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Biomedical subjects

S H Kennedy

Publications and source records attributed to S H Kennedy.

At least 19 recordsLinked to original sources
PubMed1992

Effect of chronic antidepressant treatment with adinazolam and desipramine on melatonin output.

Output of melatonin or its main metabolite, 6-sulphatoxy melatonin, provides an index of noradrenergic activity in the pineal gland, which is of interest in major depression and during its treatment with antidepressants. Fifteen female depressed outpatients did not differ in levels of 24-hour urinary 6-sulphatoxy melatonin compared with 13 female control subjects. However, a subgroup of the depressed patients (n = 9) who were treated with desipramine showed a significant elevation of 6-sulphatoxy melatonin levels after 1 week of treatment and a return to baseline levels after 6 weeks. There was also a significant negative correlation between 6-sulphatoxy melatonin levels and symptom severity as measured by the Hamilton Rating Scale for Depression after 3 weeks of treatment with desipramine. The other subgroup of depressed patients (n = 6) were treated with adinazolam, a benzodiazepine with antidepressant properties. Despite comparable antidepressant effects to those achieved with desipramine, adinazolam was not associated with any apparent change in 6-sulphatoxy melatonin output during 6 weeks of treatment. There was also no correlation between 6-sulphatoxy melatonin levels and symptom severity.

Adult↗
PubMed1992

A controlled assessment of direct intraperitoneal insemination.

OBJECTIVE: To test the efficacy of direct intraperitoneal (IP) insemination and its effect on cell-mediated immunity. DESIGN: A prospective trial with each couple having one treatment (insemination) cycle and one control (timed intercourse) cycle performed in random order with the same ovulation stimulation in both cycles. SETTING: Secondary and tertiary referral fertility clinics; university teaching hospital. PATIENTS: Twenty-six infertile couples. Excluding pregnancy, only one couple did not complete the two cycles. INTERVENTIONS: Ovulation induction in both cycles. Intraperitoneal insemination in the insemination cycles. MAIN OUTCOME MEASURES: These were pregnancy rate (treatment versus control) and mixed lymphocyte response (MLR) sensitivity (before and after direct IP insemination treatment). RESULTS: There were four control and no treatment pregnancies. This was not a significant difference (odds ratio). Mixed lymphocyte responses in fertile subjects did not change during the menstrual cycle (Wilcoxon). There was no significant increase in MLR sensitivity to partner's cells after direct IP insemination treatment. CONCLUSIONS: This controlled study found no benefit from direct IP insemination in terms of pregnancies over control cycles. There was no evidence that direct IP insemination had increased cell-mediated immune response sensitivity to husband's cells.

Adult↗
PubMed1992

Advances in diagnosis and treatment of anorexia nervosa and bulimia nervosa.

This paper reviews four areas of research into anorexia nervosa (AN) and bulimia nervosa (BN). First, in terms of diagnosis, the psychological concerns about weight and shape are now addressed in BN, bringing it more in line with the related disorder, anorexia nervosa. Second, studies of psychiatric comorbidity confirm the overlap between eating disorders and depression, obsessive compulsive disorder, substance abuse, and personality disorder. Nevertheless, there are reasons to accept the distinct qualities of each syndrome, and eating disorders are not merely a variant of these other conditions. Third, treatment advances in BN involve mainly cognitive-behavioural or interpersonal psychotherapies and pharmacotherapies primarily with antidepressants. The effect of combining more than one approach is beginning to be addressed. Finally, outcome studies involving people with both AN and BN have shown that the disorders "cross over" and that both conditions have a high rate of relapse. A renewed interest in the treatment of AN is needed.

Anorexia Nervosa↗
PubMed1991

Pineal and adrenal function before and after refeeding in anorexia nervosa.

Nine female subjects with anorexia nervosa (AN) were studied when emaciated (mean 72% of average body weight), and after refeeding (mean 85% of average body weight). They were compared to 9 individually age-matched female control subjects. On each occasion blood was sampled for serum melatonin and plasma cortisol through the night, and urine was collected over 24 hr to measure sulfatoxy melatonin levels. The AN group did not differ in their level of depression before and after weight gain. There were no significant differences in serum melatonin values among the patient group before or after weight gain and the control group. Levels of urinary sulfatoxy melatonin were also significantly higher in nighttime compared to daytime samples both before and after weight gain. Plasma cortisol values were significantly elevated in the emaciated state and this was accounted for by higher cortisol levels at 9, 10, 11, and 12 PM and at 6 AM compared with the weight restored state and to controls. This study suggests that pineal activity in patients with AN is not altered by chronic changes in weight, and is not closely associated with changes in cortisol.

Adrenal Glands↗
PubMed1991

A comparison of adinazolam and desipramine in the treatment of major depression.

Thirty-one patients with a DSM-III (R) diagnosis of Major Depression received adinazolam (n = 16) or desipramine (n = 15) during a 6 week double-blind randomized controlled trial. Both groups showed a significant decline in Hamilton Rating Scale for Depression scores (21.8 +/- 4.5 to 10.7 +/- 8.5 for adinazolam and 23.5 +/- 5.5 to 12.9 +/- 8.6) for desipramine. Melancholic and anxiety symptoms were reduced equally by both drugs. Initial sedation was the most common side-effect with adinazolam. Plasma levels of desipramine and hydroxy-desipramine correlated highly with oral dose after 3 weeks of treatment.

