Pain perception in self-injurious patients with borderline personality disorder

Pain ratings during the cold pressor test were significantly lower in female inpatients with borderline personality disorder who report that they do not experience pain during self-injury (BPD-NP group, n = 11), compared with similar patients who report that they do experience pain during self-injury (BPD-P group, n = 11), and normal female subjects (n = 6). Pain ratings were not significantly different in the BPD-P and normal control groups. Self-report ratings of depression, anger, anxiety, and confusion were significantly lower, and ratings of vigor significantly higher following the cold pressor test in the BPD-NP group, but not in the BPD-P group. Only anxiety was significantly lower in the normal control group following the cold pressor test. The implications and limitations of these preliminary findings are discussed.

Symptomatic predictors of ECT response in medication-nonresponsive manic patients

BACKGROUND

Relations between pretreatment symptom ratings and ECT outcome were examined in acute manic patients admitted at a state psychiatric center who were nonresponsive to medication.

METHOD

One or 2 days after undergoing pretreatment clinical ratings, patients were randomly assigned to intensive pharmacotherapy, right unilateral ECT, left unilateral ECT, or bilateral ECT. Patients who failed to respond to any of the first three treatment conditions were assigned to crossover bilateral ECT. Patients who failed to respond to a primary treatment condition other than bilateral ECT but refused crossover bilateral ECT and those in whom ECT was terminated due to an organic brain syndrome were not considered for this study. No psychotropic drugs were prescribed for 4-7 days before, or during, the course of ECT. Of the 24 patients who entered the study, 18 patients completed the protocol. Based on independent clinical assessments by two research psychiatrists, a favorable treatment response was defined as a complete recovery from manic episode that was sustained for 1 week during which no psychotropic medications were prescribed.

RESULTS

ECT nonresponders were significantly more angry, irritable, and suspicious than ECT responders. Severity of mania and depression ratings at baseline were not related to ECT response.

CONCLUSION

Symptoms associated with poor response to ECT may overlap with those that have been reported to predict nonresponse to treatment with lithium. Our evidence also may support the view that differential symptom patterns may predict treatment outcomes to ECT and carbamazepine, respectively, in manic patients who do not respond to treatment with lithium or neuroleptics.

Subjective awareness of abnormal involuntary movements in chronic schizophrenic patients

The authors examined the effects of verbal and visual feedback on subjective awareness of involuntary movements in 20 chronic schizophrenic patients. At initial evaluation only 25% of the patients were fully aware of their movement disorder. Both verbal and visual feedback resulted in significant immediate enhancement of awareness. However, assessment of awareness 2 weeks later showed a return to prefeedback baseline levels. Lack of awareness of involuntary movements was associated with a lack of awareness of psychiatric disorder, and both were associated with a longer duration of illness.

The pharmacologic treatment of neuroleptic-induced akathisia

Akathisia is a frequent and distressing side effect of neuroleptic medications. The literature regarding the pharmacologic treatment of acute neuroleptic-induced akathisia is critically reviewed, including nine reports of the use of anticholinergic agents, 15 of the use of beta-blocking agents, and six of the use of benzodiazepines. Reports of trials on clonidine, amantadine, piracetam, and of a patient treated with amitriptyline are also discussed. Tentative recommendations for the management of acute akathisia are proposed.

Persistent tardive dyskinesia and neuroleptic effects on glucose tolerance

The relations of persistent tardive dyskinesia (TD) to glucose tolerance and family history of type 2 diabetes mellitus (FH-NIDDM) were examined in 22 schizophrenic patients. All patients underwent a standard oral glucose tolerance test (GTT) while receiving haloperidol, and 15 patients also underwent a GTT when drug free. Fasting blood glucose (FBS) was significantly higher in the TD group than in the non-TD group in the medicated condition, but not in the drug-free state. TD and non-TD groups did not differ significantly in postload glucose levels either in the drug-free or in the medicated condition. However, relative to the drug-free state, haloperidol-treated TD patients showed decreased glucose tolerance while non-TD patients showed increased glucose tolerance. Seven (32%) of the 22 patients had an FH-NIDDM. A positive FH-NIDDM was significantly associated with the presence of TD and with higher drug-free FBS. A possible role of melatonin in mediating the TD-augmenting effects of FH-NIDDM and the neuroleptic-induced decrease in glucose tolerance has been proposed.

Increased extrapyramidal symptoms with addition of lithium to neuroleptics

To explore whether lithium exacerbates neuroleptic-induced extrapyramidal symptoms (EPS), the authors prospectively rated 10 patients on neuroleptics before and after the addition of lithium. EPS ratings increased steadily after the initiation of lithium and were significantly elevated compared with baseline. Individual items that increased significantly were: gait, shoulder shaking, elbow rigidity, and tremor. These findings indicate that usual therapeutic levels of lithium may significantly worsen neuroleptic-induced EPS. Potential mechanisms for this interaction are discussed.

Neuroleptic malignant syndrome: review and analysis of 115 cases

Neuroleptic malignant syndrome is a potentially fatal consequence of neuroleptic use that has recently gained wide attention. In this article the authors critically review the previous literature and analyze all case reports in the English-language literature (115 cases) for 43 variables. The results are discussed in light of prior literature, and recommendations are made for future research.

Symptoms of neuroleptic malignant syndrome in 82 consecutive inpatients

This study, a retrospective chart review of 82 consecutive male inpatients, assessed the spectrum and prevalence of neuroleptic malignant syndrome. The prevalence of diagnosed neuroleptic malignant syndrome (2.4%) was greater than that generally reported. Eight additional patients manifested symptoms that abated without cessation of neuroleptic treatment. This suggests that neuroleptic malignant syndrome is a spectrum disorder that has milder variants. Affective illness may be a risk factor for its development.