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At least 19 recordsLinked to original sources

Clinical outcome and emotional-behavioural status after isolated coronary surgery.

In order to evaluate clinical and psychosocial results of isolated coronary artery by-pass graft (CABG) we studied 626 consecutive patients, mean age 61 +/- 8 years (86% men), in a follow-up (median: 58 months) with a complete questionnaire about cardiosurgical problems (post-operative vital status, angina relapse, infarction, heart failure, PTCA, redo, PM) and psychosocial variables (mood, irritableness, job satisfaction, hobby satisfaction, family relations, sexual activity, general well-being and work status). Global evaluation improvement of psychosocial variables was found in 71% of patients without cardiac events (group A) and 11% of patients with cardiac events (group B); worsening was found in 2% of group A and 1% of group B; no referred variations in 13% and 2% respectively (p < or = 0.05. Interests (in work, hobbies and sexual activities) demonstrate an improvement in 20% (group A) and 2% (group B); worsening in 12% (group A) and 4% (group B); no variations in 51% (group A) and 11% (group B) (p < or = 0.005). Patients reported a well-being evaluation improvement about 66% in the group returning to work without restriction, 13% in those with limitation, 6% no further working; worse or unchanged well-being evaluation was found in 9% of patients returning to work without restriction, 3% with limitation, 3% no further working (p < or = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged

[Treatment of general psychovegetative disorders with a single night dose of dipotassium-clorazepate within a multicenter study (author's transl)].

The therapeutical effect of Tranxilium was studied in an open multicenter study by 66 general practitioners and 26 specialists. 1.027 patients were treated with Tranxilium 20, given in a single dose at night, for a period of three weeks. During this time, the patient's psychic status and functional organic disorders were assessed by means of rating scales. A complete medical assessment followed at the end of the study. States of anxiety, restlessness, depressive mood, irritation and insomnia as well as functional organic disorders improved significantly (p is less than 0.001) already after the first week of treatment. At the end of treatment, with the majority of patients the above symptoms had either completely disappeared or were found only to a small extent. In 85% of the patients, all investigators rated the stabilization and brightening effect on psychic conditions as well as the harmonizing effect on disturbed organic functions as "very good" to "good". In 89% of the patients, the overall therapeutic success was judged as "very good" to "good". The overall tolerance was excellent in 96% of the cases.

Anti-Anxiety Agents

A 10-year follow-up study of 97 epileptics.

1) Of 267 patients with epilepsy who were examined in our clinic during the period between 1964 and 1966, 97 were investigated in a 10-year follow-up study. The patients were selected according to the following criteria: the age of onset of seizures was 10 years or older and the follow-up period was 10 years after the onset of seizures. Of the 97 patients, 36 were followed up by mail. 2) In the adult 10-year follow-up study, seizures disappeared in 43.3%, decreased in 34.0%, remained unchanged in 16.5%, and were aggravated in 6.2% of the 97 patients. Comparing the five-year follow-up study with the present study, the rate of cases which were free of seizures for three years was 22.7% in the five-year study and 43.3% in this study. The seizures were controlled for at least three years in 22.9% of the cases with partial seizure and in 63.3% of the cases with generalized seizure. The worst prognoses were found in cases with versive seizure in which the seizure was unchanged and/or aggravated in 4 (44.4%) of 9 cases. Of 16 cases with psychomotor seizure, 25% were unchanged or aggravated. 3) Comparing the impaired consciousness seizure with the psychomotor seizure, there was a tendency for the psychomotor seizures to remain as a single type of partial seizure, while the impaired consciousness seizure tended to develop easily into a secondarily generalized seizure. 4) Of the 97 patients, three were personality disorders in 19 cases (19.6%), episodic psychotic state in 2 cases (2.1%), and mental retardation in 6 cases (6.2%). Disorders of mood, irritability and explosiveness associated with personality disorders were improved in three of six cases whose seizures disappeared. Personality disorders were found in half of those cases with partial complex seizures. No correlation was found between mental symptoms and the prognosis of seizures. 5) The EEG was improved in 15 (27.8%) of a total of 54 cases, unchanged in 35 (64.8%) and aggravated in 4 (7.4%). In comparing the prognosis of clinical seizure with changes in the EEG, the seizures improved in 40 (74.1%) of the cases, whereas the EEG improved in only 15 (27.8%) of 54 cases. Most of the clinical seizures were controlled or decreased, whether the EEG improved or not.

Adolescent

An attributional approach to moods and the menstrual cycle.

