Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Synthetic ovine corticotropin releasing factor (o-CRF) was administered as an intravenous bolus (100 micrograms) to eight patients suffering from a major depressive disorder, endogenous subtype. All patients showed inadequately suppressed cortisol levels after 1 mg dexamethasone. After clinical remission and normalized dexamethasone responses, these patients were reinvestigated with o-CRF stimulation. The mean adrenocorticotropic hormone (ACTH) release from the pituitary corticotroph cells was indiscriminate at both test sessions. Cortisol and corticosterone output after o-CRF tended to be higher during depression than after recovery. The o-CRF-induced increments observed with corticosterone were more marked in comparison with cortisol. Within the limitations of the current protocol, our preliminary data lend support to the view that an increased pituitary ACTH reserve or adrenocortical steroid reserve is not likely to be responsible for the defective pituitary-adrenal regulation in some dexamethasone-resistant depressives.
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PMID:ACTH, cortisol, and corticosterone output after ovine corticotropin-releasing factor challenge during depression and after recovery. 298 88

The 41-amino acid CRF fulfils all the criteria for a corticotrophin releasing factor, although considerable evidence suggests that other factors, particularly VP, also play a physiologically significant role in controlling ACTH release. Although human CRF has now been identified as a 41-residue peptide, most studies to date have used oCRF-41 in their exploration of the physiology and pathology of the hypothalamic--pituitary--adrenal axis. Low doses of oCRF-41 appear to be safe, and for specific tests of the readily-releasable pool of ACTH and related peptides 100 micrograms is a practical dose for most purposes. Although serious side-effects have only been noted at doses above 100 micrograms, it is reasonable to monitor all patients administered CRF-41 with great care, and in particular to be alert to hypotension, especially in patients with corticosteroid deficiency. There is little doubt that, in combination with the standard insulin-tolerance test, the CRF test is a useful means of diagnosing hypothalamic or portal dysfunction in patients with secondary adrenal failure. However, in the diagnosis and differential diagnosis of Cushing's syndrome, the role of the CRF test remains unclear. In normal subjects, a high basal cortisol level usually inhibits the response to CRF, such that a greatly enhanced response is suggestive of pituitary-dependent Cushing's syndrome. In patients with diagnosed ACTH-dependent Cushing's syndrome, an absent response to CRF predisposes towards an ectopic source of ACTH. However, there are exceptions in all directions, and it is uncertain whether the CRF test will prove of greater value than the traditional procedures, such as the dexamethasone suppression test. The differential diagnosis of depression and Cushing's disease may be its greatest value. In terms of treatment, there are as yet few data on the usefulness of CRF in expediting recovery of the pituitary-adrenal axis following long-term suppression, such as in patients with Cushing's syndrome treated by removal of a unilateral adenoma or trans-sphenoidal microadenomectomy. It is possible that such treatment may eventually be a useful application of CRF, although data are not yet available.
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PMID:The CRFs and their control: chemistry, physiology and clinical implications. 300 78

To further explore hypothalamic pituitary adrenal regulation in patients with affective illness, we administered 1 microgram/kg of synthetic ovine corticotropin releasing factor at 2000h to 26 drug-free patients with this disorder and to 15 healthy controls. Compared to controls, depressed patients (N = 12) showed a significant elevation in baseline cortisol and significant reductions in the net ACTH and cortisol responses to corticotropin releasing factor. These findings were normal in manic (N = 6) and improved (N = 8) subjects. An additional finding was that baseline cortisol and net ACTH and cortisol responses to CRF were negatively correlated in the entire group of patients and controls as well as in the patients alone. These data indicate that the reduced ACTH and cortisol responses to CRF in depression reflect normal functioning of the pituitary corticotroph cell (i.e., that the negative feedback effect of cortisol on ACTH secretion in depression is physiologically intact, effectively serving as a brake on the ACTH response to exogenous CRF. Thus, the hypercortisolism of depression may be due to a hypothalamic defect, possibly involving hypersecretion of endogenous CRF. This possibility may be of particular interest in light of clinical observations that depression can often be precipitated by stress and by data in experimental animals that CRF may influence several processes known to be altered in the overall symptom complex of depression.
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PMID:Abnormal ACTH and cortisol responses to ovine corticotropin releasing factor in patients with primary affective disorder. 301 Mar 82

