Adapted problem adaptation therapy for depression in mild to moderate Alzheimer's disease dementia: A randomized controlled trial

INTRODUCTION

Trials of effectiveness of treatment options for depression in dementia are an important priority.

METHODS

Randomized controlled trial to assess adapted Problem Adaptation Therapy (PATH) for depression in mild/moderate dementia caused by Alzheimer's disease.

RESULTS

Three hundred thirty-six participants with mild or moderate dementia, >7 on Cornell Scale for Depression in Dementia (CSDD), randomized to adapted PATH or treatment as usual. Mean age 77.0 years, 39.0% males, mean Mini-Mental State Examination 21.6, mean CSDD 12.9. For primary outcome (CSDD at 6 months), no statistically significant benefit with adapted PATH on the CSDD (6 months: -0.58; 95% CI -1.71 to 0.54). The CSDD at 3 months showed a small benefit with adapted PATH (-1.38; 95% CI -2.54 to -0.21) as did the EQ-5D (-4.97; 95% CI -9.46 to -0.48).

DISCUSSION

An eight-session course of adapted PATH plus two booster sessions administered within NHS dementia services was not effective treatment for depression in people with mild and moderate dementia. Future studies should examine the effect of more intensive and longer-term therapy.

Verification Study of in Silico Computed Intracardiac Blood Flow With 4D Flow MRI

OBJECTIVE

Major challenges for clinical applications of in silico medicine are limitations in time and computational resources. Computational approaches should therefore be tailored to specific applications with relatively low complexity and must be verified and validated against clinical gold standards.

METHODS

This study performed computational fluid dynamics simulations of left ventricular hemodynamics of different complexity based on shape reconstruction from steady state gradient echo magnetic resonance imaging (MRI) data. Computed flow results of a rigid wall model (RWM) and a prescribed motion fluid-structure interaction (PM-FSI) model were compared against phase-contrast MRI measurements for three healthy subjects.

RESULTS

Extracted boundary conditions from the steady state MRI sequences as well as computed metrics, such as flow rate, valve velocities, and kinetic energy show good agreement with in vivo flow measurements. Regional flow analysis reveals larger differences.

CONCLUSION

Basic flow structures are well captured with RWM and PM-FSI. For the computation of further biomarkers like washout or flow efficiency, usage of PM-FSI is required. Regarding boundary-near flow, more accurate anatomical models are inevitable.

SIGNIFICANCE

These results delineate areas of application of both methods and lay a foundation for larger validation studies and sensitivity analysis for healthy and diseased cases, being an essential step upon clinical translations.

Unquantifiably low aldosterone concentrations are prevalent in hospitalised COVID-19 patients but may not be revealed by chemiluminescent immunoassay

Objective

Previous studies have reported conflicting findings regarding aldosterone levels in patients hospitalised with COVID-19. We therefore used the gold-standard technique of liquid chromatography-tandem mass spectrometry (LCMSMS) to address this uncertainty.

Design

All patients admitted to Cambridge University Hospitals with COVID-19 between 10 March 2020 and 13 May 2021, and in whom a stored blood sample was available for analysis, were eligible for inclusion.

Methods

Aldosterone was measured by LCMSMS and by immunoassay; cortisol and renin were determined by immunoassay.

Results

Using LCMSMS, aldosterone was below the limit of detection (<70 pmol/L) in 74 (58.7%) patients. Importantly, this finding was discordant with results obtained using a commonly employed clinical immunoassay (Diasorin LIAISON®), which over-estimated aldosterone compared to the LCMSMS assay (intercept 14.1 (95% CI -34.4 to 54.1) + slope 3.16 (95% CI 2.09-4.15) pmol/L). The magnitude of this discrepancy did not clearly correlate with markers of kidney or liver function. Solvent extraction prior to immunoassay improved the agreement between methods (intercept -14.9 (95% CI -31.9 to -4.3) and slope 1.0 (95% CI 0.89-1.02) pmol/L) suggesting the presence of a water-soluble metabolite causing interference in the direct immunoassay. We also replicated a previous finding that blood cortisol concentrations were often increased, with increased mortality in the group with serum cortisol levels > 744 nmol/L (P = 0.005).

