Laurie Harkness

Sustained urinary norepinephrine and epinephrine elevation in post-traumatic stress disorder

Urinary norepinephrine and epinephrine levels (microgram/day) were measured at two-week intervals during the course of hospitalization in the following patient groups: post-traumatic stress disorder (PTSD); major depressive disorder (MDD); bipolar I, manic (BP); paranoid schizophrenia (PS); and undifferentiated schizophrenia (US). The mean norepinephrine level during hospitalization was significantly higher in PTSD (76 +/- 10.4 micrograms/day) than in BP (60.6 +/- 8.4 micrograms/day), MDD (41.2 +/- 4.7 micrograms/day), PS (33.4 +/- 4.9 micrograms/day) and US (34.3 +/- 5.9 micrograms/day) groups, according to Duncans multiple range test, (F(4,39) = 6.94, p less than 0.0003). The norepinephrine elevations in the PTSD group were sustained throughout hospitalization. The only other group to show mean levels in this range was the BP group in the first sample after hospital admission. This finding supports prior psychophysiological studies indicating increased sympathetic nervous system activity in PTSD patients. The mean epinephrine level during hospitalization was also significantly higher in PTSD (22.7 +/- 2.4 micrograms/day) than in MDD (13.6 +/- 1.7 micrograms/day), PS (14.7 +/- 2.4 micrograms/day), and US (18.9 +/- 1.8 micrograms/day), but not higher than in BP (21.5 +/- 2.7 micrograms/day). The relationship of epinephrine levels among diagnostic groups was sustained throughout hospitalization. It appears likely that the main underlying mechanisms for elevations of both hormones are psychological, but further work will be required to establish the exact nature of these mechanisms.

Elevation of urinary norepinephrine/cortisol ratio in posttraumatic stress disorder.

We have previously reported the unusual combination of low urinary free cortisol levels with high urinary norepinephrine excretion in posttraumatic stress disorder (PTSD) patients in comparison with four other patient groups: major depressive disorder, endogenous type; bipolar I, manic; paranoid schizophrenia; undifferentiated schizophrenia. Cortisol levels alone did not distinguish PTSD from paranoid schizophrenia patients and norepinephrine levels alone did not distinguish PTSD from bipolar I, manic, patients. In further consideration of these findings, we have found that combining the values for the two systems in a norepinephrine/cortisol (N/C) ratio provides a measure that significantly distinguishes PTSD from all the other patient groups throughout the hospitalization period. The N/C ratio was more than twice as high in the PTSD group than in all the other patient groups in the first sample following hospital admission, in the mean sample during hospitalization, and in the last sample before discharge. The mean N/C ratio for the PTSD group was 2.54, compared with a mean of .99 for the other four groups, which ranged from .81 to 1.18. The diagnostic sensitivity was 78% and the specificity was 94% for correct classification of PTSD in our sample. These preliminary findings yield further encouragement for exploring multivariate strategies, using hormonal ratios or profiles, in an effort to increase the diagnostic sensitivity of neuroendocrine criteria in the assessment of psychiatric patients.

A model of consumer-provider partnership: Vet-to-Vet.

Recently, there has been increased interest in consumer-provided mental health services. Two models have been proposed: One emphasizing full independence from professional services, and one in which consumers work within the mental health system. In this paper we describe Vet-to-Vet, a consumer-professional partnership model in which consumer services are embedded in a mental health system. We describe the advantages of this approach and barriers to implementation of other models. Vet-to-Vet has several unique elements, developed and implemented by consumers with professional consultation and supervision. We believe that consumer-partnership models of consumer-provided mental health services have potential for minimizing implementation barriers and for maximizing long-term sustainability.

