Kumiko Yamada

Discrepancy between subjective and objective sleep in patients with depression.

Abstract The literature investigating the relationship between objective and subjective sleep in depressed patients is limited and the results are inconsistent. Furthermore, many factors that influence the aforementioned relationship have not been investigated. The present study was carried out to clarify the characteristics of self‐estimation of sleep in depressed patients. Sleep was estimated concurrently using a sleep log and polysomnography for 5 consecutive days to investigate the relationship between subjective sleep estimation and objective sleep estimation in 23 patients with major depression (Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised; DSM‐III‐R). Factors related to a discrepancy between both types of estimation were identified. The subjective total sleep time showed a significant, but moderate, positive correlation (correlation coefficient: 0.63) with the objective total sleep time. The degree of discrepancy was significantly correlated with various objective sleep variables and severity of depression. In the underestimation group in which the subjective total sleep time was shorter than the objective total sleep time, the objective total sleep time and slow‐wave sleep time were shorter, age was greater and the extroversion score (Maudsley Personality Inventory) was lower than in the overestimation group in which the subjective total sleep time was longer than the objective total sleep time. The data suggest that subjective sleep estimation in depressed patients is influenced by their objective sleep, severity of depression, age and personality.

Cholecystokinin tetrapeptide-induced calcium mobilization in T cells of patients with panic disorder, major depression, or schizophrenia

The localization of cholecystokinin in the brain has accelerated research efforts to define this biochemicals functional role in the central nervous system. The idea of cholecystokinin as a mediator of anxiety originated from electrophysiological experiments (Bradwejn and de Montigny 1984). Benzodiazepine antagonized cholecystokinin-8S-induced excitation of hippocampal pyramidal neurons in rats. This effect was reversed by pretreatment with the benzodiazepine receptor antagonist flumazenil (Csonka et al 1988). Recently, cholecystokinin-tetrapeptide (CCK-4) has been reported to have anxiogenic effects in humans. Intravenous injections of CCK-4 induced symptoms comparable to those of a panic attack (de Montigny 1989). CCK-8S-induced hippocampal pyramidal cell excitation was attenuated by benzodiazepines, but not by meprobamate or naloxone. In a double-blind study, patients were challenged with 50 ixg CCK-4 or saline on separate occasions (Bradwejn 1990). All patients panicked after administration of CCK-4, whereas none of the subjects panicked after receiving saline. The data indicated that patients with panic disorder have an increased sensitivity to CCK-4 (Bradwejn et al 1991). These findings may reflect a neurobiochemical range in CCK in panic disorder. It has been suggested that CCK receptor

Coping behavior in depressed patients: a longitudinal study

The relationship of coping behavior to outcome in depressed patients was examined. Subjects (n=105) with major depressive disorder (n=85), depressive disorder not otherwise specified (n=7) or major depressive disorder with axis I comorbidity (n=13) were followed for 6 months. Their coping behavior (i.e. rumination, active distraction, cognitive distraction and dangerous activities) was defined using the Comprehensive Assessment List for Affective Disorders. Based on their Hamilton Rating Scale for Depression (HRSD) scores at 6 months, the patients were categorized as having had a good or a poor outcome. Severity of depression and coping behavior were similar among the three diagnostic groups. At baseline assessment, coping behavior was not correlated with either HRSD score or age. However, males were significantly more likely to be engaged in dangerous activity as a coping behavior than females. Patients with a good outcome at 6 months were significantly more likely to use rumination as a coping behavior while patients with a poor outcome were significantly more likely to use dangerous activity. Multiple regression analysis confirmed this finding, indicating that rumination and dangerous activity were significant predictors of outcome at 6 months. Rumination might be associated with good outcomes in depressed patients while dangerous activity might be associated with poor outcomes.

Predicting efficacy of electroconvulsive therapy in major depressive disorder

Abstract  The aim of this study was to investigate methods for predicting the efficacy of electroconvulsive therapy (ECT) in patients with major depressive disorder. Subjects comprised 24 inpatients with major depressive disorder diagnosed according to DSM‐IV criteria who were resistant to antidepressant therapy or who, due to adverse reactions, could not undergo pharmacotherapy at adequate doses for sufficient durations. ECT was generally performed 12 times using a sinusoidal‐wave device. Efficacy of ECT was evaluated using the 17‐item Hamilton Rating Scale for Depression (HRSD). Multiple regression analysis was performed, using the final rate of improvement with ECT as the dependent variable, and improvement rate at completion of three ECT sessions and adequacy of pharmacotherapy before ECT as independent variables. Significant positive correlations were seen between final improvement rate with ECT and improvement rate at completion of three ECT sessions (partial correlation coefficient, 0.50, P < 0.02), and significant negative correlations were seen between final improvement rate and adequacy of pharmacotherapy before ECT (partial correlation coefficient, −0.51, P < 0.02). No significant differences were identified between responders and non‐responders with respect to age, sex, duration of index episode, number of previous depressive episodes, whether depression was melancholia‐type, whether depression was accompanied by psychotic features, total HRSD score immediately before ECT, and HRSD retardation or agitation scores. These results suggest that history of pharmacotherapy prior to ECT and improvement rate at completion of three ECT sessions may offer predictors for the final rate of improvement with ECT.

