Longitudinal patterns of antidepressant prescribing in primary care in the UK: comparison with treatment guidelines

The objective of this study was to determine whether patients beginning therapy on the most common tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) differed in their likelihood of having antidepressant treatment that was consistent with recommended treatment guidelines in the UK. An analytical file constructed from a large general practitioner medical records database (DIN-LINK) from the UK for the years 1992-97 was constructed. A total of 16 204 patients with a new episode of antidepressant therapy who initiated therapy on one of the most often prescribed TCAs (amitriptyline, dothiepin, imipramine and lofepramine) or SSRIs (fluoxetine, paroxetine and sertraline) were analysed. A dichotomous measure was defined to indicate whether subjects were prescribed at least 120 days of antidepressant therapy at an adequate average daily dose within the first 6 months after initiation of therapy. Only 6.0% of patients initiating therapy on aTCA and 32.9% of patients initiating therapy on a SSRI were prescribed antidepressant treatment that was consistent with treatment guidelines. After controlling for observable characteristics, patients who initiated therapy on a SSRI were much more likely (odds ratio=7.473, p<0.001) to have a prescribed average daily dose and duration consistent with recommended treatment guidelines within the first 6 months of initiating therapy than were patients who initiated therapy on a TCA. These findings suggest that initial antidepressant selection is an important determinant of whether the subsequent course of treatment is consistent with current national guidelines for the treatment of depression in the UK.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68732/2/10.1177_026988119901300204.pd

Electrophysiological effects of dynorphin peptides on hippocampal pyramidal cells in rat

Single-unit extracellular recording was carried out in rats to characterize the effects of dynorphin and several structurally related peptides on hippocampal pyramidal cell activity. Dynorphin, applied electrophoretically or by pneumatic pressure, produced a dose-dependent depression of both spontaneous and glutamate-evoked discharge in a majority (63%) of CA1 and CA3 cells tested. In addition, a small number of cells in both cellular fields responded to the peptide with a prolonged elevation in firing. The inhibitory effects of dynorphin in were not blocked by naloxone. Moreover, administration of des-tyrosine-dynorphin depressed the firing of pyramidal cells in a manner similar to that of the parent compound. Ethylketocyclazocine produced a mixed pattern of excitatory and inhibitory effects, whereas naloxone-sensitive elevations in firing were most often observed with the application of dynorphin-(1-8). Application of [Leu5]enkephalin produced only facilitations in pyramidal cell firing. The possibility is raised that biologically significant non-opiate actions, in addition to potent opiate-mediated effects, may occur upon release of pro-dynorphin peptides in the hippocampus.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25783/1/0000344.pd

Modification of the visual response properties of cerebellar neurons by norepinephrine

Extracellular recordings were conducted in the paraflocculus of anesthetized Long-Evans pigmented rats to determine how iontophoresis of norepinephrine (NE) affects the responsiveness of individual Purkinje cells and interneurons to presentations of visual stimuli within their visual receptive fields. Presentations of moving or stationary visual stimuli during the control (pre-NE) period elicited simple spike excitations or inhibitory responses in slightly more than one-half (55%, n = 32) of the cells tested (20 of 38 Purkinje cells, 12 of 20 interneurons). The predominant effect of NE iontophoresis was to improve visually evoked responses in those neurons which showed modulations in their simple spike discharge to control presentations of visual stimuli. A clear enhancement of visual responses by NE (i.e., absolute increase over control) was observed in 18 of the units, and in 12 of the 14 remaining cells, reductions in stimulus-bound discharge during catecholamine iontophoresis were accompanied by much larger depressions in background activity, resulting in a net enhancement in the ratio of signal-to-noise. NE differentially affected responses to stimulus movement in the preferred and non-preferred direction in one-third of these neurons, such that directional selectivity was increased. However, the orientation bias of individual units was unchanged by NE. Iontophoretic application of the [beta]-adrenergic antagonist sotalol but not the [alpha]-adrenergic antagonist phentolamine blocked these facilitating noradrenergic effects. An additional feature of noradrenergic action was revealed in tests conducted in 26 cells which did not respond to control presentations of visual stimuli. Iontophoresis of NE resulted in the elicitation of visual responses in 11 of these units, suggesting the possibility that NE might act in some cases to gate the efficacy of subliminal synaptic input conveyed by classical afferent channels. It is proposed that an important aspect of noradrenergic action within local cerebellar circuits might be to refine the receptive field properties of individual neuronal elements and thereby improve information flow through the cerebellum.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28612/1/0000424.pd