Monoamine oxidase inhibitor-responsive depression

Double-blind, placebo-controlled trials have documented the efficacy of some monoamine oxidase (MAO) inhibitors in treating certain depressed patients. This preliminary report of a 6-week, double-blind, placebo-controlled study of the MAO inhibitor isocarboxazid (Marplan) examines the time course of platelet MAO inhibition and treatment response, and describes symptoms that distinguish markedly improved from slightly improved responders. Thirty male outpatients, ages 28-64, randomly divided into placebo (n = 15) and active medication (n = 15) groups, were followed weekly. Medication was started at 20 mg daily and increased to achieve 90% platelet MAO inhibition. Data were analyzed for 24 patients who completed at least 3 weeks of the study. A clinicians global change rating at the studys conclusion showed that 12 of 13 patients (92%) in the active medication group improved, while 3 of 11 (27%) patients in the placebo group improved. Significant symptomatic improvement occurred in the active treatment group by week 3. Trends suggest that anxiety improved first (week 2), followed by depression (week 3), and finally cognitive outlook (week 6). Only minimal difficulties were observed with orthostatic hypotension, hypertensive crises, or other side effects. At baseline, the only significant difference between the markedly improved and slightly improved groups was greater psychomotor retardation in the markedly improved group. Trends suggest that the markedly improved group showed less depression, anxiety, sleep disturbance, and weight loss, fewer gastrointestinal complaints, and more helplessness and worthlessness.

Platelet MAO and amitriptyline treatment

Some tricyclic antidepressants have been reported to inhibit monoamine oxidase (MAO) activity in vitro in addition to blocking the reuptake of norepinephrine and/or serotonin. While the inhibition of MAO is reversible, platelet MAO activity in depressed patients responding to amitriptyline treatment has been reported to be reduced after drug treatment. In a reverse design, we measured platelet MAO activity and drug levels in patients chronically being treated with amitriptyline and again 2 and 4 weeks after stopping the medication. Although tricyclic drug concentrations were initially within the therapeutic range and undetectable on placebo treatment, platelet MAO activities were unchanged.

Interest in technology-based therapies hampered by access: A survey of veterans with serious mental illnesses.

OBJECTIVE Computer technology is used in various ways to deliver and enhance health care. It is therefore important to understand technology use patterns among underserved populations such as persons with serious mental illnesses who often experience inequitable care. METHODS A survey was administered to 210 veterans with serious mental illnesses attending programs at a Department of Veterans Affairs community care center, with data collected on demographics, psychiatric diagnoses, access, use, and willingness to use cell phones, smart phones, Internet-based online social networking, and computerized therapies. Descriptive and multivariable analyses were conducted to determine utilization and interest in different technologies. RESULTS Although 80.4% of the respondents reported owning a cellphone, only 30.3% reported they had a computer and 13.1% reported owning a smartphone. Although 56.7% reported using the Internet and 47.6% indicated they used e-mail, 68.6% of respondents reported that they were interested in using computer programs for mental health-related problems. Older, less educated veterans, and those with alcohol use disorders were less likely to use the Internet. Veterans who were White or had PTSD diagnoses were less willing to use any computerized therapy. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Lower rates of computer use, Internet, and cell phone technologies were observed among veterans with serious mental illnesses compared to general population surveys. Sociodemographic barriers likely impede access to technology among veterans with serious mental illnesses. Providing financial resources and associated education and training to veterans with serious mental illnesses could increase access to helpful technology-based interventions in a population that traditionally experiences service gaps. (PsycINFO Database Record

Helping veterans with mental illness overcome civil legal issues: collaboration between a veterans affairs psychosocial rehabilitation center and a nonprofit legal center.

This article describes the collaboration between a Department of Veterans Affairs (VA) community-based psychosocial rehabilitation center and a nonprofit legal center that primarily addresses the civil legal issues of veterans who have mental illness and/or are homeless. The legal center is located on-site at the VA psychosocial rehabilitation center and serves veterans who receive VA mental health treatment and other social services. Once veterans establish contact with the legal center and authorize the release of their health information, legal center staff members work closely with VA clinicians to help veterans address legal issues that may be obstacles to recovery. Development of this collaboration is described, along with the legal centers funding, clientele, and operations. The most common types of civil legal matters the legal center handles are also briefly described. Experiences of the legal center suggest that professional aid for civil legal problems provided within VA facilities may be beneficial for veterans and warrants empirical study.