Biomedical subjects

M Fava

Publications and source records attributed to M Fava.

At least 127 records · Page 7Linked to original sources

PubMed1995

Early nonresponse to fluoxetine as a predictor of poor 8-week outcome.

OBJECTIVE: The purpose of this study was to quantify the proportion of patients who show no response to a fixed dose of fluoxetine after 2, 4, and 6 weeks of treatment and then respond by week 8. METHOD: In an open trial, 143 outpatients who met DSM-III-R criteria for major depressive disorder were treated with a regimen of fluoxetine, 20 mg/day. The authors analyzed the proportion of patients who had less than a 20% decrease from baseline in their scores on the Hamilton Rating Scale for Depression after 2, 4, and 6 weeks and who went on to have a 50% or greater reduction by week 8. A last-observation-carried-forward strategy was used to calculate conditional probabilities of 8-week response. Kaplan-Meier survival analysis was used to estimate probabilities of response at week 8 given degrees of response at week 2. RESULTS: Eighty-two subjects (57.3%) who started the trial responded by week 8. Of those subjects who showed no improvement at weeks 2, 4, and 6, the proportions of responders at week 8 were 36.4%, 18.9%, and 6.5%, respectively. The Kaplan-Meier estimate of 8-week response given nonresponse at week 2 was 0.45. CONCLUSIONS: The proportion of patients with no response to antidepressant treatment by 4 or 6 weeks who responded by week 8 was substantially less than that for subjects who had at least a partial response. Nonresponse as early as week 2 predicted 8-week outcome.

Adult↗

PubMed1995

Gender differences in personality disorders.

OBJECTIVE: The aim of this study was to assess gender differences in personality disorders. Since heterogeneity of axis I diagnoses could introduce variability in the assessment of axis II diagnoses, the authors studied a group of patients with a primary diagnosis of major depression. METHOD: A total of 316 patients were evaluated with the Personality Diagnostic Questionnaire--Revised, a self-rating measure, or the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), a clinician-rated instrument, or both. Axis II disorders were assessed with the Personality Diagnostic Questionnaire--Revised for 288 patients with major depression. The SCID-II was administered to 117 subjects, with an additional 95 subjects receiving the SCID-II for cluster B diagnoses only. RESULTS: The mean 17-item Hamilton Depression Rating Scale scores for 108 men (mean age = 39.28 years) and 208 women (mean age = 39.11) were 19.0 (SD = 3.8) and 19.6 (SD = 6.9), respectively. Men were significantly more likely than women to meet criteria for narcissistic, antisocial, and obsessive-compulsive personality disorders as measured by the Personality Diagnostic Questionnaire--Revised and for narcissistic and obsessive-compulsive personality disorders as measured by the SCID-II. CONCLUSIONS: These findings are consistent with those of previous studies showing a greater prevalence of antisocial and narcissistic personality disorders in men. In contrast with other investigations, however, neither the Personality Diagnostic Questionnaire--Revised nor the SCID-II revealed a higher prevalence of any personality disorder in women.

Adult↗

PubMed1995

Patterns of improvement in depressive symptoms with fluoxetine treatment.

By definition, patients who respond to antidepressant treatment show significant improvements in most, if not all, of their depressive symptoms. We assessed the patterns of change in depressed outpatients treated openly with fluoxetine 20 mg/day for 8 weeks. We studied 62 depressed outpatients with major depressive disorder who showed full response following fluoxetine treatment. Analysis of the data revealed that the symptoms that tended to improve relatively early during treatment were suicidal ideation, excessive guilt, and lack of appetite. Our tentative conclusion from this pilot study was that symptom improvement tends to occur in both cognitive and neurovegetative areas early in treatment as well as later.

Adolescent↗

PubMed1995

Hypothyroidism and hyperthyroidism in major depression revisited.

