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Biomedical subjects

S D Targum

Publications and source records attributed to S D Targum.

At least 37 records · Page 2Linked to original sources
PubMed1985

The future of research in private psychiatric hospitals.

The private psychiatric hospital setting offers some unique advantages as a locus for research. They are often able to serve as settings for clinical research programs which are, in many cases, more pragmatic than research in university settings. Types of studies which might be conducted in the private psychiatric hospital setting include focused diagnostic studies, the recovery process, psychobiological screening, psychopharmacological treatment trials, longitudinal studies, alternative delivery and training systems, and consortium studies. Funding for research exists in both the public and private sectors, with most of the money coming from the federal government. Applicants should be well-versed in the grant application at the National Institute of Mental Health.

Hospitals, Psychiatric↗
PubMed1984

Serum aldosterone following dexamethasone in depressed patients.

Serum aldosterone and cortisol responses to dexamethasone were studied in 17 patients with major depressive disorder, 16 nondepressed hospitalized patients and seven healthy controls. Serum aldosterone was neither blunted nor stimulated following dexamethasone in any of these three groups. Cortisol nonsuppression following dexamethasone, based on a criterion greater than 5 micrograms/dl, was noted in five depressed patients and two nondepressed patients. None of the seven patients with cortisol nonsuppression revealed any apparent abnormalities in their serum aldosterone secretory responses following dexamethasone. Thus, the incorporation of aldosterone measurements was not a useful extension of the dexamethasone test under the clinical conditions of this study.

Aldosterone↗
PubMed1984

Serial dexamethasone tests for predicting relapse in depressive disorder.

The dexamethasone suppression test (DST) was given to 86 patients with unipolar depression at the time of admission to the hospital. Thirty-three patients (38%) had abnormal DST responses. There was no difference in treatment response or outcome between patients with normal or abnormal DST responses on admission. Of the 33 patients who had abnormal DST responses on admission, 25 (76%) showed normal responses by the time of discharge. Five of the eight patients (63%) with "persistent" nonsuppression despite symptomatic improvement and discharge had relapse within six months, while only four of 25 patients (16%) whose DST response became normal (P less than .05) and ten of 53 patients (19%) who had normal DSTs at the time of admission (P less than .05) had relapse. These findings suggest that persistence of abnormal DST responses may provide a useful prognostic marker of risk for early relapse in depressive disorder.

Acute Disease↗
PubMed1984

The outpatient treatment of heroin addicts with methadone: a two- to five-year follow-up study.

This study is a two- to five-year follow-up of 40 patients who were discharged from a methadone maintenance program. Both "graduates" and prematurely discharged patients were surveyed. Forty-five percent of patients had been in treatment for one year or more. Outcome evaluation was based on a reduction of illicit drug use, an increase in social stability, and a decline in criminal activity. Eighteen of 40 clients were located and interviewed. Seven (39 percent) were found to be either drug free or using only prescribed methadone, and five had substantially reduced their drug use. Relapse to illicit drug use was associated with a pre-treatment history of poly-drug use, poorer work and arrest records, and a greater number of previous treatments. Abstinence appeared to be a realistic goal for only a few. The importance of retaining patients in treatment longer is discussed.

District of Columbia↗
PubMed1984

Persistent neuroendocrine dysregulation in major depressive disorder: a marker for early relapse.

Neuroendocrine challenge studies, including the dexamethasone suppression test (DST) and thyrotropin-releasing hormone (TRH) stimulation test, were administered to 86 patients meeting DSM-III criteria for major depressive disorder. Of 33 patients, 25 (76%) revealed normalization of abnormal DSTs at the time of symptomatic improvement, and 9 out of 26 patients (35%) revealed normalization of blunted TSH responses to TRH injection. Patients with normalized function revealed treatment responsiveness and low relapse rates (11%) similar to patients who had had normal neuroendocrine function at the time of admission. However, 11 of 23 patients with persistent dysregulation on either test (48%) relapsed within 6 months in contrast to 3 of 28 patients with normalized function (p less than 0.01) and 5 of 35 patients with normal neuroendocrine function on admission (p less than 0.02). These findings suggest that persistent dysregulation may be a valuable prognostic marker reflecting partial treatment responsiveness in some patients which predisposes them to early relapse. Both the DST and TRH tests appear to reflect neuroendocrine trait deficits which are independent of but interact with a coexisting predisposition to depressive disorder.

Adult↗
PubMed1984

Thyroid hormone and the TRH stimulation test in refractory depression.

Seven of 21 refractory depressed patients responded within 7 days to combined thyroid hormone-antidepressant treatment. Five of the 7 responders revealed evidence of subclinical hypothyroidism, suggesting that this subpopulation of depressed patients may benefit most from adjunctive thyroid hormone.

Adult↗
PubMed1983

Delusional symptoms associated with enlarged cerebral ventricles in depressed patients.

Computerized tomograms (CT scans) were completed on 75 melancholic depressed patients. Enlarged lateral cerebral ventricles were noted in eight of 36 delusional depressives (22%) in contrast to one of 39 nondelusional depressives (3%) (P less than .005). There were no demographic or clinical differences between patients with enlarged ventricles and those with normal ventricular size. The group of delusional patients had significantly lower verbal and performance scores on the Wechsler scales than did nondelusional patients (P less than .01), but this difference was not related to ventricular enlargement in the delusional group. The possible clinical relevance of enlarged cerebral ventricles is discussed.

