Boghos I. Yerevanian

The Utility of the REM Latency Test in Psychiatric Diagnosis: A Study of 81 Depressed Outpatients

To examine the utility of the REM (rapid eye movement) latency test in identifying outpatient primary depressions, 81 consecutive referrals to a sleep disorders center were evaluated in a phenomenologic, sleep polygraphic, and psychometric study. Modified Feighner (St. Louis) diagnoses were definite primary depression (n = 19), probable primary depression (n = 30), depression chronologically secondary to preexisting psychiatric disorders (n = 19), and nonaffective psychiatric disorder (n = 13). There were 18 nonpsychiatric controls. REM latency less than 70 minutes on 2 consecutive nights detected 62% of primary depressions, discriminating them from the other diagnostic groups with 88% specificity. There were no false positives among controls. These data provided a 90% confidence for the diagnosis of primary depression in this outpatient sample. Requiring 2 consecutive nights of shortened REM latency appears to improve significantly the specificity of a test previously considered to have high sensitivity but relatively low specificity for depressive disorders.

Antidepressants and suicidal behaviour in unipolar depression

Objective:u2002 To compare the rates of suicidal behaviour during vs. after discontinuation of treatment with antidepressants, and to determine the comparative rates of suicidal behaviour for patients maintained on tricyclic (TCA) vs. selective serotonin reuptake inhibitor (SSRI) antidepressants.

Lithium, anticonvulsants and suicidal behavior in bipolar disorder

BACKGROUNDnLithium has been found to be effective in reducing suicide rates during long term treatment of patients with bipolar disorders. Data on the efficacy of anticonvulsant mood stabilizers in reducing suicide risk are sparse.nnnMETHODnCharts of 140 bipolar patients treated continuously for a minimum of 6 months during a 23-year period of private practice by the senior author were extracted from nearly 4000 patient records. Data extracted from the charts were incidence of completed suicide, number of suicide attempts, and number of hospitalizations for suicidal ideation or behavior per 100 patient-years of either on or off lithium or anticonvulsant mood stabilizer monotherapy.nnnRESULTSnOnly one completed suicide (during a period off of lithium) occurred in the patients studied. Incidence of non-lethal suicidal behavior was not different during treatment with lithium, compared with anticonvulsants. Being on a mood stabilizer significantly protected against suicidal behavior. The relative protective effect was more modest than in reports from other treatment settings.nnnLIMITATIONSnThis was a retrospective chart review study of naturalistically treated patients.nnnCONCLUSIONSnTreatment of patients with bipolar disorder with either lithium or anticonvulsant mood stabilizers was associated with reduced risk of suicidal behavior. This study did not find evidence for a difference in the protective effect of the two types of mood stabilizing medications against non-lethal suicidal behavior in the naturalistic setting of private practice.

Plasma ACTH levels in primary depression: Relationship to the 24-hour dexamethasone suppression test

The failure of adequate cortisol suppression after 1 mg dexamethasone in 50% of patients with endogenous depression has been attributed to abnormal hypothalamic-pituitary-adrenal axis regulation, resulting in high levels of adrenocorticotropic hormone (ACTH). Because studies of plasma ACTH have been conflicting, we studied plasma ACTH levels during the 24-hour dexamethasone suppression test in a homogeneous group of 29 hospitalized patients with primary endogenous depression and 19 normal volunteers. No differences were found in ACTH levels among normal volunteers, depressed cortisol suppressors, and depressed cortisol nonsuppressors at either 4 p.m. or 11 p.m.

Impact of psychotropic drugs on suicide and suicidal behaviors

To examine the impact of psychotropic drugs on suicide and suicidal behaviors in bipolar disorders.

Hemispheric asymmetry in depression and mania : A longitudinal QEEG study in bipolar disorder

BACKGROUNDnprevious research has been inconclusive about the nature of hemispheric asymmetry in emotional processing.nnnMETHODn13 patients with DSM-IV bipolar disorder received repeated QEEGs over 2 years in different mood states. Z-score measures of asymmetry were assessed.nnnRESULTSnasymmetry in frontotemporal slow-wave activity appeared to be in opposite directions in depression compared to mania/hypomania.nnnCONCLUSIONSnmood change in bipolar disorder is associated with change in QEEG asymmetry.nnnLIMITATIONSnstudy of larger numbers of more homogenous patients under similar conditions is needed.nnnCLINICAL RELEVANCEnstudy of mood state-dependent asymmetry changes in bipolar disorder may lead to better understanding of hemispheric processing of emotion.