Changes in alpha2 adrenoreceptors in various areas of the rat brain after long-term administration of "mu" and "kappa" opiate agonists

Clonidine, an alpha2 adrenoreceptor agonist, is used to treat opiate dependent individuals who are experiencing the signs and symptoms of withdrawal. Changes in the apparent number of alpha2 adrenoreceptors in specific areas of the rat brain have been observed after chronic morphine administration. In the present study, the effects of chronically administered morphine sulfate upon alpha2 adrenoreceptors were compared to those of UM-1072, (+/-)-5,9-alpha-dimethyl-2-hydroxy-2-tetrahydro-furfuryl-6,7-benzomorphan HCl, a "kappa" agonist which does not produce typical morphine-like dependence. The maximum number of specific binding sites (Bmax) and dissociation constants (KD's) for 3H-clonidine were measured with neural membranes isolated from saline or drug-treated rats. Rats were injected with saline, morphine or UM-1072, i.p., every 8 hr for 14 days. Doses of morphine ranged from 10 mg/kg, t.i.d., on the first three days to 100 mg/kg, t.i.d., on the last two days. Doses of UM-1072 covered a similar range. In control experiments, the Bmax's for specific binding of 3H-clonidine were (in fmoles/mg protein): hypothalamus, 142 +/- 7; amygdala, 141 +/- 3; brainstem, 70 +/- 2; parietal cortex, 130 +/- 4; hippocampus, 94 +/- 2; and caudate nucleus, 62 +/- 3. After chronic morphine treatment, the Bmax's were decreased significantly in all areas except the hippocampus. After chronic UM-1072 treatment, the Bmax's were decreased significantly in all areas studied. Neither treatment altered appreciably the KD's for 3H- clonidine. This study suggests that "mu" and "kappa" agonists might have similar actions upon noradrenergic systems in the brain.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25413/1/0000862.pd

Changes in [alpha]-adrenoceptor number and function in brains of morphine-dependent rats

The effects of long-term treatment of rats with morphine sulfate were assessed upon the specific binding of [3H]clonidine to [alpha]2-adrenoceptors on neural membranes isolated from various brain areas and upon the function of presynaptic [alpha]2-adrenoceptors during field stimulation of hippocampal slices. Rats were injected with morphine every 8 h for 14 days with doses which started at 10 mg/kg per injection i.p., and which increased every 3 days to a final dose of 100 mg/kg per injection on the last 2 days. At 8 and 32 h after the last injection the Bmax for [3H]clonidine binding to neural membranes from various brain areas was significantly decreased. At the same times, the fractional release of [3H]noradrenaline during field stimulation of hippocampal slices was increased and the sensitivity of the hippocampal slice to clonidine was reduced which indicated the development of a functional subsensitivity of the presynaptic [alpha]2-adrenoceptor. These changes in receptor function persisted at 72 h after the last morphine injection although at this time there were marked increases over control values in [3H]clonidine binding to membranes from all rat brain areas except the caudate nucleus. These findings suggest that changes in [alpha]2-adrenoceptor number and function which develop during long-term morphine administration might play an important role in opiate dependence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28045/1/0000484.pd

Optical Design and Status of the Large Ultra-Violet Optical Infrared Surveyor (LUVOIR)

"In preparation for the Astrophysics 2020 Decadal Survey NASA's Goddard Space Flight Center is studying a segmented aperture telescope with broad astrophysics, solar system, and exoplanet science capability called the Large Ultra-Violet Optical Infrared Surveyor (LUVOIR). This telescope design incorporates many heritage design concepts from the Hubble Space Telescope (HST), James Webb Space Telescope (JWST), and the Wide-field Infrared Survey Telescope (WFIRST). This includes similar ultraviolet instrumentation from HST, deployable segmented optics from JWST, and high-contrast coronagraph technology from WFIRST. Several optical design trades were completed to maximize the science product while maintaining reasonable packaging and fabrication constraints. Other technology developments such as freeform optics, UV enhanced coatings, coronagraph design, and ultra-stable mirrors are being studied to further improve the observatory performance