Conclusion

When measured by LCMSMS, aldosterone was found to be profoundly low in a significant proportion of patients with COVID-19 at the time of hospital admission. This has likely not been detected previously due to high levels of interference with immunoassays in patients with COVID-19, and this merits further prospective investigation.

Development and validation of a dynamic 48-hour in-hospital mortality risk stratification for COVID-19 in a UK teaching hospital: a retrospective cohort study

OBJECTIVES

To develop a disease stratification model for COVID-19 that updates according to changes in a patient's condition while in hospital to facilitate patient management and resource allocation.

DESIGN

In this retrospective cohort study, we adopted a landmarking approach to dynamic prediction of all-cause in-hospital mortality over the next 48 hours. We accounted for informative predictor missingness and selected predictors using penalised regression.

SETTING

All data used in this study were obtained from a single UK teaching hospital.

PARTICIPANTS

We developed the model using 473 consecutive patients with COVID-19 presenting to a UK hospital between 1 March 2020 and 12 September 2020; and temporally validated using data on 1119 patients presenting between 13 September 2020 and 17 March 2021.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome is all-cause in-hospital mortality within 48 hours of the prediction time. We accounted for the competing risks of discharge from hospital alive and transfer to a tertiary intensive care unit for extracorporeal membrane oxygenation.

RESULTS

Our final model includes age, Clinical Frailty Scale score, heart rate, respiratory rate, oxygen saturation/fractional inspired oxygen ratio, white cell count, presence of acidosis (pH <7.35) and interleukin-6. Internal validation achieved an area under the receiver operating characteristic (AUROC) of 0.90 (95% CI 0.87 to 0.93) and temporal validation gave an AUROC of 0.86 (95% CI 0.83 to 0.88).

CONCLUSIONS

Our model incorporates both static risk factors (eg, age) and evolving clinical and laboratory data, to provide a dynamic risk prediction model that adapts to both sudden and gradual changes in an individual patient's clinical condition. On successful external validation, the model has the potential to be a powerful clinical risk assessment tool.

TRIAL REGISTRATION

The study is registered as 'researchregistry5464' on the Research Registry (www.researchregistry.com).

Statistical modeling of annual highest monthly rainfall in Zimbabwe

The first statistical analysis of maximum rainfall in Zimbabwe is provided. The data are from 103 stations spread across the different climatic regions of Zimbabwe. More than 90% of the stations had at least 50 years of data. The generalized extreme value distribution was fitted to maximum rainfall by the method of maximum likelihood. Probability plots, quantile plots and Kolmogorov–Smirnov tests showed that the generalized extreme value distribution provided an adequate fit for all stations. The vast majority of stations do not exhibit significant trends in rainfall. Twelve of the stations exhibit negative trends and three of the stations exhibit positive trends in rainfall. Estimates of return levels are given for 2, 5, 10, 20, 50 and 100 years.

The German Three Factor Impulsivity Index: Confirmatory factor analysis and ties to demographic and health-related variables

A growing body of research has focused on the differentiation of emotion-related versus non-emotion-related impulsivity, assessed by the Three-Factor Impulsivity (TFI) index. The goal of this study is to develop a German TFI index, and to validate the emotion-related impulsivity subscales against indices of substance abuse, physical or psychological disorder, physical exercise, BMI, and hours of sleep. 395 native-German speakers completed the German TFI index and questions on validity indicators online. Factor analyses supported the three-factor structure, including Pervasive Influence of Feelings, Lack of Follow Through, and Feelings Trigger Action. Correlations between factors were higher than in the original work. Both emotion-related impulsivity subscales correlated significantly with psychological disorder, engagement in and minutes of physical exercise per week. When included in multivariate regression models, the three factors explained 3.1%, and 29.2% of variance in amount of exercise per week and psychological disorder, respectively. In sum, findings indicated that the German TFI index has a robust three-factor structure that showed expected links to validity indicators, and novel effects in relation to physical exercise.

Efficacy, acceptability, and tolerability of all available treatments for insomnia in the elderly: a systematic review and network meta-analysis

OBJECTIVES

Symptoms of insomnia are highly prevalent in the elderly. A significant number of pharmacological and non-pharmacological interventions exist, but, up-to-date, their comparative efficacy and safety has not been sufficiently assessed.