Acceptance of an attribution pattern linking negative moods (depression, irritability) to the approach of menstruation and the likelihood of internal and external attributions were examined in a questionnaire study in which cycle phase (pre- versus postmenstrual), mood (positive versus negative), and environment (pleasant versus unpleasant) were varied. Subjects' rating indicated that (a) biology was judged important for explaining negative moods occurring premenstrually: (b) inconsistency between mood and environment produced more internal (personality) attributions, while consistency enhanced external attributions; and (c) emotionally expressive behavior was thought to reflect underlying personality dispositions despite extenuating situational factors (assumed personal causation). The theoretical relevance of the findings to a new conceptualization of premenstrual emotionality and to an attributional chain relating female self-concept and premenstrual tension is discussed.

Depression

[Sensation seeking and mood dimensions in depressive states].

This study presents the investigation of the relations between dimensions of depressive mood and sensations seeking in 55 hospitalized depressed subjects. The concept of sensation seeking, identified by M. Zuckerman as a personality dimension, has been defined as the need for the subject to reach his optimal level of activation. The four subscores of sensation seeking, relatively independent, are identified in the sensation seeking scale; they stand at different levels on the dimensions of activation and pleasure which are emotional dimensions. These emotional dimensions are investigated in the exploration of the emotional components of depressive mood; the different symptomatic regroupings, such as blunted affect or impulsivity, do not have the same relations with these dimensions. The sensation seeking concept appears fruitful to investigate the different troubles of affective dynamic, which stand on the expressive and behavioral level, and on the subjective level. As in several studies with normal populations, we find again the same inverse relation between age and sensation seeking, and men obtain higher scores on the Thrill and Adventure seeking factor and on the Desinhibition factor. Globally, depressed subjects have lower scores of sensation seeking than normal subjects (paired by age and sex); but the weakness of sensation seeking is not proportional to the intensity of depression (Hamilton Depressive Scale) and to the the intensity of anxiety (Covi Brief Anxiety Scale). Interesting relations appear with the depressive mood factors, which agree with previous studies of sensation seeking in psychology and psychopathology.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Serum levels of androgens are higher in women with premenstrual irritability and dysphoria than in controls.

Serum levels of progesterone, total testosterone, free testosterone, androstenedione (A2), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS), 17-OH-progesterone (17-OHP), and sex hormone binding globulin (SHBG) were measured in the follicular phase, around ovulation, and in the luteal phase of 11 women with severe premenstrual irritability and dysphoria and in 11 age-matched controls with no premenstrual complaints. Serum levels of free testosterone were significantly higher in the subjects with premenstrual syndrome (PMS) than in the controls in the luteal phase (p < 0.01), the follicular phase (p < 0.05), and around ovulation (p < 0.01). DHEA levels were significantly higher in the PMS subjects, as compared to controls, around ovulation (p < 0.05), while 17-OHP levels were higher in the PMS women in the luteal phase (p < 0.05). With respect to the other steroids measured, as well as SHBG, no differences between PMS subjects and controls were found. These results indicate a possible involvement of androgens in the pathophysiology of premenstrual irritability and dysphoria.

Adult

A genome-wide investigation of depression among individuals with and without irritability.

Individuals presenting with both depression and irritability may constitute a different group of individuals with respect to those presenting without irritability, but their biological differences remain unknown. We aimed to identify genetic variants associated with depression among individuals with and without irritability, highlight biological pathways, and test for genetic associations with other traits. We conducted a genome-wide association study (GWAS) using data from the UK Biobank (N&#x2009;=&#x2009;487,409). We identified a group of individuals presenting with depression and reporting never having experienced irritability (depression without irritability, n&#x2009;=&#x2009;35,857, 11.8%), and another with depression and reporting having experienced irritability (depression with irritability, n&#x2009;=&#x2009;23,613, 8.1%) and compared them to controls with no depression or irritability (n&#x2009;=&#x2009;268,012). The GWAS of depression without irritability identified 2 SNPs which reached genome-wide significance (P&#x2009;<&#x2009;5&#xd7;10-8; rs72795440 and rs1233494). The GWAS of depression with irritability (NGWAS&#x2009;=&#x2009;292,485) identified 3 SNPs reaching genome-wide significance (rs2815748, rs102275, and rs7227069). When comparing SNPs between depression phenotypes, 15 SNPs had significantly different effect sizes. Patterns of genetic correlation with 44 complex traits were overall similar between the 2 depression phenotypes, with the highest genetic overlap observed with anxiety for depression without irritability (rg&#x2009;=&#x2009;.77) and neuroticism for depression with irritability (rg&#x2009;=&#x2009;.76). This study shed light into common and distinct biological factors characterizing depression among individuals with and without irritability and contribute to better understanding the genetic architecture of depression to potentially inform treatment and personalized medicine.

