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Biomedical subjects

S J Kantor

Publications and source records attributed to S J Kantor.

18 recordsLinked to original sources
PubMed1995

ECT and the media.

Explore the source record for details and available documents.

Electroconvulsive Therapy↗
PubMed1990

Depression: when is psychotherapy not enough?

In doing intensive psychotherapy or analysis with patients who suffer both personality and affective disorders, one must simultaneously maintain psychologic and biologic perspectives. Cooper, when talking of patients suffering from panic disorders, states that analysts must distinguish between psychologic efforts to cope with miscarried brain function and the psychologic efforts to cope with disturbances of the intrapsychic world. This is also true of patients who have affective disorders. For instance, patients who suffer from untreated affective disorder often speak of their experience of themselves as being out of control. They complain that they can never predict the stability of their emotional states. This aspect of their illness must be conceptualized not as reflecting faltering defensive operations and inadequate compromise formation but as the reaction of an otherwise healthy personality to the experience of being intermittently overwhelmed by biologically generated mood states. Cooper also states that biologic illnesses must be regarded as having influences that are both developmental and ongoing. The psychoendocrine work of Puig-Antic demonstrates the existence of endogenous depression in latency age children and Carlson and Kashani's recent clinical observations in preschool children support the notion that this illness can arise during periods of development. For such patients, the normal developmental tasks of childhood and adolescence may be severely compromised. For instance, extreme mood fluctuations of inexplicable origin may serve as a major disruption in the consolidation of a healthy sense of object constancy. Before closing, I would like to briefly mention two examples of the difficulties encountered when attempting to medicate and analyze the same patient. Ostow mentions patients who may attempt to use what he refers to as the "drug cure" to reinforce their resistance to psychotherapy. The analyst must be ever alert for this. An example occurred during my analysis of a 35-year-old novelist who had entered treatment for writer's block. She had been on medication for a number of years, had a strong family history of depression, and had relapses each time the medication had been discontinued or decreased. During the eighth month of analysis she reported that she had an interesting experience. She had forgotten to take her evening medication, something extremely unusual for her. She knew that antidepressants suppressed rapid-eye-movement sleep and that stopping tricyclics was often associated with vivid dreams and nightmares. Thus, she thought that the nightmare she experienced that night, something to do with being beaten up, could be explained pharmacologically.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Transference and the beta adrenergic receptor: a case presentation.

This case presentation demonstrates the importance of recognizing that patients can have both character pathology and affective disorders, shows the need to assess the impact of one illness upon the other, demonstrates the importance of having both medical and psychological viewpoints in attempting to manage such patients, and shows the pitfalls that can be encountered in working with such difficult cases. The paper offers speculations about the ways in which the biological and psychological aspects of affective disorder may be interrelated and the mechanisms of this interrelationship.

Adult↗
PubMed1979

Clinical characteristics of imipramine-induced orthostatic hypotension.

The effects of imipramine hydrochloride on blood-pressure were examined in a prospective and a retrospective study. In a prospective study of 44 depressed patients given imipramine in doses to achieve antidepressant plasma-concentrations there was no effect of the drug on lying blood-pressure. When patients then stood up, the drug produced an average fall in systolic pressure of 26 mm Hg (t = 13.6, P less than 0.001) that was consistent over the four weeks of observation. Contrary to expectation, this fall was independent of patients' age, pre-existing heart-disease, or plasma-level of the drug. The best predictor of orthostatic hypotension during treatment was the degree of orthostatic drop in pressure before treatment (r = 0.695, P less than 0.001). In order to establish the clinical significance of this orthostatic drop in pressure, a retrospective study of 148 depressed patients treated with imipramine was conducted. These 148 patients, average age 59 years, received an average dose of 225 mg of imipramine. Almost 20% of them had symptoms usually associated with orthostatic hypotension that were severe enough to interfere with their treatment: over 4% sustained physical injuries. In our experience orthostatic hypotension is the commonest serious cardiovascular side-effect of imipramine.

Adult↗
PubMed1979

The use of the psychiatric consultation record for residency training.

The Psychiatric Consultation Record (PCR) is an instrument developed to aid in the teaching of consultation psychiatry, to evaluate the impact of this teaching, and to provide an overall assessment of the consultation training program at St. Luke's Hospital. The PCR both structures the resident's training experience and provides a tool with which he or she can integrate theoretical and practical knowledge pertaining to consultation work. Its use has enabled supervisors to detect the degree to which didactic material has become integrated into residents' thinking and has provided data through which the scope and quality of each resident's work can be rapidly assessed. Finally, its use has brought to light deficiencies in service delivery which, before the use of this instrument, had not been apparent.

Adaptation, Psychological↗
PubMed1979

The electrocardiographic and antiarrhythmic effects of imipramine hydrochloride at therapeutic plasma concentrations.