METHODS

We integrated the randomized evidence from every available treatment for insomnia in the elderly (>65 years) by performing a network meta-analysis. Several electronic databases were searched up to May 25, 2019. The two primary outcomes were total sleep time and sleep quality. Data for other 6 efficacy and 8 safety outcomes were also analyzed.

RESULTS

Fifty-three RCTs with 6832 participants (75 years old on average) were included, 43 of which examined the efficacy of one or more drugs. Ten RCTs examined the efficacy of non-pharmacological interventions and were evaluated only with pairwise meta-analyses because they were disconnected from the network. The overall confidence in the evidence was very low primarily due to the small amount of data per comparison and their sparse connectedness. Several benzodiazepines, antidepressants, and z-drugs performed better in both primary outcomes, but few comparisons had data from more than one trial. The limited evidence on non-pharmacological interventions suggested that acupressure, auricular acupuncture, mindfulness-based stress reduction program, and tart cherry juice were better than their control interventions. Regarding safety, no clear differences were detected among interventions due to large uncertainty.

CONCLUSIONS

Insufficient evidence exists on which intervention is more efficacious for elderly patients with insomnia. More RCTs, with longer duration, making more direct interventions among active treatments and presenting more outcomes are urgently needed.

Agomelatine improves sleep in a patient with fatal familial insomnia

A young patient with FFI was started on agomelatine 25 mg to medicate nocturnal insomnia. Under this treatment sleep efficiency was improved, slow wave sleep was high and awakenings during sleep period time were far less than before. Clinically the patient was less restless during nighttime.

Is the antidepressive effect of sleep deprivation stabilized by a three day phase advance of the sleep period? A pilot study

Sleep deprivation (SD) induces a rapid amelioration of mood in about 60 % of depressed patients. After the next night of sleep, however, most patients experience a relapse. Previous studies demonstrated that a six day sleep-phase advance protocol prevents relapses in about 60 % of patients who responded positively to SD. We investigated whether also a three day phase advance of the sleep period might be able to maintain the antidepressant effects of SD. Twenty-eight medicated depressed inpatients, who had a significant improvement after a SD in one night were recruited for this study. The phase advance protocol began on the first day after SD with a bed time from 5:00 p. m. to 12:00 p. m. on the first, from 7:00 p. m. to 2:00 a. m. on the second and 9:00 p. m. to 4:00 a. m. on the third day after SD. Three patients dropped out because of protocol violations. Only ten of the remaining 25 SD responders had a relapse during the three days of phase advance treatment or during the two days after it. Two of the relapsers improved again until day 6, i. e. 68 % showed an improvement of at least 30 % six days after the beginning of the treatment. This study indicates that even a three day phase advance protocol may help to prevent relapses after successful SD.

Prediction of antidepressant effects of sleep deprivation by metabolic rates in the ventral anterior cingulate and medial prefrontal cortex

OBJECTIVE

Sleep deprivation has been shown to have an antidepressant benefit in a subgroup of depressed patients. Functional imaging studies by the authors and others have suggested that patients with elevated metabolic rates in the anterior cingulate gyrus at baseline are more likely to respond to either sleep deprivation or antidepressant medications than patients with normal metabolic rates. The authors extend their earlier work in a larger group of patients and explore additional brain areas with statistical probability mapping.

METHOD

Thirty-six patients with unipolar depression and 26 normal volunteers were studied with positron emission tomography before and after sleep deprivation. Response to sleep deprivation was defined as a 40% or larger decrease in total scores on the Hamilton Depression Rating Scale.

RESULTS

One-third of the depressed patients had a significant response to sleep deprivation. Responders had higher relative metabolic rates in the medial prefrontal cortex, ventral anterior cingulate, and posterior subcallosal gyrus at baseline than depressed patients who did not respond to sleep deprivation and normal volunteers. Lower Hamilton depression scores correlated significantly with lower metabolic rates in the left medial prefrontal cortex. After sleep deprivation, significant decreases in metabolic rates occurred in the medial prefrontal cortex and frontal pole in the patients who responded positively to sleep deprivation.

CONCLUSIONS

High pretreatment metabolic rates and decreases in metabolic rates after treatment in the medial prefrontal cortex may characterize a subgroup of depressed patients who improve following sleep deprivation and, perhaps, other antidepressant treatments.

