Hypothalamic-pituitary-adrenal axis activity and 1-year outcome in depression

The relationships of longitudinal biological measures to longer-term outcome in depressed patients have not been well explored. This study was designed to investigate whether in a sample of depressed patients: (a) symptomatic and functional outcome at 1 year was significantly different in psychotic major depressed (PMD) patients as compared with nonpsychotic major depressed (NPMD) patients and (b) high urinary or plasma cortisol levels at baseline or 1 year were associated with poorer outcomes at 1 year. Forty-two depressed patients (9 psychotic, 33 nonpsychotic) were evaluated at baseline and at 1 year using a battery of clinical ratings and measures of cortisol. A group of normal, healthy control subjects were similarly evaluated at baseline. At 1-year follow-up, PMD patients did not differ from NPMD patients in their Hamilton Depression Rating Scale (HDRS) and Brief Psychiatric Rating Scale scores (BPRS), but PMD patients demonstrated significantly poorer social and occupational functioning. Significant correlations were observed (n = 18) between higher levels of urinary and plasma cortisol at 1 year and poorer social and occupational functioning at 1 year, independent of the degree of residual depression. In contrast, baseline measures of urinary and plasma cortisol did not predict social and occupational functioning at 1 year.     

Psychoneuroendocrinology of depression. Hypothalamic-pituitary-adrenal axis

We present a new approach to cardiovascular analysis based on a well-known signal processing technique, namely, the frequency subband decomposition. The subbands are chosen in accordance with physiological standards: (1) 0-0.04 Hz, (2) 0.04-0.15 Hz, (3) 0.15-0.4 Hz. It is shown that such a pre-processing drastically improves the accuracy of the analysis and introduces a new direction in the understanding of the relationships between cardiovascular signals.     

Hypothalamic-pituitary-adrenal axis activity in the inbred Brown Norway and Fischer 344 rat strains

We have examined the basal and the stress-induced secretion of corticosterone in relation to the expression of adrenal steroid receptors in the pituitary, hypothalamus and hippocampus of the inbred Brown Norway and Fischer 344 rat strains. Our data indicated that plasma transcortin and integrated plasma corticosterone levels were significantly higher in Fischer 344 compared to Brown Norway rats. Fischer 344 hypersecrete corticosterone during the dark phase of the diurnal cycle and during the phase of recovery following a 20 min period of restraint stress compared to Brown Norway rats. This hypersecretion of corticosterone was negatively correlated with the size of the adrenal gland but might be related to the higher density of mineralocorticoid receptors in the hippocampus of Fischer 344 rats.     

Hypothalamic-pituitary-adrenal axis suppression and inhaled corticosteroid therapy. 1. General principles

The safety of long-term inhaled corticosteroid therapy at commonly prescribed doses is an issue of growing concern to physicians and international regulatory bodies. This is so because long-term use of these drugs has become the mainstay of chronic asthma management and their introduction now is widely recommended in official treatment guidelines at the 'mild persistent' stage of asthma, where regular daily therapy is first begun. In addition to more frequent use of inhaled corticosteroids, there is a further trend to use higher doses of existing inhaler therapies and to use the newer and more potent compounds that have recently become available. At the same time as these developments have been taking place, there has not been a concurrent move to a more rigorous examination of the safety profile of these inhaled corticosteroid treatments - especially to assess their effects on the hypothalamic-pituitary-adrenal (HPA) axis. Most safety data with respect to HPA axis effects have been derived from testing methods that are limited in their ability to detect HPA system impairment and, more seriously, that can give the impression of functional integrity in the HPA axis when there may be moderate (or even greater) impairment. In this first part of a two-part review of the HPA axis effects of inhaled corticosteroids and of how these effects should be assessed, we examine the currently used and the currently available testing methodologies and also review the present state of knowledge concerning the structure and function of the HPA axis and the effects of its suppression. It is clear that there are state-of-the-art tests to assess in a discriminating manner the safety profile of inhaled corticosteroids. These tests have been insufficiently employed, including during the drug development process, yet they are readily available, relatively inexpensive and can detect adrenal suppression before the appearance of clinical effects. In part 2 of this review we examine what can be learned about the effects of inhaled corticosteroid therapy on the HPA axis from the limited amount of reliable published information from clinical and pharmacological studies describing their use and safety.     

