How safe are serotonin reuptake inhibitors for depression in patients with coronary heart disease?

Depression occurs frequently in patients with coronary heart disease (CHD), and confers significant risk for additional morbidity and mortality. The cardiac effects of the tricyclic antidepressants (TCAs) have been well characterized. In contrast, the cardiac effects of the selective serotonin reuptake inhibitors (SSRIs) have been less thoroughly investigated.

Screening for depression in diabetes using the Beck Depression Inventory.

Objective: The purpose of this study was to determine the utility of the Beck Depression Inventory (BDI) as a screening tool for major depression in diabetes.

Method: One hundred seventy-two diabetic outpatients (insulin-dependent diabetes mellitus [IDDM] = 59, or non-insulin-dependent diabetes mellitus [NIDDM] = 113) being evaluated for a treatment trial were studied. BDI scores were calculated for the complete 21-item measure as well as for the cognitive (13 items) and somatic (eight items) symptom subgroups.

Reading skills in children with Turner's syndrome: an analysis of hyperplexia.

Most neuropsychological studies of cases of chromosomal abnormalities report associations with disorders or disabilities. Studies of Turner's Syndrome (TS), in which their is functional absence of the information carried on the short arm of the second X chromosome, have emphasised disorders of spatial skill and potential abnormality of the parietal lobes or right hemisphere. In contrast, language skills have received little investigation despite suggestions by Shaffer (1962) of considerable verbal skill.

A randomized factorial trial of reperfusion strategies and aspirin dosing in acute myocardial infarction. The DUCCS-II Investigators.

The focus of new research efforts to improve the morbidity and mortality associated with acute myocardial infarction (AMI) has turned to adjuvant agents that show promise of improving outcomes following coronary thrombolysis. We enrolled 162 patients with AMI in a randomized trial comparing front-loaded tissue-plasminogen activator (t-PA) plus weight-adjusted heparin with anisoylated plasminogen streptokinase activator complex (APSAC) without heparin as well as standard-dose (325 mg) and low-dose (81 mg) aspirin. The primary end point was an in-hospital morbidity profile; secondary end points were clinical and angiographic potency and hemorrhagic events.

Depression in patients with coronary heart disease. A 12-month follow-up.

Little is known about the course and outcome of depression in patients with coronary heart disease, despite its prevalence and effect on medical prognosis. A series of 200 patients undergoing diagnostic cardiac catheterization and coronary angiography were administered a psychiatric diagnostic interview. Seventeen percent were diagnosed with a current major depressive episode, and another 17% with a current minor depressive episode.

Psychological determinants of anginal pain perception during exercise testing of stable patients after recovery from acute myocardial infarction or unstable angina pectoris.

The objective of this study was to test the hypothesis that psychological factors are determinants of anginal symptoms during positive exercise tests. The sample consisted of clinically stable patients who were enrolled in the Multicenter Study of Myocardial Ischemia 1 to 6 months after admission to a coronary care unit. Among 186 post-myocardial infarction patients, 151 developed ischemia (i.

The psychological profile of non-cardiac chest pain patients.

The psychological profile of non-cardiac chest pain patients is strongly influenced by the prevalent psychiatric disorders of this group. Anxiety, affective and somatization features dominate and have both mechanistic and therapeutic implications. These psychiatric disorders are important in the unsatisfactory psychosocial and functional outcome recognized in this patient population.

A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure.

Background: Congestive heart failure is the most common indication for admission to the hospital among older adults. Behavioral factors, such as poor compliance with treatment, frequently contribute to exacerbations of heart failure, a fact suggesting that many admissions could be prevented.

Methods: We conducted a prospective, randomized trial of the effect of a nurse-directed, multidisciplinary intervention on rates of readmission within 90 days of hospital discharge, quality of life, and costs of care for high-risk patients 70 years of age or older who were hospitalized with congestive heart failure.

Cognitive behavior therapy, relaxation training, and tricyclic antidepressant medication in the treatment of depression.

Outcomes of seven treatment trials comparing cognitive behavioral therapy to treatment with tricyclic antidepressant medication in major depressive disorder have been quite similar to one another. This led us to question whether treatment outcome in time-limited studies reflected a unique effect of cognitive behavioral therapy. To test the uniqueness hypothesis, relaxation training, a nonpharmacologic, noncognitive treatment, was chosen as a comparison for cognitive behavioral therapy as well as drug therapy.

Association of depression with reduced heart rate variability in coronary artery disease.

Decreased heart rate (HR) variability is an independent risk factor for mortality in cardiac populations. Clinical depression has also been associated with adverse outcomes in patients with coronary artery disease (CAD). This study tests the hypothesis that depressed patients with CAD have decreased HR variability compared with nondepressed CAD patients.

Effects of alprazolam on glucose regulation in diabetes. Results of double-blind, placebo-controlled trial.

Objective: To determine the effects of alprazolam on glucose regulation in anxious and nonanxious patients with poor glycemic control and establish whether regulatory benefits are related to anxiolytic effects of the medication.

Research Design And Methods: Fifty-eight patients with poor glycemic control, 16 (27.6%) of whom had a symptomatic generalized anxiety disorder, were entered into a randomized, double-blind, placebo-controlled, 8-week trial using alprazolam (up to 2 mg/day) as the active agent.

Depression as a risk factor for cardiac events in established coronary heart disease: a review of possible mechanisms.

Depression is highly prevalent in patients with coronary heart disease (CHD) and is associated with excess medical morbidity and mortality. This article reviews the mechanisms which may mediate the relationship between depression and cardiac events in these patients. Research in this area is at an early stage of development.

Patterns of spatial functioning in Turner's syndrome.

