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IsHak WW, Mirocha J, Pi S, Tobia G, Becker B, Peselow ED, Cohen RM. Patient-reported outcomes before and after treatment of major depressive disorder. Dialogues Clin Neurosci 2015. [PMID: 25152656 PMCID: PMC4140511 DOI: 10.31887/dcns.2014.16.2/rcohen] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patient reported outcomes (PROs) of quality of life (QoL), functioning, and depressive symptom severity are important in assessing the burden of illness of major depressive disorder (MDD) and to evaluate the impact of treatment. We sought to provide a detailed analysis of PROs before and after treatment of MDD from the large Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. This analysis examines PROs before and after treatment in the second level of STAR*D. The complete data on QoL, functioning, and depressive symptom severity, were analyzed for each STAR*D level 2 treatment. PROs of QoL, functioning, and depressive symptom severity showed substantial impairments after failing a selective serotonin reuptake inhibitor trial using citalopram (level 1). The seven therapeutic options in level 2 had positive statistically (P values) and clinically (Cohen's standardized differences [Cohen's d]) significant impact on QoL, functioning, depressive symptom severity, and reduction in calculated burden of illness. There were no statistically significant differences between the interventions. However, a substantial proportion of patients still suffered from patient-reported QoL and functioning impairment after treatment, an effect that was more pronounced in nonremitters. PROs are crucial in understanding the impact of MDD and in examining the effects of treatment interventions, both in research and clinical settings.
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Affiliation(s)
- Waguih William IsHak
- Vice Chairman for Education & Research and Consultant Psychiatrist, Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, Los Angeles, California, USA; Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, Los Angeles, California, USA; David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - James Mirocha
- Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, Los Angeles, California, USA
| | - Sarah Pi
- Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, Los Angeles, California, USA
| | - Gabriel Tobia
- Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, Los Angeles, California, USA
| | - Bret Becker
- Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, Los Angeles, California, USA
| | - Eric D Peselow
- Richmond University Medical Center and Freedom From Fear, Staten Island, New York, USA
| | - Robert M Cohen
- Department of Psychiatry, Emory University School of Medicine
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Peselow ED, Tobia G, Karamians R, Pizano D, IsHak WW. Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: outcome after long-term follow-up. Psychiatry Res 2015; 225:680-6. [PMID: 25496869 DOI: 10.1016/j.psychres.2014.11.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 11/05/2014] [Accepted: 11/15/2014] [Indexed: 11/19/2022]
Abstract
The acute efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder (MDD) is well established; however their role in longer-term prevention of recurrence remains unconfirmed. This study aims at examining: the prophylactic efficacy of four commonly used SSRIs in MDD in a naturalistic setting with long-term follow-up, the effect of concomitant cognitive behavioral therapy (CBT), and the predictors of outcome. In a prospective cohort study, 387 patients who either remitted or responded following treatment with four different SSRIs-fluoxetine, escitalopram, sertraline and paroxetine-were followed up over several years. During an average follow-up period of 34.5 months, 76.5% of patients experienced MDD recurrence. Escitalopram and fluoxetine showed a numerically higher prophylactic efficacy than paroxetine and sertraline but the difference was statistically insignificant. The prophylactic efficacy for SSRI-only treatment was limited, with a recurrence rate of 82.0%, compared to 59.0% of patient recurrence rate in concomitant Cognitive Behavioral Therapy (CBT). The relatively small size of the CBT group and the lack of randomization may undermine the extrapolation of its findings to clinical practice. Nevertheless, the study preliminary data may help in defining the clinical utility of antidepressants and CBT in the prophylaxis from MDD recurrence.
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Affiliation(s)
- Eric D Peselow
- NY Medical College, Richmond University Medical Center and Freedom From Fear, Staten Island, NY, USA
| | - Gabriel Tobia
- Detroit Medical Center, Wayne State University, Department of Psychiatry and Behavioral Neurosciences, Detroit, MI, USA
| | - Reneh Karamians
- Pepperdine University, Malibu, CA, USA; Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Demetria Pizano
- Pepperdine University, Malibu, CA, USA; Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Peselow ED, Pizano DR, IsHak WW. Maintenance treatment for obsessive-compulsive disorder: findings from a naturalistic setting. Ann Clin Psychiatry 2015; 27:25-32. [PMID: 25696778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Although the utility of medication in the acute treatment of adult obsessive-compulsive disorder (OCD) is well-established, the role of maintenance therapy is not as well-studied. This study examines the efficacy of long-term treatment for, and predictors of, stability in medicated patients with adult OCD. METHODS Using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), we retrospectively evaluated 84 OCD patients who responded to a 10- to 12-week, open-label, acute treatment in a naturalistic clinic setting. Patients were followed based on their medication response for 1 to 92 months (mean 34.3), or until they terminated therapy. We evaluated Y-BOCS scores every 6 months or sooner, if clinically indicated. RESULTS Of the 84 patients, 39 (46.4%) responded, having relapsed within a 5-year period. Predictors of longer duration of stability were adjunctive cognitive-behavioral therapy (CBT), lack of comorbid disorders, lower Y-BOCS score after treatment, and larger decrease in Y-BOCS score during treatment phase. CONCLUSIONS Our results show the importance of maintenance treatment of OCD, noting the benefits of long-term response to adjunctive CBT and of achieving maximal acute response. It is becoming crucial to develop larger maintenance studies with more uniform design to better assess the natural course of treated OCD and improve treatment strategies.