Hypothalamic-pituitary-adrenal axis function and platelet serotonin concentrations in depressed patients

Plasma cortisol and platelet serotonin (5-hydroxytryptamine, 5-HT) concentrations were determined in 39 male psychotic and 39 male non-psychotic depressed inpatients, and in 69 male healthy control subjects. Psychotic or non-psychotic depressed patients had higher predexamethasone plasma cortisol levels than found in the control group. After the dexamethasone suppression test (DST), psychotic and non-psychotic depressed patients were subdivided into suppressors and non-suppressors. Psychotic and non-psychotic patients had significantly different platelet 5-HT concentrations among themselves and compared with the control group. However, there was no significant correlation between plasma cortisol levels and platelet 5-HT concentrations. Dexamethasone administration did not affect platelet 5-HT concentrations within subtypes of depressed patients. Abnormal cortisol suppression after the DST occurred more frequently in psychotic than in non-psychotic patients. Platelet 5-HT and plasma cortisol concentrations were decreased in patients with pronounced suicidal behaviour. Our results suggest that plasma cortisol and platelet 5-HT concentrations might serve as independent biological markers for different subtypes of depression.     

Hypothalamic-pituitary-adrenal axis in abdominal obesity: effects of dexfenfluramine

BACKGROUND AND OBJECTIVE: Minimal conization with carbon dioxide laser (CO2) for safe diagnosis and treatment of cervical intraepithelial neoplasia (CIN) 1-3 has been utilized for 15 years. To evaluate the results of 15 years' follow-up. STUDY DESIGN/MATERIALS AND METHODS: Clinical prospective study: 2,903 non-pregnant women whose cervicovaginal smear revealed CIN 1-3, confirmed by colposcopy, were referred for minimal conization treatment (LMC). This outpatient free-hand excision is performed under local anesthesia with a 60-W continuous laser beam focused to a 0.1-mm spot size, giving a power density of 165,000 W/cm2. Adjuvant cervical curettage is done routinely. RESULTS: Complications after the procedure were insignificant. Histopathological investigations revealed invasive carcinoma in 1.2% of the minicones. The primary cure rate was 96.1%. In the life table analysis of the patients the cumulative risk of recurrence for all forms of CIN was 0.89% at year 5, 1.36% at year 10, and 3.02% at year 15. There was no sudden onset carcinoma during the follow-up period. CONCLUSION: Minimal conization is a safe, effective treatment for CIN and early forms of microinvasive carcinoma. Invasive carcinoma can be detected early and should be treated without delay. The cumulative risk of developing new CIN is 3.02% at year 15 and there is no risk of sudden-onset invasive carcinoma following this procedure.     

Hypothalamic-pituitary-adrenal axis function and prolactin secretion in systemic lupus erythematosus

Continued improvement in the computer price-to-performance ratio and the adoption of international standards have enhanced the feasibility of completely digital echocardiographic laboratories that were initially described more than a decade ago. Digital archival has distinct advantages over analog recording, including improved laboratory efficiency, capability of side-by-side comparison of current and historical studies, streamlined image storage, and enhanced interinstitution image transfer. Studies have demonstrated that clinical and electronic image compression allows efficient storage of data, without affecting diagnostic accuracy. Finally, digital echocardiography has important telemedicine applications.     

Hypothalamic-pituitary-adrenal axis suppression and inhaled corticosteroid therapy. 2. Review of the literature

In order to overcome the need for secondary intervention to remove metallic osteosynthesis devices after fracture healing, endeavours have been directed towards developing resorbable osteosynthesis materials during the last decade. The resorbable material must fulfil a number of basic demands. For example, an adequate holding strength of these materials is essential for undisturbed fracture union, complete resorption after bone healing, good histocompatibility without any damage to the surrounding tissues and without detrimental distant effects within the organism. Suggested materials are primarily high-polymerlactic acid or glycolic acid compounds. In particular, research was concentrated on the enhancement of the mechanical properties and biodegradation of polylactides. Debris high in crystallin was found to be responsible for late soft tissue reactions. To achieve disintegration products with lower crystallin content stereocopolymeres of lactic acids are preferred nowadays. Based on our experimental work, another osteosynthesis system manufactured from autoclaved allogenic bone tissue was developed as an alternative. This has osteoconductive properties and converts by creeping substitution into bone. In contrast to metallic plates and screws, the modulus of elasticity is quite similar to vital bone tissue. The initial strength enables its use in the field of maxillofacial surgery.     

The relationship of self-reported distress to depressive disorders and other psychopathology.