Humans

Effect of a low-tryptophan diet as an adjuvant to conventional neuroleptic therapy in schizophrenia.

Eleven patients with DSM-III-R schizophrenia were entered into a 4-day tryptophan (TRP)-deficient diet. The diet lowered total plasma TRP levels in all patients; during the diet phase, there was a greater than 50% reduction in mean total plasma TRP levels from the pre-diet phase. The low-TRP diet improved performance on the Stroop Color and Word Test. These data are especially intriguing in view of the suggestion that a deficit in color-word naming is related to frontal lobe dysfunction and the possible occurrence of frontal lobe abnormalities in patients with schizophrenia. Interestingly, depressive symptomatology did not emerge on the TRP-deficient diet, despite the lowering of total plasma TRP levels. There were statistically significant improvements noted on objective ratings of the severity of psychotic symptomatology; however, these statistical improvements were without obvious clinical significance, as the magnitude of the changes on the behavioral ratings were minimal. The results of this study suggest that there might be some adjuvant potential for a low-TRP diet in the treatment of schizophrenia, and that schizophrenia or antipsychotic medications might offer some protection against the depressive effects of a TRP-deficient diet.

Adjuvants, Pharmaceutic

[The depressive patient before depression].

This paper describes five prototypes of depression which develop from different temperamental substrates: timid-inhibited, dysthymic, hyperthymic, cyclothymic and irritable. They correspond, respectively, to anxious depressions, double depressions, anergic depressions, rapid-cycling depressions, and hostile depressions. The author argues that, despite a certain degree of overlap in pharmacologic response, each prototype has a relatively unique profile, including benzodiazepines, MAOIs, SSRIs, TCAs, lithium, low dose neuroleptics and anti-epileptic agents.

Anxiety Disorders

Transdermal clonidine reduced some withdrawal symptoms but did not increase smoking cessation.

BACKGROUND: Clonidine may be useful in controlling tobacco withdrawal and in facilitating smoking cessation. This study was developed to test the efficacy of transdermal clonidine in promoting smoking cessation. METHODS: We conducted a five-center, double-blind, placebo-controlled, randomized controlled trial of transdermal clonidine in conjunction with a minimal behavioral intervention for smoking cessation. The intervention was based on the American Lung Association's Freedom From Smoking program. Self report of not smoking was validated with exhaled air carbon monoxide of less than 8 ppm and salivary cotinine of less than 20 ng/mL. Transdermal clonidine therapy began 1 week before the target quit date: 0.1 mg/24 h for the first 4 days increasing to 0.2 mg/24 h for the next 3 days, if the lower dose was tolerated. The highest tolerated dose was then continued for 6 weeks after target quit day. Withdrawal symptoms were measured daily for the first 7 days after target quit day. RESULTS: A total of 213 patients were enrolled (106 active drug and 107 placebo). During the study, 15.5% of patients had drug therapy discontinued due to adverse effects, 24.5% (26/106) taking active drug vs 8.4% (9/107) receiving placebo. There was a significant reduction in anxiety score from 3.0 to 2.4 (placebo vs active) and irritability score from 2.2 to 1.7 (placebo vs active) during the first week after cessation. There was no reduction in other withdrawal symptoms. The overall 12-week abstinence rate was 33.0% (35/106) in the active drug group vs 34.5% (37/107) in the placebo group (not significant). CONCLUSION: This study demonstrated some reduction in early withdrawal symptoms with the use of a clonidine transdermal patch, but no increase in cessation rate, 6 weeks after medication had been discontinued.

Administration, Cutaneous

Treatment of depression in elderly patients with and without dementia disorders.

In two inter-Nordic multicenter controlled studies the effect of Citalopram on elderly patients with depression and emotional disturbances has been studied. One investigation included 98 patients in whom Alzheimer type dementia (AD/SDAT) and vascular dementia (VD) had been diagnosed, many of whom also had emotional disturbances. After four weeks treatment with Citalopram (10-30 mg/daily) there was significant improvement in confusion, irritability, anxiety, depressed mood and restlessness. No effect was seen on the intellectual capacity or motor performance measured. In the other study, which was a six weeks trial comparing Citalopram and placebo, elderly patients with a treatment-requiring depression were treated. Demented as well as non-demented patients were included. The Hamilton Depression Scale, the Montgomery-Asberg Depression Rating Scale and The Clinical Global Impressions all recorded an effect of Citalopram superior to that of placebo. In both studies depressive symptoms as well as symptoms of agitation, anxiety, restlessness and irritability improved. Citalopram is therefore considered not only an antidepressive drug but also an emotional stabilizer. The drug was well tolerated by elderly often somatically ill patients. Side effects were few.