Dynorphin (1-17): Lack of analgesia but evidence for non-opiate electrophysiological and motor effects

Dynorphin and an opiate-inactive fragment des-Tyr-dynorphin produced similar effects on EEG, motor function and hippocampal unit firing. Naloxone had no effect on the actions of dynorphin in these systems and dynorphin failed to produce analgesia upon central administration. These results suggest that dynorphin has a pharmacological character that differs significantly from the classic narcotics.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23835/1/0000074.pd

Preliminary Jitter Stability Results for the Large UV/Optical/Infrared (LUVOIR) Surveyor Concept Using a Non-Contact Vibration Isolation and Precision Pointing System

The need for high payload dynamic stability and ultra-stable mechanical systems is an overarching technology need for large space telescopes such as the Large Ultraviolet / Optical / Infrared (LUVOIR) Surveyor concept. The LUVOIR concept includes a 15-meter-diameter segmented-aperture telescope with a suite of serviceable instruments operating over a range of wavelengths between 100nm to 2.5 um. Wavefront error (WFE) stability of less than 10 picometers RMS of uncorrected system WFE per wavefront control step represents a drastic performance improvement over current space-based telescopes being fielded. Through the utilization of an isolation architecture that involves no mechanical contact between the telescope and the host spacecraft structure, a system design is realized that maximizes the telescope dynamic stability performance without driving stringent technology requirements on spacecraft structure, sensors or actuators. Through analysis of the LUVOIR finite element model and linear optical model, the wavefront error and Line-Of-Sight (LOS) jitter performance is discussed in this paper when using the Vibration Isolation and Precision Pointing System (VIPPS) being developed cooperatively with Lockheed Martin in addition to a multi-loop control architecture. The multi-loop control architecture consists of the spacecraft Attitude Control System (ACS), VIPPS, and a Fast Steering Mirror on the instrument. While the baseline attitude control device for LUVOIR is a set of Control Moment Gyroscopes (CMGs), Reaction Wheel Assembly (RWA) disturbance contribution to wavefront error stability and LOS stability are presented to give preliminary results in this paper. CMG disturbance will be explored in further work to be completed

Prescribing patterns in premenstrual syndrome

BACKGROUND: Over 300 therapies have been proposed for premenstrual syndrome. To date there has been only one survey conducted in the UK of PMS treatments prescribed by GPs, a questionnaire-based study by the National Association of Premenstrual Syndrome in 1989. Since then, selective serotonin re-uptake inhibitors have been licensed for severe PMS/PMDD, and governmental recommendations to reduce the dosage of vitamin B6 (the first choice over-the-counter treatment for many women with PMS) have been made. This study investigates the annual rates of diagnoses and prescribing patterns for premenstrual syndrome (1993–1998) within a computerised general practitioner database. METHODS: Retrospective survey of prescribing data for premenstrual syndrome between 1993–1998 using the General Practice Research Database for the West Midlands Region which contains information on 282,600 female patients RESULTS: Overall the proportion of women with a prescription-linked diagnosis of premenstrual syndrome has halved over the five years. Progestogens including progesterone were the most commonly recorded treatment for premenstrual syndrome during the whole study period accounting for over 40% of all prescriptions. Selective serotonin-reuptake inhibitors accounted for only 2% of the prescriptions in 1993 but rose to over 16% by 1998, becoming the second most commonly recorded treatment. Vitamin B6 accounted for 22% of the prescriptions in 1993 but dropped markedly between 1997 and 1998 to 11%. CONCLUSIONS: This study shows a yearly decrease in the number of prescriptions linked to diagnoses for premenstrual syndrome. Progestogens including progesterone, is the most widely prescribed treatment for premenstrual syndrome despite the lack of evidence demonstrating their efficacy