The relationship between self-reported depression and a clinical diagnosis of depression was investigated. Within 2 wks of completing the Center for Epidemiologic Studies Depression Scale (CES-D), a stratified sample of 425 primary medical care patients received the structured interview for the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R). In the weighted data set, the CES-D was significantly related to a diagnosis of depression but also to other Axis I disorders. Most distressed subjects were not depressed, a fifth of the patients with major depressive disorder (MDD) had low distress, and the CES-D performed as well in detecting anxiety as in detecting depression. MDD, other depression diagnoses, and anxiety and substance use disorders were all significant predictors of CES-D score. Differences in demographic variables, treatment history, and impairment highlight the nonequivalence of the self-report scale and diagnosable depression. The use of a self-report in place of an interview-based diagnostic measure in the study of depression, as well as the use of such a report as a screening device, is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of stressors and depressive symptoms to clinical progression of viral illness

OBJECTIVE: The aim of this research was to determine whether and in whom stressors and depressive symptoms facilitate clinical recurrence of herpes simplex virus (HSV) and progression of HIV. METHOD: Meta-analytic techniques were used to review the relations of stressors and depressive symptoms to clinical recurrence of HSV in 16 published studies and to indicators of HIV progression in 19 published studies. The authors calculated average effect sizes, performed fixed effect and random effect inferential analyses, tested for heterogeneous findings, and identified potential moderating variables. RESULTS: Depressive symptoms were associated with a slightly increased risk of HSV recurrence and increased reports of HIV-related symptoms, whereas stressors were not. However, depressive symptoms were not associated with objective indicators of accelerated HIV progression. Stressor studies, especially those that ascertained population-specific life events, found numerical and functional decrements in circulating natural killer cell populations. The candidate moderators identified include, for HSV recurrence, age, sex, and medication status, and for HIV-related symptoms, age, race, disease stage, and co-infection with HSV. CONCLUSIONS: Depressive symptoms, but not stressors, increase the risk of HSV recurrence generally. Depressive symptoms do not appear to accelerate HIV progression ubiquitously, although they are associated with increased reporting of HIV-related symptoms. Future studies that ascertain population-specific stressors should determine whether reductions in cytotoxic lymphocytes influence HIV disease progression. Moreover, researcher should investigate the role of the identified moderators and recognize psychoimmune moderators in existing and novel study groups. These analyses could confirm that certain individuals are especially susceptible to the effects on disease progression of stressors, depressive symptoms, or both.     

The relationship between interpersonal schemas and depressive symptomatology.

Turkish university students (187 men and 191 women), 17–27 years old, participated in this study. They completed the Interpersonal Schema Questionnaire (C. Hill & J. Safran, 1994) and the Beck Depression Inventory (A. Beck, A. Rush, B. Shaw, and G. Emery, 1979). This study extended the research that was conducted by Hill and Safran (1994). The results of this study revealed that individuals in the high-depressive symptomatology group expected less complementary responses from significant others in friendly, dominant, and submissive situations. They expected more complementary responses from them in hostile situations. They also rated their expected responses from others as more undesirable than did individuals in the low-depressive symptomatology group. These findings seem to be congruent with cognitive and interpersonal theories of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preliminary classification system for homeless veterans with mental illness.

The purpose of this study was that of defining psychiatric profiles among veterans based on a structured interview of 3,595 individuals administered by outreach mental health clinicians to individuals who were presently or recently homeless. The interview included ratings of presence or absence of current psychiatric disorders; alcoholism, drug abuse, psychosis, mood disorders, personality disorders, PTSD, and adjustment disorders. We identified three subgroups using cluster analysis each showing different diagnostic profiles that were characterized as "addiction" (n = 3,061), "psychosis" (n = 218), and "personality" disorders (n = 54). Cluster membership was related to demographic characteristics, living situation, length of homelessness, and symptoms and complaints including cognitive difficulties, suicidality, violence, and depression. Group comparison statistics were used to compare intercluster differences in demographics, homeless situation, symptoms, and subjective complaints. There were no major intercluster differences in socioethnic, demographic, and homeless situation variables. Differences occurred in complaints of depression, positive symptoms of psychosis, and suicidality. It was concluded that despite the disproportionate sizes of the clusters homeless veterans with mental illness are nevertheless heterogeneous with regard to their psychiatric profiles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of activity restriction in poststroke depressive symptoms.

Objective: Little is known about the determinants of poststroke depression. The Activity Restriction Model of Depressed Affect (ARMDA) may be helpful in understanding poststroke depression but has never been tested in that context. The goal of this study was to examine the relation between activity restriction and depressive symptoms in stroke survivors during the period following discharge from the hospital. Method: Participants (N = 197) were assessed on three occasions: (1) time 1 (T1), 3 weeks following discharge; (2) time 2 (T2), 3 months after discharge; and (3) time 3 (T3), 6 months after discharge. Results: Although both stroke severity and activity restriction were significantly related to depressive symptoms, the relation between stroke severity and depression was no longer significant after controlling for activity restriction. Moreover, restrictions in daily activities and social roles were both related to depressive symptoms, but these relations were found to vary during the course of the period following discharge. Conclusions: These findings support the ARMDA and have practical implications for the prevention of poststroke depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cortisol and adrenocorticotropin response to desmopressin in women with Cushing's disease compared with depressive illness

