Assessment of sexual function in depressed, impotent, and healthy men: factor analysis of a Brief Sexual Function Questionnaire for men

We report a study of sexual function in outpatient men with major depressive disorder (n = 42), compared with healthy control men (n = 37) and a clinic sample complaining of erectile dysfunction (n = 13). A principal-components factor analysis of the Brief Sexual Function Questionnaire confirmed differences in the clinical dimensions of sexual activity/performance, interest, satisfaction, and physiological competence. The four factors accounted for 72% of the variance in the analysis. Acceptable test-retest reliability, construct validity, and concurrent validity (with the Derogatis Sexual Function Inventory and a self-report behavioral log) were demonstrated. Parallel observations with findings from previous nocturnal penile tumescence studies in these same men are discussed.

Nocturnal penile tumescence is diminished in depressed men

Although depressed individuals commonly report decreased libido, it was not known if such changes are accompanied by neurophysiological alterations. Preliminary studies suggest that some depressed men may manifest diminished nocturnal penile tumescence (NPT), an objective measure of erectile capacity. We report NPT findings in 34 male outpatients with major depression (SADS/RDC) and an age-matched group of 28 healthy controls. A 3-night electroencephalographic (EEG) sleep/NPT protocol was utilized, with penile rigidity (buckling force) determined on night 3. Analysis of night 2 data by MAN-COVA revealed significant effects for age, the covariate (F = 2.86, p = 0.002), and diagnosis (F = 2.32, p = 0.02). Depressed men had significantly diminished NPT time (F = 16.8, p less than 0.001), even when adjusted for sleep time (F = 13.4, p less than 0.001) or rapid eye movement (REM) time (F = 7.2, p less than 0.01). NPT time was reduced by greater than or equal to 1 SD below the control mean in 40% of depressives and was comparable to the level seen in 14 nondepressed patients with a clinical diagnosis of organic impotence. An intermediate proportion of depressed patients (38%) had maximum buckling forces less than or equal to 500 g, indicating diminished penile rigidity, when compared to controls (16%) and men with presumed organic impairment (93%) (p less than 0.001). Diminished NPT time and low buckling force were associated with a history of erectile dysfunction within the index depressive episode (p less than 0.001). These findings suggest that depression in men is associated with a potentially reversible decrease in erectile capacity, which may be associated with significant sexual dysfunction.

Do nocturnal penile tumescence recordings alter electroencephalographic sleep?

While concurrent monitoring of sleep is considered to be a necessary component of evaluating nocturnal penile tumescence (NPT), in order to ensure that NPT data are not invalidated by fragmented sleep or diminished REM sleep, it is not known whether NPT recording itself disrupts sleep beyond the expected first night effect. In this study of 42 outpatient men with major depression and 36 normal control subjects, we found no effect of NPT recording on measures of sleep continuity, proportion of NREM to REM sleep, or REM sleep in either depressed or healthy control subjects.

Stimulation of cell membrane sodium transport activity by lithium: possible relationship to therapeutic action

Because lithium is extruded from cells by means of coupled exchange for external sodium (Na+-Li+ countertransport), we hypothesized that clinical treatment with this agent could lead to significant augmentation of net cellular sodium influx. We therefore directly measured sodium influx in vitro using erythrocytes (RBCs) from 27 depressed bipolar patients. When cells were loaded with sufficient lithium to maximally stimulate Na+-Li+ countertransport activity (5.1 mmoles/1 RBCs), there was a significant 44% increase in mean sodium influx. To approximate clinical conditions more closely, we also studied sodium influx in a subset of eight subjects after loading cells with 0, 0.40, 0.66, and 1.55 mmoles lithium/1 RBCs. Over this range of lithium concentrations, sodium influx increased progressively. In separate experiments, we found that RBC sodium content measured in eight subjects did not change significantly during a 4-week course of lithium treatment. Thus, excess cellular sodium during such treatment may be extruded by increased activity of the membrane Na+-K+ pump, which has electrogenic properties and thereby could augment the membrane potential. In the nervous system, such an effect could stabilize cell membranes electrophysiologically, and possibly affect processes, such as behavioral sensitization or kindling, proposed to have a role in the development of recurrent affective disorders.

Assessment of sexual function, interest and activity in depressed men

Sexual function, interest, and activity were assessed in drug-free outpatient depressed men (n = 26) and in age-matched healthy control men (n = 20) by means of the Derogatis Sexual Functioning Inventory (DSFI), a retrospective sexual function questionnaire (SFQ), and a prospective daily sexual function log. Good test-retest reliability over 1 month was demonstrated for the DSFI and the SFQ in depressives and controls. Compared to healthy controls, depressed men reported significantly lower sexual interest and satisfaction, but no less sexual activity, on both retrospective questionnaires and prospective daily logs. Depressed men also showed significantly more negative body image and less 'manly' sexual role function as measured by the DSFI. Significant partial correlations (controlling for the effects of anxiety) were found between severity of depression and sexual interest, satisfaction, and role.

