L Pugnetti

Publications of L Pugnetti

• Altered and asymmetric default mode network activity in a "hypnotic virtuoso": An fMRI and EEG study.

  Authors: S Lipari, F Baglio, L Griffanti, L Mendozzi, M Garegnani, A Motta, P Cecconi, L Pugnetti

  Consciousness and cognition. 12/2011; 21(1):393-400.

  Very highly hypnotizable subjects are rare, easily induced, and able to manifest the whole spectrum of hypnotic phenomena, including post-hypnotic amnesia. The aim of this study was to detect andVery highly hypnotizable subjects are rare, easily induced, and able to manifest the whole spectrum of hypnotic phenomena, including post-hypnotic amnesia. The aim of this study was to detect and localize by means of quantitative functional MRI and EEG changes in cortical activity during hypnosis induction and deep "pure hypnosis" in a hypnotic "virtuoso" subject. We focused on areas forming the default mode network (DMN), since previous studies found that very highly suggestible subjects in hypnosis showed decreased activity in anterior DMN. During undisturbed hypnosis, our "virtuoso" subject showed not only detectable changes in DMN, but also peculiar activations of non-DMN areas and hemispheric asymmetries of frontal lobe connectivity. Our findings confirm that hypnosis is associated with significant modulation of connectivity and activity which involve the DMN but are not limited to it, depending on the depth of the hypnotic state, the type of mental content and emotional involvement.

• Sensory evoked potentials to predict short-term progression of disability in multiple sclerosis.

  Authors: N Margaritella, L Mendozzi, M Garegnani, E Colicino, E Gilardi, L Deleonardis, F Tronci, L Pugnetti

  Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 11/2011;

  To devise a multivariate parametric model for short-term prediction of disability using the Expanded Disability Status Scale (EDSS) and multimodal sensory EP (mEP). A total of 221 multiple sclerosisTo devise a multivariate parametric model for short-term prediction of disability using the Expanded Disability Status Scale (EDSS) and multimodal sensory EP (mEP). A total of 221 multiple sclerosis (MS) patients who underwent repeated mEP and EDSS assessments at variable time intervals over a 20-year period were retrospectively analyzed. Published criteria were used to compute a cumulative score (mEPS) of abnormalities for each of 908 individual tests. Data of a statistically balanced sample of 58 patients were fed to a parametrical regression analysis using time-lagged EDSS and mEPS along with other clinical variables to estimate future EDSS scores at 1 year. Whole sample cross-sectional mEPS were moderately correlated with EDSS, whereas longitudinal mEPS were not. Using the regression model, lagged mEPS and lagged EDSS along with clinical variables provided better future EDSS estimates. The R (2) measure of fit was significant and 72% of EDSS estimates showed an error value of ±0.5. A parametrical regression model combining EDSS and mEPS accurately predicts short-term disability in MS patients and could be used to optimize decisions concerning treatment.

• Voxel-wise analysis of diffusion tensor MRI improves the confidence of diagnosis of corticobasal degeneration non-invasively.

  Authors: M Bozzali, M Cercignani, F Baglio, G Scotti, E Farina, L Pugnetti, J Ashburner, R Nemni, A Falini

  Parkinsonism & related disorders. 08/2008; 14(5):436-9.

  Corticobasal degeneration (CBD) presents with symptoms that often overlap with other neurological conditions. In many cases, diagnosis, prognosis and consequent clinical management remain uncertain.Corticobasal degeneration (CBD) presents with symptoms that often overlap with other neurological conditions. In many cases, diagnosis, prognosis and consequent clinical management remain uncertain. Structural and functional asymmetric brain changes represent the most consistent imaging findings that may assist in CBD diagnosis. Diffusion Tensor MRI (DT-MRI) is a quantitative technique that allows microscopic tissue abnormalities to be non-invasively assessed in vivo. A single case of clinically suspected CBD with symmetric diffuse brain atrophy on conventional-MRI scans was studied using DT-MRI by voxel-wise comparison with eight healthy subjects. The lateralized distribution of DT-MRI abnormalities was consistent with clinical features providing a substantial support to the diagnosis.

• Vestibular evoked myogenic potentials in multiple sclerosis: clinical and imaging correlations.

  Authors: D Alpini, L Pugnetti, D Caputo, F Cornelio, S Capobianco, A Cesarani

  Multiple sclerosis (Houndmills, Basingstoke, England). 07/2004; 10(3):316-21.

