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Biomedical subjects

S A Checkley

Publications and source records attributed to S A Checkley.

At least 19 recordsLinked to original sources
PubMed1992

Contribution of psychological and social factors to psychotic and non-psychotic relapse after childbirth in women with previous histories of affective disorder.

Twenty-six women with a history of bipolar or schizoaffective disorder, 17 women with histories of major depressive disorder and 45 control women without any previous psychiatric history were assessed in the 9th month of pregnancy on selected psychosocial measures. No subject was a 'case' as defined by the Research Diagnostic Criteria (RDC) from this time until the delivery. Within 6 months postpartum, 22 (51%) of the women with histories of mental illness were categorised as having relapsed (RDC case). Twelve women developed a psychosis (mania, hypomania or schizomania) and these illnesses occurred only in women with histories of affective or schizoaffective psychosis whereas 10 other women who became depressed after delivery came equally from the women with histories of psychosis (N = 5) as from those with histories of major depression (N = 5). Three (7%) control women also developed postpartum non-psychotic depressive disorders. Multivariate analyses suggest that different psychosocial factors contribute to the recurrence of affective and schizoaffective psychosis after delivery as opposed to non-psychotic postpartum affective disorders. A non-psychotic illness was predicted by antenatal neuroticism and a severe life event before illness onset. A recurrence of psychosis postpartum was predicted by a history of mania, hypomania or schizomania, a more recent psychiatric admission and reported marital difficulties. In this sample of women, life stress led to postpartum depression irrespective of the subject's past history and the high rates of recurrence of affective or schizoaffective psychosis (47%) probably mainly reflected a pre-existing physiological or psychological vulnerability which may have been exacerbated by, or contributed to, marital difficulties.

Bipolar Disorder↗
PubMed1992

Noradrenaline uptake inhibition increases melatonin secretion, a measure of noradrenergic neurotransmission, in depressed patients.

Eight patients with endogenous depression who had received no antidepressant treatment for the previous year were treated with the noradrenaline (NA) uptake inhibitor, desipramine (DMI). Pre-treatment plasma melatonin concentrations were normal. After one day of DMI treatment plasma melatonin concentrations were increased but the response was impaired compared to normal subjects. The acute effect of DMI on plasma melatonin persisted after six weeks of treatment. These findings question the hypothesis that beta adrenoceptors are supersensitive in depression and that antidepressant drugs act by down-regulating these receptors.

Adult↗
PubMed1992

The acute and chronic effects of (+) and (-) oxaprotiline upon melatonin secretion in normal subjects.

Ten healthy male subjects were treated for three weeks with (+)oxaprotiline, a selective inhibitor of noradrenaline (NA) uptake and with (-)oxaprotiline which does not inhibit NA uptake. Plasma melatonin concentrations were measured throughout the night at 0, 1, 7 and 21 days and were higher during treatment with (+)oxaprotiline than with (-)oxaprotiline for the entire three weeks of treatment. Since NA stimulates the production and secretion of melatonin, these results are consistent with a sustained increase in noradrenergic activity within the pineal, during 21 days of treatment with an effective NA uptake inhibitor.

Administration, Oral↗
PubMed1992

Women whose mental illnesses recur after childbirth and partners' levels of expressed emotion during late pregnancy.

Expressed emotion (EE) in the partners of 25 pregnant women with a history of psychosis or severe depression and in 13 pregnant control subjects without any previous psychiatric disorder was assessed in the ninth month of pregnancy. At this time, no patient presented as a case according to RDC. Eleven subjects with a history of psychiatric disorder experienced a further episode of illness in the six months following delivery. Partners of women who became ill had made fewer critical and positive comments about their wives during the pregnancy than the partners of women who remained well. Poor self-rated social adjustment in the partners was also predictive of recurrence of illness after delivery.

Adult↗
PubMed1991

Increased sensitivity of dopamine receptors and recurrence of affective psychosis after childbirth.