[Examination of primary SPF swine after experimental infection with Haemophilus parasuis. Clinical symptoms, changes in hematological parameters and in the parameters of the cerebrospinal fluid]

The objectives of this work were to cause the Glässer's disease (GD) in primary specific pathogen free piglets after experimental infection, to observe the clinical symptoms and to examine the influence of the infection on the haematological parameters. GD was caused by experimental infection of Haemophilus parasuis in seven to eight weeks old specific pathogen free piglets. In relation to the infection route the morbidity was high (83-100%) and 20% of the infected piglets died. Based on the physical examination fever, respiratory distress, cramps and paralysis were observed which are typical for GD. Arthritis and nerval symptoms are also typical but less common in Glässer's disease. PCV was significantly decreased and WBC significant increased before the piglets were euthanatized.

Naps after total sleep deprivation in depressed patients: are they depressiogenic?

Total sleep deprivation (TSD) exerts beneficial but transient effects on mood in approximately 60% of patients with a major depressive disorder. The positive effects of a night of total sleep deprivation are generally reversed after the next night of sleep. Several anecdotal reports and a pilot study by our group indicated that even short naps during the period of sleep deprivation are capable of re-inducing depressive mood in responders to TSD. The present study explored whether the structure of naps at 9 a.m. was crucial for the "depressiogenic" impact of naps on mood. A negative effect on mood was replicated, but this effect was not related to any of the nap sleep variables. The effect of naps on mood was attenuated in the early afternoon. The results support the assumption of a "depressiogenic" effect of naps in patients with major depression after successful TSD.

Effect of morning and afternoon naps on mood after total sleep deprivation in patients with major depression

In 30 depressed patients who had responded to total sleep deprivation therapy, morning naps led more frequently to relapses into depression than did afternoon naps. Longer naps were less detrimental than shorter ones, and there was no significant relationship between the effect of a nap on mood and its content of slow-wave-sleep. The amount of the rapid eye-movement sleep, too, was unrelated to clinical nap effects. Thus, some of the current theories on the relationship between sleep and depressive symptomatology are not supported by the data. Our results demonstrate the importance of nap timing, suggesting a circadian variation of propensity to relapse into depression.

[Analysis of errors in ICD 9 diagnostic classification in compliance with the Federal health care regulation]

In the present study the diagnosis from 1221 letters of discharge of the years 1986 and 1987 were additionally coded by the documentation doctor of the orthopaedic department and compared with the documentation sheets and the computer lists of the administration. Supplementary to this after one year there was carried out an additional coding of the letters by the documentation doctor. The transfer errors of the administration were amounting to 1.72 p.c. with regard to three digit numbers and to 11.87 p.c. with regard to four digit coding. During the repeated examination the documentation doctor made an error of 4.3 p.c. for the three digit coding and of 15.6 p.c. if the maximum coding was required. The corresponding errors of the house physicians for three digit numbers (maximum) were amounting to 8 p.c. (33.6 p.c.) for frequent diagnoses, to 28 p.c. (48.5 p.c.) for rare diagnoses and totally 13.7 p.c. (37.8 p.c.). In the present documentation validity and reliability still shows a good result compared to other studies. Nevertheless a documentation with an error rate to such an extend is of no use for a base documentation, and this error rate must be taken into consideration in the interpretation of global medical statistics. Automatic coding systems integrated into medical writing service seems to be the only help in view of removing these problems.

Predictors of short-term treatment outcome in bulimia nervosa inpatients

Recent studies, mostly performed on bulimic outpatients, did not find consistent predictors of treatment outcome in bulimia nervosa. This is the first study to investigate anamnestic and clinical factors predictive of the short-term outcome of hospital treatment in 31 female bulimia nervosa patients with a mean age of 22.9 yr. Treatment outcome was assessed by several self-rating instruments measuring different features of the specific and unspecific psychopathology of bulimia nervosa. The most relevant predictors of the outcome of the 8-week hospital treatment were duration of previous inpatient treatments for bulimia, the intensity of anorexic tendency and the pretreatment level of depression. The majority of predictors tested did not show a strong relationship to treatment outcome. The findings are discussed in relation to results of other studies as well as to possible implications for treatment and research.