Adolescent↗
PubMed1983

Neuroendocrine dysfunction in schizophreniform disorder: correlation with six-month clinical outcome.

The thyrotropin-releasing hormone (TRH) stimulation test and the dexamethasone suppression test (DST) were administered to 21 patients with schizophreniform disorder at the time of admission for acute illness: 9 showed dysregulation on one or the other test. Seventeen patients followed for 6 months were divided into two groups: those with persistent dysfunction and/or psychotic symptoms and those in full remission. Only 1 of 7 patients (14%) with persistent dysfunction in contrast to 7 of 10 patients (70%) in full remission revealed dysregulation on either test. Neuroendocrine challenges may be useful in the early assessment of first-break psychotic patients, and neuroendocrine dysregulation may be a predictor of episodic illness with a better prognosis.

Adolescent↗
PubMed1983

The dexamethasone suppression test in adolescent psychiatric inpatients.

The dexamethasone suppression test (DST) was administered to 120 adolescent psychiatric patients at the time of hospitalization, and cortisol levels were measured at 4:00 p.m. and 11:30 p.m. on the day after a 1-mg oral dose of dexamethasone was given. Failure to suppress serum cortisol (i.e., cortisol level less than 5 micrograms/dl) was noted in 25 patients: 7 of 17 patients who met DSM-III criteria for major depressive disorder, 7 of 38 patients with dysthymic disorder, 7 of 47 patients with conduct disorder, and 4 of 15 schizophreniform patients. The predictive value of the DST for major depressive disorder was only 28%. Although adolescent patients with abnormal DSTs may eventually develop affective symptoms consistent with a major depressive disorder, the DST did not discriminate between major depression and other psychiatric diagnoses in these hospitalized adolescents.

Adolescent↗
PubMed1983

The dexamethasone suppression test in suicidal patients with unipolar depression.

Of 49 newly hospitalized patients who met Research Diagnostic Criteria for primary unipolar depression and were given the dexamethasone suppression test (DST), significantly more patients admitted for suicide attempts than nonsuicidal patients had abnormal DSTs. All five patients who made subsequent suicide attempts (one completed) within 6 months after admission had had abnormal DSTs. These findings suggest that the tendency of endogenously depressed patients to attempt suicide is exacerbated by an underlying neurobiological disorder reflected by limbic-hypothalamic dysregulation and that depressed suicidal patients with abnormal DSTs represent a high-risk group for recurrence of suicidal behavior.

Adult↗
PubMed1983

Assessment of suicide risk: some limitations in the prediction of infrequent events.

Efforts to predict suicide and attempted suicide generally have yielded equivocal results. Neither single signs, standard psychological tests, specially devised tests, clinical judgments nor scales are found to be able to predict suicide at useful levels. Prediction of suicide is hampered by the relative rarity of this behavior together with the inadequate specificity of clinical characteristics and antecedent events. No highly unique descriptive attributes of suicide committers have been discovered. Within these existing limitations, a set of potential predictor variables are presented that may result in improved prediction of suicidal risk.

Humans↗
PubMed1983

The application of serial neuroendocrine challenge studies in the management of depressive disorder.

This paper describes the use of serial neuroendocrine challenge studies in the assessment of depressive disorder, specifically the dexamethasone suppression test (DST) and thyrotropin-releasing hormone (TRH) stimulation test. The combined use of these challenge tests revealed high sensitivity (67%) and high predictive value for the identification of endogenous depression in contrast to schizophrenia (p less than 0.025) or nondepressed patients (p less than 0.005). Further, normalization or persistence of dysregulation of these tests was correlated with clinical outcome at 6 months. Normalization of the DST occurred in 26 of 32 patients (82%) and was significantly correlated with the timing of symptomatic improvement (p less than 0.01). Five of six patients (84%) who never normalized the DST suffered an early relapse in contrast to 4 of 26 patients who did normalize (p less than 0.005). Unlike the DST, normalization of the blunted thyrotropin (TSH) response to TRH injection was not significantly correlated with the timing of symptomatic improvement. Only 8 of 19 patients (42%) ever normalized the TSH response. However, none of these 8 normalized patients suffered relapse within 6 months in contrast to 7 of 11 patients (64%) who did not normalize (p less than 0.025). Thus, failure of normalization of either the DST or TRH test was associated with a group of patients at high risk for early relapse. In this study, the use of prophylactic antidepressant medications did not avert relapse in 9 of 11 relapsed patients who had persistent neuroendocrine dysregulation.

Adolescent↗
PubMed1983

Cerebral ventricular size in major depressive disorder: association with delusional symptoms.

Computerized tomograms (CT scans) and neuroendocrine challenges (TRH stimulation test and dexamethasone suppression test) were completed in 38 melancholic depressed hospitalized patients. There were no significant differences in ventricular size between delusional and nondelusional depressives. However, 5 of 20 delusional depressives (25%) in contrast to none of 18 nondelusional depressives had ventricular brain ratios greater than 2 standard deviations from the mean of 26 neurological controls. There were no demographic, clinical, or neuroendocrine differences between patients with enlarged ventricles and those with normal CT scans. Two of 5 patients with large ventricles were rehospitalized within the 1st year of ascertainment in contrast to 3 of the other 15 delusional depressed patients. The possible relevance of cerebral ventricular size for depressive disorder is discussed.

Adolescent↗