Nocturnal penile tumescence in depressed men

Nocturnal penile tumescence recordings were performed in 10 men with major depression and 10 age-matched healthy control subjects to evaluate the possibility that clinical disturbances in sexual interest and activity often reported by depressed persons are associated with objective changes in sexual neurophysiology. Depressed men had significantly reduced minutes of tumescence time, a finding that was not attributable to alterations in sleep efficiency or REM sleep time. Three depressed men had baseline tumescence profiles suggestive of "organogenic" impotence, which improved after recovery. The authors discuss the implications of such findings for clinical practice and future research.

Electroencephalographic sleep in psychotic depression. A valid subtype?

Electroencephalographic (EEG) sleep patterns were examined in 27 psychotic and 79 nonpsychotic subjects with major depression to evaluate the validity of the psychotic-nonpsychotic subtype dichotomy. Sleep in psychotic depression was characterized by increased wakefulness, decreased rapid eye movement (REM) sleep percentage, and decreased REM activity even after controlling for clinical differences in age, severity, and agitation. Psychotic depressive subjects also were more likely to have extremely short sleep-onset REM latencies. In psychotic depression EEG sleep varied as a function of total illness duration. Patients with recent-onset syndromes had profiles characterized by marked initial insomnia, increased stage 1 sleep percentage, and long REM latency; patients with illnesses of longer duration had extremely short REM latencies. Demonstration of selected EEG sleep variables discriminating between psychotic and nonpsychotic depression further supports psychotic depression as a distinct subtype of major affective disorder.

Patterns of attrition for psychosocial and pharmacologic treatments of depression

Patient characteristics associated with early termination from psychosocial and pharmacologic treatments of depression were delineated. Patients were 125 female primary nonbipolar depressives randomly assigned to 12 weeks of protocol treatment in one of four conditions: social skills training plus placebo; short-term psychotherapy plus placebo; amitriptyline alone; and social skills training plus amitriptyline. Results indicated that premature terminators from pharmacotherapy tended to be mildly depressed and intolerant of medication side effects. In contrast, dropouts from psychosocial treatment were more severely depressed and dissatisfied with the lack of early response which often accompanies interventions of this type. These findings may support the use of short-term psychosocial approaches in lieu of pharmacotherapy in mild nonendogenous depressions. However, antidepressant medication, either alone or in conjunction with psychosocial treatment, should continue to be considered the treatment of choice in more severely depressed melancholic patients.

Evaluation of depression in a general hospital: utility and limitations of the dexamethasone suppression test

Use of the DST was studied in medically hospitalized, depressed patients. Although complicating medical factors necessarily excluded nearly 60% of referrals, post-dexamethasone plasma cortisol values were significantly higher in 14 major depressives appropriate for the DST as compared to 12 patients with milder, subsyndromal depressive conditions. Using a plasma cortisol criterion of greater than 7 micrograms/dl, the DST identified major depression with 57% sensitivity and 92% specificity in this subsample (p less than 0.005). While limited by a high exclusion rate, the DST may be useful for confirmation of major depression in carefully screened general hospital patients. Implications for research and practice are discussed.

Social skills training and endogenous depression

The clinical response to social skills training was studied in four women with definite endogenous depression (melancholia) to ascertain if a behavioral intervention could be effective with more severe and pervasive affective syndromes. Three of four patients responded to social skills training, although both patients available for longitudinal follow-up relapsed within 24 months post-treatment. Implications for research and practice are discussed.

Electroencephalographic sleep in secondary depression: a revisit

EEG sleep studies are reported in 23 inpatients with secondary depression compared to a similar number of primary depressives matched for age and severity. No major patterns of EEG sleep abnormalities were found to differentiate between these closely matched samples at baseline or during amitriptyline treatment. Such results indicate that more severely ill secondary depressives manifest the characteristic EEG sleep abnormalities of depression. While these features had been reported previously to be specific for primary depression, earlier studies of psychobiological differences between primary and secondary subtypes may reflect an epiphenomenon of sample differences in age, severity, or percentage of patients with endogenous depression. Implications for further research and clinical practice are discussed.

Age-related neuropsychological deficits in Down's syndrome

Down's syndrome (DS) has been suggested as a high-risk condition for Dementia Alzheimer's type (DAT). In the present study, neuropsychological variables were assessed in 165 DS subjects and 163 matched mentally retarded controls. Overall, DS subjects had lower scores for orientation, digit span, visual memory, object-naming, and general knowledge, as well as more "released" reflexes. Impairments were most evident in DS subjects greater than 50 years old. These findings provide further support for an association between aging and DAT in Down's syndrome. Methodological issues and areas for future research are discussed.

