1
|
Little JT, Blackall DP. Evaluation of solid-phase panreactivity with negative direct antiglobulin testing. Immunohematology 2023; 39:151-154. [PMID: 38179779 DOI: 10.2478/immunohematology-2023-022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Solid-phase red cell adherence (SPRCA) is a sensitive platform for antibody detection, but nonspecific reactions may occur. One pattern of apparent nonspecific reactivity is a panagglutinin with a negative direct antiglobulin test (DAT). The purpose of this study was to define the clinical characteristics of patients with these nonspecific reactions and their associated serologic findings. Twenty patients with panreactive SPRCA testing results were identified between November 2022 and May 2023. In addition to panagglutinins, these patients had (1) a negative polyethylene glycol (PEG) antibody detection test, (2) a negative PEG autocontrol, and (3) a negative DAT. The strength of SPRCA panreactivity and the results of eluate testing (by tube and SPRCA) were studied. Clinical characteristics of patients included age, sex, and primary diagnosis. Each patient was also assessed for evidence of hemolysis. Fourteen female and six male patients were evaluated (average age 44 years). Primary diagnoses included pregnancy (n = 10), acute bleeding (n = 4), orthopedic (n = 3), and other (n = 3). There was no clinical or laboratory evidence of hemolysis. The predominant strength of SPRCA panreactivity was evenly distributed across reaction grades (1+ to 3+). Fifty-five percent of the eluates tested in PEG showed panreactivity, consistent with warm-reactive autoantibodies, while 85 percent of eluates tested by SPRCA were panreactive. Six discrepant cases, in which PEG eluate testing was negative and solid-phase eluate testing showed panreactivity, were associated with weak solid-phase plasma panreactivity (1+). In addition, the reactivity strengths of the eluates tested by SPRCA were invariably more strongly reactive than those eluates tested in PEG. Panagglutination is a distinct SPRCA-only plasma reactivity pattern. Despite a negative PEG tube and DAT, most panagglutinins are warm-reactive autoantibodies. Fortunately, these "interfering" panagglutinins do not appear to be clinically significant and are easily managed by an alternative testing method such as PEG.
Collapse
Affiliation(s)
- J T Little
- Medical Laboratory Scientist, Providence Health and Services, Department of Pathology and Laboratory Services, Portland, OR, United States
| | - D P Blackall
- Oregon Regional Core Laboratory and Blood Bank Medical Director, Providence Health and Services, Department of Pathology and Laboratory Services, 4400 NE Halsey Street, Building 3, Portland, OR, 97213, United States
| |
Collapse
|
2
|
Kheirbek RE, Fokar A, Little JT, Balish M, Shara NM, Boustani MA, Llorente M. Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2020; 74:1916-1921. [PMID: 30753301 DOI: 10.1093/gerona/glz045] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 02/08/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Antipsychotics are prescribed to treat various symptoms in older adults, however, their safety in this context has not been fully evaluated. The objective was to evaluate mortality risks associated with off-label use of antipsychotics among older adults with no preexisting mental illness or dementia relative to those with diagnosis of dementia. METHODS Data (2007-2015) were derived from Department of Veterans Affairs registries for 730,226 patients (≥65 years) with no baseline serious mental illness, dementia). We estimated the cumulative incidence of antipsychotics prescription and 10-year all-cause mortality. The extended Cox models were used to estimate Hazard Ratios (HRs) associated with antipsychotics prescription, adjusted for time-varying covariates, dementia diagnosis, comorbidity index score, and age at time of first exposure to antipsychotics. RESULTS The study included 98% males, 13% African Americans, and 81% Caucasian. Patients with dementia and antipsychotics had the highest risk of mortality (78.0%), followed by (73.0%) for patients with dementia alone and compared with patients without dementia or antipsychotics exposure who had the lowest mortality risk (42.0%). Exposure to typical antipsychotics was associated with (HR: 2.1, confidence interval [CI] 2.0-2.2) compared with atypical antipsychotics (HR: 1.5, CI 1.4-1.5, p = <.0001). CONCLUSION In a large cohort of older adults, antipsychotics were associated with an increased risk of all-cause mortality. While significant increase in mortality was attributable to the diagnosis of dementia, the addition of antipsychotics resulted in added mortality risk among all patients. Antipsychotic medications should be used cautiously in all older adults, not only those with dementia.
Collapse
Affiliation(s)
- Raya Elfadel Kheirbek
- Veterans Affairs Medical Center, Washington, District of Columbia.,George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.,University of Maryland School of Medicine, Baltimore
| | - Ali Fokar
- Veterans Affairs Medical Center, Washington, District of Columbia
| | - John T Little
- Veterans Affairs Medical Center, Washington, District of Columbia.,Georgetown University School of Medicine, Washington, District of Columbia
| | - Marshall Balish
- Veterans Affairs Medical Center, Washington, District of Columbia.,Georgetown University School of Medicine, Washington, District of Columbia
| | - Nawar M Shara
- MedStar Health Research Institute, Washington, District of Columbia
| | - Malaz A Boustani
- Indiana University Center for Aging Research, Indianapolis.,Regenstrief Institute, Inc., Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis
| | - Maria Llorente
- Veterans Affairs Medical Center, Washington, District of Columbia.,Georgetown University School of Medicine, Washington, District of Columbia
| |
Collapse
|
3
|
Affiliation(s)
- John T Little
- Department of Psychiatry, Department of Veterans Affairs Medical Center, Washington, DC; Departments of Psychiatry and Neurology, Georgetown University School of Medicine, Washington, DC.
| |
Collapse
|
4
|
Pontone GM, Williams JR, Anderson KE, Chase G, Goldstein SR, Grill S, Hirsch ES, Lehmann S, Little JT, Margolis RL, Palanci J, Rabins PV, Weiss HD, Marsh L. Pharmacologic treatment of anxiety disorders in Parkinson disease. Am J Geriatr Psychiatry 2013; 21:520-8. [PMID: 23567419 PMCID: PMC3655116 DOI: 10.1016/j.jagp.2012.10.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 05/11/2012] [Revised: 09/27/2012] [Accepted: 10/12/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Neither best practices nor an evidence base for the pharmacologic treatment of anxiety in Parkinson disease (PD) has been established. This study investigated pharmacologic treatment of anxiety disorders in idiopathic PD and the associated clinical features. DESIGN Cross-sectional. SETTING Three community-based movement disorder neurology practices. PARTICIPANTS 250 subjects with PD. MEASUREMENTS Anxiety disorder diagnoses were established by consensus using a panel of six psychiatrists with expertise in geriatric psychiatry and movement disorders. Current medications were provided by the treating neurologists at the time of interview. RESULTS Among subjects with anxiety disorders only, 53% were untreated with medications. When anxious subjects with comorbid depressive disorders were included, 70.8% were on medications effective for treatment of anxiety. Subjects with anxiety and comorbid depressive disorders were more likely to be treated for their psychiatric disturbances than subjects with anxiety disorders alone (odds ratio: 8.33), as were subjects with comorbid motor fluctuations (odds ratio: 3.65). There were no differences in the types of anti-anxiety medications used in regard to the presence of depression or motor fluctuations. CONCLUSIONS These findings suggest that over half of nondepressed PD patients with clinically significant anxiety are untreated with medication. A better understanding of the role of clinical features associated with anxiety in PD, such as depression and motor fluctuations, may improve the recognition and treatment of anxiety disorders in this population.