Anxiety disorders comorbidity in mood disorder subgroups: data from a mood disorders clinic.

BACKGROUNDnPrevious research has identified a high rate of anxiety disorders comorbidity in patients with a primary mood disorder diagnosis. Discrepancies between studies in the comorbidity prevalence of specific anxiety disorders in mood disorders, and of anxiety disorders comorbidity between unipolar depression and bipolar mood disorder are in part due to differences in sampling and diagnostic assessment methodology.nnnMETHODnThe authors reviewed the charts of 138 patients who received the SCID-P for DSM-III on enrollment in a Mood Disorders Clinic during the period 1982 through 1988. The comorbidity of specific DSM-III Anxiety Disorders with specific mood disorders was determined and comparatively examined using non-parametric statistics.nnnRESULTSnThere was high overall comorbidity of anxiety disorders that did not differ between bipolar and unipolar subjects. There were no differences in the comorbidity of individual anxiety disorder diagnoses in the unipolar vs. bipolar groups. However, in unipolar patients with, compared to those without an additional diagnosis of dysthymia, there was greater overall anxiety disorders comorbidity, with a particularly high prevalence of generalized anxiety disorder.nnnLIMITATIONnThe subgroup of patients with bipolar I disorder was relatively small (N=8).nnnCONCLUSIONnMood and anxiety disorders comorbidity is complex and presents a continuing challenge for both clinicians and researchers.

Phototherapy for seasonal major depressive disorder: Effectiveness of bright light of high or low intensity

Eleven females and five males with fall/winter seasonal affective disorder were randomly assigned to 7-day treatment regimens from 8 p.m. to 10 p.m. using identical light at 2000 or 300 lux. A modified Hamilton Rating Scale for Depression and a Beck Depression Inventory were administered before treatment, after treatment # 7, and 2 weeks after phototherapy was terminated. Analysis of variance with repeated measures revealed a significant interaction between sex of the patient, intensity of the lights, and day of rating for scores on both the modified Hamilton Rating Scale for Depression and the Beck Depression Inventory. For both measures, the interaction occurred because all groups showed a decrease in depression ratings during the phototherapy exposure period, but only females at the higher intensity continued to have low depression scores 2 weeks after light treatment had stopped. These data indicate that bright light at both high (2000 lux) and low (300 lux) intensities is able to reduce depression in patients with seasonal affective disorder. The data also indicate that both sex of the patient and intensity of the light may interact to determine the latency to relapse.

Subtypes of antipsychotics and suicidal behavior in bipolar disorder

OBJECTIVEnAntipsychotics are commonly used in bipolar disorder, with newer (SGA) agents increasingly replacing FGA antipsychotics, particularly in bipolar depression. There are few data on differences between FGA and SGA antipsychotics in terms of their relationship to suicidal behavior in bipolar disorder.nnnMETHODnThis was a retrospective chart review of 161 bipolar veterans treated naturalistically with antipsychotics at a university-affiliated VA hospital and clinics for up to 8 years. Charts were reviewed to determine monthly antipsychotic use and occurrence of suicidal behavior: completed suicide, attempted suicide or hospitalization to prevent suicide. Suicidal behavior events were compared across patients during treatment with individual antipsychotics and FGAs or SGAs as a class.nnnRESULTSnNon-lethal suicide events were more common during FGA than SGA monotherapy (9 events/110 months of exposure vs. 6 events/381 months of exposure; χ(2)=9.65, p=0.002). Suicide event rates did not differ between FGAs and SGAs when used in conjunction with mood stabilizers. Event rates were lower with lithium than anticonvulsants when used in conjunction with antipsychotics. No differences were found between olanzapine, risperidone and quetiapine.nnnLIMITATIONSnThe retrospective chart review methodology may have led to confounding by indication and diagnostic inaccuracy. No completed suicides occurred. Study participants were primarily male veterans. Results may not be generalizable to SGAs marketed since 2003.nnnCONCLUSIONSnFGA antipsychotic monotherapy may be associated with higher suicidal behavior risk than SGA antipsychotic monotherapy. Antipsychotics used in conjunction with mood stabilizers, particularly lithium, are associated with lower rates, independent of antipsychotic subtype.