Biomedical subjects
J I Hudson
Publications and source records attributed to J I Hudson.
Valproate in the treatment of acute mania. A placebo-controlled study.
We conducted a placebo-controlled, double-blind study of valproate, a drug originally developed as an antiepileptic, in 36 patients with acute manic episodes who had previously failed to respond to or to tolerate lithium carbonate. Treatment duration was 7 to 21 days, with no other psychotropic medications permitted except lorazepam up to 4 mg/d during the first 10 days of treatment. Serum valproate concentrations were measured three times weekly; an unblinded investigator then adjusted dosage to produce serum concentrations between 50 and 100 mg/L. Valproate proved superior to placebo in alleviating manic symptoms. The 17 patients randomized to active drug demonstrated a median 54% decrease in scores on the Young Mania Rating Scale as compared with a median 5.0% decrease among the 19 patients receiving placebo. On the 100-point Global Assessment Scale of overall psychiatric functioning, patients receiving valproate improved by a median of 20 points as compared with a zero-point change with placebo. Significant differences also emerged on the Brief Psychiatric Rating Scale and in the number of supplemental doses of lorazepam required by the patients in each group. Substantial antimanic effects appeared within 1 to 4 days of achieving therapeutic serum valproate concentrations. Adverse effects were infrequent, with no adverse effect appearing significantly more frequently with valproate than with placebo. We conclude that valproate represents a useful new drug for the treatment of manic patients.
Kleptomania: clinical characteristics and associated psychopathology.
A review of research on kleptomania--the syndrome of compulsive stealing--suggests that kleptomania may be a common disorder, especially among women, and that it may frequently be associated with other forms of psychopathology, such as mood, anxiety, and eating disorders. There appears to be a range of abnormal or non-antisocial stealing behaviours, all with impulsive and/or compulsive features. Kleptomania, as defined by modern criteria, may represent the most compulsive variant. Kleptomania may be related to mood disorder, and might be a form of 'affective spectrum disorder'.
Polysomnographic characteristics of neuroleptic-induced akathisia.
To investigate nocturnal leg movement activity and other polysomnographic features in patients with neuroleptic-induced akathisia (NIA), all-night polysomnography was performed in nine patients with NIA and compared with nine healthy individuals and eight unmedicated patients with depression. Patients with NIA displayed a pattern of leg movement activity during sleep similar to healthy individuals and depressed patients. In addition, eight of nine patients with NIA exhibited 10- to 40-second bursts of increased leg muscle tone before sleep onset. Although the significance of this finding is unclear, it is possible that it may be a pathophysiological correlate of NIA.
Recurrent nightmares in posttraumatic stress disorder: association with sleep paralysis, hypnopompic hallucinations, and REM sleep.
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Kleptomania: a report of 20 cases.
OBJECTIVE: The authors' objective was to provide phenomenologic, family history, and treatment response data on a group of rigorously diagnosed patients with kleptomania. METHOD: Twenty consecutive inpatients and outpatients met DSM-III-R criteria for current kleptomania or a past history of kleptomania. These patients were given structured diagnostic interviews, and their family histories of psychiatric disorders were assessed blindly. The patients' responses to psychosocial and biological treatments were also assessed. RESULTS: All of the kleptomanic patients had lifetime diagnoses of major mood disorders, 16 had lifetime diagnoses of anxiety disorders, and 12 had lifetime diagnoses of eating disorders. A high morbid risk of major mood disorders (0.31) was found in their first-degree relatives. Ten of 18 patients receiving thymoleptic medications reported reduction or remission of their stealing behavior. CONCLUSIONS: Kleptomania may be related to major mood disorder and perhaps may represent another form of "affective spectrum disorder."
A supplemental interview for forms of "affective spectrum disorder".
OBJECTIVE: Recent evidence suggests that a number of psychiatric and medical conditions may be members or candidate members of a larger family of conditions, which we have termed "affective spectrum disorder (ASD)." In order to facilitate further research into this concept, we drafted seven interview modules, using the format of the Structured Clinical Interview for DSM-III-R (SCID), designed to diagnose the following psychiatric and medical disorders: irritable bowel syndrome, narcolepsy, Tourette's disorder, migraine, fibromyalgia, chronic fatigue syndrome, and kleptomania. METHOD: Published operational diagnostic criteria for these seven disorders were sought in the literature. Questions in SCID format were then drafted in accordance with these operational criteria. Draft modules were then sent to experts familiar with each of the disorders and suggestions and revisions from these experts incorporated into the final modules. RESULTS: The complete supplemental interview is presented with this report. Preliminary experience with this interview in more than 100 patients tentatively suggests that it is reliable for diagnosing the disorders in question; however, a formal test-retest reliability assessment is still required. CONCLUSIONS: It is hoped that this supplemental interview, used in conjunction with the SCID, will be helpful in further studies of the epidemiology, pathogenesis, and treatment of these possible forms of affective spectrum disorder.