All-night electroencephalographic sleep and cranial computed tomography in depression. A study of unipolar and bipolar patients

All-night electroencephalographic (EEG) sleep recording and cranial computed tomography were performed in 24 inpatients with major depression (14 unipolar, 10 bipolar). The patients showed the characteristic "depression-like" EEG sleep alterations and their ventricular brain ratio (VBR) was increased compared with the control subjects. No major differences were found between the unipolar and the bipolar groups. There was a close and positive association between the VBR values and several measures of slow wave sleep. It is hypothesized that this relationship is due to an altered function of the limbic-hypothalamic-pituitary-adrenocortical axis in depression that affects both EEG sleep and brain morphology.

Nocturnal sleep in Huntington's disease

Nocturnal sleep was studied in 16 inpatients with Huntington's disease. In comparison with healthy controls, patients exhibited a disturbed sleep pattern with increased sleep onset latency, reduced sleep efficiency, frequent nocturnal awakenings, more time spent awake and less slow wave sleep. These abnormalities correlated in part with duration of illness, severity of clinical symptoms, and degree of atrophy of the caudate nucleus. Patients showed an increased density of sleep spindles.

[Concepts of depressive patients regarding the cause of their disease]

In 60 patients suffering from either neurotic or endogenous depression (according to ICD-9), the aetiological concepts regarding their illness were studied by means of content analysis of answers to an interview question. Most patients had multifactorial aetiological concepts. Psychosocial concepts were more frequent than biological ones; this bias, however, was less pronounced in endogenous depressives (and, within this group, in bipolar vs. unipolar patients) than in neurotic depressives. The latter stressed triggering events as causes of illness, whereas for endogenous depressives, dispositions were more important. A positive expectancy of being able to influence the illness correlated with an aetiological model which implied triggering as well as predisposing factors.

From early to late adulthood. Changes in EEG sleep of depressed patients and healthy volunteers

In order to evaluate the impact of aging on EEG sleep patterns we investigated the polysomnograms of 74 patients with major depression and 51 healthy volunteers aged 18-65 years. In most of the EEG sleep parameters, age-related changes were obvious in both the depressives and the normals. In the patients, some of these alterations occurred earlier and were more pronounced. The amount of slow-wave sleep decreased with age, but no differences were found between the depressives and the healthy volunteers at any particular age. Rapid-eye-movement (REM) latency was clearly affected by age, but there were no significant differences between patients and controls until the middle of the fourth decade of life. On the other hand, REM density measures did not vary with age and were increased in the depressives. Therefore, REM density appears to be a more likely candidate for a biologic marker for major depression than is REM latency.

The action of clenbuterol on sleep and symptomatology in depressives

Five female inpatients with major depression (melancholic type, DMS-III-R) were treated with the beta-adrenergic agonist clenbuterol for three weeks, with doses ranging from 100 micrograms to 150 micrograms. Remission of depressive symptomatology during treatment was observed in only one patient. All patients complained of side effects, especially tremor, agitation and restlessness. The sleep EEG showed no consistent effects on sleep parameters, including REM latency and percentage of REM sleep. Thus, the impact of clenbuterol on sleep clearly differs from that of most classical antidepressants. Regarding the lack of therapeutic efficacy, the data are compatible with the hypothesis of a relationship between REM sleep suppression and an antidepressant drug effect. Despite the small sample size, it can be concluded that clenbuterol is not likely to be a promising alternative to proven antidepressants in the treatment of major depression.

Alterations of nocturnal sleep in patients with HIV infection

Nocturnal sleep of 14 patients with HIV infection was characterized by longer sleep onset latency, shorter total sleep time, reduced sleep efficiency, more time spent awake and in Stage 1. There was significantly less sleep Stage 2 than in healthy controls. REM latency was slightly reduced and correlated negatively with depressive symptomatology, while percentages of REM and slow wave sleep were normal. Patients without complaints at the time of the investigation exhibited similar sleep abnormalities. The results stress the usefulness of polysomnography as a sensitive methodology for detection and monitoring of CNS affection in HIV positive patients.