The pituitary-adrenal responsiveness to desmopressin of women with depressive illness was compared with that of patients with Cushing's disease, who are known to be highly responsive, and to that of normal controls, who are known to be poorly responsive to the peptide. Although 100% of the patients in the group with Cushing's disease met the response criterion with cortisol increases of 632 +/- 80 nmol/L above baseline (mean +/- SE), the prevalence of responders was 36% in the depressive group and 10% in normal controls, with cortisol changes from baseline of 154 +/- 28 and 79 +/- 15 nmol/L, respectively. All response parameters were significantly higher in the patients with Cushing's disease and did not differ between depressive patients and normal controls, who exhibited the same general pattern of cortisol and ACTH responses. It is concluded that the desmopressin test can be used in the differentiation between depression and Cushing's disease, and that the hypothalamic-pituitary-adrenal regulation is distinct in these two conditions.     

The relationship between age and depressive symptoms in two national surveys.

There is inconsistency in the literature on the relationship between age and depressive symptoms. Although a careful review shows that some of this inconsistency can be reconciled by recognizing the nonlinear relationship (J. P. Newmann, 1989), 2 additional issues remain unclear. One is that most previous studies used depression screening scales that contain somatic items that could introduce an age bias. The other is that most previous studies combined samples of men and women even though there is evidence that the sex difference in depressive symptoms varies with age. These 2 issues are addressed in this article, using analyzed data from 2 large national surveys. There is a consistent, but quite modest, nonlinear association between age, somatic, and nonsomatic depressive symptoms in both surveys. There is no significant sex difference in the age curves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Underlying mechanisms in the relationship between Africentric worldview and depressive symptoms.

This study examines underlying mechanisms in the relationship between an Africentric worldview and depressive symptoms. Participants were 112 African American young adults. An Africentric worldview buffered the association between perceived stress and depressive symptoms. The relationship between an Africentric worldview and depressive symptoms was mediated by perceived stress and emotion-focused coping. These findings highlight the protective function of an Africentric worldview in the context of African Americans’ stress experiences and psychological health and offer promise for enhancing African American mental health service delivery and treatment interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Avoidance personal goals and the personality–illness relationship.

Three studies demonstrated that avoidance personal goals are positively related to physical symptom reports. These results were obtained (a) using both longitudinal and retrospective methodologies and (b) controlling for neuroticism and other alternative predictor variables. In 2 of the studies, a process model was validated in which perceived competence and perceived controlledness were shown to mediate the observed relationship between avoidance goals and symptomatology. Specifically, avoidance goals predicted perceived competence and perceived controlledness, and these variables in turn predicted longitudinal and retrospective symptom reports. Ancillary results help clarify the unique roles of neuroticism and avoidance goals as predictors of physical symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Casual attributions about mental illness: relationship to family functioning

The relationship between causal attributions about mental illness and family functioning was investigated in 39 individuals with chronic mental illness and their families. Among parents and siblings, poor family functioning was associated with attribution to a person as the cause of the illness. Unexpectedly, no relationship was found between family functioning and causal attributions to genetics, biology, God, or chance.     

Decreased urinary output of conjugated tyramine is associated with lifetime vulnerability to depressive illness

In a group of normal pregnant women whose psychiatric histories were unknown, those with the lowest output of urinary tyramine (free plus conjugated) after an oral tyramine load had a significantly higher lifetime incidence of depressive illness compared with those with the highest output. as none of the women were suffering from depression at the time of tyramine loading, it seems likely that this decreased excretion of tyramine is associated in some way with vulnerability to depressive illness, whether puerperal or nonpuerperal.     

Self-disgust mediates the relationship between dysfunctional cognitions and depressive symptomatology.

Disgust has been linked to several psychopathologies, although a role in depression has been questioned. However, it has recently been proposed that rather than general disgust sensitivity, disgust directed toward the self (self-disgust) may influence the development of depression, providing a causal link between dysfunctional cognitions and depressive symptomatology. This possibility was examined by developing a scale to measure self-disgust (the Self-Disgust Scale; SDS) and then using mediator analysis to determine if self-disgust was able to explain the relationship between dysfunctional cognitions (measured with the use of the Dysfunctional Attitudes Scale) and depressive symptomatology (measured with the use of the Beck Depression Inventory and the Depression, Anxiety and Stress Scale). The developed SDS was found to exhibit a high level of internal consistency, test-retest reliability, and concurrent validity. Principal-components analysis revealed two factors to underlie responses to SDS items: the 'Disgusting self,' concerned with enduring, context independent aspects of the self, and 'Disgusting ways,' concerned with behavior. Self-disgust was found to mediate the relationship between dysfunctional cognitions and depressive symptomatology, demonstrating for the first time that self-disgust plays a role in depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)