BACKGROUND: The aim of our study was to evaluate the prevalence of thyroid abnormalities among depressed outpatients and to examine the response to treatment of those subjects with relatively low or high thyroid hormone levels. METHOD: Outpatients (N = 200) 18 to 65 years of age who met DSM-III-R criteria for major depression were screened for the presence of thyroid abnormalities using a number of thyroid indices. Of these patients, 166 were then treated openly with the antidepressant fluoxetine for 12 weeks. We assessed whether patients with relatively low or high thyroid hormone levels had a different response to treatment compared with other patients. The 17-item Hamilton Rating Scale for Depression (HAM-D-17) was administered during the study to assess changes in depressive symptoms. Thyroid function was assessed by measuring T3, T4, free T4 index (FT4I), T3 uptake (T3U), and serum thyroid-stimulating hormone (TSH) levels. RESULTS: No clinical cases of hyperthyroidism or hypothyroidism were detected. Of the patients examined, 5 (2.6%) had slightly elevated TSH levels (range, 4.7-8.2); none of these had T4 or FT4I levels below the normal range. Subnormal levels of T4 or FT4I were found in 1 subject (0.5%). T3 and T3U levels were below the normal range in a larger number of patients (7.6% and 15.0% respectively), but only 1 of these patients had elevated TSH levels. None of the patients had levels of TSH below the normal range, and only 3 subjects (1.5%) had T4 levels above the normal range. No relationship was found between response rate (assessed as either change in HAM-D-17 score or as remission of depressive symptoms with a HAM-D-17 score < or = 7 for 3 consecutive weeks) and each of the thyroid tests, even after adjusting for baseline severity of depression. CONCLUSION: In depressed outpatients, it appears that hypothyroidism and hyperthyroidism are extremely uncommon and that the presence of subtle thyroid function abnormalities does not have an impact on treatment outcome.

Adolescent↗

PubMed1995

Relapse in patients on long-term fluoxetine treatment: response to increased fluoxetine dose.

BACKGROUND: Although several studies have examined the long-term efficacy of antidepressants, relatively little attention has been paid to the management of relapses or recurrences during continued antidepressant treatment. This study examined whether depressed patients who had recovered and then relapsed on fluoxetine 20 mg/day would benefit from an increase in fluoxetine dose. METHOD: Eighteen patients who relapsed on fluoxetine 20 mg/day during long-term treatment with fluoxetine as part of a placebo-controlled study had their fluoxetine dose raised to 40 mg/day and were followed for at least 1 month (mean time = 4.7 months). RESULTS: Twelve (67%) were full responders, 3 (17%) partial responders, and 3 (17%) dropped out because of side effects (e.g., insomnia and agitation). Of those patients who had either full or partial response (N = 15; 83%), 3 complete responders had a recurrence on 40 mg/day after a mean of 5.8 months and 1 partial responder had a recurrence 11 months later. Overall, 11 (61%) of 18 patients maintained their response during their follow-up while taking the higher dose of fluoxetine. CONCLUSION: An increase in dose of fluoxetine to 40 mg/day appears to be an effective strategy in the treatment of relapse among depressed patients who had initially responded to fluoxetine 20 mg/day.

Adult↗

PubMed1995

[Diagnostic role of the combination of computerized tomography and angiography in traumatic injuries of the thoracic aorta].

AIM: To assess the diagnostic value of the combination of computed tomography and angiography in patients with blunt thoracic trauma and suspicion of aortic injury. PATIENTS AND METHODS: Retrospective analysis of six patients, aged 22 to 72 years old, with traumatic thoracic aorta injury secondary to severe trauma, specially car accidents, seen between 1985 and 1994. RESULTS: An early diagnosis was done in three patients. One patient, in whom diagnosis was delayed, died before surgery. In three cases, CAT scan showed indirect evidence of aortic rupture, consisting in alterations of aortic outline. In other three patients, it showed hemomediastinum, associated to a left hemothorax in one case. Angiography confirmed the diagnosis, localized and characterized the injury in all patients. CONCLUSIONS: The delay in the diagnosis of aortic injury may be fatal. The combination of CAT scan and angiography has a high sensitivity and specificity to localize and characterize lesions of the aorta or its branches or associated organs, essential step for surgical planning. CAT scan restricts the use of angiography, avoiding false negative studies, but cannot be used as the sole diagnostic procedure.