Correlates of antimanic response to valproate.
Seventeen patients with acute mania were treated with the antiepileptic agent valproate under placebo-controlled, double-blind conditions for 7 to 21 days. No other psychotropics were allowed, except for lorazepam, up to 4 mg per day, as needed for agitation or insomnia for the first 10 study days only. Of the 17 patients, 12 (71%) showed some response, ranging from a 30 percent to a 100 percent decrease in scores on the Young Mania Rating Scale (MRS). The remaining 5 patients displayed no response to valproate treatment, with increases on the MRS of 3 percent to 13 percent. Compared with nonresponders, responders had an older age of onset and a shorter duration of illness and displayed a higher average serum valproate concentration on Study Days 3 through 6, but not on Study Day 15 or at termination. Degree of valproate response was greater for those patients with more severe sleep disruption at baseline. However, the majority of factors assessed, including a history of rapid cycling and high levels of dysphoria, were not associated with response to valproate.
Four cases of obstructive sleep apnea associated with treatment-resistant mania.
The authors describe four cases in which obstructive sleep apnea complicated the course and treatment of mania. An association between weight gain, obstructive sleep apnea, and lithium treatment is also illustrated.
Affective spectrum disorder: does antidepressant response identify a family of disorders with a common pathophysiology?
Response to pharmacologic treatments may identify groups of disorders with a common pathophysiology. The authors applied a treatment-response model, based on four classes of antidepressants (tricyclic types, monoamine oxidase inhibitors, serotonin uptake inhibitors, and atypical agents), to the medical literature. The model identified eight disorders that may share a pathophysiologic abnormality: major depression, bulimia, panic disorder, obsessive-compulsive disorder, attention deficit disorder with hyperactivity, cataplexy, migraine, and irritable bowel syndrome. Phenomenologic and family studies support this grouping. If the model is validated, this family of disorders, which the authors term "affective spectrum disorder," would represent one of the most prevalent diseases in the population.
Effects of lithium on sleep in mania.
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Treatment of bulimia nervosa with trazodone: short-term response and long-term follow-up.
In a 6-week, placebo-controlled, double-blind study of trazodone in 42 women with bulimia nervosa, trazodone was well tolerated and proved significantly superior to placebo in reducing the frequency of episodes of binge eating and vomiting. Nine- to 19-month follow-up of 36 study subjects revealed that 26 (72%) continued improved, with 18 (36%) in remission. Most remained on trazodone or another antidepressant at follow-up.
Elevated antidepressant plasma levels after addition of fluoxetine.
Four patients treated with tricyclic antidepressants and one patient treated with trazodone all demonstrated marked increases in plasma levels of these drugs after the addition of fluoxetine. Such increases could increase adverse effects.
Valproate in psychiatric disorders: literature review and clinical guidelines.
A growing literature suggests that the anticonvulsant medication valproate may be effective and well tolerated in the acute and prophylactic treatment of some mood and psychotic disorders, particularly the manic phase of bipolar disorder and schizoaffective disorder. Valproate may sometimes be effective even in those patients who have not responded to conventional somatic therapies. This article reviews the pharmacokinetics, neurologic uses, and side effects of valproate, discusses the drug's efficacy in the treatment of primary psychiatric disorders, and presents clinical guidelines for the use of valproate.
Long-term pharmacotherapy of bulimia nervosa.
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A placebo-controlled study of trazodone in bulimia nervosa.
Forty-two women who met the new narrower criteria for bulimia nervosa of DSM-III-R completed a placebo-controlled double-blind study with trazodone. The drug proved significantly superior to placebo, both in measures of frequency of binge eating and vomiting and in the patients' subjective assessments of improvement. Trazodone produced few adverse effects.
Pharmacological treatment of kleptomania and bulimia nervosa.
We describe three patients with concurrent DSM-III-R kleptomania and bulimia nervosa who all demonstrated a partial or complete response of both bulimic and kleptomanic symptoms to fluoxetine, trazodone, or tranylcypromine. These observations raise the possibility that pharmacological treatment may benefit kleptomania, and call for further study of the relationship between kleptomania, bulimia nervosa, and major depression.
Fibromyalgia and psychopathology: is fibromyalgia a form of "affective spectrum disorder"?
Several lines of evidence support a relationship between fibromyalgia and various forms of psychopathology, particularly major affective (mood) disorder. We evaluate 3 hypotheses that might explain this relationship: (1) that psychopathology is an effect of fibromyalgia; (2) that fibromyalgia is an effect of psychopathology; or (3) that both fibromyalgia and its associated psychopathology are caused by a common (but as yet unknown) abnormality. The third hypothesis may be expanded to the more general proposition that fibromyalgia, major affective disorder, and several other medical and psychiatric disorders may represent a family of related conditions--provisionally named "affective spectrum disorder" (ASD)--that share common pathophysiologic features.