  Patients with multiple sclerosis (MS) frequently report symptoms related to vestibular disorders in the course of their disease. At present, the fundamental tests assessing vestibulospinalPatients with multiple sclerosis (MS) frequently report symptoms related to vestibular disorders in the course of their disease. At present, the fundamental tests assessing vestibulospinal involvement are posturography and vestibular evoked myogenic potentials (VEMPs). While posturography cannot be performed in every subject requiring minimal stance control, VEMPs do not require any specific skill on the part of the subjects and they may be investigated in all patients able to sit. VEMPs were recorded for 40 patients (17 men, 23 women; mean age 38 years, range 17-71 years) fulfilling diagnostic criteria of clinically defined MS, by means of rarefaction clicks, recording modulation of sterno-cleido-mastoideus tonic contraction saccule-mediated modulation. VEMPs were found to be abnormal in 28 of 40 patients. In 18 of the cases the VEMPs were asymmetric, i.e., had a prolonged latency on one side. In six cases latency was increased on both sides (mean delay 4.1 ms). In four subjects VEMPs were absent on one side. Concordance with clinical findings of presence/absence of brainstem involvement was found in 55% and with MRI findings in 65% of the cases. Abnormal VEMPs indicated brainstem dysfunction in four patients (10%) with normal MRI and no specific clinical signs.

• Vertigo and multiple sclerosis: aspects of differential diagnosis.

  Authors: D Alpini, D Caputo, L Pugnetti, D A Giuliano, A Cesarani

  Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 12/2001; 22 Suppl 2:S84-7.

  Equilibrium disorders caused by involvement of brainstem and cerebellar structures are common in patients with multiple sclerosis (MS), but peripheral conditions such as benign paroxysmal positionalEquilibrium disorders caused by involvement of brainstem and cerebellar structures are common in patients with multiple sclerosis (MS), but peripheral conditions such as benign paroxysmal positional vertigo (BPPV) can be sometimes confused with those of a central origin. Therefore, an accurate otoneurologic investigation paying attention to differential diagnosis aspects should be performed in these subjects. Among available diagnostic tools, electro-oculography, posturography and vestibular evoked myogenic potentials (VEMPs) are especially suited to assess vestibulo-oculomotor and vestibulospinal systems. This paper briefly describes the most recent otoneurologic diagnostic strategies for MS patients and the results of initial clinical experiences, and finally provides suggestions for differentiating MS-related vestibular disorders from other common otoneurological conditions.

• Falls in the elderly: the development of a risk questionnaire and posturographic findings.

  Authors: D Alpini, R Kohen-Ratz, R Braun, A Burstin, L Tesio, L Pugnetti, L Mendozzi, G Sambataro, A Cesarani, D A Giuliano

  The international tinnitus journal. 02/2001; 7(2):105-8.

  In elderly people, owing to a perturbation at several levels, including the motor, sensory and cognitive levels, a condition of dizziness and unsteadiness complicated by frequent falls often appears.In elderly people, owing to a perturbation at several levels, including the motor, sensory and cognitive levels, a condition of dizziness and unsteadiness complicated by frequent falls often appears. In this article, we review the most recent information about clinical and instrumental tools available for preventing mobility-related accidents and report the results of a comparative study of postural control, carried out through tetraataxiometry (by Tetrax, Tel Aviv, Israel), in two samples of elderly women belonging to two different populations: 24 Italian women (11 reporting falls and 13 without falls) having a mean age of 73.1 years, and 37 Israeli women (12 with falls and 25 without falls) having a mean age of 72.5 years. The posturographic findings show that the falling subjects, to maintain postural control, are highly dependent on somatosensory inputs and have a weaker "systeme postural fin" (fine postural system), according to Gagey. They also show that an elderly subpopulation exists that, for unknown reasons, is immune to destabilization and falls.

• Grading brainstem involvement in multiple sclerosis - by means of electro-oculography.

  Authors: D Alpini, D Caputo, A Hahan, L Pugnetti, B Monti, S Razzari, A Cesarani

  Journal of neurovirology. 06/2000; 6 Suppl 2:S156-9.

