Psychological problems resulting from parent-to-adolescent renal transplantation

This paper deals with the ways in which the psychological responses of renal transplant donors and recipients interfere with the developmental tasks of adolescence. The characteristic responses of donors and recipients in general are briefly reviewed. The special problems of the adolescent who has received a transplant from a parent are considered. Interference with the separation-individuation process is discussed. Also considered is the difficulty posed to the development of sexual identity. Excerpts from brief therapy are presented that illustrate the characteristic psychological conflicts described.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23095/1/0000014.pd

Cushing's syndrome after treatment: Changes in cortisol and ACTH levels, and amelioration of the depressive syndrome

Twenty-three patients with pituitary adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome were studied before and after treatment. The relationship between the amelioration of the depressive syndrome and changes in cortisol and ACTH levels was investigated. There was a significant difference in mean change in 24-hour urinary free cortisol (UFC) excretion for changes in the depressed mood score from first to last visit. There were also significant correlations between decreases in UFC and decreases in both the depressed mood score and the modified Hamilton depression score. These relationships were not found for ACTH. Furthermore, with cortisol decreased to normal levels, continued high ACTH levels did not prevent improvement in depressed mood. The possibility that cortisol may also play a role in the pathogenesis and/or maintenance of the mood disorder in psychiatric patients is discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25987/1/0000053.pd

Hippocampal formation volume, memory dysfunction, and cortisol levels in patients with Cushing's syndrome

Patients with chronic hypercortisolemia due to Cushing's syndrome (CS) exhibit cognitive dysfunction. Because glucocorticoid excess is associated with hippocampal damage in animals, and the hippocampus participates in learning and memory, we explored the relationships between hippocampal formation (HF) volume, memory dysfunction, and cortisol levels in 12 patients with CS. After magnetic resonance imaging, HF volume was determined using digital sum of track ball traces of dentate gyrus, hippocampus proper and subiculum, correcting for total intracranial volume. For 27% of the patients, HF volume fell outside the 95% confidence intervals for normal subject volume given in the literature. In addition, there were significant and specific correlations between HF volume and scores for verbal paired associate learning, verbal recall, and verbal recall Corrected for fullscale IQ (r = 0.57 to 0.70, p < 0.05). HF volume was negatively correlated with plasma cortisol levels (r = -0.73, p < 0.05). These studies suggest an association between reduced HF volume, memory dysfunction, and elevated cortisol in patients with CS.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29769/1/0000107.pd

Incorporation of Gerontology into Medical Education

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111104/1/j.1532-5415.1979.tb06060.x.pd

Discordant changes in plasma ACTH and [beta]-lipotropin/[beta]-endorphin levels in Clshing's disease patients with depression

Cushing's Disease is often associated with a depressive syndrome, with mood, vegetative, and cognitive abnormalities of variable severity. In 11 patients with (pituitary ACTH-dependent) Cushing's disease (10 women, 1 man), we studied the relationship between severity of the depressive syndrome and concordance of changes in ACTH and [beta]-lipotropin/[beta]-endorphin ([beta]-LPH/[beta]-E) levels at baseline and in response to metyrapone and dexamethasone. For each condition, blood samples were drawn at 0800h, 1200h, 1600h, and 2200h. Six patients were categorized as mildly depressed (mean[+/-SD] depressed ood SCORE=0.17+/-0.4; modified Hamilton Depression scale SCORE=7.6+/-4.5) and five as severly and five as severely depressed (mean depressed mood SCORE=2.4+/-0.5; modified Hamilton Depession scale SCORE=15+/-5.6) (pp<0.001). When each study condition was examined separately, differences in the frequency of concordance between the groups reached significance during the post-metyrapone phase and with 8.0mmg dexamethasone administration. These initial findings, taken together with data in related areas, suggest that greater diversity in regulation and consecretion of ACTH and [beta]-LPH/[beta]-E may occur than is currently suspected. Such diversity may play a role in the relationship between HPA axis dysregulation and mood disorders.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29763/1/0000101.pd

EEG sleep in cushing's disease and cushing's syndrome: comparison with patients with major depressive disorder

Because patients with Cushing' syndrome (CS) and Major depressive disorder (MDD) share features of hypercortisolism and the depressive syndrome, we compared electroencephalographic (EEG) sleep in patients with pituitary-ACTH-dependent Cushing's syndrome (Cushing's disease, CD), patients with ACTH-independent Cushing's syndrome (AICS), patients with major depressive disorder (MDD), and normal subjects. There were substantial similarities in the abnormal polysomnography profiles of patients with CD, AICS, and MDD. All three patient groups demonstrated poorer sleep continuity, shortened rapid eye movement (REM) latency, and increased first REM period density compared with normal subjects. In addition, AICS patients and MDD patients had elevated REM activity and density. These findings are discussed in terms of models of pathophysiology that relate abnormalities in sleep, mood, and hypothalamic-pituitary-adrenal function.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29943/1/0000301.pd