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M H Rapaport

Publications and source records attributed to M H Rapaport.

At least 55 records · Page 3Linked to original sources
PubMed1996

A comparison of descriptive variables for clinical patients and symptomatic volunteers with depressive disorders.

Uncertainty about the generalizability of results from clinical trials is a nagging issue plaguing psychiatric research. The possible bias introduced by the use of subjects recruited from advertisements is one source of concern. Investigators question whether these subjects are representative of the types of individuals who seek treatment in clinical practice. This article compares and contrasts demographic characteristics, functional disabilities, symptomatologies, and the health beliefs and expectations of a cohort seeking treatment at a university outpatient clinic with a cohort of symptomatic volunteers recruited by advertisements. These two groups were alike in most variables; however, the clinical subjects reported more recent exposure to psychotropic medications and were more likely to indicate that they wanted psychotherapy. The symptomatic volunteers were slightly older, endorsed more psychiatric symptoms, drank more alcohol, and believed that combined pharmacology and psychotherapy would most help them. These findings suggest that the two cohorts were remarkably similar on most variables.

Adult↗
PubMed1996

Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population.

OBJECTIVE: The authors' goal was to evaluate the association between impairment in daily function and subsyndromal depressive symptoms as well as major depression to determine the economic and societal significance of these conditions. METHOD: Using 12-month prevalence data gathered by the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program (ECA), based on responses to the NIMH Diagnostic Interview Schedule, the authors divided the 2,393 subjects from the Los Angeles ECA site into three groups: subjects with subsyndromal depressive symptoms (N = 270), major depression (N = 102), and no depressive disorder or symptoms (N = 2,021). The groups were compared on 10 domains of functional outcome and well-being. RESULTS: Significantly more subjects with depressive symptoms than subjects who had no disorder reported high levels of household strain, social irritability, and financial strain as well as limitations in physical or job functioning, restricted activity days, bed days, and poor health status. Significantly more subjects with major depression than subjects with no disorder reported major financial losses, bed days, high levels of financial strain, limitations in physical or job functioning, and poor health status. Except for lower self-ratings of health status, no significant differences were found between subjects with subsyndromal symptoms and those with major depression. CONCLUSIONS: Significantly more people with subsyndromal depressive symptoms or major depression reported impairment in eight of 10 functional domains than did subjects with no disorder. The high 1-year prevalence of subsyndromal depressive symptoms, combined with the associated functional impairment, emphasizes the clinical and public health importance and need for additional investigations into these symptoms.

Activities of Daily Living↗
PubMed1995

A comparison of demographic variables, symptom profiles, and measurements of functioning in symptomatic volunteers and an outpatient clinical population.

There is consistent concern about the generalizability of research findings generated by clinical trials. There are several reasons for concern about these findings: (1) most clinical trials involve symptomatic volunteers who are recruited by means of advertisements rather than patients recruited from general clinical populations; (2) most clinical trials have restrictive criteria for admission into the study; and (3) the design of most trials is not representative of prescribing practices in the community. These methodological issues require investigators to question whether results from trials adequately model what will be seen in a general clinical situation. This report begins to evaluate the representativeness of initial samples by studying the demographic characteristics, symptom profiles, and measurements of functional disability for clinical outpatients and symptomatic volunteers recruited for clinical trials. We found that symptomatic volunteers were statistically more likely to be older than outpatients, were less likely to be single, and reported using more alcohol and cigarettes than outpatients. The two groups had similar levels of functional impairment and similar ages at onset of symptoms, but symptomatic volunteers reported more symptoms of depression and anxiety than outpatients. However, we believe the differences identified in this study did not seem to be clinically significant.

Adult↗
PubMed1995

A review of social phobia.

