or more anxiety disorders than did parents of children with behavioral inhibition only and parents of children with no behavioral inhibition and no anxiety. CONCLUSIONS: These results indicate that the presence of parental loading for anxiety disorders may help to identify the subgroup of inhibited children at very high risk for developing childhood-onset anxiety disorders.

Adult↗
PubMed1992

Cognitive-behavioral therapy for benzodiazepine discontinuation in panic disorder patients.

The discontinuation of benzodiazepine treatment in patients with panic disorder may be associated with emergent withdrawal and anxiety symptoms, relapse of panic, and the inability to complete benzodiazepine taper. Although some patients may respond to slow taper strategies or the use of pharmacologic adjuncts, many continue to experience significant difficulties during benzodiazepine discontinuation. This paper presents a cognitive-behavioral conceptualization of benzodiazepine discontinuation difficulties, emphasizing "fear of fear" cycles. From this perspective the discontinuation process is seen as exposing panic disorder patients to somatic sensations associated with panic at a time when there is both increased anxiety and concern about re-emergence or worsening of panic episodes. As a consequence, patients may re-enter a cycle of catastrophic interpretations of symptoms, increased vigilance and fear, and panic. Cognitive-behavioral interventions may ameliorate discontinuation-associated difficulties and prevent the return of the panic disorder. Preliminary data supporting the efficacy of these interventions are described.

Anti-Anxiety Agents↗
PubMed1992

Evaluation and management of the treatment-resistant anxiety disorder patient.

Effective evaluation and management of patients with anxiety disorders require an integrated theoretical model that predicts risk for the disorder as a consequence of constitutional vulnerability shaped by developmental experience and activated or influenced by environmental factors. From this perspective, the author describes a rational therapeutic strategy with treatment-resistant patients. He particularly urges a careful evaluation of risk factors and associated conditions that may contribute to persisting distress.

Adult↗
PubMed1991

Perceptual asymmetry, plasma cortisol, and response to treatment in depressed outpatients.

Perceptual asymmetries as indicated by dichotic listening tasks have been associated with both subtype of depression and response to antidepressant treatment. To examine the association between this relatively new measure and more traditional measures of hypothalamic-pituitary-adrenal axis (HPA) activation in depression, we assessed perceptual asymmetry and basal plasma cortisol in a sample of depressed outpatients undergoing a double-blind, placebo-controlled medication trial. Each measure was examined for its ability to predict response to treatment. Perceptual asymmetry was significantly associated with plasma cortisol levels, and was also a significant predictor of treatment response. The association between plasma cortisol and treatment response did not reach significance. Our findings are limited by relatively small sample sizes but encourage further examination of perceptual asymmetry measures as predictors of treatment response and in relation to HPA activation in depression.

Adult↗
PubMed1991

Further evidence of an association between behavioral inhibition and anxiety disorders: results from a family study of children from a non-clinical sample.

Behavioral inhibition to the unfamiliar, identifiable in early childhood and reflecting the tendency to exhibit withdrawal and excessive autonomic arousal to challenge or novelty, has been found to be prevalent in young offspring of parents with panic disorder and agoraphobia and associated with risk for anxiety disorders in these children. Using family study methodology, we now examine psychopathology in first degree relatives of children from a non-clinical longitudinal cohort identified at 21 months of age as inhibited (N = 22) or uninhibited (N = 19) and followed through the age of seven years for a study of preservation of temperamental characteristics in normal children. These assessments were compared with evaluations of the first degree relatives of 20 normal comparison children. Psychiatric assessments of parents (N = 110) and siblings (N = 72) were based on structured interviews conducted blindly to the temperamental classification of the index child. Parents of inhibited children, compared with parents of uninhibited and normal controls, had significantly higher risks for multiple (greater than or equal to 2) anxiety disorders, continuing anxiety disorders (both a childhood and adulthood anxiety disorder in the same parent), social phobia, and childhood avoidant and overanxious disorders. These findings provide additional support for the hypothesis linking behavioral inhibition with risk for anxiety disorder.

Adolescent↗
PubMed1991

Major depression in panic disorder patients with comorbid social phobia.

Rates of depression among panic disorder patients are particularly elevated in patients with comorbid social phobia. However, it is unclear whether this association is specific to social phobia, or whether any comorbid anxiety disorder increases the risk of depression. We assessed 100 panic disorder patients and found a significantly higher incidence of lifetime major depression for panic patients with comorbid social phobia or generalized anxiety disorder (GAD). Panic patients with comorbid social phobia had significantly higher scores on measures of dysfunctional attitudes and lower scores on measures of assertiveness; these variables may mediate the link between social phobia and depression in this population.

Adult↗
PubMed1991

A high risk study of young children of parents with panic disorder and agoraphobia with and without comorbid major depression.