Collapse
Affiliation(s)
- Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Calleo J, Williams JR, Amspoker AB, Swearingen L, Hirsch ES, Anderson K, Goldstein SR, Grill S, Lehmann S, Little JT, Margolis RL, Palanci J, Pontone GM, Weiss H, Rabins P, Marsh L. Application of Depression Rating Scales in Patients with Parkinson's Disease with and without Co-Occurring Anxiety. Journal of Parkinson's Disease 2013; 3:603-8. [DOI: 10.3233/jpd-130264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jessica Calleo
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - James R. Williams
- Biogen Idec, Cambridge, MA, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amber B. Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Leah Swearingen
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Karen Anderson
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Susanne R. Goldstein
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- US Food and Drug Administration, Silver Spring, MD, USA
- Parkinson's and Movement Disorder Center of Maryland, Elkridge, MD, USA
| | - Stephen Grill
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Parkinson's and Movement Disorder Center of Maryland, Elkridge, MD, USA
| | - Susan Lehmann
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John T. Little
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Georgetown University Medical Center, Washington, DC, USA
- Veteran's Affairs Medical Center, Washington, DC, USA
| | | | - Justin Palanci
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Howard Weiss
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Rabins
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura Marsh
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
6
|
Williams JR, Hirsch ES, Anderson K, Bush AL, Goldstein SR, Grill S, Lehmann S, Little JT, Margolis RL, Palanci J, Pontone G, Weiss H, Rabins P, Marsh L. A comparison of nine scales to detect depression in Parkinson disease: which scale to use? Neurology 2012; 78:998-1006. [PMID: 22422897 DOI: 10.1212/wnl.0b013e31824d587f] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The Methods of Optimal Depression Detection in Parkinson's Disease (MOOD-PD) study compared the psychometric properties of 9 depression scales to provide guidance on scale selection in Parkinson disease (PD). METHODS Patients with PD (n = 229) from community-based neurology practices completed 6 self-report scales (Beck Depression Inventory [BDI]-II, Center for Epidemiologic Studies Depression Rating Scale-Revised [CESD-R], 30-item Geriatric Depression Scale [GDS-30], Inventory of Depressive Symptoms-Patient [IDS-SR], Patient Health Questionnaire-9 [PHQ-9], and Unified Parkinson's Disease Rating Scale [UPDRS]-Part I) and were administered 3 clinician-rated scales (17-item Hamilton Depression Rating Scale [HAM-D-17], Inventory of Depressive Symptoms-Clinician [IDS-C], and Montgomery-Åsberg Depression Rating Scale [MADRS] and a psychiatric interview. DSM-IV-TR diagnoses were established by an expert panel blinded to the self-reported rating scale data. Receiver operating characteristic curves were used to estimate the area under the curve (AUC) of each scale. RESULTS All scales performed better than chance (AUC 0.75-0.85). Sensitivity ranged from 0.66 to 0.85 and specificity ranged from 0.60 to 0.88. The UPDRS Depression item had a smaller AUC than the BDI-II, HAM-D-17, IDS-C, and MADRS. The CESD-R also had a smaller AUC than the MADRS. The remaining AUCs were statistically similar. CONCLUSIONS The GDS-30 may be the most efficient depression screening scale to use in PD because of its brevity, favorable psychometric properties, and lack of copyright protection. However, all scales studied, except for the UPDRS Depression, are valid screening tools when PD-specific cutoff scores are used.
Collapse
Affiliation(s)
- J R Williams
- Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Mack J, Rabins P, Anderson K, Goldstein S, Grill S, Hirsch ES, Lehmann S, Little JT, Margolis RL, Palanci J, Pontone G, Weiss H, Williams JR, Marsh L. Prevalence of psychotic symptoms in a community-based Parkinson disease sample. Am J Geriatr Psychiatry 2012; 20:123-32. [PMID: 21617521 PMCID: PMC3168582 DOI: 10.1097/jgp.0b013e31821f1b41] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVES : To determine the prevalence of psychotic phenomena, including minor symptoms, in a Parkinson disease (PD) sample and compare the clinical correlates associated with the various psychotic phenomena. To evaluate the extent to which cases met National Institute of Neurological Diseases and Stroke (NINDS)/National Institute of Mental Health (NIMH)-proposed criteria for PD-associated psychosis. METHODS : A total of 250 patients with idiopathic PD and Mini Mental State Exam scores greater than 23 from three community-based movement disorder clinics underwent comprehensive research diagnostic evaluations by a geriatric psychiatrist as part of a study on mood disorders in PD. Psychotic symptoms were categorized using a checklist, which included a breakdown of hallucinations, delusions, and minor symptoms. Clinical characteristics of groups with minor and other psychotic symptoms were compared. The NINDS/NIMH criteria for PD-psychosis were retrospectively applied. RESULTS : Of the total sample, 26% of patients were found to have any current psychotic symptoms, with 47.7% of those having isolated minor symptoms, and 52.3% having hallucinations and/or delusions. Compared to those with no current psychiatric symptoms, minor symptoms were associated with more depressive symptoms and worse quality of life, and 90.8% of those with psychotic symptoms fulfilled the NINDS/NIMH proposed criteria. CONCLUSIONS : Psychotic symptoms are common in PD patients, with minor psychotic phenomena present in nearly half of affected patients in a community-based sample. Psychotic symptoms, including minor phenomena, were clinically significant. The NINDS/NIMH PD-psychosis criteria captured the clinical characteristics of psychosis as it relates to PD. Longitudinal studies are needed to determine whether minor psychotic symptoms represent a precursor to hallucinations and delusions, and to further validate diagnostic criteria.