Adult↗

PubMed1994

Life events impact in patients with secondary amenorrhoea.

To evaluate the relationship between stressful life events and the onset of secondary amenorrhoea Paykel's semi-structured interview for Recent Life Events was administered to patients affected by secondary amenorrhea and also to healthy volunteers. The number, quality, and objective negative impact of life events were compared among different hormonal subtypes of secondary amenorrhoea and healthy normally menstruating women, as a control group. The number of life events in amenorrhoeic patients (N = 131) was significantly greater than those observed in the control group (N = 64) (45.9 vs 32.8%). Moreover, where only hypothalamic hypogonadotrophic amenorrhoea was considered, the occurrence of life events was significantly higher (59.8%) than in hyperandrogenic (26.6%) or in normogonadotrophic (20.4%) patients. The most prevalent events among hypothalamic hypogonadotrophic amenorrhoeic patients were those classified as 'undesirable', 'uncontrolled' and with 'Objective Negative Impact'. The present study supports the hypothesis of a cause-effect relationship between stressful personal life events and the onset of secondary amenorrhoea of hypogonadotrophic subtype.

Adaptation, Psychological↗

PubMed1994

Childhood psychopathology retrospectively assessed among adults with early onset major depression.

Prevalence and impact of comorbidity in early onset major depressive disorder were studied in 116 depressed adult outpatients whose onset of first major depressive episode occurred by age 18. Eighty-eight percent of these patients had at least one additional comorbid Axis I lifetime diagnosis including: social phobia (28%), simple phobia (16%), alcohol (17%) and cannabis (13%) abuse/dependence, and bulimia nervosa (8%). Comorbid anxiety disorders preceded the onset of major depression in two-thirds of individuals while comorbid substance abuse/dependence followed the onset of major depression in two-thirds and predicted more frequent occurrences into adulthood. In contrast to frequency of episodes, severity and duration of an index episode of major depression were not influenced by comorbidity.

1-Naphthylamine↗

PubMed1994

Integrating cognitive therapy and pharmacotherapy in the treatment and prophylaxis of depression: a novel approach.

Psychiatric clinicians frequently prescribe biologic treatments such as antidepressant medication in combination with psychologic treatments such as psychotherapy. In the present article we propose a model integrating antidepressant treatment with Beck's cognitive therapy, a form of psychotherapy with established efficacy in the acute treatment of depression. We argue for adding cognitive therapy following successful pharmacological treatment, i.e., for spending cognitive therapy resources in the continuation phase of treatment, where they are most likely to make a unique and separate contribution to patient well-being, particularly in the areas of relapse prevention and treating residual symptoms. We encourage researchers to compare this treatment strategy to other approaches in terms of its ability to (1) prevent relapses and recurrences of depressive episodes, and (2) to impact positively on the overall quality of life in recovered depressed patients.

Antidepressive Agents↗

PubMed1994

Personality disorder comorbidity with major depression and response to fluoxetine treatment.

The relationship between depression and comorbid personality disorders is still poorly understood. The aims of this study were to examine differences in depression severity between depressed outpatients with and without comorbid personality disorders, to determine the effect of a fixed dose of fluoxetine on personality disorders, and to assess the predictive value of personality disorder diagnoses at baseline with regard to response to fluoxetine. Eighty-three outpatients with major depressive disorder (MDD) were assessed with a self-rating scale, the Personality Diagnostic Questionnaire-Revised (PDQ-R), before and after 8 weeks of treatment with fluoxetine 20 mg/day. The presence of a cluster B diagnosis before treatment predicted positive outcome as measured by the change in score on the modified 17-item Hamilton Rating Scale for Depression (HAM-D-17*). Following treatment, we found significant reductions in the frequency of most individual personality disorder diagnoses and total PDQ-R score. While patients no longer meeting criteria for cluster B personality disorders after treatment had similar reductions in depressive symptoms compared to those maintaining the diagnoses, subjects no longer meeting criteria for cluster A and cluster C diagnoses after treatment exhibited significantly greater decreases in depression severity than those who maintained the diagnoses. Overall, these results suggest that fluoxetine may be beneficial in the treatment of certain personality disorder traits in patients with MDD.

