Biomedical subjects
Publications and source records attributed to L Tondo.
The present study concerned the evaluation of personality traits associated with sexual dysfunctions. The MMPI was used as a psychodiagnostic tool in male subjects (N = 37) with erectile disorder or premature ejaculation. The results tend to support some clinical observations based upon the cognitive-behavioral approach and some neurophysiological data.
A longitudinal case report shows a sudden remission of the severe course of a seasonal bipolar disorder after 10 years of psychopharmacological treatments. The discontinuation of heavy caffeine intake appears to have contributed to the outcome.
To explore the sensitivity of nocturnal GH secretion to different degrees of cholinergic blockade, we investigated the effects of two doses of the muscarinic receptor antagonist scopolamine (SCOP; 3.0 and 6.0 micrograms/kg, im) and placebo, administered in a randomized fashion at 2300 h on three nights to eight normal male volunteers. Both doses of SCOP produced significant reductions in mean nocturnal GH concentration compared to the effects of the placebo; the higher dose of SCOP reduced GH to a greater degree than the lower dose, but this difference was not statistically significant (mean, 2.3 micrograms/L after 6 micrograms/kg vs. 3.0 micrograms/L after 3 micrograms/kg). Both SCOP doses significantly shifted GH secretion into later portions of the night, with a significantly greater delay observed after the larger dose. Similarly, a significant delay in the time of the GH rise was produced by SCOP. In contrast, the effects of both doses of SCOP on delta-sleep or sleep onset were small. These data confirm earlier reports demonstrating that cholinergic muscarinic input represents a potentially important source of regulation of nocturnal GH release and suggest that the magnitude of the reduction in GH and the extent of delay in the GH rise time may reflect quantitative differences in the degree of cholinergic blockade. These data are in agreement with recent studies suggesting that the timing of GH release need not be associated with delta-sleep per se.
Scopolamine (SCOP) (3.0 mu/kg and 6.0 micrograms/kg) and saline were administered intramuscularly at 11:00 PM to eight normal male volunteers in a randomized design, and the effects on the sleep electroencephalogram (EEG) and nocturnal cortisol secretion (via blood sampling every 15 min) were evaluated. Compared to saline, SCOP produced a significant dose-related delay in rapid eye movement (REM) latency. In contrast, neither dose of SCOP significantly affected nocturnal plasma cortisol concentrations. These results suggest that the central cholinergic system that regulates the onset of REM sleep is more sensitive to dysregulation than the cholinergic system that controls the degree of nocturnal cortisol secretion. If central cholinergic overactivity is responsible for both the REM sleep latency and cortisol abnormalities in depressed patients, then our findings with SCOP might help explain why the incidences of these abnormalities are different.
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The Inventory for Depressive Symptomatology is a new scale for measuring depressive symptoms. The reliability, validity and correlations between self-report and clinician-rated versions of the scale were examined in 86 Italian psychiatric patients. Results confirmed the validity and internal consistency of the scales. Self-ratings and clinician ratings were highly correlated. Total score on the self-rating scale was generally higher than the corresponding clinician scale score. Item analysis revealed that most items were rated slightly higher by self-report, with the items contributing most to this discrepancy being psychomotor agitation and retardation, self-outlook, and irritable mood. Both quality of mood and psychomotor agitation were more frequently endorsed by self-report than by clinician rating.
The amount of radioactivity in vivo in the central nervous system (CNS) of the rat has been studied after tail-vein injections of (-)- [125I] iodopindolol (IPIN). The content of radioactivity in cortex and cerebellum 1 to 4 hr after IPIN administration was significantly reduced in rats pretreated with I-propranolol (1 mg/kg) given i.v. 5 min before IPIN; only a small effect of I-propranolol was seen in brainstem and spinal cord. The maximum reduction in radioactivity caused by I-propranolol was approximately the same in cortex and cerebellum (about 60-65%) and occurred 2 hr after IPIN administration. I-Propranolol was approximately 1500-fold more potent than d-propranolol in reducing radioactivity. Pretreatment of rats with other lipophilic drugs that act at beta receptors was able to reduce the binding of IPIN in vivo; in contrast, pretreatment of rats with drugs which do not have direct agonist or antagonist activity at beta adrenergic receptors (desmethylimipramine, metergoline, diazepam, fluoxetine, phentolamine and haloperidol) had no effect. Experiments using ICI 118, 551, a beta-2 antagonist and betaxolol, a beta-1 antagonist, indicated that the majority of radioactivity in the cortex in vivo was bound specifically to the beta-1 subtype of the receptor whereas in the cerebellum the majority of specific binding was to the beta-2-subtype. When the specific binding of IPIN to beta adrenergic receptors was measured in vitro in seven regions of the CNS, at a ligand concentration of 30 pM, a high correlation was found with the I-propranolol displaceable radioactivity measured in vivo (r = 0.97, P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
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434 bipolar manic-depressive patients were followed longitudinally. The course of the disease changed in many patients over the years. 67 cases became rapid cyclers (two or more cycles per year); in 40 of these cases (12 men and 28 women) the change of the course took place after intense or protracted use of antidepressant drugs. In their previous course these patients had not received antidepressant drugs. The common feature of the transformation of the previous course to a continuous circular one was the appearance for the first time in the course of the disease of hypomanic episodes after the depressions, or the accentuation of hypomanias that had been of milder intensity in previous recurrences. The patients who developed continuous circularity under antidepressant drug treatment were of highly energetic temperament. The hypothesis is advanced that these patients have latent hypomanias, which become clinically manifest under the action of antidepressants. The intensification of an underlying hypomanic process by the antidepressants would precipitate another depression and establish continuous circularity. The change to a rapid cyclical course was more frequent in middle-aged patients and in women.