Collapse
Affiliation(s)
- Joel Mack
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Rabins
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Anderson
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Susanne Goldstein
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Parkinson's and Movement Disorder Center of Maryland, Baltimore, MD, USA
| | - Stephen Grill
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Parkinson's and Movement Disorder Center of Maryland, Baltimore, MD, USA
| | | | - Susan Lehmann
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John T. Little
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Justin Palanci
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gregory Pontone
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Howard Weiss
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Laura Marsh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
8
|
Rafii MS, Walsh S, Little JT, Behan K, Reynolds B, Ward C, Jin S, Thomas R, Aisen PS. A phase II trial of huperzine A in mild to moderate Alzheimer disease. Neurology 2011; 76:1389-94. [PMID: 21502597 DOI: 10.1212/wnl.0b013e318216eb7b] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Huperzine A is a natural cholinesterase inhibitor derived from the Chinese herb Huperzia serrata that may compare favorably in symptomatic efficacy to cholinesterase inhibitors currently in use for Alzheimer disease (AD). METHODS We assessed the safety, tolerability, and efficacy of huperzine A in mild to moderate AD in a multicenter trial in which 210 individuals were randomized to receive placebo (n = 70) or huperzine A (200 μg BID [n = 70] or 400 μg BID [n = 70]), for at least 16 weeks, with 177 subjects completing the treatment phase. The primary analysis assessed the cognitive effects of huperzine A 200 μg BID (change in Alzheimer's Disease Assessment Scale-cognitive subscale [ADAS-Cog] at week 16 at 200 μg BID compared to placebo). Secondary analyses assessed the effect of huperzine A 400 μg BID, as well as effect on other outcomes including Mini-Mental State Examination, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change scale, Alzheimer's Disease Cooperative Study Activities of Daily Living scale, and Neuropsychiatric Inventory (NPI). RESULTS Huperzine A 200 μg BID did not influence change in ADAS-Cog at 16 weeks. In secondary analyses, huperzine A 400 μg BID showed a 2.27-point improvement in ADAS-Cog at 11 weeks vs 0.29-point decline in the placebo group (p = 0.001), and a 1.92-point improvement vs 0.34-point improvement in the placebo arm (p = 0.07) at week 16. Changes in clinical global impression of change, NPI, and activities of daily living were not significant at either dose. CONCLUSION The primary efficacy analysis did not show cognitive benefit with huperzine A 200 μg BID. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that huperzine A 200 μg BID has no demonstrable cognitive effect in patients with mild to moderate AD.
Collapse
Affiliation(s)
- M S Rafii
- Department of Neurosciences, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Pontone GM, Williams JR, Anderson KE, Chase G, Goldstein SR, Grill S, Hirsch ES, Lehmann S, Little JT, Margolis RL, Rabins PV, Weiss HD, Marsh L. Anxiety and self-perceived health status in Parkinson's disease. Parkinsonism Relat Disord 2011; 17:249-54. [PMID: 21292531 DOI: 10.1016/j.parkreldis.2011.01.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [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] [Received: 08/03/2010] [Revised: 01/07/2011] [Accepted: 01/10/2011] [Indexed: 11/16/2022]
Abstract
Both anxiety and depression are associated with lower self-perceived health status (HS) in persons with Parkinson's disease (PD). Given the high co-morbidity with depression and other non-motor symptoms, it is unclear whether anxiety disorders, in general, versus specific anxiety subtypes have an independent effect on HS in PD. To examine this question, comprehensive assessments of motor and non-motor symptoms from 249 subjects with idiopathic PD followed in three community-based movement disorders neurology practices were analyzed. HS was measured using the 8-item PD Questionnaire (PDQ-8). Psychiatric diagnoses were established by consensus using a panel of six psychiatrists with expertise in geriatric psychiatry and movement disorders. Stepwise multiple regression analyses were used, with the PDQ-8 score as the dependent variable, to identify independent predictors of HS among motor, psychiatric, and other non-motor variables. Among the anxiety disorders, only anxiety associated with motor fluctuations was an independent predictor of HS after accounting for co-morbid depression and other clinical features. In addition, depressive disorders were also an independent predictor of lower HS. Prevention or treatment of state-dependent anxiety may improve HS in persons with PD.
Collapse
Affiliation(s)
- Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Pontone GM, Williams JR, Anderson KE, Chase G, Goldstein SA, Grill S, Hirsch ES, Lehmann S, Little JT, Margolis RL, Rabins PV, Weiss HD, Marsh L. Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson's disease. Mov Disord 2009; 24:1333-8. [PMID: 19425086 DOI: 10.1002/mds.22611] [Citation(s) in RCA: 220] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Anxiety disorders are common in Parkinson's disease (PD), but are not well characterized. This study determined the prevalence and clinical correlates of all DSM-IV-TR anxiety disorder diagnoses in a sample of 127 subjects with idiopathic PD who underwent comprehensive assessments administered by a psychiatrist and neurologist. A panel of six psychiatrists with expertise in geriatric psychiatry and/or movement disorders established by consensus all psychiatric diagnoses. Current and lifetime prevalence of at least one anxiety disorder diagnosis was 43% (n = 55) and 49% (n = 63), respectively. Anxiety disorder not otherwise specified, a DSM diagnosis used for anxiety disturbances not meeting criteria for defined subtypes, was the most common diagnosis (30% lifetime prevalence, n = 38). Compared with nonanxious subjects, panic disorder (n = 13) was associated with earlier age of PD onset [50.3 (12.2) vs. 61.0 (13.7) years, P < 0.01], higher rates of motor fluctuations [77% (10/13) vs. 39% (25/64), P = 0.01] and morning dystonia [38% (5/13) vs. 13% (8/62), P < 0.03]. This high prevalence of anxiety disorders, including disturbances often not meeting conventional diagnostic criteria, suggests that anxiety in PD is likely underdiagnosed and undertreated and refined characterization of anxiety disorders in PD is needed. In addition, certain anxiety subtypes may be clinically useful markers associated with disease impact in PD.
Collapse
Affiliation(s)
- Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Little JT, Jurica MS. Splicing Factor SPF30 Bridges an Interaction between the Prespliceosome Protein U2AF35 and Tri-small Nuclear Ribonucleoprotein Protein hPrp3. J Biol Chem 2008; 283:8145-52. [DOI: 10.1074/jbc.m707984200] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
12
|
Abstract
Huperzine A is a natural cholinesterase inhibitor derived from the Chinese herb Huperzia serrata. There is evidence that huperzine A may compare favorably in symptomatic efficacy to cholinesterase inhibitors in use. In addition, huperzine A has antioxidant and neuroprotective properties that suggest that it may be useful as a disease-modifying treatment for Alzheimer's disease (AD). The drug is available as a nutriceutical in the US. However, there have been no published controlled clinical trials outside China assessing its toxicity and efficacy. This paper reviews the development of huperzine A as a treatment for AD, including the Phase II trial now under way in the US.