  One of the most frequent disorders of the brainstem in multiple sclerosis (MS) is internuclear opthalmoplegia (INO). The aim of this study is to show how it is possible to monitor the course of MSOne of the most frequent disorders of the brainstem in multiple sclerosis (MS) is internuclear opthalmoplegia (INO). The aim of this study is to show how it is possible to monitor the course of MS grading INO on the basis of electro-oculographic findings. We selected 130 patients with a diagnosis of clinically defined multiple sclerosis (78 males and 52 females, mean age 43.5 years) from a population of 354 MS patients. Both saccadic eye movements and spontaneous, vestibular (VOR), visuo-vestibular (VVOR) and optokinetich nystagmus (OKN) were assessed. Slowing of the adducting eye was considered as a sign of lesion of the interocular pathways. Statistical analyses showed that the most sensitive test was VVOR, the least sensitive being randomised saccades. An impairment of random saccades was always associated with abnormal results on all other tests. It seems thus possible to grade the involvement of the medial longitudinal fasciculi (MLF) in MS from an abnormality limited to the VVOR test up to an impairment of randomised saccadic movements. Grading brainstem involvement in MS is particularly important in therapeutic trials and during rehabilitation.

• Virtual Environments in the Diagnosis, Prevention, and Intervention of Age-Related Diseases: A Review of VR Scenarios Proposed in the EC VETERAN Project.

  Authors: G Riva, A. Rizzo, D Alpini, E A Attree, E Barbieri, L Bertella, J G Buckwalter, R C Davies, L Gamberini, G Johansson, N Katz, S Marchi, L Mendozzi, E Molinari, L Pugnetti, F D Rose, P L Weiss

  Cyberpsychology & behavior : the impact of the Internet, multimedia and virtual reality on behavior and society. 02/1999; 2(6):577-91.

  A group of worldwide virtual reality and health-care researchers have decided to combine their efforts in a multidisciplinary project titled VETERAN-virtual environments in the diagnosis, preventionA group of worldwide virtual reality and health-care researchers have decided to combine their efforts in a multidisciplinary project titled VETERAN-virtual environments in the diagnosis, prevention and intervention of age-related diseases. The main goal of the VETERAN project is the tuning and testing of different virtual environments, designed to address the cognitive/functional impairments that may occur due to the aging process and age-related disorders. In particular the developed modules will address the problems commonly found in the following pathologies that have a strong impact on the elderly health care policy: Alzheimer's disease and other senile dementias; stroke and unilateral spatial neglect; mobility-related accidents within specific environments (e.g., falls, shocks). The project will focus on research into clinical aspects of age-related diseases and disorders of high morbidity and specifically target goals of prevention, treatment, or delay in onset. Another goal of the VETERAN project is to define and develop new protocols and tools to be used for general rehabilitation purposes. These tools will aim to provide systematic restorative training within the context of functionally relevant, ecologically valid simulated environments. This approach is hoped to optimise the degree of transfer of training and/or generalisation of learning to the person's real world environment.

• VR experience with neurological patients: basic cost/benefit issues.

  Authors: L Pugnetti, L Mendozzi, E Barbieri, A Motta

  Studies in health technology and informatics. 02/1998; 58:243-8.

  The future of VR applications for mental health is currently regarded as depending on the rational development of ideas and systems. Criteria to guide this development have been suggested that areThe future of VR applications for mental health is currently regarded as depending on the rational development of ideas and systems. Criteria to guide this development have been suggested that are both clear and agreeable. Their application, however, may not be easy at this stage. While we may already be able to predict costs of specific VR applications, a period of more extensive clinical research is needed in order to assess adequately any benefit. In our still limited experience, the development of VR applications to increase the diagnostic sensitivity of traditional tests to strategy application disorders is worthwhile, but the uniqueness of VR assets may make the adherence to some of the proposed criteria somewhat problematic.

• Evaluation and retraining of adults' cognitive impairment: which role for virtual reality technology?

  Authors: L Pugnetti, L Mendozzi, A Motta, A Cattaneo, E Barbieri, A Brancotti

  Computers in biology and medicine. 04/1995; 25(2):213-27.

  Immersive virtual reality (IVR) is a technology already developed to assist cognitive psychologists and therapists in their clinical work with brain-damaged patients. The rationale, the software andImmersive virtual reality (IVR) is a technology already developed to assist cognitive psychologists and therapists in their clinical work with brain-damaged patients. The rationale, the software and the hardware of the first application (ARCANA 1) based on affordable technology are discussed here, in order to provide a concrete example of what the authors think may be the role of IVR as a clinical tool. Although prospects are exciting, extensive research is needed to validate this new approach and reveal its limitations and advantages.