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Affiliation(s)
- Eric D Peselow
- New York Medical College, Richmond University Medical Center and Freedom From Fear, Staten Island, NY, USA. E-mail:
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IsHak WW, Mirocha J, James D, Tobia G, Vilhauer J, Fakhry H, Pi S, Hanson E, Nashawati R, Peselow ED, Cohen RM. Quality of life in major depressive disorder before/after multiple steps of treatment and one-year follow-up. Acta Psychiatr Scand 2015; 131:51-60. [PMID: 24954156 PMCID: PMC4267902 DOI: 10.1111/acps.12301] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study examines the impact of major depressive disorder (MDD) and its treatment on quality of life (QOL). METHOD From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, we analyzed complete data of 2280 adult MDD out-patients at entry/exit of each level of antidepressant treatments and after 12 months of entry to follow-up. QOL was measured using the QOL Enjoyment and Satisfaction Questionnaire (Q-LES-Q). The proportions of patients scoring 'within-normal' QOL (within 10% of Q-LES-Q community norms) and those with 'severely impaired' QOL (>2 SD below Q-LES-Q community norms) were analyzed. RESULTS Before treatment, no more than 3% of MDD patients experienced 'within-normal' QOL. Following treatment, statistically significant improvements were detected; however, the proportion of patients achieving 'within-normal' QOL did not exceed 30%, with >50% of patients experiencing 'severely impaired' QOL. Although remitted patients had greater improvements compared with non-remitters, 32-60% continued to experience reduced QOL. 12-month follow-up data revealed that the proportion of patients experiencing 'within-normal' QOL show a statistically significant decrease in non-remitters. CONCLUSION Symptom-focused treatments of MDD may leave a misleading impression that patients have recovered when, in fact, they may be experiencing ongoing QOL deficits. These findings point to the need for investigating specific interventions to ameliorate QOL in MDD.
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Affiliation(s)
- Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - James Mirocha
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - David James
- Stanford University and Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Gabriel Tobia
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Jennice Vilhauer
- Departments of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, and Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Hala Fakhry
- Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sarah Pi
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, and University of California, Los Angeles, Los Angeles, California, United States
| | - Eric Hanson
- Loma Linda University, Loma Linda, California, United States
| | - Rama Nashawati
- University of Southern California and Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Eric D. Peselow
- Richmond University Medical Center and Freedom From Fear, Staten Island, New York, United States
| | - Robert M. Cohen
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, United States
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IsHak WW, Mirocha J, Christensen S, Wu F, Kwock R, Behjat J, Pi S, Akopyan A, Peselow ED, Cohen RM, Elashoff D. Patient-reported outcomes of quality of life, functioning, and depressive symptom severity in major depressive disorder comorbid with panic disorder before and after SSRI treatment in the star*d trial. Depress Anxiety 2014; 31:707-16. [PMID: 23861180 PMCID: PMC4777696 DOI: 10.1002/da.22152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 06/04/2013] [Accepted: 06/10/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Panic disorder (PD) is highly comorbid with major depressive disorder (MDD) with potential impact on patient-reported outcomes of quality of life (QOL), functioning, and depressive symptom severity. METHODS Using data from the sequenced treatment alternatives to relieve depression (STAR*D) trial, we compared entry and post-SSRI-treatment QOL, functioning, and depressive symptom severity scores in MDD patients with comorbid PD (MDD+PD) to MDD patients without PD (MDDnoPD). We also compared pre- and posttreatment proportions of patients with severe impairments in quality of life and functioning. RESULTS MDD+PD patients experienced significantly lower QOL and functioning and more severe depressive symptoms than MDDnoPD patients at entry. Following treatment with citalopram, both groups showed significant improvements, however, nearly 30-60% of patients still suffered from severe quality of life and functioning impairments. MDD+PD patients exited with lower QOL and functioning than MDDnoPD patients, a difference that became statistically insignificant after adjusting for baseline measures of depressive symptom severity, functioning, and QOL, comorbid anxiety disorders (PTSD, GAD, social, and specific phobias), age, and college education. CONCLUSIONS Functional outcomes using QOL and functioning measures should be utilized in treating and researching MDD so that shortfalls in traditional treatment can be identified and additional interventions can be designed to address severe baseline QOL and functioning deficits in MDD comorbid with PD.
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Affiliation(s)
- Waguih William IsHak
- Department of Psychiatry, Cedars-Sinai Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California
| | - James Mirocha
- Department of Psychiatry, Cedars-Sinai Medical Center, Los Angeles, California
| | - Scott Christensen
- Department of Psychiatry, Cedars-Sinai Medical Center and University of Southern California, Los Angeles, California
| | - Fan Wu
- Fielding School of Public Health at UCLA, Los Angeles, California
| | - Richard Kwock
- Fielding School of Public Health at UCLA, Los Angeles, California
| | | | - Sarah Pi
- University of California Los Angeles, California
| | - A. Akopyan
- University of California Los Angeles, California
| | - Eric D. Peselow
- Department of Psychiatry, NYU School of Medicine, New York, New York
| | - Robert M. Cohen
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia
| | - David Elashoff
- Department of Biostatisics, David Geffen School of Medicine at UCLA, Los Angeles, California
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Peselow ED, Karamians R, Lord M, Tobia G, IsHak WW. The discrepancy between patients and informants on clinician-rated measures in major depressive disorder: implications for clinical trials and clinical practice. Int Clin Psychopharmacol 2014; 29:111-5. [PMID: 24216755 DOI: 10.1097/yic.0000000000000015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinician-rated measures are used in clinical trials and measurement-based clinical care settings to assess baseline symptoms and treatment outcomes of major depressive disorder (MDD), with a widely held dictum that they are sufficient in assessing the patient's clinical status. In this study, we examined clinician-rated measures of depressive and global symptom severity, obtained by interviewing patients as well as informants in an attempt to examine the potential difference or similarity between these two sources of information. The sample consisted of 89 treatment seeking, DSM-IV diagnosed MDD outpatients treated between 1995 and 2004. The clinician-rated measures used included the Montgomery Åsberg Depression Rating Scale (MADRS), and the Clinical Global Impression Scale (CGI) for Severity. The scores of the clinician-rated measures collected from patients' interviews were compared with those collected from informants' interviews. Clinician-rated scores, collected by interviewing patients, were significantly higher and indicative of greater symptom severity when compared with those collected by interviewing informants. This was true for both the MADRS before (P<0.0001) and after treatment scores (P<0.0001), as well as the CGI before (P<0.0001) and after treatment scores (P<0.0001). Consistently involving informants and the time/burden it takes for them to participate might not be practical in MDD clinical trials or everyday clinical care. The discrepancies observed between the clinician-rated scores obtained from patients and informants emphasize the importance of incorporating collateral information during the assessment and rating of depressive symptom severity in both clinical trials as well as in clinical practice.
