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Biomedical subjects

R C Veith

Publications and source records attributed to R C Veith.

At least 91 records · Page 5Linked to original sources
PubMed1986

Symptomatic depression in elderly medical outpatients. I. Prevalence, demography, and health service utilization.

The authors assessed the prevalence and demography of depressive symptoms, their association with specific chronic diseases, and their influence on health service use in a large sample of elderly men seen in a primary care setting. Twenty-four percent of respondents reported clinically significant depressive symptoms; the prevalence of major depressive disorders was estimated at 10%, but only 1% reported receiving mental health treatment by a specialist. Self-reported marital separation or divorce and physical disability affecting employment were strongly associated with high depression scores, whereas the normative stresses of aging (widowhood, retirement, social isolation) were not. Only chronic lung disease was differentially associated with high depression scores, and this effect was weak. The authors discuss the implications of these findings for the design of comprehensive health services for the elderly with chronic disease.

Aged↗
PubMed1986

Galanin: a novel pancreatic neuropeptide.

Immunofluorescent staining for galanin in canine pancreatic tissue was performed together with an evaluation of the effects of synthetic galanin on pancreatic output of glucagon, somatostatin, and insulin in pentobarbital-anesthetized dogs. A dense network of galaninlike immunoreactive nerve fibers was visualized in association with the islets of Langerhans and occasional galanin immunoreactive fibers were seen to course through the exocrine parenchyma of dog pancreas. During intravenous infusion of synthetic porcine galanin (25 pmol X kg-1 X min-1) pancreatic glucagon output rapidly doubled, and the output of both somatostatin and insulin decreased by 70%. Because arterial and pancreatic venous catecholamine levels remained unchanged, the effects on hormone secretion were not secondary to activation of the sympathetic nervous system. The direct pancreatic action of galanin was confirmed by infusing a peripherally ineffective dose of galanin (0.25 pmol X kg-1 X min-1) into the pancreatic artery, which also stimulated glucagon (+90%) and suppressed somatostatin (-50%) and insulin (-70%) release. The presence of galaninlike immunoreactive neurons in dog islets, together with the direct action of galanin on pancreatic hormone release, suggest that this recently discovered peptide could serve as an important neuromodulator of endocrine pancreatic function.

Animals↗
PubMed1984

Dose-dependent suppression of norepinephrine appearance rate in plasma by clonidine in man.

Clonidine is an alpha 2-receptor agonist which lowers both blood pressure and plasma norepinephrine (NE) levels in man. To determine whether the clonidine-induced fall in plasma NE is due to decreased NE appearance into plasma or increased NE clearance from plasma, NE infusions [( 3H]NE; 15 microCi/m2 bolus and 0.35 microCi/m2 X min infusion) were performed in 10 normal subjects, aged 25-56 yr. Arterialized plasma samples were obtained for measurements of steady state [3H]NE specific activity and plasma NE to allow calculation of plasma NE appearance rate and NE clearance before and 120-140 min after 1.5 and 5.0 micrograms/kg oral clonidine. Using an identical protocol, responses were compared in 4 subjects after placebo administration. Clonidine produced a dose-related reduction in mean arterial blood pressure, but no significant change in heart rate. The basal supine plasma NE concentration of 204 +/- 21 pg/ml (mean +/- SEM) fell by 27% (P less than 0.02) after low dose clonidine and by 51% (P less than 0.001) after high dose clonidine. There was no change in plasma epinephrine levels. The basal plasma NE appearance rate of 0.25 +/- 0.03 microgram/m2 X min was reduced by 32% (P less than 0.01) after low dose clonidine and by 52% (P less than 0.001) after high dose clonidine. The basal plasma NE clearance of 1.2 +/- 0.08 liters/m2 X min was unchanged after clonidine treatment. There was no change in mean plasma NE levels, plasma NE appearance rate, or mean arterial pressure after placebo administration. These findings demonstrate that the clonidine-induced fall in plasma NE levels is due to a dose-dependent suppression of plasma NE appearance rate and provide evidence for alpha 2-adrenergic inhibition of sympathetic nervous system activity in normotensive subjects.

Adult↗
PubMed1983

Tricyclic antidepressants and supine, standing, and exercise plasma norepinephrine levels.

Fourteen depressed patients were treated for 1 to 8 wk (4.1 +/- 0.6, mean +/- SEM) with imipramine, doxepin, or amitriptyline to study the effects of tricyclic antidepressants (TCAs) on sympathetic nervous system (SNS) function. Eight had chronic but medically stable cardiac disease and six were medically healthy. Supine plasma norepinephrine (NE) and epinephrine (EPI) levels, mean arterial blood pressure (MAP), and heart rate were measured at rest, after standing, and during graded, supine maximal bicycle exercise. Eight nondepressed patients with cardiac disease were studied without drug intervention as controls. There were no baseline differences in any of these measures among the medically healthy depressed subjects, the depressed cardiac patients, and the eight nondepressed patients matched for cardiac disease. After TCAs, NE was increased by 51 +/- 6% of basal values and heart rate rose, but EPI and MAP were unchanged. The supine to 10-min standing increment in NE increased from 309 +/- 51 pg/ml at baseline to 406 +/- 55 pg/ml during TCA treatment. These findings are compatible with an increase in SNS outflow after TCAs.

