Differentiating bipolar disorders from unipolar depression by applying the Brief Assessment of Cognition in Affective Disorders.

BACKGROUND: Scholars continue to argue about whether bipolar disorders (BD) and unipolar depression (UD) are distinguishable with regard to neurocognitive function. This study aims to explore the cognitive profiles of UD and BD by applying the Brief Assessment of Cognition in Affective Disorders (BAC-A) for neuropsychological assessment. METHOD: This cross-sectional study included 68 patients with UD, 67 patients with BD, and 135 healthy control subjects. We evaluated the participants' cognitive functions at euthymic status using the BAC-A, which is made up of six traditional cognitive subtests and the Affective Processing Test. We then used a discriminant function analysis (DFA) to determine whether cognitive performance can be used to distinguish these participant groups. RESULTS: Healthy controls demonstrated better performance in all subtests of the BAC-A than both the UD and BD patients, with the exception of delayed recognition of affective interference. Compared with the BD group, the UD group exhibited better performance in working memory and emotion inhibition. Furthermore, using all BAC-A indexes, a total of 70% of participants could be correctly classified using a DFA model, and the discriminating validity between UD and BD was superior to using either the traditional cognitive domains or the Affective Processing Test alone. CONCLUSIONS: We have found that UD patients may exhibit an intermediate performance between healthy subjects and BD patients in working memory and emotional inhibition tests. The BAC-A can potentially assist in differentiating BD patients from UD patients at euthymic status in clinical settings.

Functional assessment and binge eating. A review of the literature and suggestions for future research.

This article briefly discusses the process of conducting a functional assessment of a problem behavior. Current research on the assessment of antecedents and consequences of binge eating behavior is then reviewed. The article concludes with suggestions for future research in the functional assessment and classification of binge eating.

Twin pregnancy in adolescents.

We compared the outcome of twin pregnancies born to adolescent versus adult gravidas. Five hundred forty-seven sets of twins were delivered during a 6-year period, 50 to adolescents and 395 to adults between 20-34. There were no significant differences in mean length of gestation, birth weight, or perinatal mortality. Maternal age was not a predictor of birth weight in twins. These findings suggest that twins born to adolescent gravidas do not experience significantly more unfavorable pregnancy events.

The effects of methadone treatment on the reactivity of the nonstress test.

The effect of methadone treatment on the nonstress test (NST) was studied. Thirty narcotic-addicted gravidas on methadone maintenance underwent NSTs, performed and interpreted in a standard manner, before and 1 hour after taking the usual methadone dose. Urines were screened for commonly abused substances on the day of testing. Mean gestation when tested was 34 weeks and mean methadone dose was 26 mg/day. All urines were positive for methadone, six for cocaine, two for opiates, and one for amphetamines. The reactivity of the NSTs performed 1 hour after methadone ingestion was decreased significantly compared with that of tests performed before medication (P less than .04). Decreases in the frequencies of fetal movements and fetal heart rate accelerations were significant (P less than .001 and P less than .01, respectively). These results suggest that methadone treatment altered the morphology of the NST, which may limit the reliability of this test for determining fetal well-being in these high-risk gravidas if time of medication is not taken into consideration.

Decreased incidence of intraventricular hemorrhage in infants of opiate dependent mothers.

The incidence of intraventricular hemorrhage (IVH) in infants born to opiate dependent mothers was compared to infants whose mothers denied the use of addicting substances. The two groups were comparable in birth weight, gestational age, 1 and 5 min Apgar scores, and sex distribution. The incidence of breech presentations, PROM, and type of anesthesia at delivery were similar. However, more infants in the control group were delivered by cesarean section. The incidence of IVH was 52% in the controls and 23% in the opiate infants (p less than 0.05). Neonatal risk factors such as use of ventilators, incidence of pneumothorax, administration of pressor and sedative drugs, acidosis, use of alkali therapy and volume expanders, fluid therapy in the first three days and transfers to other hospitals were the same.

Angiotensin converting enzyme activity in hypertensive pregnancy.

Recent investigations suggest angiotensin converting enzyme (ACE) activity is generally decreased in normotensive pregnancy, but less is known about the level of activity of this enzyme in hypertensive pregnant subjects. The primary source of ACE is vascular endothelium and it can be measured in serum or plasma. In a preliminary investigation, we measured and compared diastolic blood pressure and serum ACE activity in 14 uncomplicated pregnant subjects during the third trimester, and in 16 subjects of similar gestation duration hospitalized with pregnancy-induced hypertension PIH. No patient had a positive history for, or evidence of, pulmonary or other metabolic disease. Compared with levels in normal pregnancy, serum ACE activity was found to be significantly elevated in PIH. In this study, this increase was not due to differences between the groups in maternal chronologic age or gestational duration. Further studies are necessary to determine if the increase in ACE activity precedes or follows development of clinically apparent PIH. If the former is the case, ACE activity might be a useful indicator of risk for PIH.

Effects of pregnancy and magnesium sulfate infusion on blood pressure and plasma catecholamines.

Magnesium sulfate (MgSO4) infusion often lowers blood pressure, but the responsible mechanisms are not clear. Since catecholamines play a major role in blood pressure regulation, we studied the effects of MgSO4 infusion on blood pressure, pulse rate, and plasma catecholamines in late pregnant and in nonpregnant New Zealand white rabbits. Pregnancy was associated with higher levels of dopamine (P less than 0.01) and epinephrine (P less than 0.001). MgSO4 treatment decreased mean arterial pressure (P less than 0.001), increased pulse rate (P less than 0.01), decreased dopamine (P less than 0.01) and decreased epinephrine (P less than 0.001). No significant effect on norepinephrine levels was noted, and there was no evidence that the effect of MgSO4 treatment was influenced by pregnancy. Further investigation is needed to clarify the role of catecholamines in mediating the effects of pregnancy and MgSO4 treatment on blood pressure regulation.