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Affiliation(s)
- Eric D Peselow
- aDepartment of Psychiatry, Richmond University Medical Center and Freedom From Fear, Staten Island, New York bPepperdine University, Malibu cDepartment of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center dDepartment of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, California eDepartment of Psychiatry and Behavioral Neurosciences, Loyola University Chicago, Chicago, Illinois, USA
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Pundiak TM, Case BG, Peselow ED, Mulcare L. Discontinuation of maintenance selective serotonin reuptake inhibitor monotherapy after 5 years of stable response: a naturalistic study. J Clin Psychiatry 2008; 69:1811-7. [PMID: 19026252 DOI: 10.4088/jcp.v69n1117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 06/18/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Selective serotonin reuptake inhibitors (SSRIs) are effective treatments of major depressive disorder (MDD), but data to guide the duration of maintenance therapy in community settings are limited. We assessed whether extending maintenance beyond 5 years provided additional benefit and identified other predictors of outcome. METHOD All patients treated at an urban community outpatient clinic between June 1993 and September 2005 were considered for inclusion in this study. Based upon patient preference and clinician judgment, 60 patients with DSM-IV MDD elected to continue, and 27 patients to discontinue, SSRI treatment after 5 years of clinical stability on maintenance monotherapy in a community clinic. Differences in relapse risk were assessed using the Kaplan-Meier product limit method, and risk factors were evaluated in Cox proportional hazards regression, based on up to 8 years of illness course. RESULTS Subjects who continued on SSRI treatment experienced a survival probability of maintaining remission during the first year, which was twice that of discontinued subjects (0.79 vs. 0.40), and survival differences persisted for over 30 months. Median survival time until relapse for patients who continued SSRIs was 38 months, exceeding the 10-month survival time of patients who discontinued. After controlling for significant covariates, the hazard ratio for SSRI discontinuation was 4.9. Residual depressive symptoms conferred increased relapse risk, while age, gender, SSRI type and dose, and prior depressive episodes did not predict relapse. CONCLUSION After 5 years of maintenance monotherapy for MDD, SSRI discontinuation in a community setting is associated with a far poorer illness course than continued maintenance. Discontinuation of long-term maintenance is most likely to be successful in patients with minimal residual symptoms, and discontinued patients should be carefully monitored.
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Abstract
OBJECTIVE Difficulties surrounding the classification of mixed psychotic and affective syndromes continue to plague psychiatric nosology. This paper addresses the controversy regarding the diagnostic validity of schizoaffective disorder (SAD), a diagnosis that is used in both DSM-IV and ICD-10 and one that encroaches on both schizophrenia (SCZ) and bipolar disorder (BD). METHODS A systematic synthesis of clinical and empirical literature, including evidence from cognitive, neurobiological, genetic, and epidemiological research, was undertaken with the aim of evaluating the utility of the SAD classification. RESULTS Distinctions between the diagnostic categories of SCZ, SAD and BD are not clearly demarcated by findings from neuropsychological, neuroimaging, molecular neurobiology, or genetic epidemiology studies. On the contrary, convergent evidence purports overlap across current diagnostic boundaries in the heritability and pathophysiology of psychotic and affective disorders. However, there are some disorder-specific findings. CONCLUSIONS Schizoaffective disorder is a prototypic boundary condition that epitomizes the pitfalls of the current categorical classification system. Future revisions to the DSM should consider the implementation of one of two alternative models to account for individuals presenting with mixed psychotic and affective symptoms. These include the views that (i) SAD is a comorbid set of symptoms that occur as a by-product of two separate disorders (SCZ and BD) or, that (ii) SAD exists as the mid-point on a continuum between SCZ and BD, such that the incorporation of these two disorders onto one dimension may be a suitable alternative. Hence the category SAD should be omitted in future revisions of DSM, allowing the development of meaningful nomenclature that rests upon further rigorous investigation of differences and similarities between disorders.
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Affiliation(s)
- Gin S Malhi
- Northern Clinical School, University of Sydney, Sydney, Australia.
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Choy Y, Peselow ED, Case BG, Pressman MA, Luff JA, Laje G, Paizis M, Ying P, Guardino MT. Three-year medication prophylaxis in panic disorder: to continue or discontinue? A naturalistic study. Compr Psychiatry 2007; 48:419-25. [PMID: 17707249 DOI: 10.1016/j.comppsych.2007.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 03/22/2007] [Accepted: 04/05/2007] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Little is known about maintenance treatment for panic disorder. The purpose of this naturalistic study is to compare outcomes of remitted panic disorder patients continued on versus those successfully discontinued from maintenance medication. METHODS After 3 years of sustained remission with medication in a naturalistic setting, 168 patients were continued on, whereas 37 successfully discontinued from medication. Continued and discontinued groups were followed for an additional 4 to 8 years and compared for differences in treatment outcome using chi(2) and Wilcoxon rank sum tests. Times to relapse were analyzed using the Kaplan-Meier product-limit method, and risk factors for relapse were assessed using Cox proportional hazards regression. RESULTS The discontinued group was healthier at baseline but had a significantly worse outcome compared with the continued group. Panic-free survival probabilities for the continued group at 1, 2, 3, and 4 years were 0.87, 0.81, 0.71, and 0.64, respectively, and were significantly higher than respective probabilities of 0.53, 0.35, 0.29, and 0.15 for the discontinued group. Median survival time in the continued group was significantly longer, at 5.67 years, than in the discontinued group, at 1.17 years. Cognitive behavioral therapy significantly reduced hazard in the discontinued but not in the continued group. Residual symptoms in either group at time of assignment predicted poorer outcome. CONCLUSION Our small study suggests that relapse of panic disorder in routine clinical practice occurs even after long-standing remission on maintenance medication, and that relapse risk appears to be markedly higher after medication discontinuation. Discontinuation may be more successful in candidates who received cognitive behavioral therapy and have minimal residual symptoms.
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Affiliation(s)
- Yujuan Choy
- Freedom from Fear, Staten Island, NY 10305, USA.
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Abstract
OBJECTIVE Research has found low concordance of personality disorder diagnoses made during depression versus after remission and made using patient versus collateral informants, but little is known about the reliability of personality disorder (PD) diagnoses made during depression using patient and collateral reports. METHOD A total of 168 patients were evaluated for PDs during depression and following response using patient and close informant reports. kappa coefficients of inter-informant and test-retest reliability were calculated. RESULTS After depression response, the proportion diagnosed with cluster A and C PDs fell by both patient and close informant report, and overall inter-informant reliability declined. Overall test-retest reliability did not differ between patients and informants. CONCLUSION Collateral informants do not improve the reliability of PD diagnoses made during depressive episodes.
