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Biomedical subjects

L Timmerman

Publications and source records attributed to L Timmerman.

At least 19 recordsLinked to original sources
PubMed2006

[Galactorrhoea and the use of selective serotonin reuptake inhibitors].

The subject of this case study is a female patient who was treated with a selective serotonin reuptake inhibitor (SSRI), citalopram, because of a depressive episode. She developed symptoms of galactorrhea; there was a time relationship between suspension of the treatment with citalopram and a reduction of the galactorrhea symptoms. The consulting internist assumed that the symptoms were due to hyperprolactinemia arising from under-supplementation of thyroid hormone and resultant hypothyroidism. Psychiatrists usually see galactorrhea in patients who are taking antipsychotics. However, few psychiatrists know that galactorrhea can also be caused by SSRIs. When a patient has symptoms of bilateral galactorrhea and has used an SSRI and when hyperprolactinemia has been found in laboratory tests it is probably advisable to stop the SSRI medication. The article mentions what additional research is needed.

Adult↗
PubMed2001

Mirtazapine versus venlafaxine in hospitalized severely depressed patients with melancholic features.

The aim of this multicenter, randomized, double-blind, 8-week study was to compare the antidepressant efficacy and tolerability of mirtazapine and venlafaxine in the treatment of hospitalized patients with DSM-IV diagnosis of severe depressive episode with melancholic features. Patients with a baseline score of > or = 25 on the 17-item Hamilton Rating Scale for Depression (HAM-D-17) were randomly assigned to receive treatment with either mirtazapine (N = 78, 15-60 mg/day) or venlafaxine (N = 79, 75-375 mg/day, twice a day) in a rapid up-titration schedule. Efficacy was assessed with the Montgomery-Asberg Depression Rating Scale (MADRS), HAM-D-17, and Clinical Global Impression scale, and quality of life was assessed with the Quality of Life, Enjoyment, and Satisfaction Questionnaire and Quality of Life in Depression Scale. Tolerability was assessed with the Utvalg for Kliniske Undersogelser (UKU) side effect scale and by reporting adverse events. Both drugs were effective in reducing overall symptoms of depression, showing substantial reductions in group mean MADRS scores (-20.1 for mirtazapine and -17.5 for venlafaxine) and HAM-D-17 scores (-17.1 for mirtazapine and -14.6 for venlafaxine) at the end of the treatment. Although not statistically significant, at all assessment times higher percentages of patients treated with mirtazapine were classified as responders (> or =50% reduction) on the HAM-D (at endpoint, 62% vs. 52%) and MADRS (at endpoint: 64% vs. 58%). Likewise were the percentages of remitters (HAM-D score < or =7; MADRS score < or =12) also higher in the mirtazapine group. A statistically significant difference favoring mirtazapine was found on the HAM-D Sleep Disturbance factor at all assessment points (p < or = 0.03). Both treatments were well tolerated. Although slightly more subjects treated with mirtazapine reported at least one adverse event, a statistically significantly higher percentage of patients treated with venlafaxine (15.3%) than mirtazapine (5.1%) dropped out because of adverse events (p = 0.037). Quality of life improved in both treatment groups. In this study, treatment with mirtazapine resulted in a trend toward more responders and remitters than treatment with venlafaxine and in significantly fewer dropouts as a result of adverse events.

Adolescent↗
PubMed1998

Mirtazapine: efficacy and tolerability in comparison with fluoxetine in patients with moderate to severe major depressive disorder. Mirtazapine-Fluoxetine Study Group.

