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Biomedical subjects

W Vaughn McCall

Publications and source records attributed to W Vaughn McCall.

34 records · Page 2Linked to original sources
PubMed2004

Quality of life and function after electroconvulsive therapy.

BACKGROUND: The National Institute for Clinical Excellence in the UK has recommended limiting the use of electroconvulsive therapy (ECT), partly because of the inadequacy of research into the effects of ECT on quality of life and function. AIMS: To examine the effects of ECT on function and quality of life, particularly as they relate to changes in mood and cognition in the month following this therapy. METHOD: We measured changes in quality of life, function, mood and cognition in a prospective sample of 77 depressed patients given ECT. RESULTS: All quality of life and function outcomes were improved at the 2-week and 4-week marks after ECT. Improvement in quality of life was related to mood, whereas improvement in instrumental activities of daily living function was related to improvement in global cognition. CONCLUSIONS: Electroconvulsive therapy is associated with early improvement in function and quality of life. A restrictive attitude towards this therapy is not warranted on the basis of its effects on quality of life and function.

Cognition Disorders↗
PubMed2004

Long-term, non-nightly administration of zolpidem in the treatment of patients with primary insomnia.

INTRODUCTION: While it is common practice that hypnotics are used on a non-nightly basis, few investigations have been undertaken to evaluate the efficacy of the intermittent dosing strategy. The present study was designed to further evaluate this issue within a large scale, double-blind, placebo-controlled, long-term trial. METHOD: Patients who met DSM-IV criteria for primary insomnia participated in the study from January 2000 through October 2001. Patients were randomly assigned to 1 of 2 treatment groups (zolpidem 10 mg or placebo) for a period of 12 weeks. Ten pills were provided in foil packs on an every-other-week basis, and patients were instructed to take no fewer than 3 and no more than 5 pills per week. Sleep was evaluated daily with sleep diaries. Pill use was recorded in the sleep diaries. RESULTS: 199 patients (mean +/- SD age = 41.0 +/- 12.8 years; 71% female) were randomly assigned to treatment. On mean, patients receiving zolpidem exhibited (vs. baseline) a 42% decrease in sleep latency, a 52% reduction in number of awakenings, a 55% decrease in wake time after sleep onset, and a 27% increase in total sleep time. These positive clinical gains did not diminish with time and were not associated with dose escalation. There was also no evidence of rebound insomnia. CONCLUSIONS: Over a period of 12 weeks of intermittent treatment with zolpidem, sleep continuity was significantly improved, the clinical gains were sustained, and there was no evidence of subjective rebound insomnia between doses or increases in the amount of medication used during the study interval.

Adolescent↗
PubMed2004

Sleep in the Elderly: Burden, Diagnosis, and Treatment.

Insomnia is commonly seen in elderly populations and is associated with numerous individual and socioeconomic consequences. Elderly patients are more likely to suffer from chronic insomnia characterized by difficulty maintaining sleep than difficulty initiating sleep. Management of insomnia in these patients requires very careful evaluation and exclusion of an underlying medical or psychiatric condition. Nonpharmacologic interventions in elderly patients, especially use of behavioral therapy, have demonstrated some success. Commonly prescribed medications have also been effective, though they have limitations. Newer agents currently under investigation for insomnia hold promise for good efficacy and safety in the elderly population. The following review presents clinical studies, survey results, and guidelines retrieved from peer-reviewed journals in the PubMed database using the search terms elderly, temazepam, trazodone, zolpidem, zaleplon, insomnia, and prevalence and the dates 1980 to 2003. In addition, newer research with emerging agents has been included for completeness.

Journal Article↗
PubMed2003

Cognitive deficits are associated with functional impairment in severely depressed patients.

Cognitive deficits have been associated with poorer function and quality of life (QOL) in schizophrenia, but no similar findings have been confirmed in persons with major depressive episode (MDE). We investigated whether cognitive deficits were associated with detrimental effects on the QOL of persons with primary MDE. Seventy-seven non-demented adults with MDE underwent evaluations of mood, cognition and QOL. Cognition was assessed with the Mini-Mental State Exam, and delayed recall on the Rey Auditory Verbal Learning Task and the Rey Figure. QOL assessments included instrumental activities of daily living (IADL), activities of daily living (ADL), and satisfaction in role functioning and relationships. Univariate correlation and regression models were used to find those mood and cognitive variables most closely related to each QOL dimension. ADL function and satisfaction with role functioning and relationships were most closely related to depression severity and age. IADL functioning, however, was most closely associated with global cognition. This study did not take into account the physical health of the participants, and all the participants were seriously ill with depression. Thus, the results may not apply to persons with less severe MDE. Antidepressant treatments that preserve or enhance global cognition in addition to relieving core depressive symptoms may lead to the best functional outcomes.