Social phobia is a disabling disorder that has only recently become a focus of investigation. Epidemiological studies have shown social phobia too be far more common than previously thought. These studies have also found that social phobia is frequently associated with other comorbid psychiatric disorders ranging from specific phobia and substance abuse to major mood disorders. Studies of functional morbidity have found that social phobia is associated with significant educational and economic incapacitation. The confluence of recent biological data supports the contention that social phobia is a unique disorder, distinct from other anxiety disorders such as panic disorder or agoraphobia. The purpose of this article is to summarize research findings on this important and disabling disorder.

Humans↗
PubMed1995

Gender differences in outpatient research subjects with affective disorders: a comparison of descriptive variables.

BACKGROUND: Gender may play an important role in the etiopathophysiology of psychiatric illness and has become a subject of increasing interest because of its possible effects on biological markers, treatment outcome, and prognosis. Intrigued by this issue and as part of our attempt to further characterize research subjects in San Diego, we evaluated male and female research subjects from our affective disorders clinical research center on a variety of measures. Based on epidemiologic data, we postulated that female and male subjects would be similar to epidemiologic samples and would differ in terms of comorbid diagnoses and that female subjects would be more likely to have had a history of previous treatment. METHOD: The demographic characteristics; coffee, tobacco, and alcohol consumption patterns; symptom patterns; and current and lifetime comorbid DSM-III-R Axis I diagnoses of 124 female and 69 male outpatient research subjects were contrasted. RESULTS: Female research subjects had more comorbid problems with anxiety disorders, were more likely to have been previously treated, and were more likely to have a family history of psychiatric illness. CONCLUSION: Male and female research subjects were remarkably similar with respect to most characteristics assessed but, as postulated, differed in terms of their comorbid diagnoses and prior treatment history.

Adult↗
PubMed1994

The effects of prolonged lithium exposure on the immune system of normal control subjects: serial serum soluble interleukin-2 receptor and antithyroid antibody measurements.

The purpose of this study was to begin evaluating the effects of lithium carbonate on in vivo immune function in normal controls. We postulated that lithium carbonate would stimulate lymphocytes but would not affect the production of antithyroid antibodies. Twenty-seven normal controls had blood samples drawn for measurements of serum soluble interleukin-2 receptors (SIL-2Rs), antithyroglobulin antibodies, and antimicrosomal antibodies prior to and after approximately 1 and 4 weeks of treatment with lithium carbonate at therapeutic blood levels. Subjects had a small but statistically significant increase in serum SIL-2Rs after 4 weeks of lithium treatment (446.3 +/- 177.2 U/ml versus 497.6 +/- 232.3 U/ml, p = 0.033). There was no increase in the prevalence of antithyroglobulin or antimicrosomal antibodies with lithium treatment nor did lithium act as an adjuvant to increase the titers in subjects with preexisting antithyroid antibodies.

Administration, Oral↗
PubMed1994

Increased serum soluble interleukin-2 receptors in Caucasian and Korean schizophrenic patients.

Recent studies have identified immunologic abnormalities in some schizophrenic subjects. This experiment replicates previous findings that serum soluble interleukin-2 receptors (SIL-2Rs) are elevated in schizophrenic patients, and is the first study to describe this phenomenon in non-Caucasian patients. Despite differences between Korean and Caucasian schizophrenic patients in absolute serum SIL-2R levels, both groups were significantly elevated when compared with their respective ethnic control groups (477 +/- 171 U/ml versus 354 +/- 172 U/ml and 763 +/- 347 U/ml versus 567 +/- 231 U/ml, respectively). Neither age, gender, medication status, nor duration of illness correlated with SIL-2R levels. These findings are further evidence that immune activation is present, regardless of ethnic origin, in some schizophrenic patients.

Adult↗
PubMed1994

Serum cytokine and soluble interleukin-2 receptors in patients with panic disorder.

