ABSTRACT
We report a case of inadvertent overdose of baclofen given intrathecally resulting in coma. This was unresponsive to flumazenil and required supportive intensive therapy. With the increasing use of baclofen intrathecally for spasticity and its wide interpatient dose variability, there is a need to find a safe antagonist to baclofen for routine medical use.
Subject(s)
Antidotes/pharmacology , Baclofen/antagonists & inhibitors , Flumazenil/pharmacology , Muscle Relaxants, Central/antagonists & inhibitors , Adult , Baclofen/poisoning , Coma/chemically induced , Female , GABA Modulators/pharmacology , Humans , Muscle Relaxants, Central/poisoningABSTRACT
The dexamethasone suppression test (DST) was administered to 54 primary unipolar depressed patients and 19 non-depressed hospitalized inpatients. Abnormal DST were found in 23 depressed patients (43%) in contrast to 2 (11%) non-depressed patients (P less than 0.05). Within the endogenously depressed group, 69% of patients categorized as familial pure depressive disease (FPDD) in contrast to 13% of depressive spectrum disease (DSD) patients had abnormal DST results (P less than 0.02). The DSD group had significantly fewer abnormal DST results than all other subtypes of unipolar depression (P less than 0.05). The distinction revealed between DSD patients and other endogenously depressed patients may be due to biological factors or due to the heterogeneous nature of the DSD subtype group.
Subject(s)
Depressive Disorder/diagnosis , Dexamethasone , Adult , Alcoholism/genetics , Antisocial Personality Disorder/genetics , Depressive Disorder/classification , Depressive Disorder/genetics , Female , Humans , Hydrocortisone/blood , MaleABSTRACT
The thyrotropin releasing hormone (TRH) stimulation test was administered to 54 primary unipolar endogenously depressed and 19 non-depressed hospitalized inpatients. Blunted TSH responses to TRH infusion (delta max TSH less than 7 microunits/ml) were revealed in 18 depressed and no non-depressed patients (P less than 0.01). Augmented TSH responses (delta max TSH greater than 23 microunits/ml) were noted in 8 depressed and no non-depressed patients (P = n.s.). The TRH stimulation test did not distinguish between subtypes of unipolar depression using the familial subtyping criteria of Winokur. These findings are discussed in light of previously reported dexamethasone suppression test subtype distinctions.
Subject(s)
Depressive Disorder/diagnosis , Thyrotropin-Releasing Hormone , Adult , Alcoholism/genetics , Antisocial Personality Disorder/genetics , Depressive Disorder/classification , Depressive Disorder/genetics , Female , Humans , Male , Thyrotropin/bloodABSTRACT
The authors administered the thyrotropin-releasing hormone (TRH) stimulation test and the dexamethasone suppression test (DST) to 54 patients who met DSM-III criteria for major depressive disorder and to 19 nondepressed patients. A blunted thyrotropin (TSH) response to TRH injection was noted in 18 depressed patients (33%) but in no nondepressed patients. An escape from dexamethasone suppression was noted in 23 depressed patients (43%) but in only 2 nondepressed patients (11%). The combined sensitivity of the DST and the TRH test in identifying major depressive disorder was 67% with 92% specificity. Only 6 depressed patients (11%) had abnormal responses to both the DST and the TRH test, suggesting that the hypothalamic-pituitary-adrenal axis dysregulation and hypothalamic-pituitary-thyroid axis dysregulation are independent phenomena. These findings support the combined use of these neuroendocrine tests in clinical practice.
Subject(s)
Depressive Disorder/blood , Hydrocortisone/blood , Thyrotropin/blood , Adolescent , Adult , Depressive Disorder/diagnosis , Depressive Disorder/physiopathology , Dexamethasone , Female , Humans , Hypothalamo-Hypophyseal System/physiopathology , Male , Middle Aged , Pituitary-Adrenal System/physiopathology , Thyroid Gland/physiopathology , Thyrotropin-Releasing Hormone , Thyroxine/bloodABSTRACT
The thyrotropin-releasing hormone (TRH) stimulation test was administered to 47 patients meeting DSM-III criteria for major depressive disorder (with melancholia) and to 19 nondepressed patients. The wide variability of pituitary responses to TRH stimulation noted in the depressed patients provides evidence for the dysregulation of compensatory hypothalamic-pituitary-thyroid function in acute depression. Blunted thyroid-stimulating hormone (TSH) responses to TRH injection were found in 16 depressed (34%) and no nondepressed patients (p less than 0.01). Depressed patients who revealed blunted TSH responses also had blunted prolactin responses to TRH relative to other depressed and nondepressed patient groups (p less than 0.01). These patients (with blunted TSH and prolactin responses) may represent a psychobiologically distinct subgroup of endogenously depressed patients. Augmented (high normal) TSH responses to TRH stimulation were found in eight depressed patients (all women), in contrast to no nondepressed patients. These patients may have a subtle thyroidal dysfunction affecting the underlying endogenous depressive diathesis.