Serum cholesterol levels in patients with panic disorders: A comparison with major depression and schizophrenia

Abstract Results of several long‐term follow‐up studies suggest that mortality due to cardiovascular diseases is high in males with panic disorder (PD). Based on these data, various studies have been undertaken to determine the relationship between PD and total cholesterol (TC) levels; however the results obtained so far have not been consistent. We compared TC levels in 46 PD patients to those in 46 sex, age, smoking and alcohol consumption matched patients with major depression and 46 matched patients with schizophrenia. The relationship between TC and the severity of PD was investigated, and before‐ and after‐treatment TC change was compared. TC levels were significantly higher in the PD group than in the other groups, regardless of sex. The severity of PD was not correlated with TC levels. TC levels did not decrease in remitted PD patients. These findings suggest that relatively high TC levels in PD patients are attributable to endogenous disease‐specific factors. Clinicians should pay close attention to the correlation between high mortality due to cardiovascular diseases and relatively high TC levels in male PD patients.

The Sequence of Panic Symptoms

Abstract: For phenomenological elucidation of panic attacks, 26: patients with panic attacks were requested to name the panic symptoms in order of their occurrence and specify the patterns of their abatement. Panic symptoms were found to be classifiable into three categories: early symptoms consisting of dizziness or faintness, palpitations, and sweating; intermediate symptoms dyspnea, nausea or abdominal distress, flush or chills, chest pain or discomfort, shaking, and choking; late symptoms paresthesias, fear of dying, and fear of going crazy. Panic symptoms disappeared in 61.6% irrespective of the sequence of their occurrence. Twenty‐one patients were interviewed about the experience of nocturnal panic attacks, and 23.8% experienced them. These findings suggest that fear is caused by sudden physical abnormality triggered by some biological factors.

Effects of 8-OH-DPAT on corticosterone after acute and chronic administration of antidepressants

1. Serotonin has a facilitary role in the role of corticosterone secretion. 8-Hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), a selective 5-HT1A agonist, dose dependently (0.25- 1.0 mg/kg i.p.) increased rat plasma corticosterone concentration. 2. 3 days parachlorophenylalanine (PCPA) (150 mg/kg) administration did not effect the 8-OH-DPAT-induced corticosterone secretion. 3. Corticosterone responses to 8-OH-DPAT (0.5 mg/kg) were significantly attenuated by pretreatment with propranolol (5 mg/kg). Ketanserin (2 mg/kg), haloperidol (0.2 mg/kg), prazosin (0.1 mg/kg), and ICS-205930 (30 mu/kg) failed to antagonize the corticosterone response to 8-OH-DPAT. 4. 8-OH-DPAT-induced corticosterone were investigated in male rats after treatment with mianserin (2, 10 mg/kg), imipramine (5 mg/kg), desipramine (5 mg/kg), doxepine (5 mg/kg) for 1 day or 3 weeks. Chronic mianserin (10 mg/kg) and doxepine (5 mg/kg) did significantly increase 8-OH-DPAT-induced corticosterone response. Acute antidepressant, chronic imipramine, desipramine and mianserin (2 mg/kg) treatment did not change it. 5. These findings demonstrate that chronic treatment of some antidepressants potentiates 8-OH-DPAT-induced increase in plasma corticosterone, by actions at 5-HT-1A receptors located postsynaptically on 5-HT neurones.

Coping behavior in patients with panic disorder

Abstract  The purpose of the present paper was to investigate the role of coping behavior in patients with panic disorder (PD). This was done by evaluating three items of coping behavior (seeking of social support, wishful thinking and avoidance) in the Ways of Coping Checklist. The subjects consisted of 30 patients with PD (26 with agoraphobia). Coping behavior and the severity of PD was investigated at baseline and at 24 months (the final outcome). At baseline there were no gender differences in coping behavior. The severity of panic attacks significantly correlated with that of agoraphobia. The baseline severity of PD (panic attacks and agoraphobia) did not correlate with coping behavior. At the outcome assessment there was no significant correlation between the severity of panic attack and coping behavior. The severity of agoraphobia at final outcome and the coping behavior (seeking of social support) at baseline were significantly correlated. In the group that had remission in agoraphobia (the good outcome group), the severity of agoraphobia at baseline was significantly lower and the seeking of social support coping behavior was significantly higher than that of the poor outcome group. No significant difference in panic attack severity was noted between the good and poor outcome groups. Discriminant analysis revealed that seeking of social support coping behavior was a significant discriminant factor of agoraphobia. Although these are preliminary data, special coping behavior might be related to improvement of agoraphobia in patients with PD.

A method for analyzing biological rhythms in healthy subjects and depressed patients

Abstract: Rectal temperature rhythms of healthy subjects and patients with depression were fitted to a waveform having cosine components of periods 8, 12, and 24 hours using the least squares method. The nadir was then used as an index of phase. The results suggest that this method gives more exact data than the conventional method of analyzing biological rhythms, which uses a least squares fit to a single, 24‐hour‐period cosine waveform.

Method of Analysis of Temperature Rhythm in Depression and Normal Control—Least Squares Method Using Plural Cycles

Several reports have suggested that depression is brought about by the disturbance of biological rhythms.” Many of these studies used the least squares method for the analysis of these rhythms. While this is an excellent method of analysis, many problems arise in the use of this method, since it is normally applied using only one cycle for the analysis and the calculated waves tend to differ considerably from the original patterns. We conducted an investigation using the body temperature rhythm of normal healthy subjects and patients with depression in order to develop a means of reducing such problems while still using the least squares method.