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Affiliation(s)
- B G Case
- Freedom from Fear, Staten Island, NY 10305, USA.
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Case BG, Patrick L, Peselow ED. Monotherapy versus polypharmacy for hospitalized psychiatric patients. Am J Psychiatry 2005; 162:632; author reply 632-3. [PMID: 15741498 DOI: 10.1176/appi.ajp.162.3.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
We evaluated 355 subjects who entered one of six double-blind placebo-controlled antidepressant drug trials with respect to the occurrence of antecedent adverse life events and their meaning to the patient. Patients were also assessed with regard to the degree of social support they received for the negative life event. The groups differed as to whether they did or did not meet the criteria for melancholic depression; 43 one-week placebo responders were statistically significantly more likely to believe that adverse life events predisposed them to depressive illness and that such life events precipitated their current depression, compared to 312 one-week placebo non-responders. Of the 312 patients who went on to the double-blind phase in which they were treated with either drug (n = 204) or placebo (n = 108), it was noted that, for both melancholic and non-melancholic patients, responders to drug treatment (but not placebo) had a more favourable ratio of social support received/social support desired than non-responders. Non-melancholic responders to both drug and placebo were statistically significantly more likely to report fewer adverse life events and have a less strong belief that adverse life events predispose one to depressive illness than non-responders. Melancholic patients did not show this trend.
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Sanfilipo M, Wolkin A, Angrist B, van Kammen DP, Duncan E, Wieland S, Cooper TB, Peselow ED, Rotrosen J. Amphetamine and negative symptoms of schizophrenia. Psychopharmacology (Berl) 1996; 123:211-4. [PMID: 8741946 DOI: 10.1007/bf02246180] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to assess further the effect of amphetamine on negative symptoms of schizophrenia. Thirty-seven schizophrenic males meeting DSM-III criteria were rated with the Brief Psychiatric Rating Scale, the Abrams and Taylor Scale, and the Abnormal Involuntary Movements Scale before and after double-blind administration of either amphetamine (n = 26) or placebo (n = 11). Our results indicated that amphetamine administration generally did not improve negative symptoms, even when accounting for changes in positive symptoms. However, greater baseline negative symptoms were associated with a modest diminution after amphetamine treatment. Therefore, amphetamine may modestly improve negative symptoms in those schizophrenics in whom this symptomatology is more severe.
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Affiliation(s)
- M Sanfilipo
- Department of Psychiatry, New York Veterans Affairs Medical Center, 10010, USA
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Peselow ED, Sanfilipo MP, Fieve RR. Patients' and informants' reports of personality traits during and after major depression. J Abnorm Psychol 1995. [PMID: 7822585 DOI: 10.1037//0021-843x.103.4.819] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The influence of major depression on patients' and informants' reports of personality traits was examined using the Structured Interview for DSM-III Personality Disorder, both before and after successful antidepressant or placebo treatment (N = 58). According to patients' reports, Cluster A and C traits decreased significantly from pre- to posttreatment, but Cluster B traits were unchanged, excluding an increase in histrionic traits. According to informants' reports, Cluster A and B traits did not change from pre- to posttreatment, but Cluster C traits decreased significantly after treatment, not including passive-aggressive traits. Moreover, informants generally reported much higher levels of maladaptive personality traits than patients themselves. These results suggest that informants should be used in future research on personality disorders until better assessment techniques are developed.
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Affiliation(s)
- E D Peselow
- Department of Psychiatry, New York Veterans Administration Medical Center
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Abstract
OBJECTIVE To examine the effect of hypomanic states on maladaptive personality traits and personality disorders, the authors evaluated personality traits and disorders of patients during an episode of hypomania and after successful somatic treatment. METHOD The authors used the Structured Interview for DSM-III Personality Disorders to study 66 outpatients who had a lifetime diagnosis of bipolar disorder and who met the minimum Research Diagnostic Criteria for hypomania. All patients had a knowledgeable informant separately undergo the Structured Interview for DSM-III Personality Disorders during the patient's hypomanic state. Outpatients who successfully recovered from the hypomanic episode (N = 47) and their informants were read-ministered the interview 4-8 weeks after the initial assessment. RESULTS During the hypomanic state, informants generally reported higher levels of maladaptive personality traits among patients than patients themselves. For the patients who recovered successfully from the hypomanic episode, a reduction in all maladaptive personality traits except schizoid and dependent traits was reported by both patients and their informants; however, the decrease reported by patients generally was much greater than that reported by informants. In addition, schizoid traits actually increased after successful treatment according to patient reports but were unchanged according to informant reports. CONCLUSIONS Hypomania may be associated with an exacerbation of maladaptive personality traits, which may be attenuated after successful treatment. Even with the attainment of euthymic mood, however, about 50% of the cohort had at least one personality disorder, which suggests that a high degree of comorbidity may exist between bipolar disorders and maladaptive personality traits or personality disorders.
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Affiliation(s)
- E D Peselow
- Foundation for Depression/Manic Depression, New York
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Abstract
The influence of major depression on patients' and informants' reports of personality traits was examined using the Structured Interview for DSM-III Personality Disorder, both before and after successful antidepressant or placebo treatment (N = 58). According to patients' reports, Cluster A and C traits decreased significantly from pre- to posttreatment, but Cluster B traits were unchanged, excluding an increase in histrionic traits. According to informants' reports, Cluster A and B traits did not change from pre- to posttreatment, but Cluster C traits decreased significantly after treatment, not including passive-aggressive traits. Moreover, informants generally reported much higher levels of maladaptive personality traits than patients themselves. These results suggest that informants should be used in future research on personality disorders until better assessment techniques are developed.
