A rating scale for tardive dyskinesia

A rating scale for tardive dyskinesia was developed, consisting of nearly all signs seen by two groups of investigators over a 5-year period. Thirty-four items were included in the scale with a possibility of writing in idiosyncratic signs. The scale was shown to have good reliability and validity in studies carried out by both the New York and Boston groups. It is recommended as a suitable instrument for describing the breadth of tardive dyskinesia syndrome and also for quantifying the disorder. A second scale, "the abbreviated dyskinesia scale", contains 13 items which are more global than the items in the original scale. It also has been shown to be both reliable and valid. Its use is suited to situations requiring less extensively detailed assessments.

Adequacy of endoscopic biopsy specimens for disaccharidase assays

Intestinal mucosa from 40 patients obtained by fiber-endoscopic biopsy was assayed for disaccharidases to determine suitability of this tissue for assay. The combined specimens from each patient provided 4.7-38.7 mg of tissue, adequate in all instances for duplicate determinations of protein, lactase, sucrase, and maltase. Tissue remained for assays of palatinase in 39 instances, trehalase and cellobiase in 37, and alkaline phosphatase in 22 cases. Twenty-four subjects had normal lactose tolerance tests and normal sucrase/lactase ratios. Thirteen patients with abnormal oral lactose tolerance tests were identified as having a primary low lactase activity on the basis of elevated sucrase/lactase ratios. This ratio was most helpful in making the diagnosis of a primary low lactase, since the mucosal specimens were not obtained from comparable areas. Tissue from three subjects with an abnormally low maltase was unsuitable for diagnosis. Endoscopic biopsy of mucosa appears to be satisfactory for disaccharidase assays in most instances.

Evaluation of a slow-release lithium carbonate formulation

A slow-release lithium preparation was compared with a standard formulation in normal volunteers and in patients. Pharmacokinetic parameters of normal volunteers were examined after a single dose of each form and the steady-state levels after a b.i.d. dose of the slow-release form. These initial single-dose data suggested that the two formulations are not bioequivalent. However, the area under the curve of the two forms was similar, and the essentially complete recovery of lithium from urine in steady state indicates equal bioavailability. The patients' steady-state levels for the two formulations essentially confirmed the normal subjects' data: with the slow-release form plasma lithium levels were slightly higher, and the postdose lithium level variability was decreased by as much as 50%.

Tardive dyskinesia and psychotropic drug history

The adult population of a large mental hospital was screened for tardive dyskinesia (TD). Approximately 11% of the hospital population showed signs of TD; females and the elderly were over-represented in the TD group. A representative sample of those with TD was selected and a control (non-TD) patient was chosen to match each of the TD subjects in age, sex, length of hospitalization, diagnosis, and race. The charts of these subjects were searched for any indices of brain damage and the complete psychotropic medication history was recorded. There was no difference between the TD and controls in the amount of psychotropics ingested, in the duration of administration, in the kinds of drugs, or in the organicity history. Women as a group, however, tended to have more polypharmacy than men. The role of neuroleptics in TD is discussed as well as other possible etiological factors.

Loxapine succinate as a neuroleptic agent: evaluation in two populations of elderly psychiatric patients

Loxapine succinate, a newly developed neuroleptic drug, was administered to two groups of geropsychiatric patients: (a) 12 with psychosis and organic brain syndrome, and (b) 14 with chronic schizophrenia. After a two-week baseline period, loxapine was given for 12 weeks. The moderate therapeutic effect of loxapine in the "responders" was similar to that of other neuroleptic drugs. The therapeutic dosage range was found to be from 10 to 80 mg daily--about half that used for younger patients. The chief side effects were drowsiness, mild extrapyramidal symptoms, and a slight increase in blood pressure.

High- and low-potency neuroleptics in elderly psychiatric patients

The efficacy and side effects of a low-potency neuroleptic, thioridazine hydrochloride, and those of a high-potency neuroleptic, fluphenazine hydrochloride, were compared in 30 elderly chronic schizophrenic patients. Through a crossover design, each patient received both drugs with an intervening washout period. Although both drugs produced a similar degree of improvement, their side effects differed. Fluphenazine caused slightly more extrapyramidal effects than thioridazine, though few occurred with use of either drug. Thioridazine caused weight gain, blood pressure decreases, and ECG changes. High-potency neuroleptic agents appear to be the drugs of choice for elderly schizophrenic patients.

Clinical and plasma level characteristics of intramuscular and oral loxapine

The intramuscular and oral forms of loxapine succinate were compared in their clinical, side effect, and blood level characteristics in ten hospitalized chronic schizophrenic patients. The first phase of the study determined the single dose that produced moderate sedation (i.e., the sedation threshold), and this dose was essentially the same for the two forms. Continuous administration of the two forms using the individualized sedation threshold dosage also failed to indicate any clinical or side effect differences in the two forms. The blood level characteristics, however, did differ between the two forms. The kinetic studies indicated that there was a larger are under the loxapine curve with the intramuscular form than with the oral form, while the 8-OH loxapine area was larger with the oral form. The steady-state studies also showed that the i.m. form had higher loxapine levels than the oral form. The significance of these findings, both clinically and in terms of the relative activity of loxapine and its metabolites, is discussed.

Clozapine in tardive dyskinesia

Clozapine, which has had limited clinical testing in the U.S.A., was evaluated in 12 chronic schizophrenic patients with tardive dyskinesia. Its antipsychotic activity was again demonstrated and it suppressed the symptoms of tardive dyskinesia with a marked rebound occurring in these symptoms when it was withdrawn; there was no rigidity or other Parkinsonian symptoms. However, out of a total of 12 patients, neutropenia (800 and 1120) occurred in two patients, convulsion in one patient, marked withdrawal effects in three patients, and a hypotensive collapse with atrial fibrillation in one patient. If these adverse effects are confirmed in a larger sample size, then despite the novel desirable effects of clozapine it would seem unlikely that it will gain widespread or routine use.