There has been very little research investigating the interface between panic disorder and the immune system. This preliminary study explores the relationship between panic disorder and serum levels of cytokines, which have potent immune and central nervous system activity, and soluble interleukin-2 receptors, a well-known marker of T-cell activation. Fifteen women with panic disorder and 19 healthy female subjects had serum levels of interleukin-1, interleukin-2, and soluble interleukin-2 receptors (SIL-2Rs) measured by enzyme-linked immunoassay. Women with panic disorder had slightly increased serum levels of interleukin-2 but did not differ from age-comparable and gender-matched controls in serum interleukin-1 alpha, or interleukin-1 beta. And although the mean SIL-2R levels were not different for the two groups, the SIL-2R levels were present across a wider range of values in the women with panic disorder. Our data suggest that more extensive investigation of circulating levels of interleukin-2 and the soluble interleukin-2 receptor in patients with panic disorder may be warranted.

Adult↗
PubMed1994

Serum interleukin-2 and soluble interleukin-2 receptor levels in generalized social phobia.

Alternations in immune function have been described in a variety of psychiatric disorders including schizophrenia and depression; however, we do not know of any research involving social phobia and the immune system. This preliminary study explores the relationship between social phobia and two well-established immune parameters, serum interleukin-2 (IL-2) levels, a potent immune and central nervous system modulator, and soluble interleukin-2 receptors (SIL-2Rs), a well-known marker of T-cell activation. Fifteen subjects with generalized social phobia and 15 healthy volunteers had serum IL-2, and SIL-2Rs measured by enzyme-linked immunoassay. Subjects with social phobia and normal volunteers had similar mean serum IL-2 and SIL-2R levels. The data suggest that, unlike other psychiatric disorders, these immune measures may not be used to differentiate patients with generalized social phobia from normal volunteers.

Adolescent↗
PubMed1994

Immune parameters in euthymic bipolar patients and normal volunteers.

Immune system parameters were investigated in euthymic bipolar patients and matched normal volunteers. A review of the existing literature suggested that bipolar patients might be more likely to demonstrate signs of immune activation. Serum-soluble interleukin-2 receptors, circulating phenotypic lymphocyte markers, levels were measured. Euthymic bipolar patients and normal volunteers did not differ or any of these measures. Furthermore, bipolar patients could not be differentiated by medication status or gender. In conclusion, there was no evidence of immune system activation in euthymic bipolar patients.

Adult↗
PubMed1994

Serum-soluble interleukin-2 receptors in neuroleptic-naive schizophrenic subjects and in medicated schizophrenic subjects with and without tardive dyskinesia.

There is a growing body of literature suggesting that some schizophrenic subjects have evidence of immune activation. One marker that has been consistently elevated in studies is the serum-soluble interleukin-2 receptor (SIL-2R). This article reports the results of 2 experiments: the first compares concentrations of serum SIL-2R in neuroleptic-naive schizophrenic patients and matched controls, and the second study contrasts serum SIL-2R concentrations in medicated schizophrenic subjects with and without tardive dyskinesia. Serum SIL-2R concentrations were elevated in neuroleptic-naive schizophrenic subjects as compared with controls (1705.7 (SD 1124.2) U/ml vs 739.8 (SD 325.5) U/ml). Medicated subjects with tardive dyskinesia had increased serum SIL-2R levels (2385.5 (SD 1822.0) U/ml) compared with medicated subjects without tardive dyskinesia (1259.6 (SD 1365.3) U/ml). Thus, elevations in serum SIL-2R levels are present prior to neuroleptic treatment, and there may be an association between serum SIL-2Rs and tardive dyskinesia.

Adult↗
PubMed1994

Subsyndromal symptomatic depression: a new mood disorder?