Basal ganglia calcification and psychosis in Down's syndrome

A case of basal ganglia calcification (diagnosed in vivo) and schizophreniform psychosis occurring in a young adult with Down's syndrome is reported. A stress-vulnerability model is suggested. Because of the relatively high prevalence of basal ganglia calcification to Down's syndrome, this population appears well suited for systematic study of the neuropsychiatric aspects associated with this neurological condition.

Rhabdomyolysis complicating rapid intramuscular neuroleptization

A case of rhabdomyolysis is described, with onset following three intramuscular injections of loxapine and one injection of benztropine over a 7-hour period. The possible additive effects of intramuscular drug administration and psychotic episode-associated increased muscle membrane permeability are discussed. Because of the risk of acute renal failure following rhabdomyolysis, monitoring of creatine phosphokinase levels and urine tests for myoglobin are recommended for patients who develop muscular discomfort, nausea, or confusion while receiving frequent intramuscular injections of neuroleptics.

Symptomatic volunteers in depression research: a closer look

Seventy-nine carefully screened volunteers were compared with 46 clinically referred outpatient primary depressives to assess the validity of use of symptomatic volunteers in research on depression. Overall, symptomatic and clinical referral samples were similar on the majority of demographic and symptomatic variables, although volunteers were less likely to be single, had slightly lower Hamilton scores, less self-reported anxiety, and a longer index episode of depression. Symptomatic volunteer and clinical referral groups had a similar prevalence of endogenous depression by either RDC or DSM-III criteria. Results in 60 patients treated with amitriptyline indicated that both groups were comparable with respect to overall dropout rate, side-effect attrition, dosage of amitriptyline received, and clinical response. Only the proportion of patients who dropped out between completion of assessment and initiation of treatment significantly differed between groups (symptomatic volunteers = 19%; clinical referrals = 0%; p less than 0.05). These findings support use of rigorously screened symptomatic volunteers in outpatient depression research.

Validation of a Hamilton subscale for endogenomorphic depression

The current study examined the validity of a subscale for endogenomorphic depression derived from the Hamilton Rating Scale for Depression. In a sample of 147 women outpatients with primary depression, subscale (HES) scores were bimodally distributed around the mean score of 7.38. High-HES patients had significantly elevated scores on measures of depressive symptomatology, generalized symptomatic distress, and social impairment relative to low-HES patients. Classifications based on HES scores significantly predicted RDC and DSM-III subtype diagnoses of endogenous and nonendogenous depression. Diagnostic predictions based on the subscale's items were superior to predictions made using the 'non-endogenomorphic' Hamilton items. Potential applications for research are discussed.

Suicides in jails and prisons

Suicide is the leading cause of death in jails and prisons and the rate is at least 3 times higher than the national average. Nonetheless, suicides in jails and prisons have received little professional psychiatric attention. A review of the relevant literature reveals a limited number of studies, many of which contain serious methodological flaws. The current literature does suggest that the psychiatric morbidity in jails and prisons is increasing and that administrative and environmental variables appear to be at least equal to personal characteristics in contributing to inmate suicides. Recommendations for future research efforts and practical applications are made.

The use of the sleep laboratory in the diagnosis of affective disorders

Research over the past two decades has led to the development of standardized EEG sleep methodology, which in turn has proven useful for identification of characteristic sleep abnormalities for the affective disorders. Application of shortened REM latency (less than 60 minutes for most populations) or combination of EEG sleep variables as psychobiologic markers for endogenous depression has produced an accurate, reliable, and objective laboratory method to aid in differential diagnosis of affective states. In clinical practice, this method is not presently practical as a routine screening test for all depressed patients, but is very useful to help evaluate complex or diagnostically difficult cases. Beyond its role as a diagnostic aid, EEG sleep studies show great promise as a research strategy to help elucidate the pathophysiology of affective disorders and to understand mechanisms of antidepressant response. Continued application and development of EEG sleep methodology should yield further advances in diagnosis and treatment of affective disorders.

Clinical evaluation of dementia in Down's syndrome: a preliminary report

Down's syndrome residents were found to have significantly greater impairment on measures of orientation, attention span, digit span recall, visual memory, object identification and praxis, and were more likely to have pathological released reflexes than age and IQ matched controls. Neuropsychiatric status tended to worsen with advancing age in Down's syndrome, but not in controls. Forty-five percent of DS individuals age 45 or older had a full syndrome of dementia, compared to only 5% of controls. Although further research is necessary, particularly employing larger samples and more detailed medical screening, these results support the association of dementia Alzheimer type with Down's syndrome.