OBJECTIVE: To test the hypothesis that affective psychosis after childbirth is associated with an altered sensitivity to dopaminergic stimulation. DESIGN: Prospective study of pregnant women at high risk of developing an affective psychosis after childbirth. Clinical assessments in pregnancy and after delivery were made by using a semistructured interview (schedule for affective disorders and schizophrenia) and psychiatric illnesses were categorised according to operational criteria (research diagnostic criteria). SETTING: Obstetric and psychiatric departments in and around Greater London. SUBJECTS: 29 pregnant women with a history of bipolar or schizoaffective psychosis and 47 control pregnant women. Of these, 16 from each group participated in a growth hormone challenge test and the results for 15 women in each group were analysed. INTERVENTIONS: On the fourth day postpartum women participating in the hormone challenge test were given a subcutaneous injection of a small dose (0.005 mg/kg) of the dopamine agonist apomorphine. MAIN OUTCOME MEASURES: Growth hormone secretion in response to apomorphine as an index of the functional state of hypothalamic dopamine receptors. RESULTS: Eight of the 15 women at risk of psychosis subsequently had a recurrence of illness (five bipolar, one schizomanic, and two major depressive illnesses); these women had significantly greater growth hormone responses to apomorphine than the seven at risk women who remained well and the 15 controls, and there were no significant differences between groups in average baseline growth hormone concentrations. The mean (SD) concentrations for women with recurrence, women at risk who remained well, and control women respectively were: average baseline concentrations 1.06 (1.14), 1.44 (1.39), and 0.90 (1.34) mU/l; peak increase in concentrations 13.68 (12.95), 3.46 (4.68), and 3.40 (3.83) mU/l (between group difference p less than 0.05); average increase in concentrations 6.74 (7.01), 1.78 (3.39), and 1.40 (2.05) mU/l (p less than 0.05). CONCLUSIONS: The onset of affective psychosis after childbirth was associated with increased sensitivity of dopamine receptors in the hypothalamus and possibly elsewhere in the brain. Such changes may be triggered by the sharp fall in circulating oestrogen concentrations after delivery.

Adult↗
PubMed1991

Life stress and post-partum psychosis: a preliminary report.

This is a preliminary report from a prospective study of the influence of psychosocial stressors on post-natal relapse in women at high risk of psychiatric disorder after childbirth. Forty-three index subjects with a previous history of psychosis or severe depression were compared with 45 pregnant control subjects without any previous psychiatric disorder. After delivery 51% of index subjects relapsed (RDC diagnoses): 28% were categorised as psychotic and 23% non-psychotic. All psychotic relapses were in women with a previous history of bipolar or schizoaffective disorder (46% of this subgroup). Only the non-psychotic post-partum relapses (mostly depressions) were associated with an increased likelihood of a severe life event in the 12 months preceding illness onset.

Bipolar Disorder↗
PubMed1990

Changes in a proposed new neuroendocrine marker of oestrogen receptor function in postpartum women.

We describe a novel neuroendocrine test which reflects a central response to activation of oestrogen receptors. This is achieved by measurement of plasma levels of oestrogen-stimulated neurophysin (ESN) following an oestrogen challenge. In normal women the ESN response to ethinyl oestradiol is dose-dependent. This response is attenuated in normal women during the first postpartum month, although it is unchanged in patients with anorexia nervosa, in spite of their similar concurrent hypo-oestrogenic state. The altered puerperal response may result from the acute oestrogen withdrawal which occurs at delivery. The time course of the altered ESN response coincides with the period of maximum risk for puerperal psychosis. The ESN response to oestrogen provides a novel neuroendocrine measure to test the relevance of changes in central oestrogen receptor responsiveness in the pathogenesis of puerperal psychosis.

Adolescent↗
PubMed1990

Naloxone inhibits oxytocin release at orgasm in man.