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Affiliation(s)
- E D Peselow
- Department of Psychiatry, New York Veterans Administration Medical Center
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17
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Abstract
We investigated whether and how acute depressive symptoms affect the self-report of maladaptive personality traits. Sixty-eight acutely depressed patients underwent the Structured Interview for DSM-III Personality Disorder (SIDP) before and after pharmacological treatment, allowing us to determine whether self-reported maladaptive personality traits are different during depression and after successful clinical recovery. After the initial SIDP administration (during an episode of major depression), patients received desipramine treatment (dose range 150-300 mg/day) over a course of 4-5 weeks before readministration of the SIDP. For those who recovered from their depression (n = 39), cluster III trait scores were significantly lower than those assessed at baseline, and there was a lower frequency of cluster III categorical diagnoses for a personality disorder after treatment than before treatment. Recovered patients also had significantly lower cluster I personality trait scores after treatment as compared with baseline ratings. For those who did not recover from their depression after treatment (n = 29), cluster I trait scores were in fact higher than those measured at baseline, but there were no differences in categorical diagnoses before and after treatment. Cluster II personality traits and categorical diagnoses were not different between those who did and did not recover from their depression. Thus, depression may have a significant effect on the assessment of cluster I and cluster III personality traits. It is possible that cluster I and III 'personality traits' may be interwoven with depressive features and therefore subject to state influences, whereas cluster II personality traits may entail enduring, long-term characteristic modes of thinking, feeling, and behaving.
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Affiliation(s)
- E D Peselow
- Department of Psychiatry, New York University School of Medicine, NY 10010
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18
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Abstract
Using a longitudinal life-table analysis, we assessed the efficacy of lithium alone, administered within the context of a naturalistic clinical setting, by calculating the probability of patients remaining free of an affective episode (manic or depressive) over a five-year course. In addition, for those who suffered a manic or depressive relapse, we attempted to analyse the subsequent course of patients who suffered a manic/hypomanic or depressive relapse and were then restabilised on lithium plus either a neuroleptic, carbamazepine, or a benzodiazepine, or lithium plus an antidepressant. Lithium alone offered an average 83% probability against an affective relapse after one year, 52% after three years, and 37% after five years. For patients who failed on lithium alone, it appeared that combination treatment offered greater protection against subsequent affective relapse than the initial course on lithium alone.
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Affiliation(s)
- E D Peselow
- Department of Psychiatry, New York University School of Medicine, NY 10010
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19
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Abstract
OBJECTIVE The authors' goals were to examine the effects of somatic treatment and placebo in patients with and without endogenous/melancholic depression. METHOD Before entry into one of four trials of antidepressant drugs versus placebo, 231 patients were assessed as to whether they met Research Diagnostic Criteria for definite endogenous depression and/or DSM-III criteria for major depressive episode with melancholia. These patients were prospectively assessed for subsequent response to antidepressant treatment or placebo. Previous studies of the effect of endogenous/melancholic depression on treatment response were also reviewed. RESULTS Of the 76 patients with DSM-III melancholia given active medication, 41 (54%) had a complete or partial response, but only 10 (23%) of the 44 patients with melancholia given placebo had a complete or partial response. Of the 76 depressed patients without melancholia given active medication, 46 (61%) had a complete or partial response, and 15 (43%) of the 35 depressed patients without melancholia given placebo had a complete or partial response. Moderately depressed patients with DSM-III melancholia had a significantly better response to active medication than did severely depressed patients with melancholia and showed the greatest difference between response to active medication and response to placebo. The results of the review of previous studies of the effect of endogenous/melancholic depression on treatment response were mixed. CONCLUSIONS Depressed patients with melancholia were not particularly different from depressed patients without melancholia in their responses to antidepressant medication but did differ from patients without melancholia in their responses to active medication versus placebo, particularly if their depression was moderate and not severe. This suggests that patients with DSM-III melancholia may be unresponsive to nonsomatic treatments.
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Affiliation(s)
- E D Peselow
- New York University School of Medicine, Brooklyn
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20
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Abstract
We attempted to prospectively examine the effects of personality traits in 68 acutely depressed patients treated with desipramine over 4-5 weeks to assess whether the presence or absence of these traits played a role in response to antidepressant treatment. Overall the 39 responders had statistically significantly lower cluster III personality trait scores than non-responders, and a trend toward lower cluster I and cluster II scores. We then followed the 39 desipramine responders for up to 6 months on the dose to which they responded in accordance with standard clinical practice. Overall 23 of the 39 sustained their initial improvement, with eight relapsing and eight dropping out between 5 weeks and 6 months. When comparing these three groups with the 29 initial non-responders, those who sustained the 6-month response had statistically significantly lower cluster II, cluster III, and total personality scores than initial responders who relapsed, initial responders who dropped out and did not complete 6 months of treatment, and initial non-responders.
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21
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Peselow ED, Robins CJ, Sanfilipo MP, Block P, Fieve RR. Sociotropy and autonomy: Relationship to antidepressant drug treatment response and endogenous-nonendogenous dichotomy. Journal of Abnormal Psychology 1992; 101:479-86. [PMID: 1386856 DOI: 10.1037/0021-843x.101.3.479] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study evaluated the relationship of sociotropic and autonomous personality traits with response to pharmacotherapy for 217 depressed outpatients using the Sociotropy-Autonomy Scale. Sociotropy was related to nonendogenous depression, whereas autonomy was related to endogenous depression. Subjects who had high autonomous-low sociotropic traits showed greater response to antidepressants (and greater drug-placebo differences) than those who had high sociotropic-low autonomous traits (who showed no drug-placebo differences). Hierarchical multiple regression analysis showed that the sociotropy-autonomy, but not the endogenous-nonendogenous, distinction was a predictor of drug treatment response. The combination of endogeneity and autonomy predicted response to placebo. If replicated, these findings may enable better matching of patient traits to various treatment modalities for depression.
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Affiliation(s)
- E D Peselow
- Department of Psychiatry, New York University School of Medicine
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22
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Peselow ED, Fieve RR. Depressive attributional style and the dexamethasone suppression test: relationship to the endogenous/melancholic distinction and to each other. Psychopathology 1992; 25:173-82. [PMID: 1492140 DOI: 10.1159/000284769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The dexamethasone suppression test (DST) and the depressive attributional style questionnaire (ASQ) were administered to 105 depressed patients prior to participation in a double-blind outpatient study and to 29 normal controls. The depressed patients were classified into three groups (1) met criteria for both research diagnostic criteria for definite endogenous depression and DSM III melancholia; (2) met criteria for neither, and (3) met criteria for one but not both. The group that met criteria for both RDC endogenous depression and DSM-III melancholia had a statistically greater frequency of abnormal DST versus the group that met neither criteria and the normal controls. With regard to ASQ, patients who met both criteria had statistically higher bad event internality scores but statistically lower bad event stability and globality scores as opposed to the group that met neither criteria. In general, normal controls had significantly lower bad event ASQ scores than the three depressive groups. There was no correlation between ASQ and DST, as both DST suppressors and nonsuppressors had similar ASQ scores and there was no correlation between ASQ bad event attributions and initial severity of depression.