Adolescent↗

PubMed1994

Menstrual-related mood changes in patients with oligomenorrhea.

In order to evaluate the role of negative anticipation on self-report of premenstrual symptoms, we studied 13 oligomenorrheic and 12 control women with regular menses. Both hormonal and psychological measures (using the Symptom Rating Test) were obtained once a week for 5-9 weeks. The presence of ovulatory cycles was confirmed by progesterone levels > or = 3.0 ng/ml. In both groups, there was a significant increase in the total Symptom Rating Test score during the premenstrual phase with respect to the intermenstrual period. As far as specific symptoms were concerned, MANOVA showed significant premenstrual fluctuations in anxiety, depression, somatic symptoms, and inadequacy in both groups. These results suggest that premenstrual discomfort may be unrelated to both cycle length and negative anticipation of one's menses.

Adult↗

PubMed1994

Lithium and tricyclic augmentation of fluoxetine treatment for resistant major depression: a double-blind, controlled study.

Forty-one patients who had failed to respond to 8 weeks of treatment with 20 mg of fluoxetine were randomly assigned to one of three treatments for 4 weeks: 40-60 mg/day of fluoxetine, 20 mg/day of fluoxetine plus 25-50 mg/day of desipramine, and 20 mg/day of fluoxetine plus 300-600 mg/day of lithium. Patients treated with high-dose fluoxetine (N = 15) did significantly better than patients treated with fluoxetine plus lithium (N = 14) and those treated with fluoxetine plus desipramine (N = 12). High-dose fluoxetine was the most effective treatment among partial responders to previous treatment, but high-dose fluoxetine and fluoxetine plus lithium were the most effective treatments among nonresponders.

Adult↗

PubMed1994

Norms for depressed patients for the California verbal learning test: associations with depression severity and self-report of cognitive difficulties.

This study provides norms for depressed subjects for a widely used test of verbal memory, the California Verbal Learning Test (CVLT). Subjects were 156 outpatients with major depression tested during a drug washout period. Mean CVLT memory scores for these patients were generally between one-half and one standard deviation below age- and sex-corrected norms for nondepressed populations. Severity of depression in the patients was not associated with memory performance, but was associated with self-report of cognitive difficulties. A table of age-, sex-, and education-specific norms for the CVLT is provided.

Journal Article↗

PubMed1994

Dysfunctional attitudes in major depression. Changes with pharmacotherapy.

High levels of dysfunctional attitudes have been associated with greater severity of depression and poorer response to pharmacological treatment. The goal of our study was to examine this relationship and the changes in dysfunctional attitudes after treatment with fluoxetine, a relatively selective serotonin uptake inhibitor. Dysfunctional attitudes were evaluated with both the Cognitions Questionnaire (CQ) and the Dysfunctional Attitudes Scale (DAS) in 115 outpatients diagnosed as having major depressive disorder. After 8 weeks of treatment with fluoxetine, 67 of these patients again completed the DAS and the CQ. Dysfunctional attitudes were associated with depression severity both before and after treatment and decreased linearly with treatment of the depression. Negative thinking and dysfunctional attitudes, as measured by both DAS and CQ, were not predictive of the degree of improvement in depressive symptoms. These findings partly support a state-dependent interpretation of dysfunctional attitudes, and provide evidence of significant reductions in these attitudes after treatment with a serotonin uptake inhibitor.

Adult↗

PubMed1993

The influence of DST and TRH test administration on depression assessments: a controlled study.