Adult↗
PubMed1991

Current perspectives on drug therapies for anorexia nervosa and bulimia nervosa.

Anorexia nervosa and bulimia nervosa are eating disorders that strike a significant number of adolescent and young adult women and carry a significant morbidity and mortality. Over the last 30 years, virtually every class of psychiatric drug as well as atypical agents have been tested in the management of these vexing and often chronic disorders. For anorexia nervosa, there is in 1991 little if any role for pharmacotherapy. Drugs used to promote food intake and weight gain, such as cyproheptadine, amitriptyline, clonidine and opiate antagonists, have provided disappointing results. For bulimia nervosa, double-blind placebo-controlled clinical trials have confirmed an antibulimic effect for tricyclic antidepressants, such as imipramine and desipramine. Monoamine oxidase inhibitors, while having a significant antibulimic effect, require careful adherence to a dietary regimen which may limit patient compliance. Newer antidepressants such as trazodone, amfebutamone and fluoxetine may prove useful if further study substantiates preliminary beneficial results. Other agents such as anticonvulsants, benzodiazepines, lithium, fenfluramine and opiate antagonists also require additional study, indicating that the optimal integration of pharmacotherapies with other treatments awaits further research.

Adolescent↗
PubMed1991

Bright light augmentation in antidepressant nonresponders.

BACKGROUND: This study was designed to examine the potential benefit of the addition of bright lights to antidepressant treatment in depressed subjects. METHOD: Ten patients who presented during the winter months with major depression and who had failed an adequate trial of antidepressants or who had relapsed following a successful course of antidepressants underwent a 2-week course of bright light therapy. RESULTS: Augmentation with bright lights resulted in substantial improvement in 7 of the 10 patients. CONCLUSION: Bright light augmentation may provide a useful treatment alternative for patients with treatment-resistant depression.

Adult↗
PubMed1991

Adverse interaction of fluoxetine and cyproheptadine in two patients with bulimia nervosa.

The sexual side effect of anorgasmia has been reported with a variety of antidepressants, including fluoxetine. Cyproheptadine has been used to counteract these side effects. The authors report two cases of bulimia nervosa in which the serotonin antagonist effect of cyproheptadine appeared to cancel out the therapeutic benefits of the serotonin-specific uptake inhibitor fluoxetine.

Adult↗
PubMed1990

Personality disorders in anorexia nervosa and bulimia nervosa.

Two self-report questionnaires (MCMI and BSI) designed to measure personality disorder (PD) according to DSM-III (R) criteria were administered to patients with a diagnosis of anorexia nervosa (AN) (n = 19), bulimia nervosa (BN) (n = 16), or both diagnoses (AN + BN) (n = 9), both before and after treatment for the eating disorder. The main finding was that self-reported Personality Disorder (PD) diagnoses are not stable enduring characteristics among this group of eating disorder patients. A high rate of PD diagnoses occurred in all patient groups at admission (93%) and at discharge (79%). Both MCMI and BSI scales were subject to significant change following treatment. A high prevalence of borderline personality disorder was found in patients with BN. Changes in depression and self-esteem scores correlated most strongly with changes in schizoid, schizotypal, histrionic and narcissistic scales. Assessment of PD using self-report measures should be interpreted with caution in acutely symptomatic patients with eating disorders.

Adolescent↗
PubMed1990

Sulphatoxy melatonin: an index of depression in anorexia nervosa and bulimia nervosa.

Urinary excretion of the principal melatonin metabolite, sulphatoxy melatonin (aMT6s), was assessed both during the day and during the night in 38 female eating disorder patients (anorexia nervosa, n = 17; bulimia nervosa, n = 12; anorexia nervosa + bulimia nervosa, n = 9) and 14 female control subjects. Correlations between nocturnal serum melatonin and urinary aMT6s were also obtained. All patient groups and the controls showed a preservation of diurnal rhythm with elevated nocturnal urinary aMT6s values and no significant difference in amplitude between groups. However, patients with concurrent major depression had significantly lower levels of daytime and nighttime urinary aMT6s than the nondepressed group. Weight did not influence these findings. Correlations between nocturnal serum melatonin levels and urinary aMT6s were high for control subjects (r = 0.77) and moderate for the patient groups (r = 0.31). This may reflect differences in the rate of excretion of melatonin between patients and controls.

Anorexia Nervosa↗
PubMed1990

A comparison of nafarelin acetate and danazol in the treatment of endometriosis.

Nafarelin 400 micrograms daily and danazol 600 mg daily were compared in a double-blind randomized study. Eighty-two patients with endometriosis were treated for 6 months after an initial laparoscopy and 74 had a second laparoscopy. Twenty-two (30%) patients had complete disease regression, 42 (57%) patients had a partial regression, and in 10 (13%) patients disease was unchanged or worse. Both treatments led to significant regression of active disease but not of adhesions. At 3 months follow-up, 34 (64%) patients reported their symptoms were improved, 15 (28%) reported no change, and 4 (8%) were worse. Nafarelin was associated with more hot flushes and headaches, and danazol with more weight gain. No significant differences, however, were noted in treatment efficacy between the two groups.

Adult↗