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Biomedical subjects

P Doerr

Publications and source records attributed to P Doerr.

At least 19 recordsLinked to original sources
PubMed1987

Diurnal variation of mood and the cortisol rhythm in depression and normal states of mind.

A large scale chronobiological investigation was undertaken in 20 drug-free psychiatric inpatients displaying RDC major depression (endogenous subtype) in comparison to 10 healthy control subjects and 10 of the patients after clinical recovery. A series of measurements was taken 6 times a day and, in 8 of a total of 14 variables, also once a night over a period of 10 to 14 days. The following variables were assessed: mood (three different scales), performance (two tests), motor activity (three measures), salivary flow, urinary excretion of water, sodium, potassium, and free cortisol (UFC), and rectal temperature. A phase chart of the acrophases of the 8 variables with measurements taken during day and night revealed two clusters in the depressives and three in the non-depressed subjects. In the depressives, the acrophases of the mood scales clustered around the time of awakening in the morning, together with the acrophase of UFC, whereas all other acrophases clustered in the afternoon. In the non-depressed subjects, however, the mood scales reached their circadian maxima in the middle of the night around the time when sleep was interrupted to take measurements. All other acrophases corresponded roughly with those found in the depressives. The coincidence of the time course of depressed mood and cortisol excretion in the patients was interpreted as reflecting a temporal relationship between diurnal mood swings in depression and the cortisol rhythm. This interpretation was supported by the significant correlation between the acrophases of the two respective rhythms in patients showing a significant diurnal variation in mood. The mood curves of non-depressed subjects seemed unrelated to the cortisol rhythm. Probably, they mirror diurnal fluctuations of vigilance rather than fluctuations of mood. According to the literature, this rhythm is temporally related to the rhythm of melatonin secretion.

Adult↗
PubMed1987

Neuroendocrinological studies on depression with special reference to research at the Max-Planck-Institute of Psychiatry.

Hypercortisolism due to Cushing's syndrome or glucocorticoid therapy induces disturbances in several other endocrine systems and may also cause mental changes, predominantly depression of various degrees. On the other hand, it has repeatedly been shown that endogenous depression is often accompanied by hypercortisolemia, usually of a modest degree, and/or by changes in other hormonal systems similar to those observed in Cushing's syndrome and during treatment with glucocorticoids. Research performed at the MPIP on 327 psychiatric patients and 103 healthy subjects has demonstrated that, in contrast to Cushing's syndrome, the circadian rhythm in depression is usually well preserved, and that diurnal variation in mood is correlated with that rhythm. Furthermore, it was found that a modest hyperactivity of the HPA system, as indicated by enhanced UFC excretion and nonsuppression in the DST, is not specific for depression in general or its endogenous subtype. It can also be observed in many other psychiatric disorders and seems to mirror stress and the influence of other factors, such as weight loss due to anorexia, rather than a particular nosology. TSH blunting in the TRH test appears as a consequence of hypercortisolemia in psychiatric disorders as is the case in Cushing's syndrome and in the course of glucocorticoid therapy. Differences in the patterns of neuroendocrine abnormalities in depressives and other psychiatric patients probably reflect differences in the individual responsiveness of the various hormonal axes to stress rather than nosological subtypes of the disorder. A comparison of these results with the past and current literature reveals remarkable changes in the concepts of neuroendocrine dysfunctions in depression and leads to suggestions of new strategies for research on this subject.

Depressive Disorder↗
PubMed1986

The nature of neuroendocrine abnormalities in depression: a controversial issue in contemporary psychiatry.

Neuroendocrine abnormalities in depression have been regarded, by many authors, as relatively specific markers of nosological subtypes of the disorder, e.g. primary vs. secondary, endogenous vs. non-endogenous or unipolar vs. bipolar depression. They should reflect the same changes in central neurotransmitters (e.g. noradrenergic insufficiency and/or cholinergic hyperactivity) that were hypothesized as the cause of clinical symptoms. This view is challenged on the basis of our own neuroendocrine investigations in 317 psychiatric patients and 103 normal controls. According to these studies the abnormalities are nosologically rather unspecific. They are induced by a large variety of factors, e.g. emotional stress associated with the clinical symptomatology, weight loss due to malnutrition as a consequence of reduced appetite, medication and drug withdrawal. Stress-induced hypercortisolism appears to be the most common abnormality that may trigger other neuroendocrine dysfunctions, such as a blunted TSH response to TRH. Differences in neuroendocrine abnormalities of depressives are probably due to variations in the manifold factors influencing the hormonal axes involved, to temporal changes in hormonal patterns (e.g. one abnormality triggering another) and to individual differences in the basic activity and the responsiveness of the various axes.

