Genetic factors and lithium response in manic-depressive illness

The relationship between success in lithium treatment and the presence of affective illness in the families of manic-depressive patients was investigated in a double-blind study of lithium prophylaxis. Of a total of 89 outpatients who were followed for periods of up to 48 months, 43 were randomly assigned to lithium and 46 to placebo. 56% of the lithium-treated patients remained asymptomatic, as compared to 28% of the placebo patients. Of the 24 successfully treated lithium cases, 16 (66%) had at least one first-degree relative with bipolar illness, while only 4 of the 19 lithium failures (21%) had a first-degree relative with bipolar illness. No relationship was found between response to lithium and the presence of unipolar illness in the patients' families.

Cognitive performance on the Alzheimer's Disease Assessment Scale: effect of education

The cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog) is used to monitor disease progression and treatment efficacy in clinical trials of Alzheimer's disease (AD). Using data from a 12-week drug trial, we retrospectively studied the effect of education on ADAS-Cog performance in a group of 444 patients with AD. The effect of education was statistically significant on baseline ADAS-Cog total scores. This effect remained statistically significant after controlling for age, gender, and dementia severity. Education effects were also statistically significant at week 12 for ADAS-Cog total and 10 of 11 subitem scores in 138 AD patients in the placebo arm of the trial. Post hoc analysis showed that non-high school graduates performed worse than those with greater educational levels across a broad range of cognitive domains. Our results, in conjunction with reports linking lower educational level with a higher risk for AD, suggest that educational level of patients be given consideration in the design and interpretation of cognitive tests in AD drug trials.

Oxiracetam in the treatment of multi-infarct dementia and primary degenerative dementia

Oxiracetam is a recently synthesized nootropic that was tested as a potential treatment for cognitive decline in patients with multi-infarct dementia (MID) and primary degenerative dementia (PDD). Subjects were 34 MID patients and 39 PDD patients who met entrance criteria for the study. A repeated measures ANOVA showed significant improvement in both patients with MID and patients with PDD for word fluency. The total score on the Relatives' Assessment of Global Symptomatology-Elderly showed significant improvement for patients with PDD. The average score on the Instrumental Activities of Daily Living Scale, however, showed a significant decline for patients with PDD.

A possible low intracellular potassium in obesity

In comparison with lean marathon runners whose fat content was 15%, obese subjects with a fat content of 55% showed a 36% reduction in intracellular potassium. It is hypothesized that as much as 60% of this decrease may have been due to the lower proportion of muscle (which has the highest intracellular potassium of any tissue) in the fat free mass of very obese subjects. The remainder of the decrease seems to have been a measurement artefact owing to self-absorption of gamma rays by adipose tissue, most of which is distributed over potassium rich lean tissue. The low intracellular potassium values found in obesity should not be interpreted as necessarily signifying potassium deficiency.

Toward the validation of RDC schizoaffective disorder

The Research Diagnostic Criteria (RDC) for schizoaffective disorder were applied to a clinic population of 71 patients with bipolar I disorder. Twenty-five patients were found to meet RDC criteria for schizoaffective disorder. The RDC-positive group were found to be the most psychotic patients and had a younger age at onset and admission to the clinic that the RDC-negative group. They had also had their conditions diagnosed more frequently as schizophrenic by referring physicians. There was no difference, however, between the two groups on many other variables, including clinical, family history, drug response, and laboratory studies. We conclude that our bipolar I population cannot be further subdivided into meaningful clinical entities using the RDC criteria for schizoaffective disorder.

Psychosis as a predictor of response to lithium maintenance treatment in bipolar affective disorder

Sixty-six bipolar I lithium clinic patients were studied for a history of psychotic symptoms at some time during the course of their illness. Agreement between different sources of information was calculated, and the patient population was divided into psychotic and non-psychotic subgroups. Probability of remaining well on lithium for the different subgroups was analyzed by the life table method. Psychosis during mania appeared to be associated with especially good early lithium prophylaxis.

Personality features of patients with primary affective disorder

Personality variables were assessed in outpatients with primary affective disorder by use of the Maudsley Personality Inventory (MPI) and the Marke Nyman Temperament Scale (MNTS). Significant differences between diagnostic groups were initially noted for the extraversion and neuroticism scales of the MPI. However, when mood was more rigorously controlled for, these differences largely disappeared, while interdiagnostic differences for the solidity scale of the MNTS emerged. The findings suggest that these measured aspects of personality may be quite state (mood) dependent even when patients are given test instructions previously reported to minimize mood effects. This was born out in a follow-up study for the N scale, but not the E scale, of the MPI. These data indicate that assessment of neuroticism in affectively ill patients will be contaminated by the presence of even mild depressive symptoms, a finding that has important implications for studies of personality in affective disorder.

Lithium carbonate prophylaxis of depression in three subtypes in primary affective disorder

Multiple indices of depression were used to evaluate the prophylactic efficacy of lithium carbonate versus placebo in a 4-year, double-blind study of unipolar, bipolar I, and bipolar II patients diagnosed according to strict criteria. Our data indicate lithium prophylaxis of depression on several indices in all three subtypes of affective illness. Additional studies are needed, comparing tricyclic antidepressants alone, monoamine oxidase inhibitors alone, or either drug combination with lithium carbonate for prophylaxis in clearly defined depressive subtypes.