Significant antidepressant effects have been reported after administration of dexamethasone and thyrotropin-releasing hormone (TRH). The purpose of this study was to evaluate whether or not the administration of the dexamethasone suppression test (DST) and TRH test in depressed patients, just before their entering clinical trials, has any impact on their symptoms. The Hamilton Rating Scale for Depression was administered to 166 subjects at screen visit, 1 week later (baseline visit), and 1 week after beginning treatment with fluoxetine 20 mg/day (week-1). Between screen and baseline visits, 62 patients were administered the DST alone, 6 underwent the TRH test alone, and 26 received both the DST and the TRH test. Seventy-two patients were not administered either test. No statistically significant differences in depression scores were found at screen, baseline and week-1 visits between patients who underwent neuroendocrine tests and those who did not. Our data suggest that the administration of neuroendocrine tests such as the DST and the TRH test does not have a statistically significant effect on depressive symptoms and, therefore, does not interfere with study results and interpretation.

Adolescent↗

PubMed1993

Physiologic benefits of a stress reduction program for healthy middle-aged Army officers.

Stress reduction programs (SRPs) can reduce morbidity and mortality in patients with coronary artery disease (CAD). This study evaluated the effect of an SRP on metabolic and hormonal risk factors for CAD. Twenty army officers participating in an SRP, Group I, and a comparison group of seventeen SRP nonparticipants, Group C, volunteered to undergo measurement of dehydroepiandrosterone-sulfate (DHEA-S), cortisol, DHEA-S/cortisol ratio, testosterone, apolipoprotein-A1, apolipoprotein-B, triglycerides, cholesterol, fibrinogen, and leukocyte count both before and after the SRP period. No differences in the changes in biochemical risk factors for CAD were found between participant and nonparticipant except for DHEA-S. While Group C had a marked reduction in DHEA-S levels, Group I had a small increase. Previous studies indicate DHEA-S is inversely associated with extent of CAD and age-adjusted DHEA-S levels below 3.78 mumol/l confer an increased risk for CAD mortality. SRP participation appears to effect DHEA-S levels, possibly partially accounting for the benefits observed in SRPs among CAD patients.

Adult↗

PubMed1993

Stressful life events and affective disorders inhibit pulsatile LH secretion in hypothalamic amenorrhea.

The aim of this study was to evaluate relationships between emotional state and hypothalamic activity in patients with hypothalamic secondary amenorrhea. Sixty-seven normal weight patients with hypothalamic amenorrhea were submitted to concomitant psychological and LH pulsatility evaluation. Structured clinical interview for anxiety and depressive disorders (DSM III-R) as well as life events investigations (Paykel test) were performed. LH pulses (blood sampling every 10 min for 4 hr) were analyzed through DETECT program and Instantaneous Secretory Rate were computed. Twenty-one patients reporting life events associated to the onset of amenorrhea had LH pulse frequency (2.28 +/- 1.10 pulses/4 hr) lower than those without life events (3.40 +/- 1.46 p = .007). LH pulses amplitude was lower in patients meeting a DSM III-R (21 cases: 1.22 +/- 0.96 mIU/ml) diagnosis than in those without (1.99 +/- 1.20 p = .04) diagnosis. Plasma estradiol and FSH levels as well as duration of amenorrhea and Body Mass Index were similar among groups. It is concluded that psychogenic factors (namely the presence of life events related to the onset of menstrual disorder) are associated with significant and specific changes of hypothalamic activity which could be involved in determining hypogonadism.

Adult↗

PubMed1993

Buspirone therapy for Type A behavior, hostility, and perceived stress in cardiac patients.

Hostility is considered to be a risk factor for coronary artery disease. Despite the findings of reduced serotonergic function and effectiveness of treatment with serotonergic agents in similar symptom complexes, there have been no attempts at using serotonergic psychopharmacologic agents to treat this population. We conducted an 8-week open trial of 10 type A, irritable men with coronary artery disease and no diagnosable psychiatric (axis I) condition to examine the effects of buspirone on these subjects. Buspirone appears to significantly reduce type A behavior, hostility, anxiety, impatience, and perceived stress.

Adult↗