50 manic-depressive patients with rapid cycles received lithium for more than 1 year, during depression they received antidepressant drugs. Response was poor in 36, partial in 6, and good in 8. 21 of the poor responders were persuaded to endure depression without antidepressants; anxiolytics were allowed, 15 stabilized after the end of the untreated depression or after a few milder, shorter episodes; 4 improved partially; 2 were unchanged. 15 other rapid cycle patients started on lithium and stopped antidepressants at the same time. Response was good in 13, partial in 1, and poor in 1. Patients with a course of depression-hypomania (or mania)-free interval also responded poorly to prophylactic lithium when the depression was treated with antidepressants. They responded well when antidepressants were withdrawn. Antidepressants often cause or accentuate a switch from depression to hypomania or mania, and temporary refractoriness to lithium of the hypomania or mania. In this way lithium fails to prevent depression.
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Electro-convulsive treatment (ECT) was therapeutically ineffective in 27 (20%) of 136 depressed patients. Failure to respond occurred in long-lasting depressions and in patients with a history of long-lasting depressions. In these cases the depression lasted at least 6 months. The hypothesis is proposed that ECT is effective only when given within 6 months of thespontaneous end of the depression. Clinical and nosological implications are discussed.
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There is abundant evidence for substantial long-term prophylactic efficacy of lithium in bipolar manic-depressive disorders. Interruption of such treatment carries an extraordinarily high risk of recurrence within several months, even after several years of stability. Even a sharp reduction in dose may carry some risk. Gradual discontinuation of lithium was accompanied by markedly reduced risk of early recurrence. There is suggestive evidence that the phenomenon of high risk of recurrence after abrupt interruption of maintenance treatment may occur with other disorders and treatments, including neuroleptics in schizophrenia and possibly antidepressants in recurrent depression. The phenomenon of discontinuation-associated iatrogenic risk of early recurrence of major psychiatric illness has clear clinical implications. These include the need to evaluate safer methods of interrupting long-term maintenance treatment, particularly when clinical indications for rapid cessation are compelling and gradual discontinuation is not feasible. Questions also arise concerning interpretation of existing experimental studies of maintenance treatments that require interruption of treatment, reduction of dose, or crossover to a placebo, as well as the ethical and scientifically unambiguous design of future studies of this kind.
Bipolar disorder (BPD), probably the most prevalent psychotic disorder in adults, has been relatively neglected or controversial in children and adolescents over the past century. We reviewed the literature on early-onset BPD. Estimates of prevalence, particularly before puberty, are limited by historical biases against pediatric mood disorders and by formidable diagnostic complexity and comorbidity. Although clinical features of pediatric and adult BPD have similarities, pediatric cases probably cannot be defined solely by features characteristic of adult cases. Onset was before age 20 years in at least 25% of reported BPD cases, with some increase in this incidence over the past century. Pediatric BPD is familial more often than is adult-onset BPD, may be associated with a premorbid cyclothymic or hyperthymic temperament, and can be precipitated by antidepressant treatment. Pediatric BPD episodes frequently include irritability, dysphoria, or psychotic symptoms; they are commonly chronic and carry high risks of substance abuse and suicide. BPD is often recognized in adolescents, but the syndrome or its antecedents are almost certainly underrecognized and undertreated in children. Controlled studies of short- and long-term treatment, course, and outcome in this disorder remain strikingly limited, and the syndrome urgently requires increased clinical and scientific interest.
Lithium carbonate is the treatment of choice in the prevention of recurrences of bipolar mood disorders. The aim of this study is the evaluation of the pharmacokinetics of a new lithium compound to be administered "once a day", with a half-life of 32.4 hours. The present study investigates plasma lithium levels in patients treated with the novel vs. standard preparation of lithium carbonate to assess whether the new preparation may be associated with lithium plasma accumulation. The authors studied twenty-two bipolar patients whose standard lithium treatment was replaced by the new one. The total duration of the new treatment was 57 days. During this period, lithium plasma levels were monitored 7 times, 12 hours post-lithium administration. Lithium plasma level 24 hours following administration was evaluated in seven patients. The average dose of "once a day" lithium was 821 (+/- 250) mg/day, the corresponding plasma level was 0.45 (+/- 0.11) mEq/L, and the dose (g) to plasma level ratio was 1.96 (+/- 0.66). Differences between average lithium plasma levels at time T1 and successive times were not statistically significantly. Moreover, the average lithium level at 12 hours after lithium administration was not different from that after 24 hours (0.45 +/- 0.11 and 0.47 +/- 0.0.29 respectively). These results demonstrate that the new preparation, "once a day", maintains steady lithium plasma levels during our times of observation without accumulation in body fluids and tissues. "Once a day" lithium carbonate appears to be a useful alternative to the standard preparation, and may potentially improve treatment compliance by simplifying patients' medication.