Aged

Ondansetron, a 5-HT3 receptor antagonist, partially attenuates the effects of amphetamine: a pilot study in healthy volunteers.

Preclinical studies suggest that 5-HT3 antagonists modulate dopamine-mediated responses in the limbic system and may therefore have a therapeutic role in psychiatry. We have examined the effect of ondansetron, a specific 5-HT3 antagonist, on the psychological and psychomotor changes induced by amphetamine in human volunteers. Nine healthy males took part in this double-blind placebo-controlled balanced-crossover study. Each subject received one of three treatments in a randomised manner: (a) placebo/placebo; (b) placebo/amphetamine (15 mg); (c) ondansetron (4 mg)/amphetamine (15 mg). Subjects were assessed for self-ratings of hunger, mood, energy, alertness, restlessness, irritability, and asked to rate the abnormality of their overall subjective state. In addition, systolic blood pressure, and performance on psychomotor tests were repeatedly assessed. Although amphetamine did not cause any significant changes in self-rating of mood, energy, alterness, restlessness or irritability, it induced a significant increase in self-ratings for overall subjective state, and a significant decrease in self-ratings of hunger. Amphetamine also caused an increase in systolic blood pressure and a decrease in the mean time taken to complete the psychomotor tests. Pretreatment with ondansetron attenuated the effects of amphetamine on hunger and subjective state, but not on blood pressure or psychomotor performance tests. These findings suggest that in humans 5-HT3 receptor antagonists may partially modify the subjective effects of amphetamine, and are in keeping with results from animal studies that 5-HT3 receptor antagonists might affect neurotransmission within mesolimbic brain regions. However, it was not possible to exclude a pharmacokinetic interaction to explain the effects of ondansetron.

Adult

The effects of caffeine and nicotine consumption on mood and somatic variables in a penitentiary inmate population.

A sample of 144 inmates from a maximum security penitentiary responded to a request for information regarding their average daily intake of nicotine and caffeine. They also rated the quality of their appetite and sleep, their level of concentration, their mood and specific feelings of anger, anxiety, frustration, and irritability. Factor analysis generated a two-factor solution of these variables, namely general mood state (mood, anxiety, anger, frustration, and irritability) and a somatic state (appetite, concentration, and sleep). Analysis of variance showed an interaction between level of smoking (nonsmokers, low and high cigarette smokers) and caffeine use (moderate vs. high) on the general mood factor. Nonsmokers who consumed high levels of caffeine experienced poorer general mood than any other group. There was a main effect of cigarette smoking status on the somatic factor, such that greater dissatisfaction was associated with greater consumption. Caffeine consumption was generally high, averaging 800 mg of caffeine per day, per inmate, well above the amount considered to be potentially damaging to health.

Adult

Obervations on subjective symptomatology, coping behavior, and medical decisions is asthma.

The Asthma Symptom Checklist (ASC), describing the subjective symptoms reported to occur during asthmatic attacks, has been developed previously. In the present study, the ASC key cluster solution was replicated and refined within a sample of 374 asthmatic inpatients. All of the original symptom categories were reporduced, including two mood categories, Panic-Fear and Irritability, a Fatigue category, and two somatic categories. Hyperventilation-Hypocapnia and Airway Obstruction. Two refinements were notable: (1) The Airway Obstruction category was empirically divided into two conceptually clear components, Dyspnea anc Congestion, and (2) three secondary mood categories, Worry, Loneliness, and Anger, were identified, which describe a continuum of mood between the polar extremes of panic and irritability. Of the symptom categories, only Panic-Fear was related to the intensity of the discharge drug regimens recommended 2 to 6 mouths after ASC administration. Panic-Fear scores were independent of pulmonary function measurements. A combined index based on pulmonary functions and panic-fear yielded the best prediction of discharge steroid regiments. Finally, those physicians rated highest in "sensitivity" to their patients by their supervisors prescribed less steroids overall, but most frequently prescribed discharge steriod regimens in relation to their patients' Panic-Fear scores. In contrast, physicians rated lower on sensitivity prescribed higher steroid regimens overall, but based these drug recommendations more cleary on objective pulmonary functioning, and not in relation to their patients' Panic-Fear scores. The results strongly suggest that the ASC Panic-Fear scale is associated with coping behaviors that importantly affect the patient's overall clinical picture by increasing the apparent severity of the asthma, thereby leading to intensified treatment. The findings stress the need to evaluate independently the objective medical condition and subjective symptomatology with its related coping behavior, in order to direct appropriate modes of therapy to each.