Collapse
Affiliation(s)
- John T Little
- Georgetown University Hospital, Department of Psychiatry, 3800 Reservoir Road, NW, Kober-Cogan 604, Washington, DC 20007, USA.
| | | | | |
Collapse
|
13
|
Little JT, Walsh S, Aisen P. P‐198: Huperzine A as a treatment for Alzheimer's disease. Alzheimers Dement 2007. [DOI: 10.1016/j.jalz.2007.04.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Sally Walsh
- University College Hospital Galway GalwayIreland
| | - Paul Aisen
- Georgetown University Hospital WashingtonDCUSA
| |
Collapse
|
14
|
Loo LWM, Secombe J, Little JT, Carlos LS, Yost C, Cheng PF, Flynn EM, Edgar BA, Eisenman RN. The transcriptional repressor dMnt is a regulator of growth in Drosophila melanogaster. Mol Cell Biol 2005; 25:7078-91. [PMID: 16055719 PMCID: PMC1190258 DOI: 10.1128/mcb.25.16.7078-7091.2005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The Myc-Max-Mad/Mnt network of transcription factors has been implicated in oncogenesis and the regulation of proliferation in vertebrate cells. The identification of Myc and Max homologs in Drosophila melanogaster has demonstrated a critical role for dMyc in cell growth control. In this report, we identify and characterize the third member of this network, dMnt, the sole fly homolog of the mammalian Mnt and Mad family of transcriptional repressors. dMnt possesses two regions characteristic of Mad and Mnt proteins: a basic helix-loop-helix-zipper domain, through which it dimerizes with dMax to form a sequence-specific DNA binding complex, and a Sin-interacting domain, which mediates interaction with the dSin3 corepressor. Using the upstream activation sequence/GAL4 system, we show that expression of dMnt results in an inhibition of cellular growth and proliferation. Furthermore, we have generated a dMnt null allele, which results in flies with larger cells, increased weight, and decreased life span compared to wild-type flies. Our results demonstrate that dMnt is a transcriptional repressor that regulates D. melanogaster body size.
Collapse
Affiliation(s)
- Lenora W M Loo
- Division of Basic Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Harry JB, Oliver BG, Song JL, Silver PM, Little JT, Choiniere J, White TC. Drug-induced regulation of the MDR1 promoter in Candida albicans. Antimicrob Agents Chemother 2005; 49:2785-92. [PMID: 15980350 PMCID: PMC1168718 DOI: 10.1128/aac.49.7.2785-2792.2005] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Resistance of Candida albicans to azole antifungal drugs is mediated by two types of efflux pumps, encoded by the MDR1 gene and the CDR gene family. MDR1 mRNA levels in a susceptible clinical isolate are induced by benomyl (BEN) but not by other drugs previously shown to induce MDR1. To monitor MDR1 expression under several conditions, the MDR1 promoter was fused to the Renilla reniformis luciferase reporter gene (RLUC). The promoter was monitored for its responses to four oxidizing agents, five toxic hydrophobic compounds, and an alkylating agent, all shown to induce major facilitator pumps in other organisms. Deletion constructs of the MDR1 promoter were used to analyze the basal transcription of the promoter and its responses to the toxic compound BEN and the oxidizing agent tert-butyl hydrogen peroxide (T-BHP). The cis-acting elements in the MDR1 promoter responsible for induction by BEN were localized between -399 and -299 upstream of the start codon. The cis-acting elements responsible for MDR1 induction by T-BHP were localized between -601 and -500 upstream of the start codon. The T-BHP induction region contains a sequence that resembles the YAP1-responsive element (YRE) in Saccharomyces cerevisiae. This Candida YRE was placed upstream of a noninducible promoter in the luciferase construct, resulting in an inducible promoter. Inversion or mutation of the 7-bp YRE eliminated induction. Many of the drugs used in this analysis induce the MDR1 promoter at concentrations that inhibit cell growth. These analyses define cis-acting elements responsible for drug induction of the MDR1 promoter.
Collapse
MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/drug effects
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- Antifungal Agents/pharmacology
- Benomyl/pharmacology
- Blotting, Northern
- Candida albicans/drug effects
- Candida albicans/genetics
- Candida albicans/growth & development
- Candida albicans/metabolism
- Enhancer Elements, Genetic
- Gene Expression Regulation, Fungal
- Genes, Reporter
- Luciferases/genetics
- Luciferases/metabolism
- Microbial Sensitivity Tests
- Promoter Regions, Genetic/drug effects
- Promoter Regions, Genetic/genetics
- tert-Butylhydroperoxide/pharmacology
Collapse
Affiliation(s)
- Jo Beth Harry
- Department of Pathobiology, School of Public Health and Community Medicine, University of Washington, Seattle, USA
| | | | | | | | | | | | | |
Collapse
|
16
|
Little JT, Ketter TA, Kimbrell TA, Dunn RT, Benson BE, Willis MW, Luckenbaugh DA, Post RM. Bupropion and venlafaxine responders differ in pretreatment regional cerebral metabolism in unipolar depression. Biol Psychiatry 2005; 57:220-8. [PMID: 15691522 DOI: 10.1016/j.biopsych.2004.10.033] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Revised: 10/20/2004] [Accepted: 10/27/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pretreatment functional brain imaging was examined for never-hospitalized outpatients with unipolar depression compared with control subjects in a crossover treatment trial involving bupropion or venlafaxine monotherapy. METHODS Patients (n = 20) with unipolar depression received baseline (medication-free) fluorine-18 deoxyglucose (FDG) positron emission tomography (PET) scan and then at least 6 weeks of bupropion or venlafaxine monotherapy in a single-blind crossover trial. Age-matched healthy control subjects (n = 20) also received baseline FDG PET scans. For each medication PET data from patients compared with control subjects was analyzed as a function of treatment response (defined as moderate to marked improvement on the Clinical Global Impression Scale). RESULTS Treatment response rates were similar for buproprion (32%) and venlafaxine (33%). Compared with control subjects, responders but not nonresponders, to both drugs demonstrated frontal and left temporal hypometabolism. Selectively, compared with control subjects bupropion responders (n = 6) also had cerebellar hypermetabolism, whereas venlafaxine responders (n = 7) showed bilateral temporal and basal ganglia hypometabolism. CONCLUSIONS These data suggest that pretreatment frontal and left temporal hypometabolism in never-hospitalized depressed outpatients compared with control subjects is linked to positive antidepressant response and that additional alterations in regional metabolism may be linked to differential responsivity to bupropion and venlafaxine monotherapy.
Collapse
Affiliation(s)
- John T Little
- Division of Psychiatric Neuroimaging, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Kimbrell TA, Ketter TA, George MS, Little JT, Benson BE, Willis MW, Herscovitch P, Post RM. Regional cerebral glucose utilization in patients with a range of severities of unipolar depression. Biol Psychiatry 2002; 51:237-52. [PMID: 11839367 DOI: 10.1016/s0006-3223(01)01216-1] [Citation(s) in RCA: 210] [Impact Index Per Article: 9.5] [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: 10/18/2022]
Abstract
BACKGROUND Patients with unipolar depression are most often reported to have decreased regional cerebral glucose metabolism (rCMRglu) in dorsal prefrontal and anterior cingulate cortices compared with healthy control subjects, often correlating inversely with severity of depression. METHODS We measured rCMRglu with fluorine-18 deoxyglucose positron emission tomography (PET) in 38 medication-free patients with unipolar depression and 37 healthy control subjects performing an auditory continuous performance task to further investigate potential prefrontal and anterior paralimbic rCMRglu abnormalities in patients attending to this task. RESULTS Compared with control subjects, the subgroup of patients with Hamilton depression scores of 22 or greater demonstrated decreased absolute rCMRglu in right prefrontal cortex and paralimbic/amygdala regions as well as bilaterally in the insula and temporoparietal cortex (right > left); they also exhibited increased normalized metabolic activity bilaterally in the cerebellum, lingula/cuneus, and brain stem. Severity of depression negatively correlated with absolute rCMRglu in almost the entire extent of the right cingulate cortex as well as bilaterally in prefrontal cortex, insula, basal ganglia, and temporoparietal cortex (right > left). CONCLUSIONS Areas of frontal, cingulate, insula, and temporal cortex appear hypometabolic in association with different components of the severity and course of illness in treatment-resistant unipolar depression.
