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

Using an interview and questionnaire format, 358 driving under the influence of alcohol (DUI) first offenders and 141 DUI multiple offenders were compared on measures of personality traits, drinking behavior and problems, and driving behavior and history. In addition, official driving records for the two groups were compared. Results indicated that multiple offenders were significantly higher in hostility, sensation seeking, psychopathic deviance, mania, and depression than first offenders. Multiple offenders were significantly lower in emotional adjustment and assertiveness. Multiple offenders had significantly more nontraffic arrests, accidents, and traffic tickets than first offenders. They also consumed significantly more alcohol, evidenced more alcohol problems, and had higher BACs at the time of arrest than first offenders. Results are discussed in terms of general problem behavior and implications for intervention and treatment.
 ...
PMID:Personality traits and behaviors of alcohol-impaired drivers: a comparison of first and multiple offenders. 144 35

Lithium remains the mainstay of therapy for most patients with bipolar disorder. Patients with syndromal variations of bipolar disorder, such as those experiencing mixed states or dysphoria have generally had a rather poor therapeutic response to lithium. Our group conducted a double-blind, parallel-group comparison of lithium and valproate for the control of mania in 27 patients with bipolar disorder. The study addressed the question of whether certain illness characteristics might be predictive of a positive response to a particular pharmacologic agent. There were significant differences in the cohort of patients who responded favorably to valproate compared with those who did not. Pretreatment depression scores were higher in the patients responding to valproate than in nonresponders. Patients with depressed mood or anxiety associated with mixed states responded equally to lithium and valproate. Studies are needed to clarify the clinical and pathophysiologic status of mixed or dysphoric manic states and to validate predictors of response to therapeutic agents.
 ...
PMID:Dysphoric mania. 154 12

Until recently it appeared that lithium carbonate possessed a unique spectrum of clinical action in the acute and prophylactic treatment of manic and depressive episodes. It is now increasingly apparent that the anticonvulsants carbamazepine and valproate also share components of this spectrum of efficacy in the affective disorders but, in addition, are clinically effective in some lithium nonresponders. This clinical convergence can now drive a reexamination of the potential mechanisms of action of these compounds in the affective disorders. In spite of intensive study over several decades, the mechanism of action of lithium has remained elusive. A basic conundrum in the consideration of the actions of lithium has also been to explain how a simple ion could have such complex effects on multiple neurotransmitter systems and, in particular, have bimodal actions in the treatment of both manic and depressive phases of the illness. We suggest that a fundamental reconceptualization of both mania and depression as overactivated neural systems (either excitatory or inhibitory) could facilitate this conceptualization. Given the recent evidence linking lithium's effects to uncoupling receptor-mediated activity at the level of G-proteins or attenuating it at the level of second messenger systems mediated by adenylate cyclase or phosphoinositide turnover, these mechanisms become ideal candidates for considering how the drug could dampen overactivated systems potentially relevant to either depression or mania. The lag in onset of maximum therapeutic action of lithium, carbamazepine, and valproate further suggests that biologic effects associated with chronic compared with acute administration are the prime candidates for psychotropic effects. Comparison of the acute and chronic effects of carbamazepine with those of valproate is also offered to focus on the most likely receptor, second-messenger, and ion channel mechanisms involved in their anticonvulsant and psychotropic actions. It is hoped that better understanding of the comparative actions of lithium, carbamazepine, and valproate will allow better targeting of individual drugs for individual patients as well as, ultimately, the development of new and more selective treatments for the recurrent affective disorders.
 ...
PMID:Mechanisms of action of anticonvulsants in affective disorders: comparisons with lithium. 154 15

