Prolactin response to hypoglycemia in acute depression

1. We tested a group of acutely depressed patients with a neuroendocrine battery and confirmed the alterations of growth hormone response to hypoglycemia and TSH response to TRH reported by others. 2. In addition, in the same patient sample we found markedly reduced response of prolactin to hypoglycemia. 3. Prolactin response remained low when the patients were retested during depression, however, normalization took place on recovery. 4. An attempt is made to explain these findings by underlying neurotransmitter abnormalities.

Sexual and emotional intimacy between psychiatric inpatients: formulating a policy

The management of sexual and emotional intimacy among inpatients is a prominent concern on psychiatric units. A survey of psychiatrists on 70 psychiatric units throughout Ontario shows that the percentage of units that separated the involved patients was roughly the same as the percentage that supported the relationships; however, the largest percentage reported using other methods. None of the units had a written policy for approaching these situations. The authors describe how two such relationships were handled on their own unit, and outline variables--pertaining to the involved patients, the milieu, and the treating psychiatrist--to consider in handling such relationships. They believe a general policy can be formulated that will ensure a consistent, as well as flexible, approach to patient intimacy.

Estimation of lithium dose requirement by lithium clearance, serum lithium and saliva lithium following a loading dose of lithium carbonate

Renal lithium clearance and the serum lithium levels following a single oral loading dose of lithium were used as measures to predict lithium dose requirement during long-term maintenance at 3 different psychiatric centers in North America. Saliva lithium values were also investigated at one of the centers. The correlation between lithium clearance and the 17-hour serum lithium level, and subsequent dosage was high; the mean correlation co-efficient from the 3 centers being 0.84 for renal lithium clearance and 0.75 for both the 17-hour and 10-hour serum lithium levels. These tests can therefore be recommended as a guide to estimate lithium dose requirement in patients starting lithium maintenance treatment although absolute reliance should not be placed on the prediction formulae obtained. The correlation between saliva lithium and eventual dosage was poor and of little predictive value.

Long-term lithium treatment and the kidney. Interim report on fifty patients

This is a report on the first part of our study of the effects of long-term lithium treatment on the kidney. Creatinine clearance, maximum urinary osmolality and 24 hour urine volume have been tested in 50 affectively ill patients who have been on long-term lithium for more than one year. These findings have been compared with norms and with values of the same tests from screening prior to lithium, available for most of our patients. No evidence was found for any reduction of glomerular filtration during lithium treatment. Low clearance values found in several patients could be accounted for by their age and their pre-lithium values. Urinary concentration defect appeared frequent but the extent of the impairment is difficult to assess because of the uncertainty about the norms applicable to this group of patients. The concentration defect appeared reversible, at least in part. Polyuria above 3 litres/24 hours was found in 10% of patients. An attempt is made to draw practical conclusions from the preliminary findings.

Fluphenazine decanoate and fluphenazine enanthate in the out-patient management of chronic schizophrenia

39 chronic schizophrenic out-patients were given either fluphenazine decanoate or enanthate for a 1-year double-blind trial. Doses of 25 mg were given for the first 6 months and 37.5 mg for the last 6 months. For both agents the intervals between treatments lengthened significantly over the course of the trial. Fluphenazine decanoate showed a non-significant trend for a longer duration of action coupled with a significantly lower incidence of extrapyramidal side effects.

Penfluridol, a peroral long-acting neuroleptic, for the maintenance treatment of schizophrenic patients who relapse

In a multicenter collaborative study, 28 newly readmitted schizophrenic patients, stabilized for one week on short-acting neuroleptic drugs, had their medication abruptly changed to penfluridol given once a week on an outpatient basis. The average dose required for maintenance was approximately 40 mg weekly. Analysis of BPRS evaluations carried out during the 16-week trial revealed a significant linear trend toward further improvement. Social functioning, as measured by the KAS questionnaire in the outpatient period of the trial, also revealed a significant linear trend toward improvement. Significant worsening was not found with any psychometric evaluation. Side effects, when observed, were neither frequent nor severe. Three laboratory and vital sign values showed significant changes: increase in BUN concentrations, decrease in pulse rate, and increase in body weight. The changes in weight and pulse appeared to be within relatively normal ranges, and the increase in BUN concentrations did not appear to be clinically significant. During the first part of a long-term study, penfluridol received a high degree of patient acceptability and is a welcome addition to the maintenance treatment of schizophrenia.

Dopaminergic agonist nomifensine compared with amitriptyline: a double-blind clinical trial in acute primary depressions

1. Nomifensine (8-amino-2-methyl-4-phenyl-1,2,3,4,-tetrahydroisoquinoline) is a new antidepressant which displays an interesting pharmacological profile and acts as a potent dopaminergic agonist. 2. In a double-blind clinical trialnomifensine was compared with a standard and widely tested antidepressant amitriptyline. A total of 24 patients with primary acute depressions, defined by research criteria, were treated for 8 weeks and their clinical condition and laboratory values monitored at regular intervals. The dosage schedule was a flexible one, with a daily dose range from 50-200 mg for nomifensine and 50-225 mg for amitriptyline. 3. Nomifensine and amitriptyline were found to be equivalent in their antidepressant efficacy. Nomifensine, however, showed a trend towards more rapid effect and was relatively free of side-effects. 4. As nomifensine combined antidepressant activity with low frequency of adverse effects, it would seem to be suitable for wider use in the treatment of primary depressions. The results of our study have to be generalized with caution because of the limited sample size.

Bioavailabiltity and side effects of different lithium carbonate products

Among the three lithium preparations tested, no significant difference was found in the bioavailability, as expressed in serum and erythrocyte lithium concentrations and urinary lithium output. The side effect reports, however, varied significantly among the types of lithium under study. The slower the absorption of a particular preparation, the fewer the side effects. The results of this study support the view that preference should be given to lithium preparations with slow-release properites, particularly in side-effect-prone subjects.

Antibodies to Thymocytes in Sera of Normal Controls and of Patients with Schizophrenia

The sera from normal healthy individuals and from patients with schizophrenia were tested for cytotoxic antibodies against thymic antigens located on thymocytes. It was found that the sera from schizophrenics do not show higher cytotoxicity to mouse and rabbit thymocytes than the sera from normal controls. Furthermore, absorption of sera with adult mouse thymocytes and brain failed to show any difference between the sera from these two groups of subjects.

Antibodies to thymocytes in sera of normal controls and of patients with schizophrenia

The sera from normal healthy individuals and from patients with schizophrenia were tested for cytotoxic antibodies against thymic antigens located on thymocytes. It was found that the sera from schizophrenics do not show higher cytotoxicity to mouse and rabbit thymocytes than the sera from normal controls. Furthermore, absorption of sera with adult mouse thymocytes and brain failed to show any difference between the sera from these two groups of subjects.

Renal tubular function in patients on long-term lithium therapy

The authors conducted a study in which 10 patients with recurrent affective disorders who responded completely to long-term lithium therapy but who were otherwise unselected were tested for renal tubular concentrating and acidification ability. Despite frequent symptoms of thirst, polyuria, and nocturia, all patients were able to concentrate urine normally and all showed normal renal tubular acidification ability. A significant correlation was found between erythrocyte lithium concentration and maximum urinary osmolality.