William B. Saunders

Social support and depression as risk factors for loss of physical function in late life

Abstract Poor physical function status in elders is a robust predictor of not only medical service use and institutionalization but also mortality. We assessed whether depressive symptoms and low social support would predict deficits in three domains of physical function among 3,240 community-dwelling older adults in the Piedmont of North Carolina over one year. Between 7-23% of the sample declined in functional ability, depending on the domain tested. Depressive symptoms and receipt of instrumental support predicted declines in all domains of physical function. Giving instrumental support and subjective social support protected elders against declines, and subjective social support buffered the detrimental effect of depression on risk of physical decline. This study suggests that significant risk of functional impairment could be reduced among elderly persons if coincidental depressive symptoms could be alleviated and/or deficits in their social environment remedied.

Management of general medical patients with symptoms of depression

This article describes the management of depressive symptoms in a group of ambulatory patients in general medical care during a 1-year period. It also examines patient outcomes by types of management and aggressiveness of treatment. Subjects are 112 male patients longitudinally enrolled in a V.A. General Medical Clinic who screened positively on both the Zung Self-rating Depression Scale and the DSM-III criteria. Medical records were abstracted to obtain information on mental health management. During the follow-up year, 48% of the moderately depressed patients received some form of mental health management compared to 92% of the severely depressed patients. Of the treatment modes, only patients who had a mental health clinic visit and/or psychiatric consultation were significantly more improved than those not so treated--but only at 6 months (p = 0.09) and 9 months (p = 0.02). Actual treatment experience was then classified into three levels based on intensity, duration, and combinations of treatments. Of the three levels, only those patients in the moderately aggressively treated condition were significantly more improved at 3 months (p = 0.02) and at 6 months (p = 0.04) than those in the no-treatment condition.

Adrenocortical sensitivity to low-dose ACTH administration in depressed patients

We studied adrenocortical sensitivity to ACTH 1−24 in depressed patients after suppressing endogenous ACTH with dexamethasone. The dose of ACTH 1−24 used (50 ng) was based on prior studies showing that it produced a consistent response

Internal Consistency of a Diagnostic Interview for Children: The Child Assessment Schedule

The purpose of this study was to evaluate the internal consistency of the content scales of the Child Assessment Schedule (CAS). A total of 116 psychiatric patients with a mean age of 10 years were administered the interview, and 92 parents were administered the parent version. Coefficient alpha was calculated for each of the 11 content scales. High internal consistency was demonstrated for school, friends, worries, mood, physical complaints, and expression of anger. More moderate but acceptable alphas were observed for the family, fears, and self-image scales. The same general pattern of results was observed for both the child and parent interviews. Additional analyses revealed that the number of items in the CAS could be reduced up to 30% without sacrificing internal consistency. These results indicate that 9 of the scales yield reliable scores.

Neuroanatomical changes and hypothalamo-pituitary-adrenal axis abnormalities ☆

Hypothalamo-pituitary-adrenal (HPA) axis abnormalities are frequently observed in patients with major depression (Carroll 1982). The most extensively assessed abnormality is the early escape of cortisol from suppression after dexamethasone. Although this abnormality is state dependent (Carroll et al. 1976. 1981). its relationship to the initiation and development of depressive symptomatology remains an enigma. Ventricular enlargement and cerebral atrophy are also observed frequently in patients with major depression (Pearlson and Veroff 1981). The ventricular brain ratio (VBR) has been reported to be correlated with 24-hr urine-free cortisol (Kellner et al. 1983). Although Targum et al. (1983) did not find a relationship between VBR and the Dexamethasone Suppression Test (DST), Rothschild et al. (1988) recently reported a statistically significant positive correlation between VBR and highest postdexamethasone plasma cortisol concentrations. In an earlier study of patients with major

Nocturnal and early morning secretion of ACTH and cortisol in humans

It is well established that the adrenocorticotropic hormone (ACTH) stimulates the synthesis and release of cortisol from the adrenal cortex, but the role of ACTH in the physiological regulation of basal cortisol secretion has received surprisingly little study. The authors studied the nocturnal and early morning secretory pulses of cortisol and ACTH in normal subjects. A pulse detection algorithm was developed. The relationship between ACTH and cortisol pulses in terms of temporal and proportional relationship is described. Pulse concomitance for ACTH with cortisol was 47% and for cortisol with ACTH pulses it was 60%. The first description of the relationship between concomitant ACTH and cortisol pulse magnitudes in humans is presented. A highly significant linear relationship between the magnitudes of ACTH and cortisol pulses is shown. Putative reasons for dissociated pulses and the potential implication of these findings are discussed.

Internal consistency of DSM-III diagnoses using the symptom scales of the Child Assessment Schedule.

Internal consistency of the major diagnostic categories for children was assessed, using the symptom scale scores of the Child Assessment Schedule. Alpha coefficients were calculated for three samples: 116 nonpsychotic psychiatrically disturbed children, 63 children with cystic fibrosis, and 177 children from a community based sample. For the psychiatric sample, a high level of internal consistency was demonstrated for all the symptom scales (i.e., attention deficit, conduct, anxiety, and depression). For the nonpsychiatric samples, the attention deficit and depression scales were reliable, with lower levels of endorsement and more variability observed for the other scales. These results are supportive of the clustering of diagnostic criteria present in DSM-III.

RU486 in depression

RU486 is a synthetic glucocorticoid antagonist. The authors used RU486 to examine the hypothesis that the elevated plasma cortisol and ACTH in patients is due to suprahypophyseal stimulation of the anterior pituitary. Seven patients and matched controls were studied before and after the administration of RU486. RU486 produced an increase in HPA activity in depressed patients. Thus providing support for the hypothesis that there is increased suprahypophyseal stimulation of the anterior pituitary.

Fast feedback regulation of acth by cortisol

1. Fast feedback regulation of ACTH by cortisol has not been well studied in humans. The authors studied the existence and characteristics of fast feedback regulation in normal humans. 2. Hydrocortisone hemisuccinate was infused at two different rates: 6 mg/hour and 12 mg/hour for two hours. 3. The studies did not demonstrate the existence of fast feedback regulation of basal ACTH concentration by cortisol in man. Further, the response was variable and the rate sensitive character was difficult to demonstrate.

Role of serotonin in hypothalamo pituitary adrenal axis escape from dexamethasone suppression

1. The authors investigated the role of serotonin in the hypothalamo pituitary adrenal escape from depression. 2. Maximal dose of fenfluramine was administered to normal individuals pretreated with dexamethasone. 3. Fenfluramine had only a minimal and inconsistent effect on the hypothalamo pituitary adrenal axis in the presence of dexamethasone.