George Molnar

Prodromal symptoms in primary major depressive disorder.

Prodromal symptomatology was investigated, by means of a modified version of Paykels Clinical Interview for Depression, in 15 outpatients at their first episode of primary major depressive disorder. Compared to normals, generalized anxiety and irritability were significantly more frequent. Impaired work and interests, fatigue, initial and delayed insomnia were also reported. Four patients who relapsed upon discontinuation of antidepressant treatment displayed the same prodromal symptomatology as in the initial episode.

Multiple-dose Pharmacokinetics of Imipramine and Its Major Active and Conjugated Metabolites in Depressed Patients

Imipramine (IMI) and its active metabolites, desipramine (DMI), 2-hydroxyimipramine (2-OH-IMI), and 2-hydroxydesipramine (2-OH-DMI), were assayed by high pressure liquid chromatography in the serum and urine of 14 depressed patients after 1 week of twice-daily treatment with 100 mg of IMI. The concentrations of the glucuronide conjugates of 2-hydroxyimipramine (GA-O-IMI) and 2-hydroxydesipramine (GA-O-DMI) were assessed via enzyme hydrolysis. The range of serum concentrations of IMI and DMI was 65 to 1,064 ng/ml with slight elevation in total active components caused by inclusion of the unconjugated hydroxy metabolites. The average of total active compounds in smokers (239 ng/ml) was less (p less than 0.1) than in nonsmokers (524 ng/ml). The mean serum concentration ratios were 0.24 for 2-OH-IMI/IMI and 0.50 for 2-OH-DMI/DMI ratios, whereas the DMI/IMI ratio was 1.88, indicating more extensive accumulation of DMI. Appreciable glucuronide conjugate accumulation occurred with average serum concentration ratios of 8.13 for GA-O-IMI/2-OH-IMI and 6.22 for GA-O-DMI/2-OH-DMI. Covariance occurred in metabolite/precursor ratios indicating intrapatient similarities in formation/disposition rates of the hydroxy pairs and the conjugate metabolite pairs. Renal clearances of 2-OH-DMI were 35 to 267 ml/min, whereas those of the conjugates were only 10 to 110 ml/min. Total urinary recovery of these metabolites was similar to that reported previously for single IMI doses. The data indicate accumulation of substantial serum concentrations of glucuronide conjugates after therapeutic doses of IMI in depressed patients and similarities within patients in disposition of metabolite pairs.

Medical-psychiatric unit patients compared with patients in two other services

Abstract Two hundred patients in a medical-psychiatric unit (MPU) were compared with equal numbers seen in a liaison-consultation service (LCS) and in a psychiatric inpatient unit (PIU). Statistically significant (P

Management of psychotic pregnantpatients in a medical-psychiatricunit

Abstract All psychotic pregnant patients requiring psychiatric treatment in a general hospital were admitted to a medical-psychiatric unit (MPU). During a three-year period, ten patients (11 pregnancies) received care that included psychotherapy and antipsychotic medication as well as psychosocial and educational interventions. The protection of mother and fetus, clinical stabilization, and coordination of psychiatric, obstetric, and perinatal care were achieved successfully in all cases. However, attempts to educate the patients in family planning and birth control were largely unsuccessful. The clinical observations suggest that an MPU can adapt readily to providing comprehensive care to such patients.

The metyrapone test in affective disorders and schizophrenia

The metyrapone test was applied to patients suffering from major depressive illness with melancholia, from mania, and from schizophrenia. Hypoactivity of the HPA axis as assessed by the test appears to occur infrequently in affective disorders and schizophrenia. High normal or exaggerated responses to metyrapone, as observed in Cushings disease, appear to be correlated to DST non-suppression in melancholia.

Health attitudes and psychological distress in patients attending a lithium clinic

ABSTRACT– Health attitudes and psychological distress were investigated in 50 patients attending a lithium clinic and in 50 normal controls. Patients receiving lithium treatment did not report more worry about illness, hypochondriacal attitudes, concern about pain, disease phobia and bodily preoccupations than normals, even though they took fewer precautions about their health and exhibited more self‐rated psychological distress. Since most of the psychiatric patients were found to display more fears about illness and death than controls in other studies, this preliminary report may suggest that normal health attitudes are associated with lithium compliance in affective illness.

The medical-psychiatric unit: A novel psychosomatic approach

A retrospective chart review of 600 general hospital patients, of whom 200 had been admitted to a medical-psychiatric unit, 200 to a conventional psychiatric unit and 200 to medical-surgical units, and for whom psychiatric consultation had been requested, disclosed significant differences in the patient populations of these services. The data suggest that consultation psychiatry and medical-psychiatric units serve two different subgroups of patients with combined physical and psychiatric illness. A comprehensive model of clinical psychosomatic medicine encompassing consultation psychiatry, liaison psychiatry, medical-psychiatric units and after-care medical-psychiatric clinics, is proposed.

Seizures associated with high maprotiline serum concentrations

Maprotiline is a tetracyclic antidepressant which appears to have accounted for a relatively large proportion of the seizures associated with antidepressant use. The literature proposes two mechanisms of seizure induction: interaction with other medications and concomitant medical conditions lowering the seizure threshold. Observations during a study of maprotiline blood levels suggest that elevated serum concentrations achieved with therapeutic doses may also be linked to the seizure-induction mechanism. Monitoring of maprotiline blood levels may help to identify patients at risk.

Criteria for Diagnosing Depression in the Setting of Medical Disease

The evaluation of depression in the setting of medical disease is a complex task that requires considerable clinical skills. Physical illness is a common cause of psychopathology and this should alert the physician to vigorously search for possible organic explanations of depressive symptoms, especially in the elderly, where organic affective syndromes seem to be most prevalent. The multifactorial determinants and modes of expression of depression in the medically ill require further psychosomatic studies.

The dexamethasone suppression and metyrapone tests in depression

The dexamethasone suppression test (DST) and the metyrapone test (MT), a useful and reliable procedure for assessing the integrity of the hypothalamic-pituitary-adrenal (HPA) axis, were performed in 28 patients suffering from major depressive illness with melancholia. The relationship between the DST and MT appeared to be complex. Patients who failed to suppress cortisol secretion after dexamethasone administration had higher postmetyrapone cortexolone levels and cortexolone/cortisol ratios than suppressors. However, there was a wide range of metyrapone responses in patients exhibiting abnormal DST results. This suggests that failure of adequate suppression after 1 mg of dexamethasone in depressed patients does not necessarily reflect homogeneity in the HPA axis disturbances of such patients.