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23
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Abstract
We studied 75 patients on prophylactic antidepressants (imipramine or amitriptyline) to examine the effect of antidepressant dose on long-term prophylaxis of depression and to see whether lowering the dose during the prophylactic period affected subsequent relapse. There was no statistically significant difference in maintenance and prophylactic doses between the group that completed the 2 years free of a depressive episode, the group that had a depressive relapse and the group that dropped out of treatment before the end of the prophylactic period. However, the group that completed the 2 years free of a depressive episode had significantly less of a difference between the maintenance and prophylactic doses than the other 2 groups. Overall, 11/31 who remained on the same dose during the prophylactic period vs the maintenance period relapsed vs 17/25 who had their dose lowered during the prophylactic period vs the maintenance period. The difference was statistically significant.
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Affiliation(s)
- E D Peselow
- New York University School of Medicine, New York
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24
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Abstract
We evaluated learning and memory in 50 depressed patients prior to and following 4 week treatment with imipramine compared to 21 normal controls tested at corresponding times. At baseline, the depressives did worse than normals on most memory tasks with the difficult memory tasks, regardless of store, modality or type of task best distinguishing between depressive and normal memory. Following imipramine treatment, responders performed better than nonresponders on the difficult memory tasks, and not significantly differently from controls on most tasks. This, as well as the fact that the responders improved to a greater degree than controls on most measures (in a few cases the difference was statistically significant) and the fact that at 4 weeks complete responders to imipramine did significantly better than partial responders to imipramine, indicates that relief from depression is highly related to improved memory functioning. The finding that complete responders to imipramine were not significantly worse than normal controls suggests that imipramine did not have significant adverse effects on memory.
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Affiliation(s)
- E D Peselow
- Department of Psychiatry, New York University School of Medicine, NY
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25
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Abstract
1. In order to evaluate the efficacy of antidepressants in the prevention of recurrent depression, a longitudinal life-table analysis was carried out involving 217 unipolar patients whose depressive symptoms had remitted following treatment with one of five standard tricyclics (imipramine, amitriptyline, desipramine, nortriptyline, and doxepin). 2. Following six months continued euthymic mood these patients were maintained on the medication to which they initially responded to in a clinical setting over a 5 year period. These patients were compared against a group of 28 individuals who were treated acutely for their depression and responded to one of the above the 5 standard antidepressants, but following 5-6 months continuation treatment were taken off the antidepressant at their own request. 3. Though there was a lower rate of relapse in patients receiving active medication vs the no treatment group, the frequency of relapse was high for the group on active drug. 4. Using the longitudinal life-table method of Fleiss there was a pessimistic-optimistic average relapse rate of 30%, 50%, and 60%, at 1, 2, and 3 years respectively while on active drug vs a 51%, 74%, and 83% relapse rate on no treatment. Overall 87 of 217 patients on active drug (40.1%) were observed to have suffered a depressive relapse over the 5 year course.
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Affiliation(s)
- E D Peselow
- New York University School of Medicine, New York
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26
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Abstract
A comparison was made between endogenous and non-endogenous depressed patients on several characteristics on which they traditionally have been asserted to differ, and which play important roles in cognitive approaches to depression. The non-endogenous patients reported more dysfunctional attitudes and a greater number of recent life events than did endogenous patients. These results support the distinction between endogenous and non-endogenous depressions, and suggest that cognitive theories of aetiology may be more relevant for the latter group. However, both groups perceived their recent upsetting events in relatively maladaptive ways, consistent with the idea that biased perceptions are more related to the depressive state, whereas dysfunctional attitudes may represent a trait vulnerability.
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Affiliation(s)
- C J Robins
- Duke University Medical Center, Durham, NC 27710
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27
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Peselow ED, Robins C, Block P, Barouche F, Fieve RR. Dysfunctional attitudes in depressed patients before and after clinical treatment and in normal control subjects. Am J Psychiatry 1990; 147:439-44. [PMID: 2180328 DOI: 10.1176/ajp.147.4.439] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
To evaluate the role of maladaptive thinking patterns in depression, the authors administered the Dysfunctional Attitude Scale to 112 depressed patients before and after 3-6 weeks of treatment with antidepressants or placebo. Twenty-two normal subjects were also assessed twice. Depressed patients had a significantly higher initial mean score than control subjects, but during treatment their score significantly decreased, and the posttreatment score of those with complete recoveries was nearly as low as the control subjects' final score. The higher the initial dysfunctional attitude score the poorer the response to treatment. Patients with endogenous depression had significantly lower scores than nonendogenously depressed patients.
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Affiliation(s)
- E D Peselow
- Department of Psychology, School of Medicine, New York University, New York
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28
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Abstract
We evaluated the dexamethasone suppression test (DST) as a predictor of response to drugs and placebo in 105 patients, in a large double-blind placebo-controlled out-patient trial to determine the efficacy of paroxetine HCl, a selective serotonin reuptake inhibitor, compared with that of imipramine HCl and placebo. The presence of a positive or negative DST did not predict response to either paroxetine or imipramine. However, a positive DST predicted a poorer response to placebo: only 3 out of 18 patients who showed DST non-suppression responded to placebo, as opposed to 11 out of 21 who exhibited DST suppression (P less than 0.05). A positive DST was associated with a 61% response to drugs and a 16% response to placebo. This finding suggests that the presence of a positive DST implies the need for active somatic treatment.