Activities of Daily Living↗
PubMed2003

Behavioral and subjective effects of marijuana following partial sleep deprivation.

This study tested whether performance would be more impaired when marijuana use followed partial sleep deprivation (PSD) than when marijuana use followed a typical night of sleep. Seven recreational marijuana users (mean 15 of last 30 days) completed six test sessions in a double-blind randomized within-subject design. Each session began with an overnight stay in a sleep laboratory. Bed and wake times were calculated from mean data on individual sleep diaries. Time-in-bed was either regular (mean=8.2 h) or shortened (first 65% of regular time-in-bed deprived). At 3 and 5 h after waking, daytime sleepiness was measured with self-report questionnaires and a sleep latency test. Approximately 6.5 h after waking, subjects smoked a marijuana cigarette (0.003, 2, or 3.5% delta-9 tetrahydrocannabinol [THC]). Test batteries were completed 2, 62, and 122 min after smoking ended. Sleepiness was significantly greater following PSD than after regular sleep. Following regular sleep, heart rate increases with active THC doses were comparable, but heart rate with 2% THC was significantly less elevated following PSD. Ratings of "impaired" and "stoned" increased with both THC doses after regular sleep and were further increased with 3.5% THC after PSD. High-potency marijuana increased body sway similarly across sleep conditions. There were no significant effects of marijuana or PSD, alone or in combination, on brake latency. Thus, while PSD increased the dose-dependence of THC effects on heart rate and subjective impairment, it did not enhance the effects of marijuana on standing balance and brake latency.

Adult↗
PubMed2003

Stability over time of patients' attitudes toward ECT.

This study examined the stability of patients' attitudes toward electroconvulsive therapy (ECT). Surveys were administered to 64 study participants at 2 and 4 weeks post treatment. The survey responses were highly significantly correlated and not significantly different, which suggests that attitudes toward ECT are stable during this time.

Adult↗
PubMed2003

A meta-analysis of sleep changes associated with placebo in hypnotic clinical trials.

OBJECTIVES: The effects associated with placebo (EAP) have been incompletely described in clinical trials of insomnia treatment. We conducted a meta-analysis of insomnia medication trials for the purpose of estimating the magnitude of sleep EAP. METHOD: We reviewed Medline for 1966 through 2000 for the meta-analysis. The subject heading of insomnia restricted to the subheading of drug therapy was crossed against the results of a search on the subjects heading placebo and text word placebo. We selected only papers that examined primary insomnia, incorporating both placebo and active medication therapies in a randomized, double-blind, parallel-group design. We required that results be reported for 1, 2, 3, or 4 weeks of treatment, and that outcomes be reported in hours/minutes. RESULTS: Five papers satisfied our requirements for eligibility, comprising 213 patients receiving placebo for a 2-week interval. Subjective sleep latency demonstrated a significant reduction (mean+/-S.E.) of 13.1+/-2.0 min (95% confidence interval (CI) 9.2, 17.0) for the placebo group after combining the data across studies. Subjective total sleep time demonstrated a significant increase of 13.5+/-5.4 min (95% CI 2.9, 24.0). Polysomnographic (PSG) sleep latency demonstrated a non-significant reduction of 2.5+/-4.3 min (95% CI -5.9, 10.9). CONCLUSIONS: The confirmation of EAP in insomnia clinical trials argues for the retention of a placebo control in future insomnia clinical trials.

Humans↗
PubMed2003

The relationship between changes in learning and memory after right unilateral electroconvulsive therapy.

OBJECTIVE: We investigated whether the ability to learn new information, as opposed to recall information, would change significantly in depressed individuals treated by low- or high-dose right unilateral electroconvulsive therapy and tested whether change in learning explained changes in recall. METHOD: Fifty-four depressed patients randomized to receive right unilateral electroconvulsive therapy (ECT) at approximately 2.25 times their seizure threshold (ST) or at doses greater than 2.25 times ST were evaluated for verbal and figural memory as well as verbal and figural learning both pre- and post-ECT. A subset of scores from the Rey Auditory Visual Learning Test and the Rey Figure Test were analyzed using analysis of variance and linear regression techniques. RESULTS: Scores reflecting verbal learning decreased by a mean of approximately 50% immediately after a completed course of ECT as compared with pre-ECT verbal learning scores. Stratification of effect by dose of electrical charge revealed trends that did not achieve statistical significance. Approximately 8% of the change in delayed verbal recall was predicted by changes in verbal learning. Figural learning was not significantly changed in the aggregate (pre-versus post-treatment) or when the effect was stratified by electrical charge. CONCLUSIONS: Verbal learning scores declined immediately after ECT, but the change in learning scores explained only a minor part of the observed changes in verbal recall. These findings support the notion that the deficits in delayed recall after ECT represent a relatively specific cognitive effect that is not completely explained by changes in other aspects of cognition such as learning.