OBJECTIVE: To compare the efficacy and tolerability of mirtazapine and fluoxetine in depressed inpatients and outpatients. METHOD: Patients with a major depressive episode (DSM-III-R), a baseline score of > or=21 on the 17-item Hamilton Rating Scale for Depression (HAM-D), and > or=2 on HAM-D Item 1 (depressed mood) were randomly assigned to a 6-week treatment with either mirtazapine (N=66, 15-60 mg/day) or fluoxetine (N=67, 20-40 mg/day). The upper limit of the mirtazapine dose range was above the dose range approved in the United States (15-45 mg/day). Efficacy was evaluated by the HAM-D, Clinical Global Impressions, the Visual Analogue Mood Rating Scale (VAMRS), and the Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ). The efficacy analyses were performed on the intent-to-treat group using the last-observation-carried-forward method. RESULTS: Mean total 17-item HAM-D scores at baseline were 26.0 for the mirtazapine- and 26.1 for the fluoxetine-treated group. The decrease from baseline on the HAM-D was larger in the mirtazapine than in the fluoxetine group throughout the treatment period, reaching statistical significance at days 21 and 28. At assessments from day 21 and onward, the absolute difference between the 2 study groups favoring mirtazapine ranged from 3.7 to 4.2 points, the magnitude of difference usually seen between an efficacious antidepressant drug and placebo. Mean dosages at weeks 1-4 were 36.5 mg/day for mirtazapine and 19.6 mg/day for fluoxetine; the respective dosages at weeks 5-6 were 56.3 mg and 35.8 mg. Similar numbers of patients dropped out due to adverse events; tolerability profiles were comparable except for changes in body weight from baseline which were statistically significantly more pronounced in the mirtazapine group compared to the fluoxetine group. CONCLUSION: We found that mirtazapine was as well tolerated as fluoxetine and significantly more effective after 3 and 4 weeks of therapy.

Adolescent↗
PubMed1997

Effects of clomipramine on plasma amino acids and serotonergic parameters in panic disorder and depression.

We examined the effects of long-term (six months) treatment with the serotonin potentiating tricyclic antidepressant clomipramine on several serotonergic parameters in panic disorder and depressive patients. Serotonin (5-HT) levels in blood, platelets and plasma were significantly reduced to 4%, 3% and 28% of their respective baseline values. In addition, the plasma level of tryptophan was also significantly reduced, although the decrease was only 16%. Three months after discontinuation of clomipramine treatment, 5-HT in blood and platelets reached baseline values again, while the plasma 5-HT level was still reduced to 68% of pretreatment values. Unexpectedly, the plasma tryptophan concentration was even lower at this time-point than after six months of treatment. These results show that clomipramine not only has an effect on 5-HT levels in blood, platelets and plasma, but also on plasma tryptophan concentration. We speculate that low plasma tryptophan after treatment may constitute a risk for the recurrence of psychopathology.

Adult↗
PubMed1997

Trait anxiety, coping with stress, and norharman.

Plasma levels of the beta-carboline norharman, concentration of platelet 5-HT, trait measures of anxiety, and measures of coping and defense mechanisms were compared for 15 patients with panic disorder and 24 healthy volunteers. Patients indicated that they made less use of the defense mechanism of principalization than control subjects. No other differences between patients and controls were significant. Platelet 5-HT concentration was positively correlated with the subjectively reported anxiety. Plasma norharman concentration was negatively correlated with the defense mechanisms of principalization and repression and positively correlated with coping strategies involving palliation. The positive correlations of norharman levels with projection and self-comforting fell short of significance and existed in the patient group only. No correlation was apparent between levels of plasma norharman and scores on anxiety. It was concluded that norharman is not a marker for panic disorder or trait anxiety, but that it might reflect intrapsychic and coping processes.

Adaptation, Psychological↗
PubMed1996

Efficacy and tolerability of citalopram in comparison with fluvoxamine in depressed outpatients: a double-blind, multicentre study. The LUCIFER Group.

In 16 depression clinics in hospitals and outpatient facilities in the Netherlands, a study was performed to evaluate and compare the efficacy and tolerability of citalopram and fluvoxamine and to determine the difference in the incidence of gastrointestinal side-effects. A total of 217 patients with a depressive disorder (DSM-III-R criteria) and a score of at least 16 on the Hamilton rating scale for depression were randomized to treatment. The results of this study indicate that the two drugs are equally effective. The adverse events occurring during treatment show a similar pattern between the two drugs, but citalopram is better tolerated than fluvoxamine. Citalopram induces fewer gastrointestinal adverse events compared with fluvoxamine. However, this did not affect the drop-out rates.

Adult↗
PubMed1995

Calcaneal ultrasonic measurements discriminate hip fracture independently of bone mass.