The effects of magnesium sulfate infusion on blood pressure and vascular responsiveness during pregnancy.

Magnesium sulfate is primarily used for its anticonvulsive effects in treating hypertensive disorders of pregnancy. However, we have frequently observed significant falls in blood pressure in patients suffering from severe pregnancy-induced hypertension in whom little or no additional hypotensive medication was necessary for maintenance of diastolic blood pressure at 90 to 100 mm Hg while using recommended doses of this drug. We compared resting mean arterial pressure and vascular response to infusions of 50 ng/kg/min of angiotensin II and 2500 ng/kg/min of Levophed (norepinephrine) before and during infusion of a loading dose of 200 mg of magnesium sulfate intravenously in 15 minutes, followed by continuous infusions of 50 and 100 mg/hr intravenously in chronically prepared virgin (n = 14) and primigravid (n = 12) rabbits at 24 to 28 days' gestation (term = 30 +/- 1 day). Resting mean arterial pressure and vascular response to angiotensin II and norepinephrine were significantly decreased in the primigravid and virgin animals. Magnesium sulfate may attenuate blood pressure by decreasing the vascular response to pressor substances.

Plasma catecholamines and angiotensin-converting enzyme activity in hypertensive subjects with positive rollover tests.

The rollover test is useful in predicting and identifying subjects developing hypertensive disorders of pregnancy. The mechanisms responsible for positive tests are unclear, but a greater release of pressor substances occurring in subjects with positive tests has been proposed. The authors measured and compared heart rate, diastolic blood pressure, plasma norepinephrine and epinephrine levels, and serum angiotensin-converting enzyme activity in ten pregnant subjects with positive rollover tests and seven control subjects with negative rollover tests at 29 to 36 weeks' gestation. Resting levels of epinephrine were significantly lower in subjects with positive rollover tests than in the control group. Plasma levels of epinephrine increased significantly during the positive rollover tests. Basal angiotensin-converting enzyme activity was significantly increased in subjects with positive tests and may play a major role in the altered cardiovascular sensitivity to pressor substances resulting in positive tests.

Plasma angiotensin II and blood pressure changes during dietary sodium manipulation.

The renin-angiotensin system and dietary sodium have been repeatedly implicated in the pathogenesis of pregnancy induced hypertension (PIH). Mechanisms responsible for increased vascular responsiveness to angiotensin II (A-II) observed in PIH are not completely understood. Plasma A-II levels and blood pressure are functions of sodium balance in the non-pregnant state, but less is known about their relationship during gestation. Plasma levels of A-II increase in normal pregnancy, but the reported levels of this pressor substance circulating in subjects with PIH are in conflict. The pregnant rabbit demonstrates several conditions similar to those found in pregnant human subjects. We used this model to study the effects of dietary sodium manipulation on plasma levels of A-II and mean arterial pressure during late pregnancy in 30 chronically prepared New Zealand white rabbits. The animals were 24 to 28 days gestation (term 30 +/- 1 day). All animals were maintained on 1 of 3 diets for 8 days prior to operation and for the duration of the investigation: 10 were fed Purina regular chow (0.4% sodium), and permitted to drink 0.9% saline, 10 were fed trace-sodium diet (Purina 5881-R) and deionized water ad libitum; and 10 were continued on tap water and regular rabbit chow (0.4% sodium) and served as controls. Urines were collected for 24 hours prior to surgery for sodium determination. An indwelling catheter was placed in the carotid artery for blood pressure recording and blood sampling. After a 20 minute stabilization period, mean arterial pressure was repeatedly recorded and blood samples were obtained for determination of A-II levels and sodium concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary sodium manipulation and vascular responsiveness during pregnancy in the rabbit.

The interrelationship of sodium intake and blood pressure regulation during pregnancy is not clear. The effects of dietary sodium loading and restriction on plasma levels of catecholamines, mean arterial pressure, and vascular response to two pressor agents, Levophed and angiotensin II, were investigated in 49 chronically prepared primigravid rabbits. Sodium loading increased mean arterial pressure (p less than 0.005), but did not alter the response to either pressor agent. Sodium restriction did not alter mean arterial pressure, but did increase plasma norepinephrine (p less than 0.05) and epinephrine (p less than 0.02). Negative correlations between plasma levels of norepinephrine and vascular response to infusions of both pressor agents were observed during sodium restriction, -0.61 (p less than 0.05) for angiotensin II, and -0.74 (p less than 0.05) for norepinephrine. A similar correlation of -0.81 (p less than 0.05) was observed for angiotensin II in control animals. Norepinephrine appears to play a significant role in blood pressure maintenance and vascular response in pregnancy. This role is enhanced during sodium restriction.

The rabbit: a suitable model for investigation of vascular responsiveness during pregnancy.

The decreased vascular response to angiotensin II that characterizes normal pregnancy is lost in pregnancy induced hypertension and associated with an increase in response to norepinephrine. These alterations in vascular responsiveness have not been thoroughly investigated and are poorly understood. Suitable models manifesting physiologic conditions known to exist in human pregnancy have not been satisfactorily demonstrated. We investigated the chronically catheterized and unmedicated rabbit for similarities of four conditions known to occur during human pregnancy. We compared mean arterial pressure and vascular response to angiotensin II and to norepinephrine in 19 non-pregnant and 16 pregnant animals. Plasma levels of angiotensin II, norepinephrine, epinephrine, and dopamine levels were measured and compared. We found striking similarities for conditions investigated in our rabbit model when compared with data reported in the literature for human pregnancy. We conclude the rabbit is a suitable model for investigating alterations of vascular response during pregnancy.