Adaptation, Psychological

Clinical and psychological characteristics of adolescents at risk of mood disorders compared with adolescents with suicidal behavior.

Suicide is one of the leading causes of death among adolescents, yet little is understood about the biopsychosocial factors related to suicidality. The demographic, clinical, and biological characteristics of adolescents with and without psychiatric histories may help inform mechanistic approaches to treatment of mood disorders and suicidality. The 'characterizing the inflammatory profile and suicidal behavior in adolescents' and 'RAD arm of the Texas Resilience Against Depression' studies aimed to characterize the clinical and biological profiles of youth with suicidal behavior and youth at risk for mood disorders, compared to healthy adolescents (n&#xa0;=&#xa0;75 in each group). Here, we report the descriptive baseline clinical and psychological characteristics of adolescents at risk of mood disorders and those with suicidal behavior. The adolescents with suicidal behavior reported 3.53 lifetime suicidal events on average, predominantly reported moderate to very severe depression (34.7%, 24%, to 9.3%), moderate to severe anxiety (58.6%), low optimism (91.9%), and mild (39.2%) to moderate (28.4%) degree of hopelessness. The at-risk adolescents predominantly reported no depression (60%) or anxiety (68.9%), moderate optimism (50%), and a positive outlook (85.7%). Healthy adolescents predominantly reported no depression (88.3%) or anxiety (93.2%), moderate optimism (59%), and a positive outlook (87%). The adolescents with suicidal behavior and those at risk of mood disorders exhibited significantly higher irritability and borderline personality disorder features (uncorrected p&#xa0;=&#xa0;0.02 to p&#xa0;<&#xa0;0.001) and lower resilience compared to healthy adolescents. Ongoing investigations using the longitudinal clinical and biological data will help identify the immune biosignatures of suicidality in youth.

Humans

The Brisbane floods, January 1974: their impact on health.

In the 12 months following the Brisbane flood of 1974, 234 flooded families (695 persons) and 163 non-flooded families (507 persons) were interviewed to ascertain changes in health status. We found that the number of visits to general practitioners, hospitals and specialists were all significantly increased for flooded persons in the year following the flood. Persistent psychological symptoms, which included irritability, nervous tension and depressed mood, predominated in those seeking medical care, and the consumption of sleeping tablets and psychotropic drugs rose. Increased psychological symptoms were significantly more common in female than in male flood victims and significantly more common in both sexes than increased physical complaints. There was no increase in mortality after the flood. The incidence of psychiatric symptoms was directly related to dissatisfaction with help received.

Adult

Studies of superobesity: II. Psychiatric appraisal of jejuno-ileal bypass surgery.

The authors studied 12 superobese women for 10 months to 3 years following jejuno-ileal bypass surgery. All patients had significant weight loss to near normal levels and were pleased with their newfound capabilities in the areas of physical, social, and sexual activities. Enhanced self-esteem, initiative, and assertiveness were noted. Although there were no serious postoperative psychiatric complications, patients experienced more mood lability and greater awareness of anxiety, depression, and irritability; their necessary adjustments in lifestyle strained relationships with spouses and parents in some cases. The principal drawback of the procedure was the occurrence in 7 patients of major somatic complications, with concomitant discouragement and apprehension.

Adaptation, Psychological

Towards rational therapy with monoamine oxidase inhibitors.

A rational approach to the use of monoamine oxidase inhibitors (MAOIs) is outlined. Patients suitable for treatment cannot be classified adequately using conventional diagnostic labels. They include those with primary symptoms of hypochondriasis, agoraphobia and social phobias, irritability, somatic anxiety and anergia; those with primary depressed mood, guilt, ideas of reference and personality disorders seldom respond. There is great variation in the interval between the first administration of these drugs and clinical response, and this may account for the inconsistencies in published trials. The type of drug and its dose may affect rate of response, as may biochemical factors, including acetylator and monoamine oxidase status. To obtain maximum benefit, a course of therapy with MAOIs should last for several months.

Adjustment Disorders