Adrenocortical Hyperfunction↗
PubMed1985

Circadian rhythms in endogenous depression.

A comprehensive study of circadian rhythms was carried out in 16 drug-free patients with endogenous depression, 10 of whom were reinvestigated after clinical remission, and 10 healthy controls. No free-running periods were observed in body temperature, urinary excretion of potassium and free cortisol, or any other variable. Moreover, there was little, if any, indication of phase-advance. The circadian variation of several variables was reduced during depression, e.g., motor activity, body temperature, and (less markedly) urinary potassium, but not cortisol. The circadian worsening of mood tended to occur around the time of awakening during depression, i.e., several hours later than after remission or in normal controls. In patients with circadian variation of self-rated mood, the acrophase of this variable correlated significantly with that of urinary free cortisol. This indicates an entrainment of the disease process to the circadian rhythm of cortisol secretion, probably via circadian variations of neurotransmitters in the hypothalamus. The other circadian phenomena observed in depression can adequately be explained by masking effects (negative or positive) of psychopathological symptoms (e.g., early morning awakening) on overt circadian rhythms.

Adult↗
PubMed1984

The limited utility of the dexamethasone suppression test for the diagnostic process in psychiatry.

In 231 psychiatric in-patients, the 1 mg or 1.5 mg DST with blood samples at 0900 h, 1600 h and 2300 h and a post-dexamethasone plasma cortisol threshold of greater than or equal to 5 micrograms/dl were tested for their differential diagnostic utility in clinical psychiatry. Neither test significantly separated endogenous depressed patients from patients with other depressive or non-depressive psychiatric disorders. Studies of the 1 mg or 1.5 mg DST in 75 healthy subjects revealed about 12% of cortisol non-suppressors, when a post-dexamethasone cortisol threshold of greater than or equal to 5 micrograms/dl was used. This seemed to be an unacceptably low specificity of the test in normal subjects. A threshold criterion of greater than or equal to 8 micrograms/dl, however, yielded only 2.7% of non-suppressed normal subjects. Analyses of the DST data of the psychiatric patients, using a cortisol threshold of greater than or equal to 8 micrograms/dl, also failed to reveal a significantly higher specificity of the DST for endogenous depression. However, it was demonstrated that intervening variables such as stress due to hospital admission, drug withdrawal, suicidal turmoil, weight loss, as well as a low dexamethasone plasma level, enhance the rate of abnormal DST results in psychiatric in-patients, regardless of their diagnostic classification.

Adult↗
PubMed1982

Behavior, attitude, nutrition and endocrinology in anorexia nervosa.

Twenty-four anorexia nervosa patients participated in an inpatient broad spectrum behavior therapy program. The changes in body weight, anorectic behaviors and attitudes and endocrine variables (24-h plasma cortisol, dexamethasone suppression test, 24-h plasma luteinizing hormone) were measured. Data indicate that specific anorectic behaviors and attitudes showed significant improvement during inpatient treatment, while attitudes of a more general neurotic scope such as the feeling of insufficiency, general distress, (sexual) anxieties and anancasm did not. On admission 24-h plasma cortisol levels were elevated, episodic secretory spikes occurred at unusual times and the number was increased, cortisol plasma half-life was increased and non-suppression of cortisol secretion following the application of dexamethasone was observed. All these parameters normalized already after 10% weight gain. 24-h plasma LH pattern showed a close relationship with body weight. Our data suggest that the dysfunctions in anorexia nervosa patients in the hypothalamo-pituitary-adrenal and -gonadal axis have little specificity for this disease and are mainly a consequence of nutritional factors and starvation. The relationship between cortisol and HL-secretion, behavioral and attitudinal variables and weight gain was more complex than previously suggested by others and a positive relationship between the LH secretory pattern and anorectic symptomatology could be established.