We studied 336 elderly white women, of whom 22 had previously suffered a hip fracture and 22 had previously suffered a vertebral fracture. All subjects were 60 years old or older with a mean age of 73:7 years. Measurements of ultrasonic transmission velocity (UTV), broad-band ultrasonic attenuation (BUA) and stiffness (STF) were made at the os calcis using a Lunar Achilles ultrasound device. Measurements of lumbar spine bone mineral density (L2-4 BMD) and femoral neck BMD were made using dual-energy X-ray absorptiometry. The fracture groups were significantly older and had more years since menopause than the control groups. Logistic regression showed that measurements of UTV, STF and BUA discriminated between fracture and non-fracture subjects for both the hip (p < 0.001) and spine (p < 0.05). Femoral neck BMD discriminated both hip and vertebral fractures from controls (p < 0.001 and p < 0.01, respectively). Spinal BMD discriminated between subjects with vertebral fractures and those without (p < 0.01), but not hip fractures (p = 0.64). For hip fracture, areas under receiver-operating characteristic (ROC) curves were 0.85 for UTV, 0.83 for STF, 0.79 for BUA, 0.78 for femoral neck BMD and 0.53 for spinal BMD. For vertebral fracture, areas under the ROC curve were 0.68 for UTV, 0.70 for STF, 0.66 for BUA, 0.66 for femoral neck BMD and 0.67 for spinal BMD.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Better discrimination of hip fracture using bone density, geometry and architecture.

Bone density predicts the risk of hip fracture. Because hip strength is determined by bone geometry and architecture as well as density, we tested which variables in geometry and architecture were independent discriminators of hip fracture and, if combined with density, improved the discrimination of fracture from non-fracture over bone density alone. The design was a case-control study. The subjects were Caucasian women over the age of 60 years who had sustained a hip fracture after the age of 58 years (n = 22), and controls matched for age and weight (n = 43) and unmatched controls (n = 317) with no history of hip fracture. Variables in density, geometry and architecture were obtained from dual-energy X-ray absorptiometry images and from radiographs of the upper end of the femur. In a univariate model, of the measures of bone mass, the best discriminator of hip fracture was bone mineral density of the neck of femur; of the geometric measurements, it was hip axis length; and of the measurements of bone architecture, it was Singh grade. In a multivariate model, these three variables were shown to be independent discriminators of hip fracture. When hip axis length was combined with bone mineral density, there was significant improvement in discrimination of hip fracture (p = 0.014), and when Singh grade was combined with hip axis length and bone mineral density there was a further significant improvement (p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1994

Cloning and characterization of NF-ATc and NF-ATp: the cytoplasmic components of NF-AT.

Present evidence indicates a pathway of signal transmission in T cells that is outlined in figure 1. The elevation in intracellular calcium that is induced by interactions at the antigen receptor leads to the activation of the calcium-dependent phosphatase calcineurin. This in turn leads to the nuclear association of the cytosolic component of NF-ATc. The activation of calcineurin and the nuclear import of NF-ATc can both be blocked by cyclosporin A or FK506 in complex with their respective immunophilins. Once in the nucleus, NF-ATc interacts with NF-ATn to form an active transcriptional complex. NF-ATn is a ubiquitous protein, can be synthesized in response to PMA, and has many similarities to AP-1. The mechanism by which NF-ATc enters the nucleus is unknown, and although it appears to require calcineurin, NF-ATc has not yet been shown to be an in vivo substrate of calcineurin. Alternative mechanisms include the possibility that NF-ATc operates on some cytoplasmic anchor or that other proteins that are controlled by calcineurin carry out the nuclear import of NF-ATc. Although NF-ATp copurifies with NF-ATc, there is as yet no understanding of how NF-ATp is functioning in vivo. Now that these proteins are purified and cloned, the major goals will be to understand their role and the roles of other family members in thymic development.

Animals↗
PubMed1994

Increasing occupational therapy research: is it time to try something new?

Lack of substantial occupational therapy research is a recognized and persistent problem; which is often discussed throughout the literature but not truly addressed. Action must be taken to involve clinicians in the effort to substantiate the efficacy of treatments through outcome studies. We offered several proactive recommendations that could be implemented on a national level to encourage hesitant practitioners to conduct research. Past recommendations have not tapped the expertise of a large segment of our profession. Our recommendations will enhance the accessibility of research to a greater percentage of occupational therapy professionals by specifically targeting problems related to money, education, and time.

Education, Continuing↗
PubMed1992

Positive associations between anticipatory anxiety and needle pain for subjective but not for physiological measures of anxiety.