ACTH-release by primary cultures of rat anterior pituitary cells in response to CRF, vasopressin, epinephrine, norepinephrine and VIP is readily suppressible by dexamethasone. Rat hypothalamic extract-induced ACTH release is less sensitive to the inhibitory effect of dexamethasone than that elicited by CRF and the other secretagogues mentioned above. In studying the additive and potentiating effect on ACTH release of CRF in combination with vasopressin, VIP and the catecholamines it became evident that only the combination of micromolar concentrations of epinephrine or norepinephrine together with nanomolar concentrations of CRF will make ACTH release significantly less sensitive to the suppressive effect of dexamethasone. Other combinations of CRF and vasopressin or CRF and VIP will render ACTH release as suppressible to dexamethasone, as that elicited by each of these compounds by itself. This observation in the rat might explain at least in part the observation that a diminished suppressibility of the pituitary-adrenal axis to dexamethasone can be found in patients with psychiatric disease, especially depression.
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PMID:High concentrations of catecholamines selectively diminish the sensitivity of CRF-stimulated ACTH release by cultured rat pituitary cells to the suppressive effects of dexamethasone. 301 54

The clinical course of 24 patients with insulin-requiring diabetes mellitus who had received total parenteral nutrition (TPN) was retrospectively analyzed. Routine nutritional assessment disclosed significant depression of anthropometric indices and secretory protein levels in patients with chronic renal failure complicating juvenile onset diabetes mellitus (JODM). Biochemical complications including hypo- or hyperglycemia were significantly more frequent (p less than 0.001) in JODM than in maturity-onset diabetes and found to a lesser degree in patients with renal failure. The catheter infection rate was substantially higher (17%) than usually encountered in TPN therapy. Positive nitrogen balance was achieved in the majority of patients with an average 84% and 92% of estimated protein and caloric requirements being provided. Close monitoring and a protocol of infusion plus supplemental subcutaneous regular insulin was useful in providing adequate TPN safely to these high-risk patients.
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PMID:Total parenteral nutrition in patients with insulin-requiring diabetes mellitus. 308 5

Aluminum has been proposed as the causative agent in dialysis encephalopathy syndrome. We prospectively assessed whether other, less severe, neuropsychologic abnormalities were also associated with aluminum. A total of 16 patients receiving chronic dialytic therapy were studied. The deferoxamine infusion test (DIT) was used to assess total body aluminum burden. Neurologic function was evaluated by quantitative measures of asterixis, myoclonus, motor strength, and sensation. Cognitive function was assessed by measures of dementia, memory, language, and depression. There were four patients with a positive DIT (greater than 125 micrograms/L increment in serum aluminum) that was associated with an increase in the number of neurologic abnormalities observed, as well as an increase in severity of myoclonus, asterixis, and lower extremity weakness. Patients with a positive DIT also showed significant impairment in memory; however, no differences were noted on tests of dementia, depression, or language. There was no significant correlation between sex, age, presence of diabetes, mode of dialysis, years of chronic renal failure, years of dialysis or years of aluminum ingestion and any neurologic or neurobehavioral measurement, serum aluminum level, or DIT. These changes may represent early aluminum-associated neurologic dysfunction.
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PMID:Relationship of aluminum to neurocognitive dysfunction in chronic dialysis patients. 317 74

The authors present a case of a 62-year-old woman who was hospitalized with severe medical problems that included congestive heart failure secondary to mitral stenosis and atrial fibrillation, coronary artery disease, chronic renal failure, and a recent history of a right cerebral lacunar infarction. She also had a 2-year history of anxiety and depression, manifested in the hospital by frequent crying spells, sleeplessness, and ruminating about her illnesses. The patient received buspirone 5 mg three times a day for her anxiety and depression. Approximately 12 hours after her first dose, she developed dramatic myoclonus, dystonias, and akathisia. She was given 25 mg of intramuscular diphenhydramine and 1 mg of intramuscular benztropine mesylate, which resulted in little relief; however, 1 mg clonazepam caused both the myoclonic jerks and dystonias to resolve completely.
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PMID:Acute generalized myoclonus following buspirone administration. 337 31

