Biomedical subjects

J Pava

Publications and source records attributed to J Pava.

6 recordsLinked to original sources

PubMed1998

Course and treatment of atypical depression.

Atypical depression is the most common form of depression in outpatients, but compared with melancholia, little is known about its comorbidity, course, and treatment. Beyond the well-characterized constellation of symptoms that define atypical depression (mood reactivity, hypersomnia, leaden paralysis, hyperphagia, and rejection sensitivity), specific Axis I and II comorbid conditions may differentiate atypical from other depressed patients. Similarly, age at onset, duration of episodes, frequency of relapses and recurrences, and frequency of complete remission in atypical depression may be different. It has not even been established if atypical depression is a stable subtype or if it is just one of several forms of depression that an individual may express during a lifetime of recurrent depressions. Monoamine oxidase inhibitors (MAOIs) are superior to tricyclic antidepressants (TCAs) for the treatment of atypical depression, but few studies have compared MAOIs to the newer generation of antidepressants (SSRIs, bupropion, venlafaxine, nefazodone, and mirtazapine). Because of the favorable benefit/risk ratio, clinicians tend to use these newer antidepressants for all outpatients, including those with atypical depression, even though the literature is limited. A review and critique of the relevant literature on atypical depression will be presented.

Adolescent↗

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↗

PubMed1985

A limiting factor in the "normalization" of schizophrenic orienting response dysfunction.

Forty schizophrenic patients, 40 non-schizophrenic patients, and 40 normal subjects were given 60 each alternating 1000- and 2000-Hz, 1-second tones at 60 dB. Half of each sample, the Press Group (PG), had to press a pedal to the high (low) target tone, ignoring the nontarget tone. The other half, the Nonpress Groups (NPGs), were given no reason to attend. Skin conductance response (SCR), finger pulse volume (FPV), and electroencephalographic (EEG) activity were recorded. NPG schizophrenic subjects were more often nonresponsive in both SCR and FPV than other samples, but less often responsive in EEG only when a 20 percent criterion of alpha blockade was used. Schizophrenic subjects showed greater consistency of OR nonresponsiveness in SCR and FPV, and nonsignificantly greater consistency in criterion alpha block, pointing to a deficit in orienting response (OR) rather than in peripheral response. When the targeted signal was given, schizophrenic subjects showed the same response as other groups in all systems. This was not due to an indiscriminate increase in reactivity, since response increase centered on the targeted signal itself in all groups. As the target signal was repeated, autonomic OR in schizophrenics declined sharply so that they again became underresponsive. Thus, OR "normalization" achieved by targeting significant signals is restricted to relatively early responsiveness. The rapid decline in autonomic OR may help explain differences in schizophrenic subjects between P300 and autonomic ORs to significant stimuli. Schizophrenic subjects were no different from controls in bilateral SCR or FPV asymmetry, but displayed less frequent criterion alpha blockade and reduced background alpha power in the left hemisphere. Each system showed a different pattern of bilateral asymmetry, reflecting complex, not well understood relations among these responses. This was further emphasized by the fact that skin conductance level (SCL) incremented over trials in PG subjects, reflecting sustained activation, while EEG background showed an increase in slower wave power, consistent with reports of increased drowsiness. The only drug effect seen was a lowering of SCL. Neuroleptics were associated with a flexible inhibitory control of SCL, permitting normal-like increment when circumstances required. Depressed patients' data suggested they might show heightened OR nonresponsiveness to innocuous stimuli which might not be subject to "normalization" by manipulation of stimulus significance; hence OR deficit might still differentiate schizophrenic from depressive patients.

Adult↗

PubMedDate not supplied

Anxiety disorders in major depression.

The prevalence and clinical impact of anxiety disorder comorbidity in major depression were studied in 255 depressed adult outpatients consecutively enrolled in our Depression Research Program. Comorbid anxiety disorder diagnoses were present in 50.6% of these patients and included social phobia (27.0%), simple phobia (16.9%), panic disorder (14.5%), generalized anxiety disorder ([GAD] 10.6%), obsessive-compulsive disorder ([OCD] 6.3%), and agoraphobia (5.5%). While both social phobia and generalized anxiety preceded the first episode of major depression in 65% and 63% of cases, respectively, panic disorder (21.6%) and agoraphobia (14.3%) were much less likely to precede the first episode of major depression than to emerge subsequently. Although comorbid groups were not distinguished by depression, anxiety, hostility, or somatic symptom scores at the time of study presentation, patients with comorbid anxiety disorders tended to be younger during the index episode and to have an earlier onset of the major depressive disorder (MDD) than patients with major depression alone. Our results support the distinction between anxiety symptoms secondary to depression and anxiety disorders comorbid with major depression, and provide further evidence for different temporal relationships with major depression among the several comorbid anxiety disorders.

Adult↗

PubMedDate not supplied

Cardiovascular risk factors in depression. The role of anxiety and anger.

The authors hypothesized that patients with anxious or hostile depression may have a greater risk of mortality from coronary artery disease (CAD) than other depressed patients and therefore proceeded to assess the possible relationship between CAD risk factors and anger and anxiety in a sample of 138 depressed outpatients. The authors observed that increased anxiety scores were associated with higher cholesterol levels and with prolonged QTc intervals. Similarly, the patients with anger attacks tended to have higher cholesterol levels compared with the patients without these attacks. The study's findings partially support the authors' hypothesis that hostile or anxious depressed patients are at greater risk for CAD than other depressed patients.

Adolescent↗

PubMedDate not supplied

Tridimensional personality questionnaire and treatment response in major depressive disorder: a negative study.

BACKGROUND: Recent studies have found that the Tridimensional Personality Questionnaire can be used to help predict antidepressant treatment response in depressed outpatients. As this finding could be of great clinical importance, we attempted to replicate these findings. METHODS: Our study included 199 outpatients with major depressive disorder in an 8-week open trial with fluoxetine 20 mg/day. The Tridimensional Personality Questionnaire (TPQ) was administered to all patients before treatment. RESULTS: There was a significant correlation between pre-treatment scores on the TPQ subscale of harm avoidance and severity of depression at baseline as determined by Hamilton Depression Rating Scale-17 (HAM-D-17) scores. There was no correlation of harm avoidance scores and percent improvement of HAM-D-17 after treatment with fluoxetine. There was also no correlation of baseline HAM-D-17 scores or percent improvement with the subscales of reward dependence and novelty seeking. LIMITATIONS: Our study's limitations include a possible selection bias, lack of controls and fixed dosing of fluoxetine. CONCLUSIONS: In contrast to previous studies, we failed to find a relationship between temperament type as defined by the TPQ and antidepressant response. Our failure to replicate the findings of other studies may in large part be related to the use of different classes of antidepressants. Further studies using similar antidepressants may be helpful to clarify this discrepancy.

Adolescent↗