Adult↗
PubMed1983

Urinary MHPG excretion and treatment with desipramine or amitriptyline: prediction of response, effect of treatment, and methodological hazards.

Urinary 3-methoxy-4-hydroxyphenylglycol (MHPG) excretion was measured in 49 unipolar depressed outpatients to examine the relationship between pretreatment MHPG levels and therapeutic response to desipramine and amitriptyline and to determine the effects of these agents on MHPG excretion. Pretreatment MHPG excretion was greater in amitriptyline responders than amitriptyline nonresponders, but no different in desipramine responders compared to desipramine nonresponders. Pretreatment MHPG excretion did not differentiate desipramine from amitriptyline responders. Treatment for 3 weeks was associated with a decrement in MHPG excretion, particularly in the desipramine responders and combined desipramine and amitriptyline responders. Among patients within the postulated optimal desipramine plasma level range and patients with plasma amitriptyline plus nortriptyline levels greater than 70 ng/ml, high pretreatment MHPG excretion predicted therapeutic response and response was accompanied by a reduction in MHPG excretion. The interpretation of these findings is possibly confounded by the demonstration of a poor correlation (r = 0.61) between duplicate MHPG samples analyzed by a widely employed gas chromatography method and a gas chromatography/mass spectrometry technique. The methodological pitfalls encountered in the course of this investigation and their possible implications for similar studies are discussed.

Adult↗
PubMed1982

Cardiovascular effects of tricyclic antidepressants in depressed patients with chronic heart disease.

Twenty-four depressed patients with heart disease were treated for four weeks in a double-blind trial of imipramine, doxepin, or placebo to assess the effects of tricyclic antidepressants on ventricular function and rhythm. The tricyclic antidepressants had no effect on left ventricular ejection fraction at rest or during maximal exercise, as measured by radionuclide ventriculograms obtained before and after treatment. Premature ventricular contractions were reduced by imipramine but were not consistently changed by doxepin or placebo. Treatment with imipramine and doxepin, but not placebo, was associated with significant improvement (P less than 0.001) in standard ratings of depression. Our findings underscore the need for a reappraisal of the cardiovascular risks of tricyclic antidepressants and suggest that in the absence of severe impairment of myocardial performance, depressed patients with preexisting heart disease can be effectively treated with these agents without an adverse effect on ventricular rhythm or hemodynamic function.

Adult↗
PubMed1982

Screening for depression in hospitalized geriatric medical patients.

As part of an effort to improve the detection of depression in geriatric hospitalized medical patients, the validity of two self-rating depression scales, the Zung Self-rating Depression Scale (SDS) and the Popoff Index of Depression (ID), was evaluated. These two scales were completed by 42 medical inpatients whose mean age was 68 years. A psychiatrist who was "blind" to scale results interviewed each patient and diagnosed the presence or absence of depression according to the Diagnostic and Statistical Manual-III (DSM-III) criteria for Major Depressive Episode. On both the SDS and the ID, there was significant agreement between the scale results and the interview diagnosis. Compared with the interview diagnosis, the SDS had a sensitivity of 58 per cent and a specificity of 87 per cent, and it correctly identified 74 per cent of the patients as being either depressed or nondepressed. The ID had a sensitivity of 88 per cent and a specificity of 52 per cent, and it correctly identified 66 per cent of the patients. Although performance on both scales is reduced compared with that of younger depressed patients, these self-rating scales appear to be useful aids for the detection of depression in geriatric medical patients.

Aged↗
PubMed1982

Depression in the elderly: pharmacologic considerations in treatment.

The pharmacologic treatment of depression in the aged is complicated by an increased frequency of concurrent medical disease and multiple drug use. In addition, age-related physiologic changes may alter the pharmacokinetics and pharmacodynamics of the antidepressant medications. As a consequence, the variability of response and the incidence of adverse effects are increased in the elderly. The clinical implications of these factors and guidelines for the use of antidepressants in the elderly are discussed.

Aged↗
PubMed1982

Screening for depression in geriatric medical patients.

Depression, a common and treatable psychiatric disorder in later life, is often overlooked in geriatric medical patients. The authors evaluated the validity of two self-rating depression scales, the Zung Self-Rating Depression Scale and the Popoff Index of Depression, for 55 elderly patients. They compared these ratings with the diagnosis assigned by a psychiatrist who was blind to scale results and who interviewed these patients using DSM-III criteria. The two scales correctly classified 80% and 69% of the subjects, respectively. The authors identify six items from the two scales that may serve as a simple screening instrument for the detection of depression in geriatric medical patients.

Aged↗
PubMed1982

ECG effects of comparable plasma concentrations of desipramine and amitriptyline.

