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J R Calabrese

Publications and source records attributed to J R Calabrese.

80 records · Page 5Linked to original sources
PubMed1985

Autoimmune thyroiditis in manic-depressive patients treated with lithium.

To explore whether lithium-induced hypothyroidism is related to an exacerbation of underlying autoimmune processes such as thyroiditis, the authors comprehensively assessed thyroid function in 16 manic-depressive patients. Each of the three patients who showed detectable titers of thyroid microsomal antibodies before treatment manifested a marked increase in antibody titer from 4 to 12 months after lithium treatment was begun. Thus, lithium-induced thyroid dysfunction may not only involve direct effects on the thyroid itself but also involve exacerbation of an underlying indolent autoimmune thyroiditis, possibly by causing shifts in T lymphocyte subpopulations.

Acute Disease↗
PubMed1985

The neonatal narcotic abstinence syndrome: a brief review.

Because substance abuse experts are not available in many institutions, the consulting psychiatrist is required to diagnose and manage conditions such as the neonatal narcotic abstinence syndrome, which is readily recognized and treated. The authors discuss morbidity due to this syndrome in neonates born to narcotic addicted mothers. The clinical usefulness of neonatal narcotic abstinence scales is reviewed, with special reference to their application in treatment. The dosing of various drugs currently in use is also discussed.

Chlorpromazine↗
PubMedDate not supplied

Anticonvulsants for treatment of manic depression.

Although lithium remains the treatment of choice for manic depression, it is now well recognized that 20%-40% of patients either do not tolerate the drug or their disease does not respond to it. This subgroup of patients accounts for a substantial majority of the morbidity that accompanies this illness. For this reason, alternatives to lithium therapy will have a significant clinical impact. In a great majority of cases, the rapid-cycling variant of this disorder accounts for the resistance to lithium treatment. Recently, a growing body of literature has suggested that several medications routinely used in the management of seizure disorders, particularly carbamazepine and valproate, have therapeutic mood-altering properties. These drugs have been evaluated in numerous drug trials using open, double-blinded, longitudinal, and (in the case of carbamazepine) randomized designs. The authors comment on the phenomenology of manic depression and review the literature on use of anticonvulsants in the management of lithium-resistant manic depression.

Anticonvulsants↗
PubMedDate not supplied

Patient and spouse acceptance and adaptation to implantable cardioverter defibrillators.

Although electrophysiologic devices have been available since 1932 for managing sudden cardiac death, it was not until 1980 that the predecessor to the automatic implantable cardioverter defibrillator was introduced. Subsequently, questions about psychosocial adaptation have prevented wide acceptance of these devices. To study this issue, 69 patients with treatment-resistant ventricular arrhythmias were sent a questionnaire following cardioverter implantation; spouses also received questionnaires. Of these, 42 patients and 38 spouses completed and returned questionnaires. The questionnaire was designed to elucidate psychosocial adaptation. Results suggest that patients and couples adapt to the automatic implantable cardioverter defibrillators adequately, but not without some specific reservations.

Adaptation, Psychological↗
PubMedDate not supplied

Efficacy of divalproex vs lithium and placebo in the treatment of mania. The Depakote Mania Study Group.

OBJECTIVE: To compare the effectiveness of divalproex sodium with that of lithium and placebo in patients with acute mania. DESIGN: Randomized, double-blind, parallel-group study of treatment outcomes in patients with manic-depressive illness. PATIENTS: A total of 179 hospitalized, acutely manic patients meeting the Research Diagnostic Criteria for manic disorder, approximately half of whom had been nonresponsive to lithium previously, were studied at nine university-affiliated hospitals. INTERVENTIONS: After a minimum 3-day washout period, random assignment for 21 days to divalproex, lithium, or placebo in a 2:1:2 ratio. Dosage of divalproex and lithium was increased if tolerated to a target concentration of 1041 mumol/L (150 micrograms/mL) or 1.5 mmol/L (conventionally expressed as milliequivalents per liter), respectively. MAIN OUTCOME MEASURES: Primary outcome measures were changes in the Mania Rating scale derived from the Schedule for Affective Disorders and Schizophrenia. RESULTS: Intent-to-treat analysis for efficacy was based on data from 68, 35, and 73 patients in the divalproex, lithium, and placebo groups, respectively. Groups were initially comparable except that all eight patients with four or more manic episodes in the previous year were in the divalproex group. In 30%, 33%, and 51% of the above groups, treatment was prematurely terminated due to lack of efficacy, with fewer premature terminations from divalproex than placebo (P = .017). The proportions of patients improving at least 50% were higher for divalproex and lithium groups than for the placebo group: 48% for divalproex (P = .004) and 49% for lithium (P = .025) vs 25% for placebo. Divalproex was as effective in rapid-cycling manic patients as in other patients. CONCLUSIONS: Both divalproex and lithium were significantly more effective than placebo in reducing the symptoms of acute mania. The efficacy of divalproex appears to be independent of prior responsiveness to lithium.

Acute Disease↗