Secondary analyses in a subsample (N = 9160) of the National Institute of Mental Health Epidemiologic Catchment Area Program data base revealed that 19.6% of the general population reported one or more depressive symptoms in the previous month. One-year prevalence of two or more depressive symptoms in the general population was 11.8%, a prevalence figure exceeding the 9.5% 1-year prevalence for all the DSM-III mood disorders combined. We have labeled this potential clinical condition as subsyndromal symptomatic depression (SSD), defining it as any two or more simultaneous symptoms of depression, present for most or all of the time, at least 2 weeks in duration, associated with evidence of social dysfunction, occurring in individuals who do not meet criteria for diagnoses of minor depression, major depression, and/or dysthymia. SSD has a 1-year prevalence in the general population of 8.4%, two thirds of whom are women (63.4%). The most common SSD symptoms reported are insomnia (44.7%), feeling tired out all the time (42.1%), recurrent thoughts of death (31.0%), trouble concentrating (22.7%), significant weight gain (18.5%), slowed thinking (15.1%), and hypersomnia (15.1%). Increased prevalence of disability and welfare benefits was found in SSD as compared with respondents with no depressive symptoms. SSD represents a significant clinical population not covered by any DSM-III, DSM-III-R, or DSM-IV mood disorder diagnosis. Since SSD is also associated with significant increases in social dysfunction and disability, we feel there is good evidence to conclude that SSD is an unrecognized clinical condition of considerable public health importance that is deserving of further characterization and study.

Adolescent↗
PubMed1993

Increased serum soluble interleukin-2 receptors in schizophrenic monozygotic twins.

There is a confusing history of immune findings associated with schizophrenia. At least some of these discrepant results may be artifacts caused by heterogeneity. In an attempt to decrease heterogeneity, we studied three groups of monozygotic twins who were either discordant for schizophrenia, concordant and ill, or concordant and well. This comparison minimizes environmental and genetic variance, and heightens differences that are actually due to the disorder. Overall, schizophrenic subjects had higher levels of serum soluble interleukin-2 receptors (SIL-2Rs) than unaffected individuals (480.8, SD 238.6 U/ml vs 380.9, SD 170.6 U/ml; F = 5.256, df = 1.61, P = 0.02). When data from discordant and concordant twin groups were analysed separately, both the discordant ill twins (P = 0.06) and concordant ill twin pairs (P = 0.08) showed trends towards higher serum SIL-2R levels than their respective control groups. These data contribute to the growing body of evidence that immune activation is associated with some forms of schizophrenia.

Adult↗
PubMed1993

Beneficial effects of nalmefene augmentation in neuroleptic-stabilized schizophrenic patients.

It was postulated that chronic blockade of the opioid system in neuroleptic-stabilized schizophrenic patients would have a beneficial behavioral effect. Eleven neuroleptic-stabilized psychotic inpatients received augmentation with nalmefene for an average of 36.7 days in a double-blind placebo-controlled study. The patients exhibited significant reductions in Bunney-Hamburg psychosis ratings and the Brief Psychiatric Rating Scale thinking disturbance subscale during the augmentation period. This study presents preliminary data supporting the hypothesis that chronic augmentation of neuroleptic-stabilized schizophrenic patients with opiate antagonists is beneficial.

Adolescent↗
PubMed1993

A comparison of ICD-10 and DSM-III-R criteria for substance abuse and dependence.

As part of DSM-IV field trials for substance use disorders, 100 inpatients from two psychiatric substance abuse units were interviewed using a modified version of the Substance Abuse Module (SAM) to ascertain substance use diagnoses according to ICD-10 and DSM-III-R criteria. Both criteria sets developed from the theoretical framework presented by Gross and Edwards (1976) and thus, they should demonstrate close concurrence in diagnoses of dependence and abuse/harmful use. The kappa scores obtained in these analyses demonstrate good to excellent agreement on the diagnoses of dependence across substances. There was poor agreement between DSM-III-R and ICD-10 for abuse/harmful use diagnoses. Although there is generally good agreement between DSM-III-R and ICD-10 for substance dependence diagnoses, important differences exist between the two criteria sets both for the diagnoses of abuse and harmful use, and for the diagnosis of marijuana dependence. These differences are primarily due to the inclusion of social problems and repeated use of substances in hazardous situations as DSM-III-R criteria.

Alcoholism↗