Cortisol secretion patterns in addiction and addiction risk.

Addiction to alcohol or nicotine involves altered functioning of the brain's motivational systems. Altered functioning of the hypothalamic-pituitary-adrenocortical (HPA) axis may hold clues to the nature of the motivational changes accompanying addiction and vulnerability to addiction. Alcohol and nicotine show at least three forms of interaction with HPA functioning. Acute intake of both substances causes stress-like cortisol responses. Their persistent use may dysregulate the HPA. Finally, the risk for dependence and for relapse after quitting may be associated with deficient cortisol reactivity to a variety of stressors. The HPA is regulated at the hypothalamus by diurnal and metabolic signals, but during acute emotional states, its regulation is superseded by signals from the limbic system and prefrontal cortex. This top-down organization makes the HPA responsive to inputs that reflect motivational processes. The HPA is accordingly a useful system for studying psychophysiological reactivity in persons who may vary in cognitive, emotional, and behavioral tendencies associated with addiction and risk for addiction. Chronic, heavy intake of alcohol and nicotine may cause modifications in these frontal-limbic interactions and may account for HPA response differences in seen in alcoholics and smokers. In addition, preexisting alterations in frontal-limbic interactions with the HPA may reflect addiction-proneness, as shown in studies of offspring of alcohol- and drug-abusing parents. Continuing research on the relationship between HPA function, stress responsivity, and the addictions may yield insights into how the brain's motivational systems support addictions and risk for addictions.     

The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression.

This study attempted to replicate an earlier study (R. J. DeRubeis & M. Feeley, 1990) of the prediction of symptom change from process variables in cognitive therapy for depressed outpatients. Measures of in-session therapist behavior and therapist-patient interactions were correlated with prior and subsequent symptom change. One of the positive findings was confirmed, but the other received only marginal support. A "concrete" subset of theory-specified therapist actions, measured early in treatment, predicted subsequent change in depression. The therapeutic alliance was predicted by prior symptom change in 1 of the 2 later assessments, but only at a trend level. Several negative findings were similar to those obtained in the earlier study. Specifically, the alliance, an "abstract" subset of theory-specified therapist actions, and facilitative conditions did not predict subsequent change. Implications for causal inferences in psychotherapy process research are discussed.     

EEG patterns in various subgroups of endogenous depression

Twenty-three patients with major depressive disorders were examined clinically, biochemically and electroencephalographically before antidepressive treatment was initiated. EEG characteristics were related to clinical items and to a serotonin re-uptake indicator. The results suggested that at least three definable EEG patterns were associated with certain specific features of major depressive disorders. Thus, an EEG pattern characterised by increased beta activity was associated with the recurrent type of depression. Another EEG pattern, with signs of decreased alertness, was present in patients with insomnia, agitation and in those without depression in their families. A significant correlation was also found between the alertness indicator and the serotonin accumulation rate. The third type of EEG feature was represented by interhemispheric asymmetry in the EEG which could be seen in patients with high scores of anxiety. The results suggest that the EEG findings may be helpful in defining various subgroups of major depressive disorders.     

Postpartum depression: in relation to life events and patterns of coping

Summary The purpose of this study was to estimate the prevalence of postpartum depression (PPD) and its relationship with life events (LE) and patterns for coping. We performed a cross-sectional study of 113 women, on the 10^th day of puerperium, at the Obstetric Clinic of the São Paulo University Medical School. The study was based on the following: Pitt (1967) and Stein (1980) Scales, Beck Depression Inventory (1961), Holmes and Rahe Schedule of Recent Events (1967), Folkman and Lazarus Ways of Coping (1985) and questionnaire of social-demographic and obstetric data. Logistic regression was performed to calculate prevalence of PPD and its association with several risk factors. The significance level was defined at 5%. The prevalence of PPD was 15.9% (IC 9.7% to 24.0%). According to the multivariate analyses, the variables of coping with distancing, number of children and ethnic origin were significant. There were no association between PPD and LE. The depressed puerperal women have a low educational level, greater number of children and resort to inadequate coping strategies, such as distancing. This pattern of coping might be an etiological factor of the PPD as well as a reaction to their difficult life environment.     