Aged↗
PubMed2003

ECT resistance and early relapse: two cases of subsequent response to venlafaxine.

Many depressed patients who fail to respond to numerous trials of antidepressant medications are ultimately referred for electroconvulsive therapy (ECT). However, a complete response does not occur in all depressed patients referred for ECT. The erroneous portrayal of ECT as a 'last ditch' treatment of depression leads to predictable despair if ECT fails or if early relapse occurs after a brief response. Therapeutic nihilism is not warranted in these cases. There is evidence in the literature that patients who fail to respond to adequate trials of antidepressant medications prior to ECT failure or early relapse subsequently respond to psychopharmacological treatment with high doses of venlafaxine. The following two case reports provide examples of depressed patients who subsequently responded to high doses of venlafaxine after demonstrating resistance to ECT, or experiencing rapid relapse after successful ECT.

Antidepressive Agents, Second-Generation↗
PubMed2002

Diagnostic codes associated with hypnotic medications during outpatient physician-patient encounters in the United States from 1990-1998.

STUDY OBJECTIVES: This investigation tabulates the most common diagnostic codes associated with use of hypnotic medications during physician-patient encounters in the U.S. DESIGN: Estimates were derived from the National Ambulatory Medical Care Survey (NAMCS) from 1990 through 1998. Diagnoses were coded according to the International Classification of Disease-Clinical Modification-9th Edition (ICD-9-CM). SETTING: The NAMCS collects outpatient visit data from nonfederal physicians of all specialties, except anesthesiology, pathology, and radiology. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Hypnotic medications were more commonly associated with psychiatric codes than with the symptom of insomnia. Primary insomnia did not appear among the codes most commonly associated with a hypnotic prescription. CONCLUSIONS: Hypnotics were more commonly associated with psychiatric codes than with insomnia codes, but it is unknown whether the coding accurately reflects the true diagnoses. Still, since there is minimal data on the efficacy and safety of hypnotics in persons with psychiatric disorders, these findings may signal a critical knowledge gap in the treatment of insomnia.

Drug Administration Schedule↗
PubMed2002

Proxy validation of patient self-reports of ADL and IADL function before and after electroconvulsive therapy.

OBJECTIVE: To determine whether electroconvulsive therapy (ECT) patients' self-reported functional status is similar to that reported by a proxy. BACKGROUND: Increasing levels of depression are associated with deteriorating functional status as reflected in the Instrumental Activities of Daily Living (IADL) scale. Depressed patients referred for ECT have poorer IADL status compared with depressed patients receiving medications, suggesting that IADL status may shape physicians' decision to recommend ECT ( 1). Further, IADL status improves with treatment of depression, both in ECT-and medication-treated patients. Given the potential importance of IADL status for ECT patients, we examined whether IADL status as reported by patients prior to ECT was comparable to IADL status as described by a proxy. DESIGN/METHODS: Forty depressed patients (23 men and 17 women, mean age 58.1 +/- 17.5) were each interviewed alone with the 21-item Hamilton Depression Rating Scale (HDRS), Mini-Mental State Exam (MMSE), an Activities of Daily Living (ADL) scale, and an IADL scale. We then privately interviewed a first-degree relative who lived with each patient and recorded their impression of the patient's ADL and IADL function before ECT, and at 2 and 4 weeks after ECT. RESULTS: baseline scores for HDRS and MMSE were consistent with a severe level of depressive symptoms and intact global cognitive function. Patients' and proxies' IADL scores were highly correlated before ECT, 2 weeks after ECT, and 4 weeks after ECT. Significant, but slightly weaker correlations were seen for ADL scores. CONCLUSIONS: Ideally, ADL and IADL function would be measured by direct observation rather than either patient or proxy report. At this time it is unknown whether the patient or the proxy report should be considered the "gold standard." In this study, the patients' self-reported functional scores were highly correlated with the proxies' scores. We conclude that patients' reports of their function are roughly comparable to proxies' impressions before and after ECT.

Activities of Daily Living↗
PubMed2002

Markedly suprathreshold right unilateral ECT versus minimally suprathreshold bilateral ECT: antidepressant and memory effects.