To compare the electrocardiographic effects of therapeutic doses of desipramine and amitriptyline, weekly electrocardiograms (ECGs) were obtained from 46 depressed outpatients treated blindly for 3 weeks to a maximum of 200 mg/day. There was no difference in mean weekly plasma tricyclic antidepressant levels achieved for the two drugs. Compared to baseline measures, treatment with both drugs was associated with an increase in heart rate and a reduction in T wave amplitude, whereas prolongation of the QRS and QTc intervals was significant only for desipramine patients. Comparisons between drugs revealed a greater prolongation of QRS interval duration with desipramine treatment. Changes in ECG measures were not correlated with plasma tricyclic antidepressant levels. The absence of QRS interval prolongation among amitriptyline patients is additional evidence for the importance of distinguishing between the ECG effects of therapeutic and toxic doses of the tricyclic antidepressant.

Adult↗
PubMed1981

Depression in older persons: diagnosis and management.

Depression is a common psychiatric disturbance of late life that is frequently not recognized by nonpsychiatric physicians. Confusion in psychiatric nosology, variability in clinical presentation, increased frequency of medical disease and medication use and cultural biases toward older persons complicate the diagnosis. Detection of depression is important because often this disorder can be successfully treated.

Adult↗
PubMed1980

Electrocardiogram changes and plasma desipramine levels during treatment of depression.

Twenty-six symptomatic subjects who met research diagnostic criteria for major affective disorder and were free of cardiovascular disease were treated for 3 wk with a fixed dosage schedule of desipramine (DMI) to a maximum of 200 mg/day. An electrocardiogram (ECG) and DMI plasma level determinations were obtained before treatment and weekly thereafter. DMI levels during the trial ranged from 13.4 to 882.2 ng/ml. DMI treatment was associated with increase in heart rate (p less than 0.001), prolongation of the PR (p less than 0.001), QRS (p less than 0.001), and QTc intervals (p less than 0.001), and increase in T wave amplitude (p less than 0.001). Significant (p less than 0.001) but relatively weak correlations were noted between DMI plasma levels and heart rate (r = 0.405), QRS interval (r = 0.346), QTc interval (r = 0.534), and T wave amplitude (r = -0.386). PR interval prolongation was independent of DMI levels (r = 0.171). DMI treatment induced no clinically significant ECG alterations or cardiovascular adverse effects. The relevance of DMI plasma level and the possible roles of other contributing factors in the production of these ECG changes are discussed.

Adult↗
PubMedDate not supplied

The neurobiology of aging: does it predispose to depression?

This review examines the various research approaches undertaken to investigate possible central nervous system correlates of major depressive illness and relates findings from these studies to the alterations in central nervous system and neuroendocrine function that normally accompany aging in humans. The topics reviewed include: epidemiology of depression and suicide in the elderly; monoamine theories of depression; neuroendocrine disturbances in depression; and imaging studies.

Aged↗
PubMedDate not supplied

Effects of advanced aging on plasma catecholamine responses to the cold pressor test.

Increased basal norepinephrine (NE) concentrations have been demonstrated repeatedly in human aging, but these studies have included almost exclusively "early aging" subjects younger than age 75. We asked if "advanced aging" (over age 80) enhanced the effects of early aging on plasma NE and epinephrine (EPI) concentrations at rest and in response to the cold pressor test (CPT). Eight medically well, cognitively intact advanced aging subjects (84.4+/-0.9 years), 28 medically well cognitively intact early aging subjects (70.3+/-1.3 years), and 19 medically well young subjects (25.4+/-0.9 years) were studied. Both basal NE and the acute NE increase after CPT were significantly higher in advanced aging than in either early aging or young subjects. Plasma EPI concentrations were higher in the advanced aging group than in the other groups and an acute plasma EPI increase after CPT occurred only in the advanced aging group. These results suggest specific effects of advanced aging on both the sympathoneural and sympathoadrenomedullary components of the sympathetic nervous system.

Adult↗
PubMedDate not supplied

Cardiovascular and neuroendocrine responses to extended laboratory challenge.

The purpose of this study was to examine the effects of a 2-hour laboratory challenge on heart rate, blood pressure, catecholamines, and cortisol; and investigate the contribution of the physical act of speaking on both neuroendocrine and cardiovascular measures. Using a within-subjects design, 14 subjects were tested individually during two separate laboratory sessions. During one session, subjects engaged in two cognitively demanding tasks for 2 hours. During the other session, subjects executed the verbal demands of the tasks for 2 hours, but cognitive demands were absent. During both sessions, blood pressure and heart rate were measured and arterialized blood samples were obtained for the measurement of epinephrine, norepinephrine, and cortisol. Subjects demonstrated significantly greater increases in systolic blood pressure diastolic blood pressure, heart rate, epinephrine, and cortisol during the cognitively challenging session than during the control session. It is concluded that sustained elevations in cardiovascular and neuroendocrine measures can be achieved in the laboratory, and that the effects of such tasks cannot be attributed solely to the physical demands of speaking. Implications for the measurement of circulating catecholamines and cortisol during laboratory studies are discussed.

Adult↗