The rapid-cycling variant of bipolar disorder constitutes about 15%-20% of all bipolar patients, and 72%-82% of these patients exhibit less than adequate response to lithium therapy. Valproate's spectrum of efficacy was examined in 78 patients with rapid-cycling bipolar disorder in a prospective, open, 15.8-month trial. Thirty patients received valproate monotherapy and 48 received combination therapy. Treatment assignment was nonrandomized and based on prior treatment history. A marked acute response was seen in 54% of the patients with mania, 87% of those with mixed states, and 19% of those with depression. Marked prophylactic responses were seen in 72% of manic patients, 94% of mixed states patients, and 33% of depressed patients. In addition, moderate acute antimanic responses were observed in another 31% of the patients, prophylactic antimanic responses in 17%, acute antimixed state responses in 0%, prophylactic antimixed state responses in 0%, acute antidepressant responses in 25%, and prophylactic antidepressant responses in mixed states in 34%. Pattern analysis was conducted to examine the spectrum of efficacy of valproate in various cells (e.g., the cohort of patients who had an acute antimanic response to the drug). Pattern analysis showed that 40% of the patients with a marked prophylactic antimanic response had a marked antidepressant response to valproate. However, among the patients with a marked antidepressant response to valproate, 91% had a marked antimanic response. The most common side effects of valproate in our study, as in earlier studies, were gastrointestinal problems (nausea, stomach cramps, diarrhea), tremors, lethargy, and hair thinning.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Spectrum of efficacy of valproate in 78 rapid-cycling bipolar patients. 154 18

The historical antecedents of the current diagnostic criteria for mania involve the German phenomenologic descriptions of the late 1800s, the introduction of lithium for treatment and prevention of mania (which broadened the definition of mania in this country), the attempts to subclassify bipolar disorder into at least two subtypes, and the differentiation of patients with mania and hypomania from those with depression alone. Current diagnostic criteria for bipolar disorder are delineated in DSM-III-R. The differential diagnosis of bipolar disorder includes other conditions that may have manic-like symptoms, including organic mood disorders such as endocrine or metabolic conditions, drug intoxications, and tumors. Mania occurring in the context of substance abuse would be called a secondary mania. In addition, schizoaffective disorder can be diagnosed if there is a manic syndrome superimposed in the context of schizophrenia. Because of the absence of duration criteria for mania in DSM-III-R, the differential diagnosis within the bipolar disorders is largely based on severity and duration of depression. A problem in studying mania at present is that the prototypic cases have largely disappeared from treatment centers because of the success of lithium maintenance treatment. Patients available for study at psychiatric treatment facilities are largely treatment resistant, atypical, and likely to have experienced considerable amounts of substance abuse in their histories. Among the changes being considered for DSM-IV are to include duration criteria for mania, to separate bipolar II patients (depression and hypomania) from bipolar not otherwise specified, to refine the criteria for hypomania, and to add rapid cycling to the list of parenthetical modifiers for bipolar disorder with mania and bipolar disorder with hypomania.
 ...
PMID:Differential diagnosis of bipolar disorder. 154 21

The effects of once- and twice-daily dosing with lithium carbonate were compared in a non-blind, cross-over study on 20 consecutive patients with mood disorders. Mental status, side effects and target organ function were examined after a minimum of a 1-month treatment with each regimen. Eighteen patients completed the study and 2 withdrew because of side effects. There were no significant differences between the 2 groups on the Hamilton Rating Scale for Depression, the Bech-Rafaelsen Mania Scale, the UKU Side Effects Scale or in serum lithium, electrocardiogram and urine volumes. Most blood tests showed no significant difference between the 2 treatment schedules except for white blood cells, ionized calcium and phosphate concentration. The once-daily regimen was associated with a higher white cell count, increased serum phosphate and elevated serum ionized calcium. We conclude that patients are able to tolerate once-daily dosing with lithium carbonate as well as twice-daily dosing.
 ...
PMID:Lithium treatment: a comparison of once- and twice-daily dosing. 154 52

Fluoxetine, a selective serotonin reuptake inhibitor, is gaining increased acceptance in the treatment of adolescent depression. Generally safe and well tolerated by adults, fluoxetine has been reported to induce mania. The cases of five depressed adolescents, 14-16 years of age, who developed mania during pharmacotherapy with fluoxetine, are reported here. Apparent risk factors for the development of mania or hypomania during fluoxetine pharmacotherapy in this population were the combination of attention-deficit hyperactivity disorder and affective instability; major depression with psychotic features; a family history of affective disorder, especially bipolar disorder; and a diagnosis of bipolar disorder. Further study is needed to determine the optimal dosage and to identify risk factors that increase individual vulnerability to fluoxetine induced mania in adolescents.
 ...
PMID:Mania associated with fluoxetine treatment in adolescents. 156 30

