Robert A. Maricle

Dose-response relationship of levodopa with mood and anxiety in fluctuating Parkinson's disease: A double-blind, placebo-controlled study

We investigated the effect of levodopa on mood and anxiety in eight Parkinsons disease patients with motor fluctuations.Each patient received 0.0-, 0.5-, and 1.0-mg/kg/hr levodopa infusions in randomly assigned order under double-blind conditions on consecutive days. Mood elevation and anxiety reduction based on half-hourly patient rating and a corresponding increase in tapping speed occurred with active drug infusion but not placebo infusion. The effects were dose related. The higher-dose infusion rate produced more rapid onset, greater magnitude, and longer duration of response. We conclude that mood and anxiety fluctuations related to levodopa dosing are robust pharmacologic, and not placebo, effects. NEUROLOGY 1995;45: 1757-1760

Depression in patients being evaluated for heart transplantation

In the evaluation of 68 consecutive heart transplant candidates, 37 (54%) had one or more depressive syndromes. Premorbid psychiatric risk factors of depression were prevalent throughout the group. Statistically significant associations with depression were found with age, educational and occupational levels, and a history of past depressive episodes, but not with family psychiatric history, parental loss in childhood, history of serious childhood illness, or history of substance abuse. Of the 43 patients transplanted, 16 of 22 who were depressed preoperatively required psychiatric intervention postoperatively compared to 8 of 21 who were not depressed; 75% had a beneficial response to treatment. We recommend that a diagnosis of depression not be considered reason to exclude otherwise suitable candidates for cardiac transplantation.

Mood response to levodopa infusion in early Parkinson's disease.

Mood response to levodopa infusion was studied in 18 Parkinsons disease (PD) patients during the first year of levodopa therapy before and after 2-hour (1.0 mgkgh) levodopa infusions at baseline and 6-and 12-month follow-up. Mood elevation was greatest after a 2-day levodopa holiday at the 6- and 12-month assessments. Age, sex, duration and severity Of PD, and ongoing oral levodopa dose did not correlate with mood response. Mood response in these patients differs from that seen in advanced patients, possibly because of sensation to levodopas mood effects.

The prevalence and significance of medical illness among chronically mentally ill outpatients.

The prevalence and significance of medical illnesses were examined in a sample of chronically mentally ill patients from an urban community mental health program. Eighty-eight percent had at least one significant medical illness, 51% had at least one previously undiagnosed illness and 53% were judged to be in need of some form of medical attention. The bulk of these illnesses were typical of primary care problems. In terms of causal significance, nearly as many medical illnesses appeared to be the result of the psychiatric disorder (18%) as vice versa (22%). Community mental health programs should make provisions for the medical needs of patients in comprehensive management programs.

Pseudocyesis: a model for cultural, psychological, and biological interplay

Pseudocyesis provides a unique opportunity to observe the mind-body interplay. In this paper, recent information including biological, psychological, and cultural factors in this supposedly rare disorder are summarized and discussed. Implications of these interrelationships give rise to possible influences of the psychological state on other obstetrical and gynecological problems.

Correlations of Cardiac Function and SCL-90R in Heart Transplantation Candidates

Measurements of cardiac function and Symptom Checklist-90R (SCL-90R) data were retrospectively analyzed in two independent groups of cardiac transplant candidates in an effort to identify organic correlates of depressive syndromes. In the first study, no significant inverse correlations were found between depression measures and cardiac index as had been predicted. However, elevated right atrial pressure was associated with increased scores of the SCL-90R depression subscale (DEP) and global symptom index (GSI). A significant positive correlation was also found between the phobia subscale and cardiac index. In a second sample, again, cardiac index did not correlate inversely with DEP or GSI. The phobia-cardiac index correlation was replicated but the right atrial pressure correlations were not. Combining both groups, there were significant correlations between six SCL-90R subscales (including DEP and GSI) and cardiac index. All were positive correlations, refuting the initial hypothesis and suggesting patients with the best cardiac function reported the worst psychological distress and that patients with the worst cardiac function reported the least psychological distress. Possible explanations for these findings are discussed.

Medication-associated depression: a two and one-half year follow-up of a community sample.

A community sample of forty subjects (of a total of 5 0) were followed up an average of two and one-half years after a SADS/RDC diagnosis of depression. The group was composed of twenty-one subjects whose depressions were judged to be associated with a medical illness or medication use and nineteen without this association. There was no difference in outcome as measured by persistence or recurrence of depression when groups were defined by associated medical illness. There was a significant difference when groups were defined by association with medication use. Of the nine subjects whose depressions were associated with medication, six were still depressed at follow-up; all six had continued to use implicated “depressogenic” medications. The three who were not depressed at follow-up were no longer using the originally implicated medications. The use of depressogenic medication appears to influence the course and/or duration of depression and must be accounted for in epidemiological studies and clinical practices.