Using family study methodology and psychiatric assessments by blind raters, this study tested hypotheses about patterns of familial association between anxiety and depressive disorders among high risk children of clinically referred parents. The study design contrasted five groups of children defined by the presence or absence in a parent of (1) panic disorder and agoraphobia (PDAG) without comorbid major depressive disorder (MDD) (n = 14); (2) comorbid PDAG plus MDD (PDAG + MDD) (n = 25); (3) MDD without comorbid PDAG (n = 12); (4) other psychiatric disorders (n = 23); and (5) normal comparisons (n = 47). While the PDAG and PDAG + MDD groups had similarly elevated rates of anxiety disorders and MDD, offspring of MDD parents had an elevated rate of MDD but not of anxiety disorders. Among children of parents with PDAG + MDD, the presence of an anxiety disorder did not significantly increase the risk for MDD in the same child. Thus, anxiety and MDD did not cosegregate among children of PDAG parents. These findings indicate that parental PDAG, either alone or comorbidly with MDD, increases the risk for both anxiety and depressive disorders in offspring. In the absence of PDAG, however, parental MDD does not appear to place children at risk for anxiety disorders. These findings are most consistent with the hypothesis that PDAG and PDAG + MDD share common familial etiologic factors while MDD alone is an independent disorder. More studies are needed to confirm these preliminary findings as well as to identify mediating factors that influence the transition from childhood to adult anxiety disorders.

Agoraphobia↗
PubMed1991

Screening for dysfunction in the children of outpatients at a psychopharmacology clinic.

OBJECTIVE: The goals of this study were 1) to determine whether the use of the Pediatric Symptom Checklist in an adult-oriented psychiatric practice was feasible, 2) to determine if scores indicative of dysfunction on the Pediatric Symptom Checklist were associated with parental or background factors, 3) to determine whether children flagged by their scores on the Pediatric Symptom Checklist were receiving psychiatric services, and 4) to compare the psychosocial dysfunction in this group of children with that found in children screened as part of routine pediatric visits. METHOD: Adult outpatients in a hospital's clinical psychopharmacology unit were asked to complete the Pediatric Symptom Checklist regarding their children. These patients were the parents of 100 school-aged children. Factors such as the parents' diagnoses and demographic variables were also examined. RESULTS: The Pediatric Symptom Checklist was readily accepted by parents and fit easily into the routine of general psychiatric practice. Significantly more of the children of these outpatients than of children in comparable pediatric offices had scores indicative of psychiatric dysfunction (scores above the cutoff). Children of parents who were single, of low socioeconomic status, or with a diagnosis of personality (especially borderline) or mood disorder were more likely to have scores above the cutoff. More than a third of the children who had scores above the cutoff on the Pediatric Symptom Checklist were not currently receiving psychiatric services. CONCLUSIONS: The Pediatric Symptom Checklist provided a rapid and simple method for general psychiatrists to identify psychosocial dysfunction in their patients' children.

Adult↗
PubMed1991

Behavioral inhibition in children: a possible precursor to panic disorder or social phobia.

A biological-environmental interaction currently provides the best explanation of an anxiety disorder's evolution. In this sense, anxiety disorders are like other medical disorders for which a person may have a predisposition. Our knowledge of the evolution of anxiety disorders would be enhanced by the ability to identify those persons predisposed to anxiety and to identify such "proneness" before an anxiety disorder emerges in adulthood. We discuss the developmental aspects of panic disorder and social phobia, in particular findings suggesting that behavioral inhibition in children may be a precursor to phobic disorders in adults. Only longitudinal studies will resolve whether childhood response patterns are specifically linked to the risk of developing anxiety disorders or other psychopathology across the life cycle. In the interim, we suggest some guidelines for parents and clinicians to meet the unique needs of the inhibited child.

Adult↗
PubMed1991

Anger attacks in depressed outpatients and their response to fluoxetine.

"Anger attacks" are spells of anger that are inappropriate to the situation and have physical features resembling panic attacks. The Anger Attacks Questionnaire, designed to assess these attacks, was administered to 79 consecutive patients (25 men and 54 women, mean age 38.8 +/- 10.3 years) diagnosed as having major depression with the Structured Clinical Interview for DSM-III-R. Of these 79 depressed patients, 34 (13 men and 21 women) reported having anger attacks according to our criteria. The prevalence of anger attacks in a group of 31 younger depressed patients (48%) was significantly higher (p = .048) than that of 29 normal controls (21%) of similar age. Of the 79 depressed patients, 19 (7 men, 12 women) were treated openly with fluoxetine at 20 mg/day for at least 8 weeks. At pretreatment, 9 patients (47%) had reported anger attacks, only 3 (16%) continued to report them after treatment, and the difference was statistically significant (p less than .05).

Adult↗
PubMed1991

Fluoxetine treatment of cocaine abuse in heroin addicts.

The authors administered fluoxetine to 11 cocaine-abusing heroin addicts entered in a methadone maintenance program to determine whether it would decrease cocaine craving and use. Three patients discontinued treatment within a few days of initiation because of lack of any acute therapeutic effect. The remaining 8 received fluoxetine for at least 1 week and were followed up over 1 to 6 months. Of these 8, 5 (63%) were successfully treated for cocaine abuse. Three case examples are presented. Fluoxetine may prove a useful addition to the therapeutic armamentarium in the treatment of cocaine abuse.

Adult↗