• MRI and cognitive patterns in relapsing-remitting multiple sclerosis.

  Authors: L Pugnetti, L Mendozzi, A Motta, A Cattaneo, P Biserni, D Caputo, C L Cazzullo, F Valsecchi

  Journal of the neurological sciences. 05/1993; 115 Suppl:S59-65.

  We studied the relationships between magnetic resonance imaging (MRI) and the Luria-Nebraska Neuropsychological Battery (LNNB) in 64 patients with relapsing-remitting multiple sclerosis (MS). MRIWe studied the relationships between magnetic resonance imaging (MRI) and the Luria-Nebraska Neuropsychological Battery (LNNB) in 64 patients with relapsing-remitting multiple sclerosis (MS). MRI films were scored according to arbitrary descriptive criteria designed to emphasize patterns of alterations. Five groups were created: group 1 and 2 had typical discrete white matter lesions, group 3 had confluent lesions, group 4 had large discrete lesions and group 5 had only few small lesions. In addition, groups 2 and 3 had evidence of parenchymal atrophy. Groups 2 and 3 were the most impaired on the LNNB, but none of these patients was actually demented. Groups 1 and 5 were globally intact in spite of very different mean age and MRI pattern. Group 4 was composed of younger subjects with a shorter disease duration; they showed mild loss of attentive and abstracting abilities. We suggest that since their MRI was showing greater signs of local biological activity their mental deficits may be a transitory condition capable of two distinct outcomes: a favorable one as in groups 1 and 5, and a slowly progressive one associated with loss of brain tissue as in groups 2 and 3.

• Frontal lobe dysfunction in multiple sclerosis as assessed by means of Lurian tasks: effect of age at onset.

  Authors: L Mendozzi, L Pugnetti, M Saccani, A Motta

  Journal of the neurological sciences. 04/1993; 115 Suppl:S42-50.

  We investigated frontal cognitive function in a group of 153 patients with multiple sclerosis and 100 healthy controls using a global scale composed by a set of items from the Luria-NebraskaWe investigated frontal cognitive function in a group of 153 patients with multiple sclerosis and 100 healthy controls using a global scale composed by a set of items from the Luria-Nebraska Neuropsychological Battery (LNNB) which has been validated by Malloy and colleagues on frontally damaged patients. A second scale was built with LNNB items tapping parietal lobes function. Patients who were specifically impaired on the frontal scale (12%) had a shorter disease duration and were less physically disabled than those failing on the parietal tasks (8.5%) or those showing combined deficits (21.5%). Sixty-four patients were also tested on the Wisconsin Card Sorting Test (WCST). Twenty-seven (37.5%) patients were found to be impaired on the WCST, but the latter could not predict reliably their performance on the LNNB frontal scale. We also examined whether age of onset and disease duration could have had any effect on the cognitive performance of selected groups of patients. We found that relative to normals, deficits on the frontal scale were more severe in patients with a clinical onset around age 20 than in patients with a later onset (i.e., around 35), the two groups being comparable for duration and degree of disability. Furthermore, patients with a longstanding illness (> 10 years) were more affected on visuospatial processing and frontal control of language than those with a short duration (1.5 yrs). We propose that a greater disease activity interacting with contingent (developmental?) factors is responsible for the appearance of transient frontal deficits in several young MS patients.(ABSTRACT TRUNCATED AT 250 WORDS)

• Quazepam versus triazolam in patients with sleep disorders: a double-blind study.

  Authors: M C Mauri, S Gianetti, L Pugnetti, A C Altamura

  International journal of clinical pharmacology research. 02/1993; 13(3):173-7.

