Adrenaline and MAO-inhibition in CSF and brain.
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Animals↗
Biomedical subjects
O J Rafaelsen
Publications and source records attributed to O J Rafaelsen.
Cerebrospinal fluid vasopressin--changes in depression.
Cerebrospinal fluid (CSF), thyrotropin releasing hormone (TRH), CSF-vasopressin (AVP), plasma-AVP, CSF-osmolality, plasma-osmolality, CSF-adrenaline (A) and -noradrenaline (NA) were measured in psychiatric patients and controls. Psychiatric patients were classified according to ICD-9 and grouped into endogenous depression, non-endogenous depression, mania and schizophrenia. The depressive groups were classified according to the Newcastle Rating Scale for Depression 1965. Severity of disease was quantified by BRMES, BRMS and BPRS. No difference in CSF-TRH levels was seen among the different diagnostic groups and controls. A positive correlation between CSF-TRH and CSF-A was demonstrated. CSF-AVP concentrations were significantly lowered in both endogenous and non-endogenous depression; no correlation with CSF-A or -NA was seen. Neither did any difference between plasma levels of AVP, plasma-osmolality or CSF-osmolality appear among the groups investigated.
Adolescent↗
Assessment of the anticholinergic effects of antidepressants in a single-dose cross-over study of salivation and plasma levels.
In order to evaluate the anticholinergic effect of antidepressant drugs, 11 healthy volunteers were given single oral doses of reference drug, test drugs or placebo on a double-blind basis at weekly intervals. The doses corresponded to average daily patient medications. Spontaneous whole mouth and parotid salivation, and plasma levels of drug and possible metabolites were measured 2, 6 and 10 h after drug administration. Moderate, statistically significant inhibition of salivation was found when nortriptyline, imipramine-N-oxide and mianserin were given. Less pronounced, but still statistically significant inhibition occurred after ingestion of nomifensine and zimelidine. The zimelidine effect was exclusively due to the metabolite norzimelidine, and the inhibition after imipramine-N-oxide was mainly due to the metabolite imipramine, but imipramine-N-oxide itself also had slight activity. Isocarboxazide and lithium had no effect on salivation. From these results and reported values of pharmacokinetic variables, the average level of anticholinergic activity during long-term treatment may be predicted: for mianserin and (nor-)zimelidine moderate inhibition of salivation, although less pronounced than with nortriptyline; for nomifensine no clinically significant effect; and for imipramine-N-oxide a negligible contribution from the unmetabolized drug.
Adult↗
Vasoactive intestinal polypeptide decreased in cerebrospinal fluid (CSF) in atypical depression. Vasoactive intestinal polypeptide, cholecystokinin and gastrin in CSF in psychiatric disorders.
Vasoactive intestinal polypeptide (VIP), cholecystokinin (CCK) and gastrin in the cerebrospinal fluid (CSF) were studied in patients with endogenous depression, non-endogenous depression, mania, schizophrenia and a control group. All patients were classified according to ICD-9 and the group of depressions was further classified according to the Newcastle Rating Scales for depression (Carney et al. 1965) (N-I). In the group of non-endogenously depressed patients, CSF-VIP levels (median 16 pmol/l) were found to be significantly lower than those of controls (median = 32 pmol/l) and endogenous depressives (36 pmol/l). In the non-endogenous group, it appeared that the low CSF-VIP was due to a group of patients who, during a past or present depressive episode, had been diagnosed as suffering from endogenous depression. Moreover, this group was clinically characterized by 'dysphoric/hysterical features', 'reversed diurnal variation' (i.e. worse in the evening), and 'lack of clearly circumscribed episodes'. In many aspects this group seems similar to the atypical depressives described as monoamine oxidase inhibitor responders. Concerning CSF-CCK and CSF-gastrin, no significant differences between the examined groups were demonstrated.
Adult↗
Salivation after single-doses of the new antidepressants femoxetine, mianserin and citalopram. A cross-over study.
Twelve healthy volunteers were given oral single doses of a reference drug (nortriptyline), test drugs, and placebo on a randomised single-blind basis at weekly intervals. The doses corresponded to average daily patient medication. Spontaneous whole mouth salivation was measured before (at 10 p.m.) and 10 hours after drug administration (at 8 a.m.). Drug plasma levels were determined after 4 and 10 hours. When analysing the salivations 10 hours after drug administration adjusted for the effects of the pre-treatment salivations, statistically significant inhibition of salivation was found after nortriptyline (56%), femoxetine (34%), and mianserin (29%) when compared with placebo, while for citalopram and cis- and trans-flupenthixol no significant inhibition of salivation was demonstrated (Fig. 1, Table 5). From the estimated log linear regression coefficients, relating adjusted salivation rates and drug plasma levels 10 hours after drug administration (Table 6), and reported average steady-state plasma drug levels (Table 7), semiquantitative predictions of the average level of anticholinergic activity during long-term treatment may be made: For femoxetine and mianserin, moderate anticholinergic activity, less pronounced than with nortriptyline, are predicted, while for citalopram no such activity can be predicted (Table 7).
