Biomedical subjects
M Strober
Publications and source records attributed to M Strober.
The pharmacotherapy of depressive illness in adolescence: II. Effects of lithium augmentation in nonresponders to imipramine.
The antidepressant value of lithium augmentation was assessed in a 3-week open trial involving 24 adolescents who remained highly depressed after 6 weeks of treatment with imipramine hydrochloride. Two patients responded dramatically during the first week, with an additional eight patients showing partial improvement during the 3-week trial. The overall magnitude of improvement in depression ratings was significantly greater than in an historical control group of nonresponders who continued to receive imipramine monotherapy during their hospital treatment. Results suggest the potential use of this adjunctive strategy in some tricyclic resistant adolescent depressives, although it appears less efficacious overall in this age group than in adults.
Relevance of early age-of-onset in genetic studies of bipolar affective disorder.
Early age-of-onset appears to predict higher familial loading in bipolar affective disorder. This finding, coupled with ongoing attention to the importance of genomic heterogeneity for segregation and linkage analyses, underscores the value of research on juvenile samples. This research is reviewed, and implications for future research on genetic classification of bipolar illness are noted.
Pituitary-adrenal-immune system in normal subjects and in patients with anorexia nervosa: the number of circulating helper T lymphocytes (CD4) expressing the homing receptor Leu8 is regulated in part by pituitary-adrenal products.
The association between plasma pituitary-adrenal (PA) hormones and the number of certain populations of peripheral blood lymphocytes (PBL) was examined in subjects with normal PA function and in patients with anorexia nervosa (AN). AN patients display several neuroendocrine dysfunctions, including hypercortisolemia. In the normal subjects there were positive correlations between adrenocorticotropic hormone (ACTH) and the number of PBL and helper T lymphocytes expressing the homing receptor Leu8 (CD4+Leu8+); there was a negative relationship between cortisol and these lymphocyte populations. These latter, inverse correlations did not occur in the AN patients, either while underweight or after weight recovery, with some persistence of hypercortisolemia. Administration of dexamethasone (DEX) suppressed cortisol levels and reduced, perhaps via a receptor-mediated mechanism, the number of circulating PBL and CD4+Leu8+ in the normal subjects but not in the AN patients. These results support the physiological relevance of PA-CMI interaction in subjects with normal PA function and indicate that the PA-CMI interrelationship is disrupted in AN patients with hypercortisolemia.
Family-genetic studies of eating disorders.
The possible contribution of genetic factors to the etiology of anorexia nervosa and bulimia nervosa is a question of mounting interest. Empirical studies are few in number, yet there is suggestive evidence of familial aggregation. The existing literature is reviewed and methodological problems are highlighted. It is suggested that predisposing elements are best accounted for by genetically transmitted dispositional traits, especially as are observed in the background of individuals with anorexia nervosa.
Relapse following discontinuation of lithium maintenance therapy in adolescents with bipolar I illness: a naturalistic study.
The authors conducted an 18-month naturalistic prospective follow-up study of 37 adolescents whose bipolar I illness had been stabilized with lithium carbonate during inpatient hospitalization. Thirteen of the patients discontinued prophylactic lithium therapy shortly after discharge. The relapse rate of bipolar illness in these 13 patients was nearly three times higher than the rate in patients who continued lithium prophylaxis without interruption. Early relapse among lithium-treated patients was associated with a greater risk of relapsing again. The authors discuss the theoretical and clinical implications of these findings.
The structuring of interpersonal relations in schizophrenic adolescents: a decentering analysis of Thematic Apperception Test stories.
This study tested the hypothesis that schizophrenics employ more developmentally immature levels of decentering in their structuring of interpersonal relations. A 9-point scale of interpersonal decentering, developed originally by Feffer, was applied to Thematic Appercetion Test stories produced by schizophrenic adolescents and a control group of psychiatrically disturbed patients equivalent in age and intellectual functioning. Results provided convincing support for the hypothesis tested and suggest the theoretical utility of viewing interpersonal deficit in schizophrenia from a cognitive-developmental perspective.
Body image disturbance in anorexia nervosa during the acute and recuperative phase.
Perception of body size, subjective experience of body image distortions and differentiation of body concept in the human figure drawing were assessed in adolescent anorexia nervosa patients and controls shortly after hospital admission, and again 6 months later during the recuperative phase. Size estimation was not found to be a distinguishing variable, as both groups exhibited overestimation tendencies of comparable magnitude at both time periods. By contrast, experiences denoting estrangement from the body, insensitivity to body sensations, and weakness of body boundaries were more prevalent in anorexics, and persisted at high levels after frank symptoms of weight and eating disorder had subsided. Anorexics were also shown to depict the human figure with less differentiation relative to controls. Within the anorexic sample the presence of vomiting was linked to greater subjective experience of body image distortion, and such phenomena appear to be a more enduring feature in this subgroup. Overall, the results were viewed as lending support to the argument that defects in body image formation render the anorexic vulnerable to their manifest pathology, which is itself activated by maturational conflicts unique to adolescence.
Manic-depressive illness in early adolescence. A study of clinical and diagnostic characteristics in six cases.
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Affective disorder in adolescence: issues in misdiagnosis.
This case report describes a young adolescent female with bipolar manic-depressive illness, (MDI), whose behavioral symptomatology was originally attributed to non-affective forms of psychopathology. We review her entire clinical course to date and elucidate several factors that may account for diagnostic error.
Effects of intravenous and oral dexamethasone on selected lymphocyte subpopulations in normal subjects.
Our studies describe the effects of 1 mg oral (PO) and intravenous (IV) administration of dexamethasone (DEX) on certain subpopulations of circulating lymphocytes in normal subjects. We compared the outcomes of PO and IV DEX administration because of individual differences in gastro-intestinal absorption of DEX and the issue of noncompliance in patients undergoing the dexamethasone suppression test (DST). Both routes of DEX administration were equally effective in suppressing plasma cortisol levels below 5 micrograms/dl, the customary criterion level. Both routes of DEX administration also significantly decreased the percent and absolute number of CD4+ cells, the CD4+/CD8+ ratio, and the percent and absolute number of virgin, but not of memory, CD4+ cells.