Hereditary aspects of duodenal ulceration: pepsin 1 secretion in relation to ABO blood groups and ABH secretor status.

Pepsin 1, the ulcer-associated pepsin, occurred significantly more frequently in the gastric juice of those patients with duodenal ulcer who did not secrete A, B, or H antigens into gastric juice than in those secreting these antigens. This observation may explain the increased proportion of such non-secretors among patients with duodenal ulceration. In patients with gastric ulcer and non-ulcer dyspepsia, and in a miscellaneous group of patients, there was no association of pepsin 1 secretion with secretor status, suggesting that the association noted in duodenal ulceration is an indirect rather than a direct one. No increase of pepsin 1 occurred in group O patients with peptic ulcer, so that the increased proportion of such patients in peptic ulcer does not arise from differences in pepsin 1 secretion.     

Polysomnography and depressive symptoms in primary alcoholics with and without a lifetime diagnosis of secondary depression and in patients with primary major depression.

BACKGROUND: There is evidence suggesting that there is: (1) additive polysomnographic effects of alcoholism and depression; and (2) elevated baseline REM density in primary alcoholics with (PASD) and without lifetime history of secondary depression (NPA). METHODS: 23 PASDs, 59 NPAs, and 23 primary major depression patients (PMD) underwent polysomnography. Any drinking within 3 months after a 1-month inpatient alcohol rehabilitation defined relapse. RESULTS: PASDs' polysomnography was more like NPAs than PMDs. Polysomnography reflected 3-month sobriety status more than diagnosis. LIMITATIONS: Not all PASD's met full major depression criteria upon admission. CONCLUSIONS: Alcoholism affected polysomnography more than depression. Elevated admission REM density predicted 3-month relapse in PASDs and NPAs.     

Increased recognition of depression in primary care. Comparison between primary-care physician and ICD-10 diagnosis of depression

BACKGROUND: Underrecognition and undertreatment of depression in primary care has been regarded as a major public health problem. In contrast, some studies found that among patients labeled as depressed by primary-care physicians (PCPs), a relevant proportion do not satisfy international diagnostic criteria for depression. The aims of this study are: (1) to assess disparity between PCP diagnosis and research diagnosis of depression; (2) to compare antidepressant treatment in concordant and discordant cases of depression. METHODS: Data are gathered from a national survey on depressive disorders in primary care, conducted with the collaboration of 191 PCPs. Three hundred and sixty-one PCP patients were evaluated, and their psychiatric diagnosis was established by the 'unaided' PCPs and by using a research interview for depression. RESULTS: PCPs recognized 79.4% of cases of depression and prescribed antidepressants to 40.9% of them. Yet, 45.0% of patients labeled as depressed by the PCPs were not cases of depression according to ICD-10 criteria; 26.9% of false-positive cases received an antidepressant. Globally, 35% of antidepressants for 'depression' were prescribed to false-positive cases. CONCLUSIONS: Underrecognition and undertreatment of depression in primary care seem to be less alarming. Conversely, PCP diagnoses of depression appear to be more inclusive than psychiatric diagnostic criteria. A possible consequence of this apparently more inclusive diagnostic threshold may be an excessive use of antidepressants. These changes require a corresponding change in research, toward efficacy and safety of the treatment of milder cases, and in education, toward the distinction between the management of mild and severe cases of depression.     

Free and total plasma tryptophan in endogenous depression.

The free and total plasma tryptophan concentrations were measured in 41 female depressive. Fifteen patients were subsequently treated with L-tryptophan. The free and total tryptophan were normal in the drug-free depressives and in the depressives on lithium. No significant in free and total plasma tryptophan were found between unipolar and bipolar depressed subjects, or between patients who recovered from depression following L-tryptophan therapy and patients who were resistant. The results suggest that the basal free tryptophan concentration in the plasma of depressed subjects is normal. They furthermore indicate that neither free nor total plasma tryptophan concentrations are valid predictors for the course of a treatment of depressed subjects with L-tryptophan.     