Right unilateral (RUL) ECT is reported to have fewer memory side effects than bilateral (BL) ECT. We compared RUL ECT at eight times the seizure threshold (ST) against BL ECT at 1.5 times the ST. Adults with major depression were randomly assigned to RUL ECT at eight times ST or BL ECT at 1.5 times the ST. Blinded ratings of mood and memory were made before ECT, 1 to 3 days after the final ECT, and at 2 and 4 weeks after ECT. Forty patients received RUL and 37 received BL ECT. The antidepressant response rate was not significantly different for the RUL and BL groups (60% vs. 73%). Sustained antidepressant response, accompanied by recovery from anterograde memory side effects, was seen through the first month with both treatments. Measures of mood and memory were not significantly different for the two groups at any time point. The modest sample sizes of this study do not rule out a type II error in the detection of small but meaningful differences between assigned treatments. Also, the period of post-ECT observation consisted of 1 month of naturalistic treatment. Both RUL ECT at eight times the ST and BL ECT at 1.5 times the ST produce similar mood and memory effects. Both forms of ECT produced acceptable antidepressant response rates and only transient anterograde amnesia. No clear advantage emerged for either form of ECT, and both are justifiable as first-line techniques of ECT.

Adult↗
PubMed2002

Increased physician-reported sleep apnea: the National Ambulatory Medical Care Survey.

BACKGROUND: Despite increased recognition of sleep apnea as a major health problem, little is known about physician practice patterns regarding this condition. METHODS: We used the National Ambulatory Medical Care Survey (NAMCS) data between the years of 1990 to 1998, a weighted estimate of the frequency of physicians' diagnoses nationwide in their outpatient practices, to address the following questions: (1) has there been an increase in physician reporting of sleep apnea, (2) which physicians reported diagnoses of sleep apnea, and (3) what are the demographic characteristics of patients with diagnoses of sleep apnea? RESULTS: During this 9-year period, there was a 12-fold increase in the diagnosis of sleep apnea in outpatients, from 108,121 to 1,305,624 diagnoses (p < 0.001). Among other primary sleep disorders, only insomnia had an increase in reporting (fourfold, p < 0.001). Report of sleep apnea was greatest among primary care providers (37%), pulmonologists (24%), and otolaryngologists (18%). Sleep apnea was reported more often in men than in women (3:1, respectively), and 80% of diagnoses occurred in the following age groups: 30 to 39 years (12%), 40 to 49 years (33%), 50 to 59 years (27%), and 60 to 69 years (12%). Conditions associated with sleep apnea included hypertension (10%), obesity (6%), and COPD (7%). Increased reporting of sleep apnea by NAMCS physicians was associated with increases in the number of accredited sleep laboratories and the number of sleep publications in the medical literature during the period of review (p < 0.001). CONCLUSION: Sleep apnea is recognized increasingly by physicians. Further investigation is necessary to define those factors that influence physician recognition and reporting of sleep apnea, and approaches associated with optimum patient outcomes.

Female↗
PubMedDate not supplied

Adequacy of antidepressant treatment by psychiatric residents: the antidepressant treatment history form as a possible assessment tool.

OBJECTIVE: Facility in psychopharmacology is a major goal of psychiatric residency. This study assesses the adequacy of pharmacotherapy provided to depressed patients in a resident clinic. METHODS: Charts of all 285 patients seen in an outpatient triage clinic during 2000 were reviewed. One hundred twelve patients had diagnoses of major depression, dysthymia, depressive disorder not otherwise specified, adjustment disorder with depressed mood, or bipolar disorder with a documented depressed episode during the studied period. Pharmacotherapy prescribed to these 112 patients was rated using the Antidepressant Treatment History Form (ATHF). Also analyzed were weeks in treatment and Clinical Global Impression (CGI) Severity score assigned retrospectively. RESULTS: Of the 112 charts subjected to detailed review, 49.1% documented adequate treatment. Antidepressant Treatment History Form ratings increased with treatment duration. No correlation was found between ATHF ratings and CGI ratings. CONCLUSIONS: Results suggest that time retained in treatment is a major factor in treatment adequacy.

Adjustment Disorders↗
PubMedDate not supplied

Aripiprazole for agitation in a 13-year-old girl with neuroleptic malignant syndrome.

UNLABELLED: Neuroleptic Malignant Syndrome (NMS) rarely results from atypical antipsychotic therapy. To date, no information is available on the incidence of NMS with aripiprazole, a newer neuroleptic. OBJECTIVE: To examine the results of a trial of aripiprazole administered to a 13-year-old Mexican-American girl during the course of NMS. METHODS: Vital signs and laboratory values obtained before and during the aripiprazole trial were compared. RESULTS: Aripiprazole administration resulted in a mild increase in tachycardia and brief worsening of serum creatinine kinase level, but did not significantly affect temperature, respiratory rate, or blood pressure. CONCLUSIONS: In this adolescent with NMS, aripiprazole treatment was associated with a mild worsening of symptoms.

Adolescent↗