This paper presents results from a study of task performance on a variety of spatial tasks in 9-11 year-old children with Turner's Syndrome (T.S.), divided into those with genotype 45XO and those with Mixed genotypes, including isochromosomes of X and mosaicism.

Neonatal seizures: long-term outcome and cognitive development among 'normal' survivors.

The authors report the long-term outcome and cognitive development in the late-teenage years of 'normal' survivors of neonatal seizures. The outcome of the children was good, and normal in that they had attended normal schools and had normal overall intelligence test scores as adults. However, all of the sample displayed abnormal neuropsychological development in terms of intelligence test profile and subtest scatter, or development of spelling, or development of memory.

Major depression and medication adherence in elderly patients with coronary artery disease.

Little is known about the effects of depression on adherence to medical treatment regimens in older patients with chronic medical illnesses. Poor adherence may explain the increased risk of medical morbidity and mortality found in depressed medical patients. Ten of 55 patients over the age of 64 with coronary artery disease met the criteria for major depression from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.

A randomized trial of intravenous heparin in conjunction with anistreplase (anisoylated plasminogen streptokinase activator complex) in acute myocardial infarction: the Duke University Clinical Cardiology Study (DUCCS) 1.

Objectives: We designed a randomized trial to evaluate the effects of heparin administration in conjunction with anistreplase (anisoylated plasminogen streptokinase activator complex [APSAC]) on arterial patency and clinical end points.

Background: The role of conjunctive intravenous heparin therapy with APSAC has not been tested despite the recommendations that intravenous heparin should be used.

Methods: Four hours after APSAC administration, 250 patients with acute myocardial infarction were randomly assigned to receive 325 mg of either aspirin alone or aspirin and a continuous infusion of heparin (15 IU/kg body weight per h).

Intellectual functioning of children with Turner syndrome: a comparison of behavioural phenotypes.

This study reports the results of 19 girls with Turner syndrome (TS), aged between nine and 12 years, in relation to intellectual profile and genotypic variation. The results were consistent with the notion that the behavioural phenotype of mixed TS involving predominantly mosaic karyotypes is less deviant from the normal pattern than that of pure 45XO. The results for the pure TS girls were consistent with an exaggeration of a normal sex difference, but for mixed TS girls this effect was task-dependent.

Ventricular tachycardia and psychiatric depression in patients with coronary artery disease.

Purpose: The purpose of this study was to examine the relationship between psychiatric depression and ventricular arrhythmias in patients with coronary artery disease (CAD). The hypothesis was that depressed patients with CAD would have a higher prevalence of ventricular tachycardia (VT) than nondepressed patients with CAD.

Patients And Methods: One hundred three patients who were found to have significant CAD by elective diagnostic cardiac catheterization were administered a standardized psychiatric interview and underwent 24-hour Holter monitoring.

Similarity of depression in diabetic and psychiatric patients.

Diabetic and psychiatric out-patients were studied to determine whether the symptom profile of depression was similar in medically ill and medically well subjects. The diagnosis of major depression was determined using psychiatric interviews and DSM-IIIR criteria. The 21-item Beck Depression Inventory (BDI) was used to characterize the prevalence and severity of depression symptoms, and the measure was divided into cognitive (13 symptoms) and somatic (eight symptoms) subsets.

Randomized angiographic trial of recombinant tissue-type plasminogen activator (alteplase) in myocardial infarction. RAAMI Study Investigators.

Clot dissolution with restoration of infarct-related artery blood flow is the likely mechanism for the improved prognosis and mortality reduction seen after thrombolytic therapy of acute myocardial infarction. A pilot study has suggested that 100 mg of recombinant tissue-type plasminogen activator (rt-PA) infused over 90 min may lead to higher patency rates than the current standard of 100 mg over 3 h. In this multicenter, randomized, open label trial, 281 patients with acute myocardial infarction receive 100 mg of rt-PA according to either the standard 3-h infusion regimen (an initial 10-mg bolus followed by 50 mg for the 1st h, then 20 mg/h for 2 h) or an accelerated 90-min regimen (15-mg bolus followed by 50 mg over 30 min, then 35 mg over 60 min).

Major depression in coronary artery disease patients with vs. without a prior history of depression.

Major depression (MD) is common in patients with coronary artery disease (CAD). Some of these patients have a history of prior depressive episodes, whereas others experience their first episode around the same time that their CAD is diagnosed. The purpose of this study was to determine whether there are systematic differences between these two subgroups of depressed patients.

Prescribing therapy for depression: the role of learned resourcefulness, a failure to replicate.

Work in 1985 by Simons, Lustman, Wetzel, and Murphy showed that a patient's score on Rosenbaum's self-control scale predicted differential response to treatments for depression, with a high score predicting a good outcome with talking therapy and a low score a good outcome with drug therapy. This study of 37 patients did not replicate those findings. Using the same paradigm, we predicted response correctly 7 times and incorrectly 16 times, a clear failure.

Effect of osteopathic medical management on neurologic development in children.

For 3 years, children between 18 months and 12 years of age with and without recognized neurologic deficits were studied at the Osteopathic Center for Children. Their response to 6 to 12 osteopathic manipulative treatments directed to all areas of impaired inherent physiologic motion was estimated from changes in three sensory and three motor areas of performance. Houle's Profile of Development was used to compare neurologic with chronologic age and rate of development, and scores were age-adjusted.

Data management and accountability in behavioral and biomedical research.

Regulations recently enacted by the Public Health Service and the National Science Foundation to address misconduct in scientific research were designed primarily to curtail deliberate forms of misconduct, such as fabrication or falsification of findings; however, researchers may also be held accountable for inadvertent deficiencies in data management. This article examines some of the problems in data quality control, documentation, and data retention that can occur when computers are used in scientific research. It focuses on deficiencies that could make it difficult to verify the integrity of research data or to reproduce statistical analyses.