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Affiliation(s)
- E D Peselow
- Department of Psychiatry, New York University School of Medicine, New York
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29
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Meiselas KD, Spencer EK, Oberfield R, Peselow ED, Angrist B, Campbell M. Differentiation of stereotypies from neuroleptic-related dyskinesias in autistic children. J Clin Psychopharmacol 1989; 9:207-9. [PMID: 2500463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Videotapes of autistic children with stereotypies and/or neuroleptic-related dyskinesias were shown to three experienced raters blind to the children's medication treatment status and history, if any, of neuroleptic exposure. Upon observation of the videotapes, stereotypies and neuroleptic-related dyskinesias were not well differentiated from each other. These results emphasize the importance of assessing and documenting baseline abnormal movements before patients receive neuroleptic therapy. Meticulous baseline evaluation, integral to all patient care, is of particular concern in treating patient populations that often show abnormal movements unrelated to neuroleptic exposure. Such movements can be mistaken clinically for neuroleptic-related dyskinesias and, in the absence of baseline data for comparison, can be misdiagnosed as such.
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Affiliation(s)
- K D Meiselas
- Department of Psychiatry, New York University Medical Center, New York 10016
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30
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Abstract
The Research Diagnostic Criteria (RDC) define endogenous depression by the presence of a particular subset of depressive symptoms. This typological approach to classification implicitly assumes that endogenous and non-endogenous patients differ only or primarily in this subset of symptoms, rather than simply in severity of all depressive symptoms. We tested this assumption in a sample of 80 patients with a current episode of major depressive disorder. Whereas RDC endogenous patients (n = 53) had significantly higher levels of most criterial symptoms than did non-endogenous patients (n = 27), they differed on almost no non-endogenous symptoms. These findings support the concept of a specific endogenous symptom cluster.
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Affiliation(s)
- C J Robins
- Duke University Medical Center, Durham, NC 27710
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31
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Robins CJ, Block P, Peselow ED. Relations of sociotropic and autonomous personality characteristics to specific symptoms in depressed patients. J Abnorm Psychol 1989. [PMID: 2708646 DOI: 10.1037//0021-843x.98.1.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A number of writers have suggested that two sets of personality characteristics are associated both with vulnerabilities to depression in response to different classes of events and with different clinical presentations of depression. The present study examined the relations between levels of sociotropic and autonomous personality characteristics and specific, theoretically derived clusters of symptoms in 80 unipolar depressed patients. As was predicted, sociotropy was related to the cluster of symptoms associated with the concept of anxious-reactive depression and was unrelated to the autonomous symptoms cluster. In contrast, the predicted relations of autonomous personality characteristics and symptoms were not found. These results support the idea that the symptom picture in depression may be related to personality characteristics, but they also suggest that the measurement of autonomy may require revision.
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32
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Robins CJ, Block P, Peselow ED. Relations of sociotropic and autonomous personality characteristics to specific symptoms in depressed patients. Journal of Abnormal Psychology 1989; 98:86-8. [PMID: 2708646 DOI: 10.1037/0021-843x.98.1.86] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A number of writers have suggested that two sets of personality characteristics are associated both with vulnerabilities to depression in response to different classes of events and with different clinical presentations of depression. The present study examined the relations between levels of sociotropic and autonomous personality characteristics and specific, theoretically derived clusters of symptoms in 80 unipolar depressed patients. As was predicted, sociotropy was related to the cluster of symptoms associated with the concept of anxious-reactive depression and was unrelated to the autonomous symptoms cluster. In contrast, the predicted relations of autonomous personality characteristics and symptoms were not found. These results support the idea that the symptom picture in depression may be related to personality characteristics, but they also suggest that the measurement of autonomy may require revision.
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33
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Abstract
To evaluate the dexamethasone suppression test (DST) as an aid in monitoring clinical recovery, the authors evaluated 127 outpatients with major depression who received the DST during depression and after clinical recovery. Although DST response varied among the 73 patients who met the Research Diagnostic Criteria for definite endogenous depression, their mean postdexamethasone plasma cortisol level was significantly higher during depression than after recovery. However, the DST's utility in monitoring long-term outcome was not great, as there was a high chance of remaining stable for 6 months after recovery regardless of cortisol value during depression or after recovery.
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34
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Fieve RR, Goodnick PJ, Peselow ED, Barouche F, Schlegel A. Pattern analysis of antidepressant response to fluoxetine. J Clin Psychiatry 1986; 47:560-2. [PMID: 3533909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Seventy patients with unipolar major depressive disorder were treated with fluoxetine or placebo in a 6-week double-blind trial and were evaluated by changes in scores on the Hamilton Rating Scale for Depression (HAM-D) and the global improvement measure of the Clinical Global Impressions (CGI) scale. High correlations were found between the changes in HAM-D scores from baseline to endpoint and the final CGI improvement ratings. In patients with moderate depression (baseline HAM-D score of 20 or more), the differences in endpoint analysis between active treatment and placebo groups were significant. A persistent pattern of improvement was noted in 27% of those receiving fluoxetine but in none of those receiving placebo. Physician and patient evaluations as determined by the improvement measure of the CGI were closely correlated.
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35
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Peselow ED, Lautin A, Wolkin A, Rohrs C, Novatt A, Siekierski J, Rotrosen J. The dexamethasone suppression test and response to placebo. J Clin Psychopharmacol 1986; 6:286-91. [PMID: 3534005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The predictive value of the dexamethasone suppression test (DST) was evaluated in two consecutive double-blind, placebo-controlled trials evaluating 61 depressed inpatients randomized to either one of two drugs, sertraline or oxaprotiline, or placebo over a 4-week clinical trial. For 30 patients who completed at least 3 weeks of double-blind treatment on either drug, the initial DST was not predictive of response to drug treatment. For the 17 patients who completed at least 3 weeks of double-blind treatment on placebo, the presence of a positive DST predicted a statistically significantly poorer response to placebo as opposed to a negative DST. These preliminary findings suggest that for depressed individuals who present with a positive DST, remission without active medication is less likely and somatic treatment should be considered.
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36
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Peselow ED, Goldring N, Stanley M, Barouche F, Fieve RR. The dexamethasone suppression test (DST) in predicting response to desipramine and amitriptyline in depressed outpatients. Int Clin Psychopharmacol 1986; 1:17-23. [PMID: 3549869 DOI: 10.1097/00004850-198601000-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The predictive value of the dexamethasone suppression test (DST) was evaluated in two consecutive clinical trials involving 99 individuals treated with amitriptyline or desipramine. Following one week observation, and following one week on low-dose desipramine or amitriptyline (50 mg), all patients who remained depressed (Hamilton score 16 or greater) were given a full clinical trial of either desipramine or amitriptyline (150-300 mg/day) over a minimum 3-5 week period. In all, 68 patients required this trial, 31 receiving amitriptyline and 37 receiving desipramine. For these patients there was no relationship between DST suppression/non-suppression vs clinical response to either desipramine or amitriptyline. There was a non-significant trend for suppressors (negative DST) to respond either spontaneously or to low-dose desipramine or amitriptyline as opposed to non-suppressors (positive DST).