Removing a sewing needle from the pelvic cul-de-sac with an operative laparoscope

A case is reported of an unusual foreign body, a sewing needle, found in the pelvis beneath the peritoneum of the cul-de-sac and its successful removal via laparoscopy. The preoperative radiologic localization techniques are discussed. The use of the laparoscope for removing accessible foreign bodies can obviate the need for a more extensive surgical procedure.

Extraosseous osteogenic sarcoma following an intramuscular injection

A 29-year-old white male with an extraosseous osteogenic sarcoma is reported. He first noted a nodule at the site of eventual tumor development some eight years previously, following an intramuscular penicillin injection. Treatment consisted of wide surgical excision and radiation therapy, and he remains healthy some 8 months later. To our knowledge this represents the first case of extraosseous osteogenic sarcoma occurring at the site of a previous intramuscular injection.

Adverse effects of intravenous cannabis tea

Adverse effects occurred in four youths after intravenous injection of an aqueous cannabis-seed tea, which was prepared by boiling the seeds. The effects were immediate and included nausea, vomiting, abdominal pain, watery diarrhea, chills, fever, hypovolemic shock, hypotension, and non-oligemic transitory renal failure. Other manifestations included persistent hypoglycemia, tachycardia, gastrointestinal bleeding, conjunctival hemorrhage, injury, jaundice, splenomegaly, leucocytosis, myalgia, arthralgia, motor weakness, and prostration. Ischemia was noted on electrocardiogram (EKG). All manifestations appeared to reverse within weeks, but these effects had been potentially fatal.

Deanol in the treatment of tardive dyskinesia

Ten hospitalized chronic psychotic patients with symptoms of tardive dyskinesia were given deanol and placebo, each for 8 weeks following a double-bline, crossover design. No psychotropic agents were administered during the trial. Improvement occurred in all patients during the first treatment phase regardless of which drug the patients received; seven patients were on deanol and three on placebo during this time. The possible reasons for this decrease were discussed. It was concluded that deanol may have contributed to the decline but that its effect on the disorder was not dramatic.

An unusual complication of corticosteroid therapy for sarcoidosis

This report describes the rapid development of an amoebic liver abscess in a patient receiving prednisone by mouth for hypercalcaemia associated with sarcoidosis. The diagnosis and treatment of amoebiasis in this setting are discussed.

Two dosages of imipramine in hospitalized endogenous and neurotic depressives

Fifty-one newly hospitalized depressed patients participated in a double-blind comparison of two dosage levels of imipramine hydrochloride (150 mg vs 300 mg daily). Although some patients were suffering from neurotic depressions, they, together with the endogenous depressives, were a severely depressed group who required hospitalization. Improvement occurred with both dosage regimens, although a greater and more consistent improvement was noted in the 300-mg group than in the 150-mg group. There were a few differences between the response of the endogenous and that of the neurotic depressives, as assessed by the physician and self=rating scales. However, endogenous depressives who received 150 mg were overrepresented in the treatment failure group. A comparison of the response of deluded and nondeluded depressives indicated that the deluded patients responded less well than the nondeluded depressives, although half of the delusional group did respond to the treatment.

Therapeutic failure of oral thyrotropin-releasing hormone in depression

A double-blind investigation of the psychological and hormonal responses to orally administered thyrotropin-releasing hormone (TRH) in a dosage range of 200 to 300 mg daily was conducted in a group of 11 depressed patients hospitalized for an initial 10-day period and followed as outpatients for the balance of a 30-day period of observation. The study was purposely restricted to depressives conventionally classed as reactive, neurotic, or characterologic, the groups most commonly encountered clinically. Contrary to some reports of TRH as an effective antidepressant, our results indicated not only failure of benefit but actual antitherapeutic effects in 3 of 6 treated patients as compared with placebo controls. Excessive CNS arousal with psychomotor activation produced dysphoric mental and behavioral effects in these patients.

Lithium in tardive dyskinesia

A single blind trial and a placebo controlled double blind trial of lithium were carried out in elderly patients with tardive dyskinesia. In the pilot study, neuroleptics were continued: in the controlled trial, neuroleptics were discontinued. The results of both studies were essentially negative. Thus, the suppression effect of neuroleptics is much more dramatic than anything seen in the two studies. Several reasons for this were discussed namely, the severity and chronicity of the symptoms.

Once versus thrice daily thiothixene in the treatment of schizophrenic in-patients

Reports have been accumulating in the literature attesting to the failure of patients, particularly out-patients, to take medication as prescribed (Stewart and Cluff, 1972; Moulding et al., 1970). The incidence of these failures, which may include anything from missing occasional doses to taking no medication at all, has been reported to range from 25–59 Per cent. In addition, it has not been possible to identify those patients who will have the highest failure rates (Blackwell, 1972). While most of the studies have involved medical patients, it is probably legitimate to assume that schizophrenic patients are at least as unreliable in taking medication as the medical patients. Thus, in one study of 125 psychiatric patients, Willcox et al. (1965) found that 48 per cent took no medication at all.

Helium Flux from the Earth's Mantle as Estimated from Hawaiian Fumarolic Degassing

Averaged helium to carbon dioxide ratios measured from systematic collections of gases from Sulphur Bank fumarole. Kilauea, Hawaii, when coupled with estimates of carbon in the earth's crust, give a helium flux of 1 x 105 atoms per square centimeter per second. This is within the lower range of other estimates, and may represent the flux from deep-seated sources in the upper mantle.