Collapse
Affiliation(s)
- Tim A Kimbrell
- North Little Rock VA Medical Center (TAKi), North Little Rock, Arkansas, USA
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Mulsant BH, Pollock BG, Nebes RD, Miller MD, Little JT, Stack J, Houck PR, Bensasi S, Mazumdar S, Reynolds CF. A double-blind randomized comparison of nortriptyline and paroxetine in the treatment of late-life depression: 6-week outcome. J Clin Psychiatry 2001; 60 Suppl 20:16-20. [PMID: 10513853] [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: 02/14/2023]
Abstract
BACKGROUND Some studies have suggested that selective serotonin reuptake inhibitors may be less efficacious than tricyclic antidepressants in the treatment of severe depression in older patients. The objective of this study was to compare the 6-week outcome of treatment with nortriptyline and paroxetine in older patients with a major depressive episode. METHOD A double-blind randomized comparison of nortriptyline and paroxetine was conducted in 80 elderly (mean +/- SD age = 75.0 +/- 7.4 years) psychiatric inpatients and outpatients who presented with a major depressive episode. Dropout and response rates were compared in patients who began or completed treatment. Rates of response of inpatients and patients with melancholic depression were also compared. RESULTS Over 6 weeks, there were no significant differences in dropout rates due to side effects (nortriptyline, 14% vs. paroxetine, 19%) or for any reason (27% vs. 33%). Similarly, there were no significant differences between the rates of favorable response to nortriptyline or paroxetine (intent-to-treat analysis, 57% vs. 44%; completer analysis, 78% vs. 66%). Analyses restricted to inpatients or to patients with melancholic depression yielded similar results. CONCLUSION Nortriptyline and paroxetine appear to have similar efficacy and tolerability in the acute (6-week) treatment of older depressed patients, including hospitalized patients and those with melancholic features.
Collapse
Affiliation(s)
- B H Mulsant
- Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, Western Psychiatric Institute and Clinic and Department of Psychiatry, University of Pittsburgh, PA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Wylie ME, Miller MD, Shear MK, Little JT, Mulsant BH, Pollock BG, Reynolds CF. Fluvoxamine pharmacotherapy of anxiety disorders in later life: preliminary open-trial data. J Geriatr Psychiatry Neurol 2001; 13:43-8. [PMID: 10753007 DOI: 10.1177/089198870001300107] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors present data from an open trial of fluvoxamine (median daily dosage: 200 mg) in the treatment of generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder in 19 older outpatients (mean age = 66.8). Of the 12 subjects completing the 21-week trial, 8 achieved a good response (50% reduction in symptom measures) and 7 were rated as much or very much improved. Fluvoxamine pharmacotherapy also had a significant effect in reducing comorbid depressive symptoms and in increasing levels of functioning. These data support the effectiveness of fluvoxamine in older subjects with anxiety disorders (particularly generalized anxiety disorder) and warrant further double-blind, placebo-controlled evaluation.
Collapse
Affiliation(s)
- M E Wylie
- The Intervention Research Center for Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh Medical Center, Pennsylvania, USA
| | | | | | | | | | | | | |
Collapse
|
20
|
Little JT, Kimbrell TA, Wassermann EM, Grafman J, Figueras S, Dunn RT, Danielson A, Repella J, Huggins T, George MS, Post RM. Cognitive effects of 1- and 20-hertz repetitive transcranial magnetic stimulation in depression: preliminary report. Neuropsychiatry Neuropsychol Behav Neurol 2000; 13:119-24. [PMID: 10780630] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To determine the cognitive effects of daily repetitive transcranial magnetic stimulation (rTMS) administered under the conditions of a treatment trial for major depression. BACKGROUND Although daily left dorsal prefrontal rTMS has improved mood in some patients with treatment-refractory depression, potential cognitive side effects of extended daily treatment have not been systematically studied. METHOD In a randomized double-blind treatment study, 10 subjects (mean age, 42 +/- 15 years) with an episode of major depression received either 2 weeks of low-frequency (1 Hz) or high-frequency (20 Hz) rTMS (800 pulses, 20 trains over 20 minutes, 80% of motor threshold, 5 days per week) to the left dorsolateral prefrontal cortex and then were crossed over to the other treatment condition. Patients received cognitive testing at baseline and after the first and second weeks of low- or high-frequency rTMS, which was examined by repeated-measures ANOVA. RESULTS Of 16 cognitive measures tested after 1 or 2 weeks of rTMS compared with baseline status, none showed deterioration, and the only significant main treatment effect indicated improvement on a list-recall test from pre- to post-rTMS after 1 week (p <0.05). CONCLUSIONS These preliminary data suggest no gross deleterious cognitive effects of 2 weeks of 1- or 20-Hz rTMS at 80% of motor threshold over the left prefrontal cortex. Further cognitive studies of the effects of rTMS at other parameters used in clinical trials for mood disorders remain to be undertaken.
Collapse
Affiliation(s)
- J T Little
- Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20892-1272, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Kimbrell TA, Little JT, Dunn RT, Frye MA, Greenberg BD, Wassermann EM, Repella JD, Danielson AL, Willis MW, Benson BE, Speer AM, Osuch E, George MS, Post RM. Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biol Psychiatry 1999; 46:1603-13. [PMID: 10624541 DOI: 10.1016/s0006-3223(99)00195-x] [Citation(s) in RCA: 210] [Impact Index Per Article: 8.4] [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: 01/11/2023]
Abstract
BACKGROUND Recent studies suggest that both high frequency (10-20 Hz) and low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) have an antidepressant effect in some individuals. Electrophysiologic data indicate that high frequency rTMS enhances neuronal firing efficacy and that low frequency rTMS has the opposite effect. METHODS We investigated the antidepressant effects of 10 daily left prefrontal 1 Hz versus 20 Hz rTMS with the hypothesis that within a given subject, antidepressant response would differ by frequency and vary as a function of baseline cerebral glucose metabolism. After baseline PET scans utilizing [18F]-Fluorodeoxyglucose, thirteen subjects participated in a randomized crossover trial of 2 weeks of 20 Hz paired with 2 weeks 1 Hz or placebo rTMS. RESULTS We found a negative correlation between degree of antidepressant response after 1 Hz compared to 20 Hz rTMS (r = -0.797, p < .004). Additionally, better response to 20 Hz was associated with the degree of baseline hypometabolism, whereas response to 1 Hz rTMS tended to be associated with baseline hypermetabolism. CONCLUSIONS These preliminary results suggest that antidepressant response to rTMS might vary as a function of stimulation frequency and may depend on pretreatment cerebral metabolism. Further studies combining rTMS and functional neuroimaging are needed.
