Resistant depression.
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Biomedical subjects
Publications and source records attributed to M Assael.
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Six female postmenopausal psychiatric inpatients with rheumatoid arthritis (RA), domineering personality, hypochondriasis, alexithymia and perfectionism are presented. None of the patients fully responded to antidepressant drug treatment. Five of the six women were professionally engaged in sewing, which might be considered a mechanical risk factor for rheumatoid arthritis. Several psychiatric aspects of RA are discussed, particularly the existence of the "arthritic personality" and the influence of psychological stress in RA patients.
A false belief exists that depressed patients are not creative. On the contrary, they have an urge to create--the creative spells are equivalent to the depression. They express themselves more easily through painting than through speech. They express their repressed feelings and ideas of sin and affect, suicidal tendency, etc., and in some cases, the spontaneous paintings have prophetic meaning. It is much easier for them to express their feelings through universal signs and symbols such as: face, posture; church, tower, bell, cross; coffin, tomb, cemetery, grave; skeleton, skull, bones; tree, mountain, boat, chair.
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The effect of dibenzepin, a tricyclic antidepressant drug, on electrically induced ventricular fibrillation was studied in 20 cats and nine dogs. The ventricular fibrillation threshold and the ability of the ventricle to defibrillate spontaneously were determined before and after the administration of dibenzepin, with each animal serving as its own control. The drug raised the ventricular fibrillation threshold in all the animals tested. Before treatment, spontaneous ventricular defibrillation occurred in only 8 of the 20 cats and in none of the dogs. After treatment, all of the cats and eight of the dogs exhibited spontaneous ventricular defibrillation. The study of drugs that have a self-defibrillatory effect may serve to further understanding of the mechanism of ventricular fibrillation and its spontaneous termination.
Dibenzapine (720 mg, Noveril) was infused intravenously to 16 depressed patients during a period of 3 h. Serum prolactin levels were determined by radioimmunoassay and changes in clinical condition were evaluated according to the Hamilton Equation. The two variables were correlated to each other. In most of the patients Noveril caused a dramatic but short-lived improvement in depressive symptoms. There was much variability in the prolactin response to the drug. Serum prolactin levels showed a great elevation in 9 patients. In all patients the hormonal levels returned to their former normal levels after termination of the infusions. The treatment was then continued with Noveril per os. There was no significant correlation between serum prolactin levels and clinical condition or its change. The elevation of serum prolactin levels as a reaction to Noveril treatment may be explained by the prominent serotonergic action of Noveril. A time lag between serotonergic and dopaminergic actions of the drug when given in higher doses may be an additional explanation. Other possible hypotheses are discussed.
The etiology of sleepwalking is controversial, the theory that sleepwalking is an epilepsy-like symptom is mostly discounted. Electroencephalogram records, obtained by using sphenoidal needles, are presented as a useful technique and aid to etiological and topical diagnosis. A temporal focus of waves of 4-6 cps was recorded which was not found in the routine EEG procedures. The question is thus raised as to whether sleepwalking may be a result of a paroxysmal disorder in the temporal lobe.
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The antimuscarinic potency of dibenzepin (Noveril) was estimated by measuring (a) central in vivo effects in mice (antihypothermia and antitremor, both induced by oxotremorine), (b) peripheral in vivo activity (mydriasis caused by systemic administration of the drug), (c) the effects of dibenzepin on isolated smooth muscle from guinea pig ileum, and (d) in vitro determination of the affinity constant of dibezepine toward the muscarinic binding sites in whole mouse-brain homogenate. The data allowed the construction of a normalized antimuscarinic potency scale for some of the common tricyclic antidepressants. With a value of 1 for scopolamine, the following relative anticholinergic potencies were calculated: dibenzepin--1/600, nortriptylne--1/300, imipramine - 1/200, and amitriptyline - 1/75. These values suggest an explanation for the absence of clinically detectable anticholinergic side effects during treatment of depression with high doses of dibenzepin. Structural and spatial interrelations among various tricyclic antidepressants and scopolamine are discussed.
Serum-prolactin was measured by radioimmunoassay during the menstrual cycle in 28 women who had the premenstrual syndrome (P.M.S.) and in a control group who did not have P.M.S. symptoms. Throughout the menstrual cycle mean serum-prolactin was signficantly higher in women with P.M.S. than in the controls. The average individual increase in serum-prolactin during the premenstrual period compared with the first 3 weeks of the cycle was also significantly higher in women with P.M.S. It is not clear whether the increase in serum-prolactin was merely an indicator of stress or was actually involved in producing some of the symptoms which constitute P.M.S.
In many cases of patients who had rheumatic fever--at times undiagnosed--there is a chronic involvement of the brain as a result of disseminated recurrent obliterating arteritis or emboli in the small blood vessels, especially in the brain membranes or the cortex. As a result, disseminated, unstable, and transient neurological and psychiatric symptoms appear. The nature of these symptoms depends upon the age of the patient and the time of onset of the disease. It is suggested that the term "rheumatic brain disease" or "rheumatic encephalopathy" be used, and introduced into the nomenclature of the American Rheumatic Association.