  Quazepam, a recently introduced long-half-life benzodiazepine, seems to have a more specific hypnotic activity and a physiological mechanism of action. The present study evaluated clinical efficacyQuazepam, a recently introduced long-half-life benzodiazepine, seems to have a more specific hypnotic activity and a physiological mechanism of action. The present study evaluated clinical efficacy and eventually rebound symptoms after the treatment with quazepam and triazolam. Sixty-five patients, affected by sleep disorders, were entered into the study. Patients were treated with a placebo for four days and, if no amelioration of insomnia was observed, they were allocated randomly to receive 15 mg of quazepam (32 patients) or 0.5 mg triazolam (33 patients) for eight weeks and finally the placebo for another week. The sleep quality, the sleep efficacy, the unwanted effects and the rebound effects had been assessed by specific evaluation scales. Both of the drugs showed a hypnogenic efficacy but patients treated with quazepam had significantly less night awakenings; at the treatment's interruption, only the patients treated with triazolam had longer awakenings and rebound symptoms. In conclusion, quazepam seems to have a good hypnotic effect without inducing rebound effects. On the contrary, triazolam turned out to be just a hypnoinducent drug with higher risks of rebound effects after withdrawal.

• Neurofunctional assessment of early phases of Alzheimer's disease: a preliminary note on hemispheric EEG characteristics during cognitive tasks.

  Authors: S Scarone, E Pieri, R Cattaneo, O Gambini, C Colombo, L Pugnetti

  Human neurobiology. 02/1988; 6(4):289-93.

  EEG characteristics, in terms of power distribution in 1-4, 4-6, 6-8, 8-10, 10-13, 13-18, 18-30 Hz frequency bands were evaluated in six putative non-medicated male Alzheimer patients. The latterEEG characteristics, in terms of power distribution in 1-4, 4-6, 6-8, 8-10, 10-13, 13-18, 18-30 Hz frequency bands were evaluated in six putative non-medicated male Alzheimer patients. The latter were compared with six age and sex-matched normal controls during both resting conditions and tactile identification tasks specific for the left and right hemispheres. The result indicate a significant difference in the power of the 8-10 frequency band between the two groups and a significant hypovariability in the 6-8 and 8-10 bands during tactile tasks: Alzheimer patients showed reduced power and, also, where less reactive, no differences between the left and right hemispheres having appeared. These findings seem to confirm the specificity of EEG modifications in Alzheimer's disease, even in the very early phases of the pathological process. Possible implications are discussed in the light of some biochemical hypotheses.

• Biological heterogeneity of major depressive disorder: indications by sleep EEG and TRH stimulation test findings.

  Authors: L Pugnetti, S Scarone, F Brambilla

  Neuropsychobiology. 02/1987; 17(3):124-9.

  A group of 27 patients with definite (n = 20) or probable (n = 7) RDC major depressive disorder underwent 2 sleep EEGs and 1 TRH test while in a drug-free depressive phase. A short mean REM latencyA group of 27 patients with definite (n = 20) or probable (n = 7) RDC major depressive disorder underwent 2 sleep EEGs and 1 TRH test while in a drug-free depressive phase. A short mean REM latency (less than 60 min) identified 55.5% of major depressives while added use of blunted TSH responses (delta max. less than 5 microU/ml) increased that percentage by 11%. When patients were subdivided into RDC endogenous and nonendogenous, mean REM latency and global depression scores distinguished the 2 groups, while delta TSH did not. A short mean REM latency identified endogenous depression with 80% specificity and 76% sensitivity. The combination of REM latency and delta TSH reduced the specificity to 60%, and therefore cannot be recommended for differentiating endogenous from nonendogenous depression.

• Abnormal anterior pituitary responsiveness to hypothalamic hormones in depression: neurophysiological correlates and psychopharmacological effects.

  Authors: F Brambilla, L Pugnetti, S Scarone, O Gambini, M Maggioni, P Nobile

  Advances in biochemical psychopharmacology. 02/1985; 40:69-80.

• EEG and clinical findings during pemoline treatment in children and adults with attention deficit disorder. An 8-week open trial.

  Authors: L Caresia, L Pugnetti, R Besana, F Barteselli, A Guareschi-Cazzullo, L Musetti, S Scarone

  Neuropsychobiology. 02/1984; 11(3):158-67.

  A clinical study has been conducted on a selected group of 9 children and 12 adults with attention deficit disorder, evaluating the response to the therapy with magnesium pemoline by means of EEGA clinical study has been conducted on a selected group of 9 children and 12 adults with attention deficit disorder, evaluating the response to the therapy with magnesium pemoline by means of EEG power spectra. Pemoline was given orally in increasing doses ranging from 20 to 80 mg/day. EEG was recorded during baseline and at three fixed intervals during the treatment. Clinical response was assessed by objective and subjective ratings. In the adult sample, the drug produced two opposite patterns of EEG response which allowed us to discriminate by the 1st day of treatment responders who reported a paradoxical calming and non-responders who reported a worsening in anxiety. Inconsistent EEG power changes produced by the drug in children did not allow the discrimination of responders and non-responders. Children did not show paradoxical signs of sedation. EEG and clinical data suggest that adults and children show different drug response and that the paradoxical sedation is present only in adults.