Collapse
Affiliation(s)
- T A Kimbrell
- Biological Psychiatry Branch, National Institutes of Health, Bethesda, Maryland, Psychiatry Department, University of Arkansas, Little Rock, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Frye MA, Gary KA, Marangell LB, George MS, Callahan AM, Little JT, Huggins T, Corá-Locatelli G, Osuch EA, Winokur A, Post RM. CSF thyrotropin-releasing hormone gender difference: implications for neurobiology and treatment of depression. J Neuropsychiatry Clin Neurosci 1999; 11:349-53. [PMID: 10440011 DOI: 10.1176/jnp.11.3.349] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 11/30/2022]
Abstract
In light of the postulated role of thyrotropin-releasing hormone (TRH) as an endogenous anti-depressant, 56 refractory mood-disordered patients and 34 healthy adult control subjects underwent lumbar puncture for cerebrospinal fluid (CSF) TRH analysis. By two-way analysis of variance, there was no difference between CSF TRH in patients (as a group or by diagnostic subtype) and control subjects (n = 90, F = 0.91, df = 2.84, P = 0.41). There was, however, a CSF TRH gender difference (females, 2.95 pg/ml; males, 3.98 pg/ml; n = 90, F = 4.11, df = 1.84, P < 0.05). A post hoc t-test revealed the greatest gender difference in the bipolar group (t = 2.52, P < 0.02). There was no significant difference in CSF TRH in "ill" vs. "well" state (n = 20, P = 0.41). The role of elevated levels of CSF TRH in affectively ill men--or the role of decreased levels of CSF TRH in affectively ill women--remains to be investigated but could be of pathophysiological relevance.
Collapse
Affiliation(s)
- M A Frye
- Biological Psychiatry Branch, National Institute of Mental Health (NIMH), Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Little JT, Ketter TA, Mathé AA, Frye MA, Luckenbaugh D, Post RM. Venlafaxine but not bupropion decreases cerebrospinal fluid 5-hydroxyindoleacetic acid in unipolar depression. Biol Psychiatry 1999; 45:285-9. [PMID: 10023503 DOI: 10.1016/s0006-3223(98)00078-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [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: 10/18/2022]
Abstract
BACKGROUND While the antidepressants venlafaxine and bupropion are known to have different neurochemical profiles in vitro, their effects on human cerebral metabolism in vivo have not been directly compared. METHODS Cerebrospinal fluid (CSF) levels of 5-hydroxyindoleacetic acid (5-HIAA), serotonin, 3-methoxy-4-hydroxyphenylglycol (MHPG), homovanillic acid (HVA), and 3,4-dihydroxyphenylacetic acid (DOPAC) were examined in 14 never-hospitalized outpatients with unipolar depression and 10 age-similar healthy controls. Patients received a baseline lumbar puncture (LP), which was repeated after at least 6 weeks of randomized monotherapy with either venlafaxine or bupropion, while controls received only a baseline LP. RESULTS Patients (n = 9) receiving venlafaxine showed a significant decrease (42%) in their CSF 5-HIAA concentrations after treatment, but no change in other CSF measures. In contrast, patients receiving bupropion (n = 8) showed no change in CSF measures compared to pretreatment values. CONCLUSIONS While the mechanism for this differential effect of venlafaxine remains to be determined, the current study provides confirmation of the different aminergic effects of venlafaxine and bupropion.
Collapse
Affiliation(s)
- J T Little
- Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892-1272, USA
| | | | | | | | | | | |
Collapse
|
24
|
Little JT, Reynolds CF, Dew MA, Frank E, Begley AE, Miller MD, Cornes C, Mazumdar S, Perel JM, Kupfer DJ. How common is resistance to treatment in recurrent, nonpsychotic geriatric depression? Am J Psychiatry 1998; 155:1035-8. [PMID: 9699690 DOI: 10.1176/ajp.155.8.1035] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Effective treatments are available for major depressive disorder in later life. The purpose of this study was to elucidate the frequency of treatment resistance among the elderly. METHOD Treatment resistance, defined as lack of recovery despite combined pharmacotherapy and psychotherapy, was prospectively examined in 180 elderly patients in an episode of recurrent, nonpsychotic major depression who were referred to a university medical center for treatment. They received open acute and continuation treatment with nortriptyline and interpersonal psychotherapy. RESULTS Among the 159 patients who completed acute treatment, 19 (11.9%) did not experience a remission of depression. In addition, nine patients who had achieved remission relapsed during continuation therapy and did not recover despite vigorous treatment. Hence, excluding dropouts, 18.4% of the patients met the criteria for treatment resistance by their lack of response to acute treatment or by relapsing during continuation therapy and not recovering subsequently despite further vigorous treatment. CONCLUSIONS The study suggests a relatively low rate of resistance to treatment among depressed geriatric patients referred to a university tertiary care setting.
Collapse
Affiliation(s)
- J T Little
- Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh Medical Center, PA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Little JT, Johnson DN, Minichiello M, Weingartner H, Sunderland T. Combined nicotinic and muscarinic blockade in elderly normal volunteers: cognitive, behavioral, and physiologic responses. Neuropsychopharmacology 1998; 19:60-9. [PMID: 9608577 DOI: 10.1016/s0893-133x(98)00002-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [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] [Indexed: 02/07/2023]
Abstract
Establishing a pharmacologic model of the memory deficits of Alzheimer's disease could be an important tool in understanding how memory fails. We examined the combined effects of the muscarinic antagonist scopolamine and the nicotinic antagonist mecamylamine in eight normal elderly volunteers (age 61.9 +/- 8.3 yrs, SD). Each received four separate drug challenges (scopolamine (0.4 mg i.v.), mecamylamine (0.2 mg/kg up to 15 mg PO), mecamylamine + scopolamine, and placebo). There was a trend toward increased impairment in explicit memory for the mecamylamine + scopolamine condition as compared to scopolamine alone. Increased impairment was also seen for the mecamylamine + scopolamine condition as compared to scopolamine alone in selected behavioral ratings. Pupil size increased when mecamylamine was added to scopolamine, while systolic blood pressure and pulse changed in concordance with ganglionic blockade. These data together with previous brain-imaging results suggest that this muscarinic-nicotinic drug combination may better model Alzheimer's disease than either drug alone.
