Standardised assessment and recording of depressive symptoms.
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Depression↗
Biomedical subjects
M Hamilton
Publications and source records attributed to M Hamilton.
[Use and abuse of rating scales and statistics in psychopharmacology].
Scientific method in clinical work and research is still fully accepted in th world of medicine. There is still much misunderstanding of the principles and errors in its application. Rating scales are particularly useful in the evaluation of treatments, though they have other applications. But they are not absolutely necessary for this purpose and there are simpler methods available, though they are less efficient. Scales provide information in a standard form which permits the making of many different kinds of comparisons. They are not a substitute for sound clinical Judgement applied to properly designed clinical trials. Uncontrolled trials cannot distinguish between good and effective treatments and useless or even harmful ones. Statistical analysis is necessary because all patients are different. Unfortunately, incorrect or inappropriate statistical analysis is still not uncommon. Some examples are given.
Clinical Trials as Topic↗
Depression and endogenicity.
There is evidence from genetic and clinical studies, especially from therapeutic response to biological treatments, that endogenous or constitutional factors are important in some types of depressive illnesses. Unipolar depression is inherited differently from bipolar depression; monozygotic twins have a higher concordance rate than dizygotic twins. Endogenous depressions are cyclic in nature: the length of phases as well as the length of cycles are log-normally distributed. The effectiveness of antidepressants and ECT in endogenous depression points to a biochemical disorder. The author discusses the distinction between endogenous and exogenous depressions or between psychotic and neurotic depressions by reporting the work of Brown and others on "significant vs. stressful" events and on increased vulnerability.
Antidepressive Agents↗
Extended comparison of quality of life between stable heart failure patients and heart transplant recipients.
Heart failure has been associated with poor quality of life, which can improve after heart transplantation. Long-term quality-of-life comparisons between patients with heart failure stabilized with medical therapy and heart transplant recipients have not been performed. We assessed quality of life at the time of heart transplantation evaluation and again after 41 months in 12 patients with advanced heart failure stabilized with medical therapy and in 19 patients who had gone on to undergo heart transplantation. Quality of life was measured by three questionnaires. Both groups had similar quality-of-life and clinical features during the transplantation evaluation. Over time, feelings of anxiety and depression, psychologic adaptation, and perceived functional capability improved in the transplant recipients. However, transplant recipients reported more weakness after surgery; this was the major symptom that limited activities. At follow-up 41 months later, we found no significant differences in quality-of-life changes over time between patients stabilized with medical therapy and heart transplant recipients. Overall quality of life for patients who remain stable while receiving medical therapy may not be significantly different from patients who have undergone transplantation.
Aged↗
Does short-course induction with OKT3 improve outcome after heart transplantation? A randomized trial.
OKT3 is often used routinely for induction immunotherapy or selectively to avoid acute cyclosporine nephrotoxicity in heart transplant recipients at high risk for immediate postoperative kidney failure. It has not been shown in a randomized trial to be useful in patients at low risk for early kidney failure. We randomized 30 patients with a serum creatinine level of less than 1.4 mg/dl before heart transplantation to be treated with triple-drug immunotherapy with cyclosporine, which was started before surgery, (group 1) or to be treated with OKT3 for 4 to 6 days after surgery with oral cyclosporine, which was started between days 2 and 4, after renal function had stabilized (group 2). Follow-up for 6 months revealed no significant differences in the total number of rejection episodes, total number of infections, or in the serum creatinine level. Four patients in group 1 and five patients in group 2 have had no rejection. OKT3 showed a trend to delay time to first rejection (p = 0.10), as has been reported for the 14-day induction course of OKT3. A short course of OKT3 induction in heart transplant recipients at low risk for immediate postoperative kidney failure prolongs the time to first rejection for most patients but does not appear to reduce the total incidence of rejection in the first 6 months after heart transplantation.
Creatinine↗