We examined the effect of naloxone on plasma oxytocin levels during sexual activity in men. Eight normal men took part in a double-blind, two-period, cross-over design. Mean plasma oxytocin rose to 362% of baseline values at orgasm with placebo (saline) but showed no increase with naloxone (P less than 0.01). While naloxone had no effect on heart rate or blood pressure at orgasm, a decrease in the level of subjective arousal and pleasure at orgasm was noted. We conclude that opioid receptor blockade with naloxone has an inhibitory effect on the neural pathways mediating the oxytocin response at orgasm.

Adult↗
PubMed1989

Effects of light treatment upon mood and melatonin in patients with seasonal affective disorder.

Ten patients with seasonal affective disorder received the following treatments for 5 days each: (a) artificial daylight (2500 lux) from 20.00 to 23.00 and from 07.00 to 10.00 hours; (b) red light (300 lux) from 20.00 to 23.00 and from 07.00 to 10.00 hours; (c) artificial daylight (2500 lux) from 22.00 to 23.00 and from 07.00 to 08.00 hours. The antidepressant effect of treatment (a) was superior to that of treatment (b), suggesting that the effect of light treatment in winter depression is more than that of a placebo. The antidepressant effect of treatment (a) was superior to that of treatment (c), although these two treatments equally suppressed plasma melatonin concentrations. Consequently, in these patients there is a dissociation between the effect of light treatment on melatonin and the reduction of depression ratings.

Adult↗
PubMed1989

A study of the effects of desipramine treatment alone and in combination with L-triiodothyronine on 6-sulphatoxymelatonin excretion in depressed patients.

Urinary 6-sulphatoxymelatonin (alpha MT6s) excretion was measured after one day and one, two and three weeks of desipramine treatment in eight depressed patients. There was significant increase in the urinary excretion of alpha MT6s after one week of treatment, and at no time was there any decrease in alpha MT6s excretion. These findings are opposed to the hypothesis that desipramine reduces noradrenergic neurotransmission in the human pineal. In a further five patients whose depression was resistant to desipramine alone, urinary alpha MT6s excretion was measured during treatment with adjunctive L-triiodothyronine (T3). There was no change in alpha MT6s excretion, and thus the previously reported potentiation of the efficacy of tricyclic antidepressants in combination with T3 does not appear to be mediated through an alteration in noradrenergic neurotransmission.

Adult↗
PubMed1988

Growth hormone response to clonidine after recovery in patients with endogenous depression.

The growth hormone response to clonidine was measured in ten drug-free recovered patients, seven of whom had previously been tested when endogenously depressed, and compared with the response in ten individually matched controls. In eight of the patients there was an impairment of the growth hormone response, despite clinical recovery, although the hypotensive effect of clonidine in these patients was normal. This is suggestive of a persisting abnormal alpha2-adrenoceptor function in forebrain regions after recovery from an episode of endogenous depression, and may represent a trait marker for this condition.

Adult↗
PubMed1988

A comparison of melatonin secretion in depressed patients and normal subjects.

Depressed patients were carefully matched in pairs with normal subjects for the variables which are known to influence the secretion of melatonin in humans. In contrast to the previous literature, nocturnal melatonin secretion was not lower in the depressed group than in the normal group, and there was no difference in the timing of secretion; indeed, the trend was for greater melatonin secretion in the depressed group. The results are discussed in relation to previous studies, none of which has been so carefully controlled for the relevant variables.

Adult↗
PubMed1988

A study of sulphatoxymelatonin excretion and gonadotrophin status during weight gain in anorexia nervosa.

To clarify a controversy as to whether melatonin secretion is related to body weight, urinary sulphatoxymelatonin (aMT6s) excretion was estimated in 10 patients with anorexia nervosa before and after weight gain, and compared with 10 age-matched controls. There was no change in aMT6s excretion after weight gain, and no significant difference between the patients and control groups at either point. Significant increases in plasma LH, FSH, and estradiol were detected after weight gain in anorexic patients, independent of aMT6s excretion.