Collapse
Affiliation(s)
- J T Little
- Geriatric Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20892, USA
| | | | | | | | | |
Collapse
|
26
|
Broocks A, Little JT, Martin A, Minichiello MD, Dubbert B, Mack C, Tune L, Murphy DL, Sunderland T. The influence of ondansetron and m-chlorophenylpiperazine on scopolamine-induced cognitive, behavioral, and physiological responses in young healthy controls. Biol Psychiatry 1998; 43:408-16. [PMID: 9532345 DOI: 10.1016/s0006-3223(97)00388-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [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: 02/07/2023]
Abstract
BACKGROUND There is evidence from animal and human experiments that learning and memory come under the separate influence of both cholinergic and serotonergic pathways. We were interested in learning whether serotonergic drugs could attenuate or exacerbate the memory-impairing effects of anticholinergic blockade in humans. METHODS The selective serotonin 5-HT3 receptor antagonist ondansetron (0.15 mg/kg i.v.) and the serotonergic agent m-chlorophenylpiperazine (m-CPP; 0.08 mg/kg i.v.) were administered in combination with the anticholinergic agent scopolamine (0.4 mg PO) and compared to scopolamine alone in 10 young, healthy volunteers. Testing occurred on three separate days. RESULTS As expected, i.v. administration of scopolamine induced significant impairments in episodic memory and processing speed; however, these scopolamine-induced cognitive deficits were not attenuated by pretreatment with i.v. ondansetron (0.15 mg/kg), nor were they exacerbated by administration of i.v. m-CPP (0.8 mg/kg) in addition to scopolamine; however, administration of i.v. m-CPP was followed by a significant increase of self-rated functional impairment, altered self-reality, and dysphoria ratings, and scopolamine's effect on pupil size was potentiated. CONCLUSIONS Together, these results suggest that in young, healthy volunteers scopolamine-induced changes of cognitive performance are only minimally modulated by the serotonergic effects on ondansetron and m-CPP. Further studies with older controls are needed to test whether these findings may be influenced by age.
Collapse
Affiliation(s)
- A Broocks
- Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Maryland 20892-1264, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
George MS, Wassermann EM, Kimbrell TA, Little JT, Williams WE, Danielson AL, Greenberg BD, Hallett M, Post RM. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. Am J Psychiatry 1997; 154:1752-6. [PMID: 9396958 DOI: 10.1176/ajp.154.12.1752] [Citation(s) in RCA: 320] [Impact Index Per Article: 11.9] [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] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Preliminary studies have indicated that daily left prefrontal repetitive transcranial magnetic stimulation might have antidepressant activity. The authors sought to confirm this finding by using a double-blind crossover design. METHOD Twelve depressed adults received in random order 2 weeks of active treatment (repetitive transcranial magnetic stimulation, 20 Hz at 80% motor threshold) and 2 weeks of sham treatment. RESULTS Changes from the relevant phase baseline in scores on the 21-item Hamilton depression scale showed that repetitive transcranial magnetic stimulation significantly improved mood over sham treatment. During the active-treatment phase, Hamilton depression scale scores decreased 5 points, while during sham treatment the scores increased or worsened by 3 points. No adverse effects were noted. CONCLUSIONS These placebo-controlled results suggest that daily left prefrontal repetitive transcranial magnetic stimulation has antidepressant activity when administered at these parameters. Further controlled studies are indicated to explore optimal stimulation characteristics and location, potential clinical applications, and possible mechanisms of action.
Collapse
Affiliation(s)
- M S George
- Biological Psychiatry Branch, NIMH, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Sunderland T, Molchan SE, Little JT, Bahro M, Putnam KT, Weingartner H. Pharmacologic challenges in Alzheimer disease and normal controls: cognitive modeling in humans. Alzheimer Dis Assoc Disord 1997; 11 Suppl 4:S23-6. [PMID: 9339269] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Alzheimer disease (AD) is a progressive disorder characterized by cognitive and behavioral dysfunction, central to which are deficits in the cholinergic and other neurotransmitter systems. These results in the essential symptoms of dementia, including impairment of memory, judgment, and abstract thinking. The pharmacologic relationships among the various neurotransmitters (e.g., cholinergic, serotonergic, nicotinic, and dopaminergic) are highly complex and are still being investigated. Information on the pharmacologic basis of cognitive and behavioral dysfunction in AD has applications to drug therapy. One method of obtaining this information is by pharmacomodeling, using individual or combined drugs. Joint cholinergic antagonism with both muscarinic and nicotinic blockade combines to produce short-term memory impairment, which approximates to mild AD in normal elderly people. This effect is better than that achieved with either agent alone. Mixed cholinergic and serotonergic antagonism has an effect on the cognitive function of AD patients and on depression-related behavior. Dopaminergic dysfunction is linked with the development of hallucinatory and psychotic symptoms and may also be involved in dysfunction of verbal fluency. Combination pharmacomodeling allows the various behavioral and cognitive deficits in AD to be studied and allows models for drug trials to be developed.
Collapse
MESH Headings
- Aged
- Alzheimer Disease/drug therapy
- Alzheimer Disease/physiopathology
- Brain/drug effects
- Brain/physiopathology
- Drug Synergism
- Humans
- Memory, Short-Term/drug effects
- Memory, Short-Term/physiology
- Models, Neurological
- Neurotransmitter Agents/physiology
- Psychotropic Drugs/therapeutic use
- Receptors, Cholinergic/drug effects
- Receptors, Cholinergic/physiology
- Receptors, Dopamine/drug effects
- Receptors, Dopamine/physiology
- Receptors, Muscarinic/drug effects
- Receptors, Muscarinic/physiology
- Receptors, Nicotinic/drug effects
- Receptors, Nicotinic/physiology
- Receptors, Serotonin/drug effects
- Receptors, Serotonin/physiology
Collapse
Affiliation(s)
- T Sunderland
- National Institute of Mental Health, Geriatric Psychiatry Branch, Bethesda, Maryland 20892, USA
| | | | | | | | | | | |
Collapse
|
29
|
Kumar BN, Walsh RM, Walter NM, Little JT. Histiocytic necrotizing lymphadenitis (Kikuchi's disease) of the cervical lymph nodes. ORL J Otorhinolaryngol Relat Spec 1997; 59:176-8. [PMID: 9186974 DOI: 10.1159/000276933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Histiocytic necrotizing lymphadenitis (HNL), or Kikuchi's disease, is a benign cause of lymph node enlargement of unknown origin. It may be mistaken for malignant lymphoma, both clinically and histologically. Though well recognized in the pathological literature few clinicians are aware of the disease. We present a case of cervical HNL and review the literature.
Collapse
Affiliation(s)
- B N Kumar
- Department of Otolaryngology, North Staffordshire Royal Infirmary, Stoke on Trent, UK.
| | | | | | | |
Collapse
|
30
|
Abstract
Neoplasms of the facial nerve presenting as a parotid mass are uncommon. In the absence of a facial palsy their origin from the nerve is usually diagnosed intraoperatively. The majority of these neurogenic neoplasms are schwannomas, with neurofibromas occurring rarely. Although the Schwann cell is the key element in both, they have distinct histopathological characteristics, and their clinical course and management often differs. The first reported case of an intraparotid facial nerve schwannoma in a child in the English literature is presented.
