Edward H. Liston

Prolongation of the antidepressant response to partial sleep deprivation by lithium

Depressed patients given a loading dose of lithium on the first of 2 successive days of partial sleep deprivation (PSD), and kept at maintenance levels thereafter, showed significantly greater prolongation of the antidepressant effects of PSD than patients treated with PSD and placebo, even though the acute elevation in mood derived from PSD was as great on placebo as on lithium. Depression was assessed 3 days after PSD with an augmented version of the Hamilton Rating Scale for Depression. Patients on lithium alone, without PSD, did not have the acute elevation in mood seen in the two PSD groups and had significantly less improvement in depression than those who received PSD with lithium.

Lithium sustains the acute antidepressant effects of sleep deprivation: Preliminary findings from a controlled study

Early morning sleep deprivation (patient awake from 0200 to 2200 hours) produces a same-day antidepressant effect in approximately one-half of patients with major depression. Unfortunately, these antidepressant effects are short-lived and patients usually relapse to baseline depression levels within 48 hours. Recent work suggests, however, that the use of lithium with early morning sleep deprivation sustains this rapid antidepressant effect and makes it clinically useful. In a 30-day study, we compared the abilities of four different treatments (lithium plus early morning sleep deprivation, lithium plus a control sleep deprivation procedure, and desipramine with either of the two sleep manipulations) to induce a rapid (next-day) and sustained antidepressant response in 16 depressed patients. Lithium plus early morning sleep deprivation produced a quicker response than lithium with the control sleep deprivation, and the response was sustained for at least 30 days. In this design, however, lithium/early morning sleep deprivation was no faster than either of the two desipramine/sleep deprivation conditions in inducing remission. These results support the results of previous studies and suggest further investigation of this novel sleep/pharmacologic intervention is warranted.

Effects of Electroconvulsive Therapy in Adolescents with Severe Endogenous Depression Resistant to Pharmacotherapy

BACKGROUND This open, prospective study examined the effects of electroconvulsive therapy (ECT) in 10 adolescents with primary, endogenous, psychotic depression who were resistant to antidepressant pharmacotherapy. METHODS Change in symptom severity from baseline was assessed weekly with Hamilton Depression Rating Scale (HDRS) ratings, and outcome was measured additionally at 1 month, and again at 1 year, post-ECT. RESULTS All but 1 patient demonstrated dramatic improvement, with statistically significant decreases in mean HDRS score detected after the first week of treatment. All responders maintained the benefits of their treatment. CONCLUSIONS The results provide evidence of the clinical effectiveness of ECT in adolescents with phenomenological characteristics shown to be predictive of ECT response in adults.

Behavioral responses to amphetamines in identical twins

Male, monozygotic twins (six pairs) were repeatedly tested before and after d-amphetamine, l-amphetamine, or placebo administration. Drug effects on cognitive, psychomotor, personality, mood, and pain variables were assessed. Members of a twin pair tended to respond similarly on several tests under placebo conditions, indicating genetic determination of the behavioral variables. In addition, cotwins tended to show similar responses to amphetamine as measured by one test of cognitive function, by several mood and personality variables (hostility, autonomic arousal, friendliness, feelings of tension and loss of control), and tended to have similar plasma levels of both amphetamine isomers. Although shared environmental effects cannot be ruled out, the results are consistent with genetic mediation of a variety of behavioral effects of amphetamines.

Hospital Treatment of Elderly Neuropsychiatric Patients. II. Statistical Profile of the First 122 Patients in a New Teaching Ward

Data are presented on the first 122 patients admitted to a geropsychiatric teaching ward in a university hospital. A high incidence of medical problems as reflected by abnormal laboratory findings complicated the management of these patients, most of whom had dementia or depression. In all diagnostic categories, the patients appeared to benefit from the intensive inpatient treatment. Difficulties in the areas of diagnosis, treatment, length of hospital stay, discharge placement and program evaluation are discussed.