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37
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Stanley M, Deutsch SI, Banay-Schwartz M, Peselow ED, Eliazo CE. Brain glycine levels following lithium toxicity: case report. J Clin Psychiatry 1985; 46:239. [PMID: 3922960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A case is reported of a patient who died as a result of lithium toxicity. Brain lithium levels and changes in brain glycine levels are discussed.
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38
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Peselow ED, Goldring N, Barouche F, Fieve RR. Dexamethasone suppression test in predicting response to tricyclic antidepressants in depressed outpatients. Psychopathology 1985; 18:206-11. [PMID: 4089119 DOI: 10.1159/000284406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
75 outpatients who presented to an affective disorder clinic received the dexamethasone suppression test (DST). Following 1 week observation, and following 1 week on low-dose imipramine HCl, all patients who remained depressed (Hamilton score 16 or greater) were given a full clinical trial of imipramine HCl (150-300 mg/day) over a minimum 3- to 5-week period. Of the 45 patients who required this trial and who received imipramine HCl for at least 3 weeks, there was no relationship between DST suppression or nonsuppression vs. clinical response to imipramine HCl. There was a statistically significant trend for suppressors (negative DST) to respond either spontaneously or to low-dose imipramine HCl as opposed to nonsuppressors (positive DST).
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39
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Abstract
Blunted responses to thyrotropin-releasing hormone (TRH) stimulation have been found consistently in depressed patients, and have been reported in other affective disorders as well. In a smaller number of schizophrenic subjects, TRH tests have generally been normal. Thus, it has been suggested that this test may have diagnostic utility in distinguishing schizophrenia from affective disorders. In the present study the TRH test was performed upon a sample of 51 subjects that included 17 schizophrenics in order to further study the diagnostic or symptom specificity of this endocrine test. Abnormal TRH tests were present in both schizophrenic and affectively disturbed patients. There were no correlations with ratings of depression or other aspects of psychopathology. Factors which may have previously obscured abnormal TRH tests in schizophrenia are discussed.
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40
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Abstract
In contrast to a recently published report by Amsterdam and associates, the authors noted a higher frequency of abnormal dexamethasone suppression test results in 88 outpatients with primary depression (particularly the endogenous subtype) than in 49 normal controls.
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41
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Peselow ED, Serby M, Wolkin A, Deutsch SI, Fricchione G, Rotrosen JP. Plasma cortisol values after dexamethasone in depressed inpatients. J Clin Psychopharmacol 1983; 3:45-6. [PMID: 6833525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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42
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Abstract
In addition to its incorporation into proteins, glycine functions as both a regulator of one-carbon metabolism and as an inhibitory neurotransmitter. Clinical recognition of the hyperglycinemias and reported elevations of erythrocyte glycine concentrations in patients with bipolar disorders have implicated this amino acid in the etiopathology of some neuropsychiatric disorders. Moreover, chronic lithium administration, an almost specific intervention for the treatment and prophylaxis of bipolar disorders, has been shown to induce elevations in brain and erythrocyte glycine levels. In view of glycine's complex metabolic interrelationships and neurotransmitter function, additional research exploring its possible role in either affective illness or lithium's action is indicated.
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43
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44
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45
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Mann JJ, Frances A, Peselow ED, Gershon S. Differential efficacy of L-deprenyl, a selective MAO type-B inhibitor, in endogenous and nonendogenous depression. Psychopharmacol Bull 1982; 18:182-4. [PMID: 6818606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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46
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Abstract
The authors assessed lithium's prophylactic effect against depression in unipolar (N = 43), bipolar II (N = 102), and cyclothymic (N = 69) patients using a longitudinal life-table analysis and calculated the probability of remaining free of a depressive episode. The probability of remaining free of one depressive episode after 2 years of taking lithium ranged from 42% to 55% for the bipolar II patients, 31% to 42% for the unipolar patients, and 26% to 36% for the cyclothymic patients. The average probability of suffering one depressive episode severe enough to require either pharmacologic intervention or hospitalization in a 2-year period was 51% for the bipolar II patients, 64% for the unipolar patients, and 69% for the cyclothymic patients.
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47
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Peselow ED, Gulbenkian G, Dunner DL, Fieve RR, Deutsch SI. Relationship between plasma lithium levels and prophylaxis against depression in bipolar I, bipolar II, and cyclothymic patients. Compr Psychiatry 1982; 23:176-80. [PMID: 7067431 DOI: 10.1016/0010-440x(82)90062-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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48
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Kaufmann M, Kahaner K, Peselow ED, Gershon S. Steroid psychoses: case report and brief overview. J Clin Psychiatry 1982; 43:75-6. [PMID: 7056709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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49
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Mann JJ, Frances A, Kaplan RD, Kocsis J, Peselow ED, Gershon S. The relative efficacy of l-deprenyl, a selective monoamine oxidase type B inhibitor, in endogenous and nonendogenous depression. J Clin Psychopharmacol 1982; 2:54-7. [PMID: 6802883 DOI: 10.1097/00004714-198202000-00008] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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50
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Peselow ED, Deutsch SI, Stanley M, Banay-Schwartz M, Virgilio J, Fieve RR. Erythrocyte glycine in depressed, hypomanic, and euthymic bipolar patients treated with lithium carbonate. Psychopharmacology (Berl) 1982; 78:314-6. [PMID: 6818590 DOI: 10.1007/bf00433732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Red blood cell (RBC) glycine levels were examined in 27 bipolar patients, treated with lithium carbonate for a minimum of 8 months, who were either hypomanic, depressed, or euthymic in their mood. We found no difference in the RBC glycine or in the RBC: plasma glycine ratio between the hypomanic, depressed, or euthymic patients (P less than 0.1). There were statistically significant differences in RBC glycine levels in lithium-treated euthymic patients and normal controls. There was a strong positive correlation between serum lithium levels and both RBC glycine levels and the RBC: plasma glycine ratio.
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