Neuronal responses in cat primary auditory cortex to electrical cochlear stimulation. III. Activation patterns in short- and long-term deafness

The effects of auditory deprivation on the spatial distribution of cortical response thresholds to electrical stimulation of the adult cat cochlea were evaluated. Threshold distributions for single- and multiple-unit responses from the middle cortical layers were obtained on the ectosylvian gyrus in three groups of animals: adult, acutely implanted animals ("acute group"); adult animals, 2 wk after deafening and implantation ("short-term group"); adult, neonatally deafened animals ("long-term group") implanted after 2-5 years of deafness. For all three groups, we observed similar patterns of circumscribed regions of low response thresholds in the region of primary auditory cortex (AI). A dorsal and a ventral region of low response thresholds were found separated by a narrow, anterior-posterior strip of elevated thresholds. The two low-threshold regions in the acute and the short-term group were arranged cochleotopically. This was reflected in a systematic shift of the cortical locations with minimum thresholds as a function of cochlear position of the radial and monopolar stimulation electrodes. By contrast, the long-term deafened animals maintained only weak or no signs of cochleotopicity. In some cases of this group, significant deviations from a simple tri-partition of the dorsoventral axis of AI was observed. Analysis of the spatial extent of the low-threshold regions revealed that the activated area in acute cases was significantly smaller than the long- and the short-term cases for both dorsal and ventral AI. There were no significant differences in the rostrocaudal extent of activation between long- and short-term deafening, although the total activated area in the short-term cases was larger than in long-term deafened animals. The width of the narrow high-threshold ridge that separated the dorsal and ventral low-threshold regions was the widest for the acute cases and the narrowest for the short-term deafened animals. The findings of relative large differences in cortical response distributions between the acute and short-term animals suggests that the effects observed in long-term deafened animals are not solely a consequence of loss of peripheral innervation density. The effects may reflect electrode-specific effects or reorganizational changes based on factors such as differences in excitatory and inhibitory balance.     

Twenty-four-hour patterns of sleep in depression.

Alterations of nocturnal sleep have been widely described in affective disorders. However, little is known about putative daytime sleep and to what extent daytime sleep could interfere with nocturnal sleep. The goal of this study was to investigate 24-hr sleep patterns in 12 depressed patients hospitalized for a major depressive disorder and in 10 control subjects studied under the same experimental conditions. Patients and controls were free to sleep whenever they chose, and sleep recordings were performed using the Oxford Medilog System during 60 hr. Daytime sleep episodes were detected in 50% of the patients and in 60% of the controls. Patients took naps at various times of the day, whereas controls napped in the early afternoon, during the well-known "postlunch dip". Thus daytime sleep prevalence was similar in both groups; however, the biphasic distribution of sleep observed in controls disappeared in the patients. Napping did not affect subsequent nocturnal sleep in either group.     

Hemagglutination patterns of Aeromonas spp. in relation to biotype and source

Aeromonas spp. show patterns of hemagglutination with human group O cells in the presence of fucose, galactose, and mannose. These patterns are related to biotype as well as to the source of isolates. There was good correlation between hemagglutination pattern and the presence of diarrhea among strains isolated in Western Australia, which was the only source with adequate data for classification of children with an without diarrhea. Most of the environmental and other nonfecal isolates produced patterns different from those in strains associated with diarrhea. These results suggest that hemagglutinins should be considered with enterotoxins as virulence factors in Aeromonas spp.     

Irrational beliefs in relation to self-esteem and depression

The joint relationship of depression and self-esteem to Ellis' "irrational beliefs" as measured by the Irrational Beliefs Test (Jones, 1968) was investigated in an Australian sample (N = 268) of students and nonstudents. Analysis that used partial correlation and canonical correlation showed six irrational beliefs to be jointly related to low self-esteem and depression: Demand for Approval, High Self-expectations, Frustration Reactivity, Anxious Overconcern, Problem Avoidance, and Helplessness. The results confirm the findings of previous studies and are consistent with the concept of depressive self-schemas.     