Collapse
Affiliation(s)
- B N Kumar
- Department of Otolaryngology, North Staffordshire Royal Infirmary, Stoke on Trent, UK
| | | | | | | | | |
Collapse
|
31
|
Sunderland T, Esposito G, Molchan SE, Coppola R, Jones DW, Gorey J, Little JT, Bahro M, Weinberger DR. Differential cholinergic regulation in Alzheimer's patients compared to controls following chronic blockade with scopolamine: a SPECT study. Psychopharmacology (Berl) 1995; 121:231-41. [PMID: 8545529 DOI: 10.1007/bf02245634] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [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: 01/31/2023]
Abstract
The effects of low-dose chronic scopolamine on measures of cerebral perfusion and muscarinic receptors were tested in eight Alzheimer's disease (AD) subjects and eight elderly controls. Single photon emission computed tomography (SPECT) scans using technetium-labelled hexamethypropylene amine oxide (99mTc-HMPAO) to measure cerebral perfusion before and after chronic scopolamine revealed a significant 12% increase in the normal controls (P < 0.01) while the AD subjects showed no significant change. In contrast, the controls showed decreased muscarinic binding as evidenced by 123I-quinuclidinyl-4-iodobenzilate (123I-QNB) labelling after chronic drug (-10%, P < 0.01) whereas the AD subjects showed increased 123I-QNB labelling (+8%, P < 0.05). The difference between AD and control subjects was even more marked when the ratio of I-QNB to HMPAO uptake was compared, pointing to a double dissociation in the SPECT results. These data cannot be explained by group differences in cerebral perfusion alone and suggest a differential sensitivity between AD and elderly controls to chronic cholinergic blockade.
Collapse
Affiliation(s)
- T Sunderland
- Section on Geriatric Psychiatry, LCS, National Institute of Mental Health, Bethesda, MD 20892, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Little JT, Broocks A, Martin A, Hill JL, Tune LE, Mack C, Cantillon M, Molchan S, Murphy DL, Sunderland T. Serotonergic modulation of anticholinergic effects on cognition and behavior in elderly humans. Psychopharmacology (Berl) 1995; 120:280-8. [PMID: 8524975 DOI: 10.1007/bf02311175] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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: 01/31/2023]
Abstract
Cholinergic neurotransmission is thought to be modulated by serotonin as documented in animal and human studies. We examined the effects of the muscarinic antagonist scopolamine (0.4 mg IV) given alone or together with the serotonin mixed agonist/antagonist m-chlorophenylpiperazine (m-CPP, 0.08 mg/kg IV), and the selective 5-HT3 receptor antagonist ondansetron (0.15 mg/kg IV). Ten normal elderly volunteers each received five separate pharmacologic challenges (placebo, ondansetron, scopolamine, scopolamine+ondansetron, and scopolamine+m-CPP). Cognitive, behavioral, and physiologic variables were analyzed using repeated measures analysis of variance. The acute effects of scopolamine in certain cognitive, behavioral, and physiological measures were significantly exaggerated by the addition of m-CPP. Scopolamine's cognitive effects were unaffected by ondansetron at the dose tested, nor did ondansetron given alone affect basal cognitive performance. This pilot study suggests that the serotonin mixed agonist/antagonist m-CPP may influence cholinergic neurotransmission. The changes associated with the combination of scopolamine and m-CPP do not appear to be secondary to simple pharmacokinetic alterations and suggest a complex interaction between the cholinergic and serotonergic systems centrally.
Collapse
Affiliation(s)
- J T Little
- Section on Psychobiology, Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 208-992, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Little SE, Little JT. Rapid protease screening using ammonium sulfate precipitations and a high-performance centrifuge. Am Biotechnol Lab 1995; 13:28. [PMID: 7626264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- S E Little
- Beckman Instuments, Inc., Palo Alto, CA 94304-0803, USA
| | | |
Collapse
|
34
|
Abstract
A retrospective review of 71 patients with probable Alzheimer's disease was analyzed with respect to nursing evaluations of sundowning status (recurring confusion or agitation in the late afternoon or early evening). The prevalence of sundowning (including probable sundowners) was 24%. Sundowners and non-sundowners differed with regard to number of sedatives received daily, particularly chloral hydrate, and the number of days on the inpatient unit. There were no differences between sundowners and non-sundowners with respect to other types of medications, medical diagnoses, current age, age of onset of Alzheimer's disease, or Mini-Mental State Exam. Restlessness was the most common sundowning behavior, although multiple behavioral disturbances were seen. This survey suggests that the sundown syndrome is a common problem in severely demented Alzheimer's patients and requires further study.
Collapse
Affiliation(s)
- J T Little
- Biological Psychiatry Branch, NIMH, Bethesda, Maryland 20892, USA
| | | | | | | |
Collapse
|
35
|
Abstract
Deficient immunoregulation has been postulated to play a role in the pathogenesis of Alzheimer's dementia. Recently, lymphopenia was reported to be more prevalent in Alzheimer patients than in control subjects. In addition, a decreasing number of total lymphocytes was found to be significantly correlated with increasing severity of dementia. In an attempt to replicate these findings, we studied 55 Alzheimer patients and 41 healthy controls of comparable age and gender, but found no significant difference in the distribution of total lymphocytes between these groups. Furthermore, total lymphocytes were not significantly correlated with dementia severity. Our findings, therefore, do not lend further support to an immune hypothesis for Alzheimer's dementia.
Collapse
Affiliation(s)
- M W Dysken
- Minneapolis VA Medical Center, GRECC Program (11G), MN 55417
| | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
The prescribing habits of all (401) general practitioners in the North Staffordshire health district for the treatment of otorrhoea was ascertained by questionnaire; 301 (75%) responded. Of those, 198 (66%) would not give topical treatment when the tympanic membrane was perforated. Only 41 (14%) would give topical treatment in cases of discharging grommets. Although there is a theoretical risk of ototoxicity to aminoglycosides in topical preparations, this is the most effective medical treatment and is the standard teaching advocated in specialist textbooks and practised by otolaryngologists. The results of the survey suggest that there is undue concern about possible ototoxicity and a degree of confusion in the management of this common clinical condition.
Collapse
|
37
|
Abstract
We describe a 46-year-old, schizophrenic woman with late-onset myoclonus after treatment with antipsychotic drugs. The myoclonic jerking of the neck with synchronous contractions of the face persisted after all the antipsychotic drugs had been discontinued. Tardive myoclonus has not been documented previously.
Collapse
Affiliation(s)
- J T Little
- Department of Neurology, Baylor College of Medicine, Houston, Texas 77030
| | | |
Collapse
|
38
|
Clark RG, Little JT, King R. Effect of intra-operative balanced salt solution on postoperative salintolerance. Br J Surg 1969; 56:613. [PMID: 5797725] [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] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
39
|
McDonald JF, Little JT, Ruckensteiner E. A STUDY IN BACTERIAL MORPHOLOGY. J Bacteriol 1927; 13:255-67. [PMID: 16559247 PMCID: PMC374936 DOI: 10.1128/jb.13.4.255-267.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J F McDonald
- School of Medicine, Creighton University, Omaha, Nebraska
| | | | | |
Collapse
|