Plasma dopamine beta hydroxylase activity in affective disorders

Plasma dopamine beta hydroxylase (DBH) activity was measured in patients with affective disorders and in their relatives. The groups studied had wide distributions of values for plasma DBH activity. No significant difference of plasma DBH activity was found between unipolar and bipolar patients, nor between patients given lithium or placebo. Exercise on a treadmill at 40 degrees or 10 degrees C elicited a different pattern of response for plasma DBH activity in three patients as compared to control subjects. In familial studies we found the values of plasma DBH activity to be almost identical in monozygotic twin pairs and quite similar in dizygotic twin pairs. All pairs, however, were discordant for affective illness. There was also a marked similarity of plasma DBH activity in 15 pairs of the same sex sibs discordant for affective illness. These studies suggest that the resting level of plasma DBH activity is not related to affective illness but is genetically determined.

The use of autocorrelation analysis in the longitudinal study of mood patterns in depressed patients

The statistical method of autocorrelation, commonly used in econometrics and engineering, was applied to the daily mood scores of ten depressive hospital in-patients. The analyses made possible the quantification of two aspects of the longitudinal course of individual patients' psychopathology, the degree of day-to-day stability and the degree of periodicity in mood. Quantification of the degree of day-to-day mood stability yielded wide variations between patients and suggested that patients might be usefully categorized in terms of this characteristic. Mood stability during periods of severe depression was found to be less pronounced than during periods of relatively moderate depression. Furthermore, the existence of 'mini-cycles', cyclical fluctuations in mood of one to two weeks' duration occurring during the course of depressive episodes, was demonstrated in three cases.

Lithium carbonate and affective disorders. V: A double-blind study of prophylaxis of depression in bipolar illness

The efficacy of lithium carbonate as a prophylactic drug against depression in bipolar manic depressive patients was assessed through a double-blind, placebo-controlled study of patients who had histories of recurrent depressions and hypomanias ("bipolar II"). The results revealed that treatment with lithium carbonate resulted in a reduction in the frequency of depressive attacks was observed with lithium carbonate treatment during the study (mean length of study, approximately 16 months), although there was a suggestion that the depressive attacks that occurred during treatment with lithium carbonate might be less severe than with placebo treatment.

The life table. A method for analyzing longitudinal studies

The life table is presented as the method of choice for analyzing data from longitudinal studies in which the outcome under study occurs randomly and in which patients are followed up varying lengths of time. We discuss the superiority of the life table to methods typically used, the calculation of its entries, and some of the clinical uses that can be made of its results. The method is applied to follow-up data on manic-depressive patients maintained with prophylactic lithium carbonate or with control regimens, and it is shown to disclose mathematical regularities in the parameters of longitudinal course.

Lithium carbonate in affective disorders. IV. A double-blind study of prophylaxis in unipolar recurrent depression

The prophylactic efficacy of lithium carbonate vs placebo was examined in a double-blind study in a carefully delineated group of 28 unipolar recurrent depressed patients followed up from three months to four years. Indexes of prophylactic efficacy revealed a statistically significant decrease in episode frequency, depth of global depression scores, and increased clinic attendance rate in the lithium carbonate group compared with the placebo group. Planned studies are now needed to determine which unipolar patients do best on a maintenance regimen of lithium carbonate alone, lithium carbonate plus tricyclic drugs, or tricyclic drugs alone.

Double-blind procedure: an assessment in a study of lithium prophylaxis

Fifty-seven patients with primary affective disorder who were in a double-blind outpatient study to evaluate the prophylaxis of lithium were questioned as to whether they believed they were receiving lithium or placebo. Research nurses who were 'blind' to the patients' medication and a close relative living with each patient were also questioned. Nearly all patients (96%) said they beleived they were receiving lithium, ascribing this belief in 63% of the cases to a perceived improvement in condition. In only 14% of the cases on lithium was the presence of side-effects implicated in the patients' beliefs. One of the three nurses had a correct guess rate in excess of chance expectancy. All nurses tended to be more accurate in their guesses in the cases of patients who had been in prophylactic trials of over 15 months' duration than for patients with briefer periods in the study. Patients' relatives were, as a group, extremely accurate, their correct guess rate exceeding chance expectancy at the 0-001 level.

Longitudinal studies of diurnal variations in depression: a sample of 643 patient days

Diurnal variations in symptom intensity have long been recognized as a characteristic feature of depression, and have always had a prominent place in clinical descriptions of the illness. A worsening of depression in the morning has classically been associated with endogenous depression, while a worsening in the evening has been described as characteristic of reactive or neurotic depression (Kiloh and Garside, 1963; Winokur, Clayton and Reich, 1969). Yet, in spite of the widely held belief of the diagnostic relevance of diurnal patterns, little systematic research on these patterns has been reported.