Four cases of baclofen intoxication are reported, with a review of 33 cases from the literature. Analysis of these 37 cases suggests that there are two types of baclofen intoxication syndrome. Patients with acute intoxication present with four major clinical manifestations: encephalopathy (disturbance of consciousness and/or seizure), respiratory depression, muscular hypotonia, and generalized hyporeflexia. Patients with chronic intoxication present with hallucinosis, impaired memory, catatonia, or acute mania. The acute intoxication syndrome has a faster onset, shorter duration, more severe clinical manifestations, and higher incidence of seizures than the chronic intoxication syndrome. Baclofen intoxication, although it may cause grave encephalopathic manifestations and electroencephalographic findings, has a benign outcome if actively managed.
 ...
PMID:Baclofen intoxication: report of four cases and review of the literature. 157 99

Guanine nucleotide binding (G) proteins play a pivotal role in postreceptor information transduction. An important characteristic of G proteins is their increased guanine nucleotide binding following agonist stimulation, which in turn leads to their activation. We have developed a method that enables the measurement of early events in signal transduction beyond receptors, through activated receptor-coupled guanine nucleotide exchange on G proteins. Using this method, lithium was recently demonstrated to inhibit the coupling of both muscarinic cholinergic and beta-adrenergic receptors to pertussis toxin-sensitive and cholera toxin-sensitive G proteins, respectively, thus suggesting alteration of the function of G protein by lithium, as the single site for both the antimanic and antidepressant effects of this drug. One of the most puzzling aspects of the ability of lithium to ameliorate the manic-depressive condition is its relatively selective action upon the central nervous system (CNS). It was previously shown that lithium selectively attenuated the function of Gs proteins in the CNS. In the present study, we show that inhibition by lithium of muscarinic receptor-coupled G protein function is also selective to the CNS. The clinical profile of lithium, carbamazepine, and electroconvulsive treatment (ECT), agents that are effective in the prevention and treatment of bipolar affective disorder, differs from that of purely antidepressant drugs. Antidepressant drugs are effective in the acute treatment and prevention of depression only, and can even precipitate hypomanic or manic "switches," or "rapid cycling" between mania and depression. We have investigated and compared the effects of chronic antibipolar and antidepressant treatments on receptor-coupled G protein function. Antibipolar treatments (lithium, carbamazepine, ECT) attenuate both receptor-coupled Gs and non-Gs (i.e., Gi, Go) proteins function; in contrast, only Gs protein function is inhibited by antidepressant drugs [either tricyclics or monoamine oxidase (MAO) inhibitors]. Moreover, an integral adrenergic neuronal system is required for antidepressant inhibition of Gs protein function, as pretreatment with the noradrenergic neurotoxin DSP-4 (N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine) specifically abolishes the effects of antidepressant drugs on Gs protein, whereas antibipolar drug effects on G protein function are unaffected by DSP-4. Our results suggest that attenuation of beta-adrenergic receptor-coupled Gs protein function, which is common to both antidepressant and antibipolar treatments, may be the mechanism underlying their antidepressant therapeutic efficacy.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:Ziskind-Somerfeld research Award. The involvement of guanine nucleotide binding proteins in the pathogenesis and treatment of affective disorders. 158 23

The familial transmission risk of developing bipolar disorder for first=degree relatives of the patient is 1.5-10.2%, however, the risk of any affective primary disorder is 15-20% in such relatives. Pregnancy places additional stress on patients, and physiological changes are particularly acute during postpartum. The risk of abnormalities and teratogenicity from psychotropic drugs is significant: taking of phenothiazines, tricyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, lithium, valproate, and clonazepam require extreme caution. In 225 pregnancies exposed to lithium in the 1st trimester congenital malformations occurred in 11%. Premature birth and macrosomia may also increase, thus halting lithium well before planned conception with weekly serum monitoring is advised. Recurrence of the illness can be managed by electroconvulsive therapy. About 40% of patients can experience postpartum mania or depression. Taking drugs up to delivery can result in behavioral teratogenesis in the neonate even in the absence of physical malformations. Lithium toxicity causes lethargy, hypotonia, tachycardia, coma, cyanosis, and chronic twitching in the newborn. Breast feeding is discouraged in women taking lithium because of the high rate of transmission to the infant. The stress of parenting can also trigger relapses of the disease. The deleterious effect of a manic or depressive mother on the child's development is manifested in criticism and stressing achievement often leads to low self-esteem. It behooves the psychiatrist to frankly reveal the risks of pregnancy to couples who wish to have a child or to advise about the pregnancy to term so they can make an informed decision.
 ...
PMID:Family planning for women with bipolar disorder. 158 11


<< Previous 1 2 3 4 5 6 7 8 9 10