Morphine, experimental pain, and psychological reactions.

This study examines the effects of morphine (10 mg/70 kg body weight) versus placebo (isotonic saline) on experimentally induced cold pressor pain threshold and tolerance, on self-reports of psychological states and drug effects, observer ratings of psychological states, and performance on timed cognitive-motor tasks in 20 non-drug using, normal male volunteers (21–28 years of age). Morphine increased both threshold and tolerance for cold pressor pain, and also increased ‘euphoric’ and decreased ‘clear thinking’ responses on the respective scales. Morphine, in contrast to placebo, increased scores on depression, fatigue, and cognitive loss-dysfunction scales and decreased scores on carefree and ‘friendliness’ scales. Three sets of psychological variables were observed to covary significantly: Measures of anxiety and hostility; reports of fatigue and cognitive dysfunction; and reports of carefree feelings and perceptions of clear thinking. While measures of hostility, fatigue, and cognitive dysfunction covaried positively, reports of carefree feelings and perception of clear thinking covaried negatively with increased pain threshold and tolerance. Anxiety, contrary to reports in the literature, also covaried positively with the pain measures. The results were interpreted as supporting a relationship between increased arousal of the nervous system and decreased pain sensitivity in conjunction with the known analgesic effects of morphine.

Depression in Alzheimer's disease: An overview of adrenergic and cholinergic mechanisms

Abstract Depression is frequently associated with Alzheimers disease and has traditionally been viewed as either a psychological reaction to the dementia or a coincidental phenomenon. However, recent studies suggest that neuroanatomic and neurochemical interrelationships between Alzheimers disease and depression may exist. That is, the loss of ascending noradrenergic and cholinergic cortical projections due to neuronal degeneration in the nucleus locus coeruleus and the nucleus basalis of Meynert may have implications for the development of depressive disorder in this primary degenerative dementia. The authors review these issues, explore related brain-behavior hypotheses and suggest research strategies and questions for further investigation.

Urinary phenylacetate and response to methylphenidate

Phenylacetate (PAA) is the metabolic end-product of phenylalanine, a catecholamine precursor, and of phenylethylamine, a centrally active neurochemical substance which has been implicated in the actions of stimulant medications. PAA has been reported to be low in unipolar depression. We measured 24-h urinary PAA in normal controls (N = 21) and in-patients with unipolar depression (N = 33; 12 drug-free) and did subsequent dexamethasome suppression tests (DST). We also gave patients methylphenidate challenges, examining mood response. There were no significant differences between depressed patients and controls in 24-h urinary PAA excretion (P greater than 0.9). However, the variance in PAA excretion was higher in patients than normals and 5 patients had values at or above the 99% confidence limits for the normal control group. There was no association of DST results with PAA excretion (P greater than 0.4). Patients with a worsened mood after taking methylphenidate excreted less PAA than those with an improved mood, however (P less than 0.025). The clinical and theoretical significance of these results is discussed.

Attorneys' perceptions of electroconvulsive therapy: Impact of instruction with an ECT videotape demonstration

The knowledge of attorneys from the Los Angeles Superior Court was studied before and after education about electroconvulsive therapy. They viewed a videotape explaining ECT and questions were answered. There were significant improvements in overall knowledge and in positive opinions regarding ECT.

Hospital Treatment of Elderly Neuropsychiatric Patients. I. Initial Clinical and Administrative Experience with a New Teaching Ward

Program planning and the initial experience of a new teaching ward for geriatric psychiatry are described. Elderly psychiatric patients, with diagnoses predominantly of depression and dementia, demonstrate more self‐centeredness and less group awareness than do younger patients. Ward staff members often experience frustration, sadness and anger in response to working with them. Major problems unique to a geriatric psychiatry service include the paucity of adequate resources for post‐discharge care and the necessity to obtain excellent medical‐surgical consultation and support.