58 patients with severe arterial hypertension (AH) refractory to antihypertensive drug therapy including beta-blockers, calcium antagonists, antiadrenergic drugs and diuretics with addition of captopril and/or minoxidil were studied. In all the patients 3-6 sessions of plasmapheresis (PA) with plasma exchange up to 30 ml/kg body weight per 1 session were performed. After the course of plasmapheresis BP depression on the average by 24% as well as restoration of sensitivity to antihypertensive drugs and elimination of signs of malignant AH in certain cases were observed. PA was not enough effective in patients with AH combined with signs of chronic renal failure. Persistent BP depression as a result of the treatment is probably caused by positive hormonal changes, improved renal function, increased sensitivity of tissue receptors of target organs to antihypertensive drugs as well as improved peripheral blood circulation.
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PMID:[Treatment of refractory arterial hypertension by plasmapheresis]. 340 44

End-stage renal disease (ESRD) is recognized as imposing severe psychosocial stresses upon patients with the result that depression is believed to be highly prevalent. A number of studies have reported low levels of depression, however, and this contradictory finding has been explained via the construct of defensive denial-i.e., patients may minimize the impact of illness-related experiences upon their overall experiences of life. The present study tested this hypothesis in a sample of seventy ESRD patients. Participants rated a series of twelve life dimensions (e.g., work, family and martial relations, recreation) in terms of perceived intrusiveness and control as well as indicating their perceived similarity using a card sort task. Standard measures of depression, positive and negative moods, somatic symptoms of distress, self-esteem, and life happiness were also obtained via structured interviews. A multidimensional scaling analysis applied to the card sort data indicated that ESRD patients do, indeed, perceive illness-related and nonillness aspects of life as independent. However, an analysis of partial variance-controlling for age and nonrenal health-failed to provide evidence of defensive denial. The suggestion is forwarded that previous findings of a high prevalence of depression in ESRD may be in error due to the misidentification of uremic symptoms as symptoms of depression.
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PMID:Denial as a defense against depression in end-stage renal disease: an empirical test. 352 8

This article examines contraception in adolescents with hematologic, oncologic, dermatologic, and psychiatric disorders, connective tissue diseases, and renal disease and transplants. Teens with iron-deficiency anemia or heavy menstrual flow who need contraception could benefit from oral contraceptives. The IUD is contraindicated for these teens. The IUD is also contraindicated in females with hemorrhagic disease, and hormonal contraceptives are a more appropriate choice for these females. Teens with sickle cell hemoglobinpathies should not use the IUD. Safe use of oral contraceptives (OCs) is questionnable for these teens. The best choice would be barrier methods. Concerns regarding contraception in teens with tumors are mainly 2-fold: effects of pregnancy or contraception on the tumor, and effects of the tumor or tumor therapy on pregnancy and fertility. Therapy including drugs and radiation can have profound effects on the fetus and future fertility. There seems to be no indication that pregnancy has adverse effects on nonhormonal-dependent tumors common in young adults. Malignant melanoma has a strong positive relationship with the use of OCs. OCs have been reported to be helpful in some chronic skin disorders. OCs may not be appropriate for teens who are taking antidepressants or who have a history of depression, although there are contradictory reports in the literature on the effect of the pill on depression. It is helpful for contraceptive services for mentally ill women to be provided by specially trained individuals who are able to obtain informed consent, while taking into account the specific needs of the psychiatrically impaired individual. There are special concerns in prescribing contraception to the mentally retarded teen. Combinations OCs should probably be avoided in adolescents with systemic lupus erythematosus. Because teens with severe chronic renal failure or those on hemodialysis are usually infertile, contraception is less of an issue than for other teens. A barrier method woudl be the msot appropriate method for such teens if they need contraception.
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PMID:Contraceptive use in the chronically ill adolescent female. Part II. 353 Nov 20


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