Adult↗
PubMed1988

A controlled trial of d-fenfluramine in bulimia nervosa.

A double-blind, placebo-controlled trial of d-fenfluramine in bulimia nervosa was undertaken in order to assess its efficacy in controlling bulimic behavior and relieving more general symptoms. A high proportion of the patients evaluated were reluctant to enter the drug trial in spite of the offer of additional supportive psychotherapy and counselling on dietary control. Moreover, 17 out of the 42 enrolled patients withdrew halfway through the 12 week trial. Were it not for this high rate of defaulting, there might be clearer support for the efficacy of d-fenfluramine in reducing the frequency of overeating and self-induced vomiting in these bulimic patients. An unexpected finding was that among the noncompleters, those on d-fenfluramine had experienced relief of their bulimic symptoms. The persistence of depressive symptoms and features of the eating disorder probably contributed to the noncompleters leaving the trial. Reassuring findings were the absence of weight loss and serious unwanted effects from d-fenfluramine. By itself, d-fenfluramine did not benefit some of the patients with severe bulimia nervosa, but it may yet prove a useful adjunct to psychological treatments.

Adolescent↗
PubMed1987

Changes in oxytocin and vasopressin secretion during sexual activity in men.

We measured plasma oxytocin (OT) and arginine vasopressin (AVP) concentrations in 13 normal men during sexual arousal and ejaculation. Mean plasma AVP increased from 1.4 +/- 0.2 (+/- SE) to 5.3 +/- 1.7 pmol/L (P less than 0.05) during arousal, but there was no significant change in OT. In contrast, at ejaculation mean plasma OT rose from a basal value of 1.4 +/- 0.3 to 7.3 +/- 0.6 pmol/L (P less than 0.01) and then fell to basal concentrations in 30 min. AVP, however, had returned to basal levels at the time of ejaculation and remained stable thereafter. We conclude that in man AVP is secreted during sexual arousal, and there is, subsequently, a selective release of OT at the time of ejaculation.

Adult↗
PubMed1986

Neuroendocrine and other studies of the mechanism of antidepressant action of desipramine.

It is not known whether in depressed patients antidepressant treatment increases or reduces monoaminergic neurotransmission. Clinical studies are therefore reviewed that investigate adaptive changes at adrenoceptors in depressed patients treated with desipramine, and the net effect of these changes upon neurotransmission. Although in animals chronic desipramine treatment enhances the responsiveness of alpha 1-adrenoceptors to phenylephrine, no such effect could be demonstrated in patients upon the responsiveness of pupil diameter to phenylephrine. However, in keeping with animal studies, clinical evidence of altered responsiveness of alpha 2-adrenoceptors could be demonstrated after chronic desipramine treatment. The alpha 2-mediated growth hormone response to clonidine was increased after one week's treatment with desipramine and then reduced during the second and third weeks of treatment. No clinical measure of the responsiveness of central beta-adrenoceptors is available. However, the secretion of melatonin is a measure of neurotransmission at noradrenergic terminals in the pineal with alpha 1-, alpha 2- and beta 1-adrenoceptors. In normal volunteers the secretion of melatonin was increased by the noradrenaline uptake inhibitors desipramine and (+)-oxaprotiline; (-)-oxaprotiline had no effect. In depressed patients melatonin secretion was increased after three weeks' treatment with desipramine. These and other clinical studies suggest that antidepressant treatments increase noradrenergic neurotransmission in depressed patients.

Animals↗
PubMed1986

No effect of naloxone on plasma oxytocin in normal men.

The role of endogenous opiates in the control of the secretion of oxytocin in the basal state in healthy male volunteers was investigated with the opiate antagonist naloxone. There was no change in plasma oxytocin levels, assessed for a 120 min period following the intravenous administration of naloxone (10 mg). Although there was no effect of opiate receptor blockade with naloxone in this basal situation, further studies are needed to evaluate the possible role of opioid regulation of oxytocin during lactation and parturition.

Adult↗