The electrocardiographic effects of imipramine hydrochloride at therapeutic plasma concentrations were determined in 44 depressed patients during a 6-week clinical outcome study of depression. During each week of the protocol, i.e., 2 weeks of control and 4 weeks of drug treatment, a standard 12-lead ECG, high-speed, high-fidelity ECG tracings, and a 24-hour continuous ECG recording were obtained. PR, QRS, and QTc intervals, T-wave amplitude, heart rate and frequency of ventricular premature depolarizations (VPDs) were measured. The plasma concentration of imipramine and desmethylimipramine was measured three times a week. Imipramine prolonged the PR (p less than 0.001), QRS (p less than 0.001) and QTc (p less than 0.001) intervals, increased the heart rate (p less than 0.001) and lowered T-wave amplitude (p less than 0.05) during the 4 weeks of treatment. No patient developed high-grade atrioventricular block or severe intraventricular conduction abnormalities. In addition, imipramine had a potent antiarrhythmic action in patients who were recovering from depression. Ten of 11 patients who had more than 10 VPDs/hour had 90% or greater arrhythmia suppression during antidepressant treatment with imipramine at plasma concentrations ranging from 100--302 ng/ml.

Adult↗
PubMed1978

The cardiac effects of therapeutic plasma concentrations of imipramine.

The authors studied the effects of imipramine hydrochloride at plasma concentrations associated with antidepressant activity in seven patients hospitalized for severe depressive illness. They found that the drug usually produced prolongation of intraventricular cardiac conduction. Although this was generally well tolerated, the authors suggest that patients with preexisting conduction system disease may be at increased risk when taking tricyclic antidepressants. They feel that the orthostatic hypotension seen in all seven patients represents a potentially serious problem with tricyclic antidepressants. They discuss the antiarrhythmic properties associated with imipramine and significant interactions between imipramine and drugs taken by patients with cardiovascular disease.

Adult↗
PubMed1977

Clinical implications of imipramine plasma levels for depressive illness.

Sixty depressed nonschizophrenic patients were admitted to a research unit. Following one drug-free week and one week of placebo, patients received 3.5 mg/kg of imipramine hydrochloride for 28 days. Plasma levels of imipramine and its metabolite desipramine hydrochloride (desmethylimipramine) were measured three times weekly and the relationship between plasma steady-state levels and clinical outcome was examined. Steady-state levels ranged from 50 to 1,050 ng/ml. There was a statistically and clinically significant relationship between plasma levels and response. The relationship existed across the entire sample, and was accentuated when the bipolar and unipolar nondelusional populations were examined. Because a strong relationship between sex and outcome was observed, the unipolar nondelusional patients were stratified by sex and a significant relationship still persisted. Only the unipolar delusional patients failed to demonstrate an association between blood level and clinical response.

Bipolar Disorder↗
PubMed1977

Delusional depressions: natural history and response to treatment.

A review of the abundant literature concerning the distinction between delusional and non-delusional depressions, especially of the work of Aubrey Lewis, reveals that before the introduction of specific therapies most in-patients with major depressive illness eventually recovered; the small percentage who did not almost all came from the delusional group. The dichotomy lost its clinical significance after the introduction of ECT, as both groups were equally responsive. However, accumulating evidence indicates that unipolar delusional depressives are significantly less responsive to tricyclic anti-depressant therapy than non-delusional depressives. The presence or absence of delusional thinking should be considered as a significant criterion in the classification of depressive disorders, and the presence or absence of delusional thinking should influence the choice of treatment for severely depressed patients.

Antidepressive Agents, Tricyclic↗
PubMed1976

Plasma levels of imipramine in depression. Environmental and genetic factors.

On the basis of tentative evidence obtained with 26 patients with unipolar affective illness, the variability in the response to imipramine is mostly due to interindividual differences in hydroxylating microsomal enzymes which are genetically controlled but whose activities are subject to modification by environmental factors such as overall pharmacological exposure and tobacco smoking. Additional significant pharmacodynamic variability (twofold) was found in the range of the volumes of distribution of imipramine in the patients. Clinical outcome was unequivocally related to plasma level. Unipolar nondelusional patients with levels less than 180 ng/ml had a low probability of recovery, while levels above 180 ng/ml were assoicated with a high probability of recovery. Unlike the findings of investigators working with nortriptyline, our data do not suggest an upper limit on plasma levels beyond which clinical response deteriorates. It appears that, on the basis of family studies, similar genetic characteristics are related to the ones controlling the pharmacodynamics will be the subject of further examination in our continuing studies.

Adult↗
PubMed1975

Imipramine-induced heart block. A longitudinal case study.

A 2:1 atrioventricular block developed during treatment with the tricyclic antidepressant imipramine in a 74-year-old man with a three-year history of right bundle-branch block. Serial cardiographic studies and determinations of blood imipramine concentrations showed that the heart block was directly related to the plasma concentration of the drug and occurred below the atrioventricular node in the His-Purkinje system.

Administration, Oral↗
PubMed1975

Depression, Delusions, and Drug Response.

Depressed patients with delusions were found to be markedly unresponsive to tricyclic drug therapy during an ongoing study of depressed patients. After four weeks of administration of imipramine hydrochloride, only 3 of 13 delusional depressed patients had responded to the drug, but 14 of 21 nondelusional depressed patients had responded. The authors conclude on the basis of these data and those of other researchers that delusional depressed patients should not be treated with tricyclic antidepressants and that current research with depressed patients should be reevaluated in the light of this finding.

Adult↗