Life events and depression. Part 2. Results in diagnostic subgroups, and in relation to the recurrence of depression

Although there is evidence that the occurrence of stressful life events might be important for the onset and development of depression, it is still unclear whether differences occur in diagnostic subgroups of depressed patients, or in relation to type of episode, i.e., whether the first event or a relapse in a depression with a recurrent course. The present study has been carried out to investigate these issues more closely. Two hundred and six depressed patients have been classified into bipolar, unipolar, neurotic-reactive, and unspecified subgroups according to given definitions. The patients have also been classified into those suffering from a first episode and those suffering from recurrent depression. Each patient, when sufficiently improved, was given a semistructured interview, based on a specially constructed 56-item life events inventory. Unipolar and bipolar patients proved to have experienced significantly fewer events, even of the 'fateful' type (i.e., independent of depression) than the neurotic-reactive patients. However, this difference appeared to be due to difference in age among the groups and not to diagnosis. No difference occurred between uni- and bipolar patients. Patients with recurrent depression showed only small differences compared with patients in their first episode. These differences were consistently in the direction of fewer events in patients with recurrent depression. The implications of these results are discussed in relation to findings published by other authors.     

Cortisol and TGF-beta inhibit secretion of platelet-activating factor- acetylhydrolase secretion in a monocyte-macrophage model system

Recent studies have suggested that platelet activating factor (PAF) plays an important role in various reproductive functions, including ovulation, implantation and parturition, and that the local concentration of PAF is modulated by PAF-acetylhydrolase (PAF-AH), a potent PAF inactivator. In this study, we investigated the possible effects of various bioactive substances, which are present at high concentrations in the human pregnant uterus, on PAF-AH secretion from decidual macrophages using a monocyte-macrophage model system, human myelocytic leukaemia cells (HL-60). By treatment with 12-O- tetradecanoylphorbol-13-acetate (TPA), HL-60 cells were transformed to macrophage-like cells, which secreted PAF-AH into the culture medium time- and dose-dependently. After treatment with 10(-8) M TPA, the effects of various substances on the secretion of PAF-AH were examined. Among the substances examined, cortisol and TGF-beta suppressed PAF-AH secretion from TPA-stimulated HL-60 cells in a significant and dose- dependent way. Endothelin, epidermal growth factor, and brain natriuretic peptide had no significant effect on PAF-AH secretion from TPA-stimulated HL-60 cells. These results suggest that local PAF concentrations in the pregnant uterus might be regulated, at least partly, by cortisol and TGF-beta; thus these substances may play a role in the initiation of parturition via regulation of local PAF concentrations.      

Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D

BACKGROUND: Anxious depression, defined as Major Depressive Disorder (MDD) with high levels of anxiety symptoms, may represent a relatively common depressive subtype, with distinctive features. OBJECTIVE: The objective of this study was to determine the prevalence of anxious depression and to define its clinical correlates and symptom patterns. METHOD: Baseline clinical and sociodemographic data were collected on 1450 subjects participating in the STAR*D study. A baseline Hamilton Rating Scale for Depression (HAM-D) Anxiety/ Somatization factor score of > or =7 was considered indicative of anxious depression. The types and degree of concurrent psychiatric symptoms were measured using the Psychiatric Diagnostic Screening Questionnaire (PDSQ), by recording the number of items endorsed by study participants for each diagnostic category. MDD symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology (IDS-C30). RESULTS: The prevalence of anxious depression in this population was 46 %. Patients with anxious MDD were significantly more likely to be older, unemployed, less educated, more severely depressed, and to have suicidal ideation before and after adjustment for severity of depression. As far as concurrent psychiatric symptoms are concerned, patients with anxious depression were significantly more likely to endorse symptoms related to generalized anxiety, obsessive compulsive, panic, post-traumatic stress, agoraphobia, hypochondriasis, and somatoform disorders before and after adjustment for severity of depression. Anxious-depression individuals were also significantly less likely to endorse IDS-C30 items concerning atypical features, and were significantly more likely to endorse items concerning melancholic/endogenous depression features. CONCLUSION: This study supports specific clinical and sociodemographic correlates of MDD associated with high levels of anxiety (anxious depression).