Nocturnal sleep EEG in patients with HIV infection

Nocturnal sleep was studied in 14 human immunodeficiency virus (HIV)-positive patients without opportunistic infections of the central nervous system. Seven patients had no bodily complaints at the time of the investigation. Patients exhibited an impaired nocturnal sleep with longer sleep onset latency, reduced total sleep time, reduced sleep efficiency, and more time spent awake and in stage 1. Stage 2 sleep was significantly decreased; in 2 cases, sleep spindle density was extremely low. REM latency was reduced and correlated negatively with depressive symptomatology, while the percentages of REM and slow wave sleep were normal. No significant differences in sleep parameters were present among patients in different stages of the illness, or between patients with and without bodily complaints. Ventricular size and sulcal width on computed tomography scans correlated with sleep variables indicating reduced sleep quality, and with REM density. Decreased tryptophan plasma levels were associated with shorter and less efficient sleep, and with reduced stage 2 sleep. The findings demonstrate that sleep EEG investigations can be valuable for detecting and monitoring central nervous system affection in HIV-positive individuals.

Effect of dexfenfluramine on sleep in healthy subjects

The acute effects of dexfenfluramine on nocturnal sleep were studied in ten healthy male subjects by means of sleep EEG recordings and ratings of subjective sleep quality. Four different dosages (3 mg, 7 mg, 15 mg, and 30 mg) were tested, administered over a period of 3 days each. Under 15 mg and 30 mg dexfenfluramine, only slight effects on sleep were observed: 15 mg led to decreased sleep efficiency in the first night of medication, and to reduced percentage of slow wave sleep in the first and third night. A significant lengthening of REM latency was present in the third night under 30 mg dexfenfluramine, without changes in other REM sleep parameters. Daily doses of 3 mg and 7 mg dexfenfluramine did not influence sleep, except for a significant REM latency reduction observed in the first night under 3 mg. Apart from a transient slight impairment under 30 mg, ratings of subjective sleep quality did not mirror any impact of dexfenfluramine. The data suggest that therapeutic dosages of dexfenfluramine only slightly influence nocturnal sleep, which contrasts with the known impact of other anti-obesity agents like the amphetamines. Unlike classical antidepressants, dexfenfluramine does not reduce REM sleep; in light of a hypothetical link between REM sleep reduction and antidepressant action of a drug, dexfenfluramine is not expected to have a pronounced antidepressant effect.

Brain morphology and sleep EEG in patients with Huntington's disease

In 12 patients with Huntington's disease, the relationship between brain morphology, nocturnal sleep EEG, and clinical variables was studied. Global cerebral atrophy did not significantly correlate with sleep parameters, whereas atrophy of the caudate nuclei was associated with reduced slow wave sleep and increased time spent awake. Several clinical parameters (e.g., anergia and thought disturbance scores of the Brief Psychiatric Rating Scale, illness duration and global clinical assessment) showed significant correlations with global cerebral atrophy. Similar studies in other neuropsychiatric disorders demonstrate associations between sleep alterations and brain morphological changes of different localizations, thus pointing to a complex relationship between both. It can be hypothesized that the caudate nuclei may be involved in sleep regulation; indirect evidence from studies with positron emission tomography (PET) point in the same direction.

Investigations of morning and laboratory dream recall and content in depressive patients during baseline conditions and under antidepressive treatment with trimipramine

REM sleep abnormalities like shortened REM (rapid eye movement) latency, prolongation of the first REM period and heightening of REM density often found in patients with a major depression have prompted an increasing number of studies investigating the neurobiology and neurophysiology of REM sleep in depressive patients, as well as in healthy humans and animals. On the other hand, since the early 1970s investigation of the psychological concomitant of REM sleep, i.e., dreaming, in depressive patients has been extremely sparse. The present study aimed at investigating morning and laboratory dream recall and content in patients with a major depressive disorder to shed more light on this neglected area. In short, morning as well as laboratory dream recall in depressive inpatients was drastically reduced. The low number of scorable dream reports collected did not reveal a heightened incidence of "masochistic" or "negative" content, indeed were rather mundane. In contrast, depressive outpatients (probably less depressed) had a higher rate of morning dream recall. Interestingly, antidepressive treatment with trimipramine (an antidepressant which does not suppress REM sleep) led to a positive influence on patients' mood that was paralleled by a change of dream mood in a positive direction.