Adolescent↗
PubMed1982

Efficacy and side effects of haloperidol in psychotic patients: oral versus intravenous administration.

It is a commonly held view among clinicians that intravenously administered haloperidol has a greater antipsychotic effect than oral haloperidol. To test this hypothesis, the authors carried out a double-blind study on patients with acute schizophrenia and patients with schizophreniform or schizoaffective (with manic features) psychoses. Using biologically equivalent doses, they found that intravenously administered haloperidol was slightly more effective during the first 3 hours; thereafter the route of administration did not make a difference in effectiveness.

Administration, Oral↗
PubMed1982

Neuroendocrinological and neurophysiological studies in major depressive disorders: are there biological markers for the endogenous subtype?

The possibility of characterizing subgroups of depressive disorders by biological markers was studied by means of the dexamethasone suppression test (DST), the 24-hr urinary free cortisol (UFC), the growth hormone response to the insulin tolerance test (ITT), and polygraphic sleep recordings. Forty-five hospitalized patients suffering from a moderate to severe nonpsychotic major depressive disorder were clinically subdivided into three groups: endogenous (n = 20), neurotic (n = 19), and "ambiguous" (n = 6). These clinical diagnoses were supplemented by operational diagnostic tools, namely, the Research Diagnostic Criteria (RDC) and the Newcastle Scale. The different diagnostic procedures exhibited a high degree of correspondence. Whereas the results of the ITT were normal in almost all patients, 20% of all patients were dexamethasone nonsuppressors and more than half of the patients showed a shortened REM latency. Both markers did not reveal any specificity for the endogenous subtype. A significant influence of weight loss on the DST and the excretion of UFC was evident.

Adult↗
PubMed1981

Temporal coordination of rest-activity cycle, body temperature, urinary free cortisol, and mood in a patient with 48-hour unipolar-depressive cycles in clinical and time-cue-free environments.

During medication-free observation a 66-year-old male patient showed an almost strict alternation of days with depressed mood and days with normal mood. The experiment consisted of two parts; the first was 4 weeks' observation in the psychiatric ward, while the second was 2 weeks' observation in an experimental unit where the patient was deprived of all known information on local time. In the psychiatric ward the observed circadian rhythms, i.e., the rest-activity cycle, the body temperature, the urinary free cortisol, and the mood rhythm, were all synchronized with the geophysical day. Under isolation from time cues the average rest-activity cycle duration was reduced to about 19.5 hr, whereas the body temperature and the urinary free cortisol continued to show rhythms with near-24-hr periods. The main finding of the study is the persistence of a near-48-hr periodicity in the mood fluctuation under isolation from time cues. Besides this, in the time course of body temperature and urinary free cortisol evoked components correlating with the mood cycles were found.

Activity Cycles↗
PubMed1979

Relationship between mood changes and adrenal cortical activity in a patient with 48-hour unipolar-depressive cycles.

A 66-year-old patient with 48-hour unipolar-depressive cycles was studied in the hospital for one month and in an isolation unit for two weeks. At 3-hour intervals during the day and once at night the mood state was assessed by two self-rating scales and urine was collected for the determination of urinary free cortisol (UFC). In the hospital there was a regular alternation between 'good' and 'bad' days. Without exception the switch from normal to depressive mood occurred between 22:00 and 2:30, when the patient was sleeping. The switch from depressive to good mood was variable and occurred in the late morning or in the afternoon. On a 24-hour basis a highly significant correlation was seen between the mood state and the UFC excretion: r = 0.73, P less than 0.001 (hospital); r = 0.82, P less than 0.01 (isolation unit). The shape of the 24-hour profile for the UFC excretion was similar on good and bad days, with a maximum between 2:30 and 7:00 and a minimum between 19:00 and 2:30. However, on bad days UFC was elevated at all clock times. A decrease in adrenal cortical activity preceded or was parallel to substantial improvement in the mood state. Internal desynchronization occurred in the isolation unit but not in the hospital, with a rest-activity period of 18.6 h and a period close to 24 h for UFC excretion. Changes in mood were associated with both cycles, and a very close link between the switch from normal to depressive mood and the sleep state could be demonstrated.

17-Hydroxycorticosteroids↗