Biomedical subjects

R T Joffe

Publications and source records attributed to R T Joffe.

187 records · Page 11Linked to original sources

PubMedDate not supplied

Major depression and subclinical (grade 2) hypothyroidism.

Subclinical hypothyroidism (SCH) has been reported to occur in patients with a variety of affective syndromes. However, the clinical correlates of SCH in patients with major depression have received limited attention. We therefore examined demographic, clinical and treatment response variables in a cohort of patients with unipolar, nonpsychotic major depression with and without SCH. Of 139 subjects, 19 had SCH defined as an elevated basal TSH with normal circulating levels of T3 and T4. Major depression with SCH differed from that without SCH by the presence of a concurrent panic disorder and a poorer antidepressant response.

Adult↗

PubMedDate not supplied

Quality of life and lifestyle disruption in euthymic bipolar disorder.

The objective was to assess the extent and pattern of illness intrusiveness, one measure of quality of life, in subjects with bipolar disorder (BD) and to determine whether specific illness variables had influenced the degree of intrusiveness experienced. To compare findings from BD subjects relative to published findings for subjects with chronic medical conditions. The study involved the administration of a self-report assessment tool to euthymic outpatients with BD attending a university based hospital clinic. Of the 155 eligible participants, 112 completed a standardized psychiatric interview (SADS-L) and 87 of these met study criteria for euthymia and were approached to participate in the study. Sixty-eight completed self-report measures were returned. The main outcome measure was the Illness Intrusiveness Rating Scale (IIRS) which was analysed along with a composite measure of life events. It resulted that individuals' with BD experience significant illness intrusiveness into a number of life domains even after controlling for negative life events. Factors such as type of BD, the presence of a depressive episode in the preceding year and current Hamilton depression rating scale score contributed to the total illness intrusiveness. The degree of total illness intrusiveness experienced by individuals with BD was similar to that of subjects with multiple sclerosis and greater than subjects with end stage renal disease and rheumatoid arthritis. It seems apparent that quality of life, as determined by illness intrusiveness, is compromised in subjects with BD even during periods of euthymia. BD is at least as intrusive as several chronic medical conditions. Those with a type II BD report greater impairment in all domains compared with type I. Future research should determine specific psychosocial interventions aimed at reducing the impact of BD.

Adult↗

PubMedDate not supplied

Relationship between antidepressant partial and nonresponse and subsequent response to antidepressant augmentation.

OBJECTIVE: To evaluate the relationship between the degree of antidepressant nonresponse and subsequent response to lithium and triiodothyronine (T3) augmentation. METHOD: This is a retrospective analysis of data combined from two previous controlled studies of lithium and triiodothyronine augmentation of tricyclic antidepressants. RESULTS: There was no difference in the rate of augmentation response between partial and nonresponders to tricyclic antidepressant treatment. CONCLUSIONS: Augmentation response does not appear to be related to the degree of nonresponse to the preceding antidepressant trial.

Adult↗

PubMedDate not supplied

Is self-criticism unique for depression? A comparison with social phobia.

BACKGROUND: This study further examined the diagnostic specificity of the self-critical personality dimension, as measured by the Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976. The Depressive Experiences Questionnaire. Yale University Press, New Haven). METHODS: Patients with major depression (n=26) were compared to social phobia patients (n=32). RESULTS: Depressed patients scored significantly higher on the DEQ Self-Criticism dimension. However, when current level of depressed mood was controlled for, self-criticism was not a significant predictor of diagnostic status. Further, the level of DEQ self-criticism reported by patients with social phobia was almost three times greater than the level reported in an earlier diagnostic specificity study with panic disorder patients [Bagby et al., 1992. Diagnostic specificity of the dependent and self-critical personality dimensions in major depression. J. Affect. Disord. 26, 59-64]. LIMITATIONS: Only one measure of self-criticism was used in this study, and the research design was cross-sectional rather than prospective. CONCLUSIONS: Self-criticism is not unique to major depression, and this personality dimension may be implicated in other forms of psychopathology [Blatt, 1991. A cognitive morphology of psychopathology. J. Nerv. Ment. Dis. 179, 449-458]. Some cognitive features believed to play an important role in depression may also be salient in persons with social phobia.

Adult↗

PubMedDate not supplied

Mexiletine in treatment-resistant bipolar disorder.

BACKGROUND: The purpose of this study was to evaluate the efficacy and safety of mexiletine, a medication with antiarrhythmic, anticonvulsant and analgesic properties, in treatment-resistant bipolar disorder patients. METHODS: Twenty subjects with rapid-cycling bipolar disorder who had failed to respond or were intolerant to lithium, valproic acid and carbamazepine were entered into the 6-week, open label study. Subjects were followed on a weekly basis for dosing of mexiletine, blood levels, and completion of the Hamilton Depression Rating Scale (HAM-D) and the Manic State Rating Scale (MSRS). "Burden of Mood Symptoms" (BMS) was calculated by combining scores for the HAM-D and MSRS. RESULTS: Thirteen subjects (10 female, 3 male), mean age 41 years (S.D.=7.6), and mean duration of illness 20 years (S.D.=7.7) completed the study. The dose range of mexiletine was 200-1200 mg/day. Full response (>/=50% reduction in BMS) was seen in 46% of the subjects, and a partial response (25-49% reduction in BMS) in 15%. Of note, 5/5 subjects with a mixed or manic state demonstrated a full or partial response. LIMITATIONS: This study has an open label design, and a small number of subjects. CONCLUSIONS: Mexiletine may be effective and safe in patients with highly treatment-resistant, chronic bipolar disorder. Randomized, controlled trials are required to confirm the current results.

Adult↗

PubMedDate not supplied

Neuroendocrine effects of carbamazepine in patients with affective illness.

Carbamazepine, a drug that is clinically effective in paroxysmal pain syndromes and in epilepsy, also appears to be effective in the treatment of manic-depressive illness. The mechanisms of action of carbamazepine and its endocrine effects remain unclear. Therefore, the hormone responses to sequential stimuli--namely, arginine, thyrotropin-releasing hormone (TRH), and luteinizing hormone-releasing hormone--were studied in six patients with major depressive disorder before and during treatment with carbamazepine. The drug was found to blunt the thyrotropin-stimulating hormone response to TRH and to augment the prolactin response to arginine. The advantages of the experimental design and the implications of the findings for carbamazepine's mechanism of action in affective illness are discussed.

Adult↗

PubMedDate not supplied

Discharge planning in mental health: the relevance of cognition to community living.

OBJECTIVE: The purpose of this study was to investigate the relationship between cognitive disability and performance of daily living skills and stability of cognitive level after discharge in a sample of adult psychiatric inpatients (N = 40). METHOD: The Allen Cognitive Level Test-90 (ACL-90) was administered at time of discharge (Time I) and at 21 days to 28 days after discharge (Time II). The self-report version of the revised Routine Task Inventory (RTI-2) was also administered at Time II. RESULTS: No significant correlation was found between the ACL-90 at Time I and the RTI-2 scores; however, significant correlations were found between the ACL-90 scores at both times and between the ACL-90 score at Time II and the RTI-2 scores. CONCLUSION: The findings suggest that cognitive level remains relatively stable over a 1-month period in the postacute stage of a psychiatric illness. Cognitive level and performance of daily living skills are related, but the relationship is sensitive to time. Implications for occupational therapy assessment include recognizing the temporal constraints of functional assessments and refining instruments to be more sensitive to performance of familiar tasks, taking into consideration client adaptation to exigencies.

Activities of Daily Living↗