Adolescent↗
Diurnal variation of total plasma tryptophan in depressive patients.
Total plasma tryptophan was analysed during a 24-h period in 27 control persons and 42 patients with a diagnosis of endogenous depression. Total plasma tryptophan was unchanged in endogenously depressed patients compared with controls. The effect of one night's sleep reversal was investigated in control persons. During the following day, when the persons were asleep, plasma tryptophan concentration fell below control values. The normal diurnal variation with low values in the night and high values in the daytime disappeared when the persons were kept fasting.
Adult↗
World Health Organization Schedule for Standardized Assessment of Depressive Disorders (WHO/SADD-5). Item combinations and interobserver reliability.
In this study we have examined four parts of the 5th revision of the World Health Organization schedule for Standardized Assessment of Depressive Disorders (WHO/SADD-5): (I) items that cover the present depressive state; (II) items that cover the psychiatric history; (III) a global assessment scale for the severity of depression, and (IV) the current ICD-9 diagnosis. Our analysis was based on a comparison of the interobserver reliability of item combinations leading to DSM-III, RDC, Newcastle and Melancholia Scale classifications of patients with depressive disorders. To facilitate these combinations we had added 4 items to SADD: (a) quality of depression, (b) persistence of depression, (c) reactivity of symptoms, and (d) accusations of others. Our results showed that WHO/SADD-5 has an acceptable degree of interobserver reliability both at the levels of global assessment of severity of depression and ICD-9 diagnosis, whereas the item combinations obtained lower intraclass coefficients. However, the items analysis focused on two SADD subscales of acceptable interobserver reliability: a severity scale of 16 items selected from our Melancholia Scale, and a diagnostic scale of another 10 items selected from the two Newcastle Scales.
Adult↗
Catecholamines and vasoactive intestinal polypeptide in cerebrospinal fluid in depression.
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Catecholamines↗
The Hamilton Anxiety Scale. Evaluation of homogeneity and inter-observer reliability in patients with depressive disorders.
In the present study the Hamilton Anxiety Scale (HAS), originally constructed for patients with neurotic anxiety, has been applied to patients with diagnosis of depressive disorders. The inter-rater reliability and homogeneity are evaluated and total scale score has been correlated to the Bech-Rafaelsen Melancholia Scale (BRMES). Twenty-two patients entered the study, 13 with endogenous depressions, and 9 with non-endogenous depressions when classified according to the ICD-8. For both scales the inter-rater reliability was found statistically significant. Concerning the homogeneity of the HAS, statistical significance was obtained for 7 items reflecting psychic anxiety, whereas in the BRMES statistical significance was found in all items apart from 2. Total scale score on HAS correlated positively with total score on BRMES for all 2 patients. However, when the patients were classified according to the ICD-8 this correlation seemed to be due to the endogenously depressed group as no significant correlation was seen for the group of non-endogenous depression. On the other hand, when the patients were classified according to the MULTI-CLAD system no significant intercorrelation of the HAS and BRMES scores was found within the subtypes of depression.
Adjustment Disorders↗
Diurnal variation of blood glucose during lithium treatment.
Plasma glucose was analysed during a 24-hour period in 62 lithium-treated patients. Compared with 59 normal control persons and 80 psychiatric controls the lithium-treated patients with neutral mood had higher maximum glucose and higher mean plasma glucose. Depressed lithium-treated patients had lower mean plasma glucose than the neutral lithium-treated patients. Depressed patients among the psychiatric controls did not differ from the neutral patients in this group with respect to plasma glucose.
Adolescent↗
Peptic ulcer complaints in lithium-treated and non-lithium-treated manic-depressive patients.
A possible protective effect of lithium against the occurrence of peptic ulcer complaints in manic-depressive patients, treated with lithium, was investigated. 167 manic-depressive patients, 91 in lithium treatment, 76 not in lithium treatment, were questioned about clinical symptoms of peptic ulcer. Thirteen of the lithium-treated and 23 of the non-lithium-treated patients reported symptoms of peptic ulcer. The difference was statistically significant. The hypothesis that lithium treatment reduces the frequency of symptoms of peptic ulcer in manic-depressive patients was thus confirmed.
Bipolar Disorder↗
Symposium on the teaching of psychiatry. Undergraduate medical students in Denmark.