• Bromocriptine therapy in chronic schizophrenia: effects on symptomatology, sleep patterns, and prolactin response to stimulation.

  Authors: F Brambilla, S Scarone, L Pugnetti, R Massironi, G Penati, P Nobile

  Psychiatry research. 04/1983; 8(3):159-69.

  Ten chronic schizophrenic patients were given bromocriptine in doses increasing from 1.25 to 5 mg over 6 days (the low-dose therapy) and then up to 40 mg over 15 days (the high-dose therapy).Ten chronic schizophrenic patients were given bromocriptine in doses increasing from 1.25 to 5 mg over 6 days (the low-dose therapy) and then up to 40 mg over 15 days (the high-dose therapy). Psychopathological status was assessed using the Brief Psychiatric Rating Scale, twice daily the first 6 days, and every 2 days thereafter. The prolactin (PRL) response to haloperidol stimulation (1 mg i.v.) was measured in five cases before and 3 days after the end of high-dose therapy, and in one patient before and 3 days after the end of low-dose therapy. Electroencephalographic sleep studies were carried out before therapy and every 2 nights during low-dose therapy in five patients, and in two cases during high-dose therapy. Bromocriptine therapy modified neither clinical symptomatology nor sleep patterns. The PRL response to haloperidol after therapy was markedly lower than that before therapy in the five patients treated with high doses, and markedly higher in the single patient tested who was treated only with low-dose therapy.

• Daytime sleep patterns of primary depressives: a morning nap study.

  Authors: L Pugnetti, A Colombo, C L Cazzullo, G Leccardi, F Sicuro, S Scarone

  Psychiatry research. 01/1983; 7(3):287-98.

  The electroencephalographic sleep patterns of 10 primary depressives were recorded during baseline nights and two morning nap sessions using a fixed time schedule. Averaged sleep measures forThe electroencephalographic sleep patterns of 10 primary depressives were recorded during baseline nights and two morning nap sessions using a fixed time schedule. Averaged sleep measures for baseline nights replicated previous findings of altered rapid eye movement (REM) sleep patterns and sleep continuity. REM sleep during morning naps occurred only in patients with elevated REM indexes on baseline and prenap nights; it failed to appear in morning sleep of patients who exhibited contrasting REM characteristics. An analysis of hourly REM sleep distribution and averaged deviations from group means revealed significant differences between the two groups which could account for the uneven daytime REM propensity.

• Abnormal anterior pituitary responsiveness to hypothalamic hormones in primary affective disorders. Effect of desipramine therapy.

  Authors: F Brambilla, S Scarone, R Massironi, P Nobile, L Pugnetti

  Neuropsychobiology. 02/1982; 8(5):269-75.

  Abnormal anterior pituitary responsiveness to acute administration of thyrotropin-releasing hormone was investigated in 8 patients, 6 women and 2 men, with primary affective disorders in a depressiveAbnormal anterior pituitary responsiveness to acute administration of thyrotropin-releasing hormone was investigated in 8 patients, 6 women and 2 men, with primary affective disorders in a depressive phase and in 2 women with schizoaffective disorders. Thyrotropin-releasing hormone, 500 micrograms i.v., induced a rise of plasma growth hormone levels in 1 patient suffering from primary affective disorders and in the 2 schizoaffective subjects, a rise of follicle-stimulating hormone in 1 schizoaffective patient, of luteinizing hormone in the 2 schizoaffective patients, an excessive prolactin rise in 5 patients with primary affective disorders and in 1 schizoaffective subject and a flat response of thyroid-stimulating hormone in 4 patients with primary affective disorders and in 2 schizoaffective patients. Desipramine was given at a dose of 50-100 mg/day for 3-5 weeks. The thyrotropin-releasing hormone stimulation test was repeated when the patients were improving or after 5 weeks of treatment without improvement. The hormonal impairments tended to disappear in those patients showing symptomatic improvement and were still present in those who did not improve.