So far, the association between anxiety and pain has not been studied with measures tapping a physiological dimension of anxiety. Therefore, during a blood extraction procedure, we recorded subjective anxiety, electrodermal activity, heart rate, and intensity of pain. Subjects were 15 patients with panic disorder and 24 healthy subjects. Positive associations between subjective anxiety and pain were found in each group. The physiological activity preceding the venipuncture, however, was not significantly related to the intensity of the pain.

Adult↗
PubMed1991

Practical considerations for the use of the pedobarograph.

The pedobarograph functions as a device for the dynamic, quantitative measurement of pedal pressures. To date, little attention has been paid to various practical questions concerning its operation. For example, the number and timing of trials sufficient to provide meaningful information upon which to reliably base investigational or management decisions has yet to be addressed. Twenty volunteers were used for the measurement of pedal pressures for 15 trials during three separate sessions. Statistical analysis for the determination of MIVQUE(0) estimates and maximum likelihood estimates were used to determine the individual variability, the variability of the specific area of the foot, the daily variability, and the trial-to-trial variability. This analysis indicated that for the assessment of pedal pressures in a clinical setting, the variance factors were sufficiently minimized by obtaining multiple measurements. The improvement in the estimate of error by obtaining trials on different days was overshadowed by the potential benefit of doing extra trials on a single day. Three trials on 1 day should sufficiently reduce estimates of error for both clinical and investigational purposes.

Adult↗
PubMed1990

A quantitative assessment of the effect of metatarsal pads on plantar pressures.

The treatment of metatarsalgia secondary to the plantar prominence of the metatarsal heads has lead to the development of numerous orthotic devices designed to decrease pressures in these areas. In spite of the considerable cost of some of these devices, there has yet to be much objective evidence of their efficacy. This study assessed the effect of a simple metatarsal pad on pressures transmitted to the metatarsal heads. Quantitative measurements of dynamic peak pressures for 10 asymptomatic subjects with and without metatarsal pads were made using the pedobarograph. Female volunteers had a reduction in peak metatarsal pressures from 12% to 60% when a small metatarsal pad was appropriately applied to the foot. In two of five males there was a decrease in metatarsal pressure of 14% to 44%. One male had no change in pressure, while two others had an increase in pressure from 8% to 28%. When properly positioned and appropriately monitored, metatarsal pads can be an inexpensive and effective means of reducing metatarsal pressures.

Adult↗
PubMed1989

Molecular characterization of MHC class II antigens (beta 1 domain) in the BB diabetes-prone and -resistant rat.

The BB or BB/Worcester (BB/W) rat is widely recognized as a model for human insulin-dependent diabetes mellitus (IDDM). Of at least three genes implicated in genetic susceptibility to IDDM in this strain, one is clearly linked to the major histocompatibility complex (MHC). In an attempt to define the diabetogenic gene(s) linked to the MHC of the BB rat, cDNA clones encoding the class II MHC gene products of the BB diabetes-prone and diabetes-resistant sublines have been isolated and sequenced. For comparison, the beta 1 domain of class II genes of the Lewis rat (RT1L) were sequenced. Analysis of the sequence data reveals that the first domain of RT1.D beta and RT1.B beta chain of the BB rat are different from other rat or mouse class II sequences. However, these sequences were identical in both the BB diabetes-prone and BB diabetes-resistant sublines. The significance of these findings is discussed in relation to MHC class II sequence data in IDDM patients and in the nonobese diabetic (NOD) mouse strain.

Amino Acid Sequence↗
PubMed1988

A molecular basis for MHC class II--associated autoimmunity.

Class II major histocompatibility (MHC) molecules have an immunoregulatory role. These cell-surface glycoproteins present fragments of protein antigens (or peptides) to thymus-derived lymphocytes (T cells). Nucleotide sequence polymorphism in the genes that encode the class II MHC products determines the specificity of the immune response and is correlated with the development of autoimmune diseases. This study identifies certain class II polymorphic amino acid residues that are strongly associated with susceptibility to insulin-dependent diabetes mellitus, rheumatoid arthritis, and pemphigus vulgaris. These findings implicate particular class II MHC isotypes in susceptibility to each disease and suggest new prophylactic and therapeutic strategies.

Amino Acid Sequence↗