The increasing role of psychiatry in the medical curriculum in Denmark is described. The general schedule of psychiatric teaching to medical students is outlined, emphasizing some of the special features of the Danish tradition. Roughly speaking, six per cent of all curriculum time is devoted to psychiatry. Clinical psychiatry, medical psychology and human sexuality are described separately. Interesting new possibilities for psychiatry in connection with a current curriculum reform, allotting more time to clerkships, elective periods and liaison teaching are pointed out.
Curriculum↗
The Melancholia Scale and the Newcastle Scales. Item-combinations and inter-observer reliability.
The reliability of the total scores on three rating scales (Melancholia Scale and the two Newcastle Scales) and the algorithms leading to the Feighner, Research Diagnostic Criteria, and the DSM-III subtypes of depression have been compared. The degree of inter-observer agreements for the various item-combinations was significantly higher than would be expected by chance. The average agreement for each assessment system ranged from 80 to 93 per cent. This 7 to 20 per cent lack of total agreement probably reflects the limitation of clinical assessments including the influence of halo effects.
Adult↗
Organic cerebral reactions in alcoholism: psychobiological aspects of treatment.
The paper considers the rational biological basis for treatment of alcohol withdrawal reactions, alcoholic hallucinosis and the Wernicke-Korsakoff syndrome. Both clinical and experimental data indicate that the alcohol withdrawal reaction reflects a state of hyper-reactivity of the central nervous system. The evidence comprises physiological, electrophysiological and biochemical findings. Magnesium, vitamins and antipsychotics are not specific in the treatment of the alcohol withdrawal reactions per se; rational treatment comprises drugs that may substitute for the suppressive effects of alcohol in the CNS during readaptation to the alcohol free condition (e.g. barbiturates or benzodiazepines). Alcoholic hallucinosis is characterised by acutely developed auditory hallucinations of an evil or reproachful nature. The condition may develop during or shortly after excessive alcohol consumption in chronic alcoholics. Suggestibility and unclear consciousness is not part of the condition. Tentatively three subgroups are suggested to occur: a) a withdrawal reaction; treatment with sedatives is recommended; the prognosis is good, b) a toxic reaction occurring during the drinking bout; this condition should be treated with antipsychotics until symptoms have disappeared. The prognosis is fairly good, c) a schizophreniform condition. Long-term treatment with antipsychotics must be applied. The Wernicke-Korsakoff syndrome is described. The condition often occurs during or shortly after an acute withdrawal reaction. The biochemical role of the etiological factor thiamine in glucose metabolism suggests that precautions (thiamine treatment) must be taken when giving a glucose load to alcoholics. Finally focus is set on the recent suggestion that the syndrome may in some cases result from an inborn enzymatic abnormality comprising low binding of thiamine pyrophosphate to transketolase. Psychobiological aspects of treatment in alcoholism may apply to a very large spectrum of conditions involving symptoms of cerebral, hepatic, gastrointestinal, cardial and peripheral nervous system origin. In the present expose we shall concentrate on organic cerebral reactions partly or exclusively presenting with psychiatric symptoms and signs. Thus the review will consider the rational biological basis for treatment of alcohol withdrawal reactions (including delirium tremens), alcoholic hallucinosis and the Wernicke-Korsakoff syndrome.
Alcohol Amnestic Disorder↗
Report of international activities--current research in Denmark.
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Amino Acids↗
Multi-axial classification of depression: MULTI-CLAD-2 case record system.
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Affective Disorders, Psychotic↗
Lithium treatment regimen and renal water handling: the significance of dosage pattern and tablet type examined through comparison of results from two clinics with different treatment regimens.
For many year two Danish psychiatric hospitals having used different lithium treatment regimens. In one, slow-release tablets were given in two daily doses and, in the other conventional tablets were given in a single daily dose. In both hospitals many patients developed polyuria. Multiple regression analyses with sex, age, treatment duration, serum lithium concentration, and treatment regimen as predictor variables showed that the two treatment regimens did not affect the glomerular filtration rate or the proximal reabsorption differently, but that distal water reabsorption was significantly less affected and polyuria less pronounced in the patients given conventional tablets once daily than in those give slow-release tablets twice daily. The authors are divided among themselves as regards the implications of these findings.
Adult↗
Nocturnal temperature in affective disorder.
The temperature rhythms of 9 drug-free patients with primary affective disorder were measured during depression and after recovery and compared with those of 12 normal controls. The patients had higher nocturnal temperatures and decreased 24-hour amplitudes when depressed than when they had recovered and compared to the controls. There was no evidence that the temperature minimum occurred earlier in the night in depression compared to controls. However, in 4 of 7 patients the temperature minimum occurred earlier in the night during depression compared to recovery.
Adult↗