Action of trimipramine on sleep and pituitary hormone secretion

Trimipramine is unlike other antidepressants in that it does not suppress REM sleep and possesses an atypical pharmacological profile. This antidepressant was administered in the evening to 10 depressed patients at a dosage of 75 mg on night 1 with 25 mg increments each night, up to 200 mg on night 6 and at this dosage thereafter. Sleep parameters were measured at baseline and on nights 2, 11 and 21. On nights 11 and 21, there was a significantly improved sleep pattern as shown by increases in sleep period time, total sleep time and sleep efficiency, and there was a decrease in sleep onset latency. No suppression of REM sleep occurred, and an increase was even noted; this, however, may have been due to a particularly low baseline value. Subjective assessments in which self-ratings of sleep quality were used also demonstrated an improvement in sleep. In addition, the neuroendocrine effects of trimipramine were investigated in 8 healthy volunteers after a single oral 75 mg dose. After 3 hours, a significant fall in plasma cortisol concentration from 117 to 43 micrograms/L and a significant rise in plasma prolactin concentration from 6 to 16.3 micrograms/L were observed, but there was no significant effect on plasma human growth hormone concentration. These results further support the effectiveness of trimipramine therapy in normalising a disturbed sleep pattern in depressed patients, and it may be of use in non-depressed insomniacs. The acute neuroendocrine effects of trimipramine are similar to those observed with neuroleptics and further indicate its atypical pharmacological profile.

Reactivation of the androgen receptor from murine preputial gland by thioredoxin or GSH

The androgen receptor from murine preputial gland was inactivated by density gradient centrifugation, affinity chromatography and isoelectric focusing. The hormone binding of the receptor could be partially restored (roughly 40%) by the thioredoxin-thioredoxinreductase system, by thioredoxin plus dithiothreitol or by glutathione. Dithiothreitol, by itself, was unable to reactivate the androgen receptor. These findings show that the receptor inactivation is, at least partially, due to thiol group oxidation and removal of SH-reducing and/or -stabilizing substances from the receptor during purification.

Isolation and characterization of the androgen receptor of murine preputial gland

The androgen receptor of murine preputial gland showed in binding experiments a biphasic saturation curve and a biphasic Scatchard plot. The receptor converted from an 8.5-9 S form to a 4.5-5 S form in high ionic strength buffer. The apparent dissociation constant was KD 0.5 +/- 0.2 nM for the 8.5-9 S receptor form. A 6.5-7 S receptor form could be detected in some experiments. The ligand specificity was evaluated by competition experiments: testosterone greater than androstenedione greater than dihydrotestosterone greater than androstanediol greater than estradiol greater than progesterone greater than dexamethasone. The receptor of murine preputial gland was less stable than the androgen receptor of skeletal muscle of the same mice.

Monohydroperoxides of linoleic acid in endoplasmic lipids of rats exposed to tetrachloromethane

An accurate method for the quantitative determination of hydroperoxy and hydroxy fatty acids in liver microsomes is presented which involves the use of 18O-labeled internal standards. The method is employed for the determination of hydroperoxides in rat liver microsomes after aerobic incubation with Fe2+/ADP and in microsomes from animals exposed to 75 mg tetrachloromethane/kg body weight. The amounts found after artificial microsomal "lipid peroxidation" are almost two orders of magnitude larger than those in microsomes from tetrachloromethane-exposed animals.

Partnership problems as causes of endogenous and neurotic depressions

Content analysis of biographic interviews with endogenous and neurotic depressives shows that problems in a partnership carry particular weight as triggers of depression. In this respect, however, separations and the death of a partner play a comparatively less important role. Neurotic depressives become significantly more often depressive because of partnership-related events than endogenous depressives. Also in qualitative respects the causes for depression differ between the two groups: in endogenous depressives a threat of real loss often triggers depression, whereas neurotic depressives fall ill more frequently as a result of disappointments and injuries caused by the partner. Accompanying differences in the course of the partnership, the choice of partner and the premorbid personality are discussed.

Successful treatment of anovulatory sterility by use of pulsatile GN-RH application

In this paper the Authors describe a new successful way of therapy of anovulatory sterility with the introduction of the pulsatile gonadotrophin releasing hormone stimulation of the hypophysis by the gonadoreline cyclomat-pump.