Appearance of mania in drug-resistant bipolar depressed patients after treatment with L-triiodothyronine.

L-Triiodothyronine (T3) has been reported to potentiate the antidepressant effects of tricyclic antidepressants (TCAs) in patients who do not respond to these drugs, while thyroxine (T4) has been used to treat rapid-cycling bipolar disorder patients. The development of mania in antidepressant-resistant bipolar depressed patients after T3 was added to their antidepressant treatment is reported. It is speculated that thyroid hormone-catecholamine receptor interaction might underlie these T3-associated clinical manifestations. It is concluded that T3 did not prevent the switch to mania in the bipolar depressed patients reported here. Further study is necessary to determine if T3 plays a role in promoting the switch to mania in depressed patients treated with T3 in conjunction with TCAs, and if bipolar depressed patients are particularly vulnerable to mania from the combined effects of TCAs and T3.

Lithium and the nephrotic syndrome.

The authors report the occurrence of the nephrotic syndrome in association with the use of lithium carbonate in a 41-year-old man, review other reports of this adverse effect, and discuss implications for the clinician.

The dexamethasone suppression test in the clinical setting.

The authors administered the dexamethasone suppression test (DST) to 47 inpatients on a clinical, nonresearch psychiatric unit who had been diagnosed according to DSM-III. Of the 30 patients with major depression, 23 (77%) exhibited nonsuppression (serum cortisol concentrations greater than 5 micrograms/dl); only 1 of the 17 patients with other diagnoses and depressive symptoms exhibited nonsuppression. There was no difference in the rate of nonsuppression between the patients with subgroups of major depression, but those with major depression and psychosis had significantly higher postdexamethasone cortisol levels than those with major depression with and without melancholia and those with diagnoses other than major depression.

The MMPI as a measure of the emotional correlates of chronic hemodialysis: a review.

The MMPI has been the most frequently used objective personality measure in studies of the emotional correlates of chronic hemodialysis for end-stage renal failure. This paper reviews MMPI findings of these studies and examines the utility of this instrument with chronic dialysis patients. Overviews of the basic research strategies employed and of the methodological shortcomings of the published studies are presented. Research findings are reviewed, and pros and cons of using the MMPI with this population are briefly discussed. The most consistent finding to date has been elevation in the "neurotic triad" (scales 1, 2, and 3), but the meaning of this configuration for dialysis patients is ambiguous.

Longitudinal study of neuropsychological functioning in patients on chronic hemodialysis: a preliminary report.

This study is part of a five-year project to investigate the long term effect of chronic hemodialysis on patients with end-stage renal failure. Previous research has associated hemodialysis with progressive dialysis encephalopathy (PDE), which is characterized by speech disturbances, cognitive impairment, myoclonus and behavioral changes. Little is known about the cause or the course of this syndrome except that it begins 14-36 months after treatment onset and usually culminates in death. The purpose of this study was to investigate neuropsychological (cognitive and behavioral) functioning in dialysis patients over a period of years. To date, 34 patients have been studied for 22 months utilizing a cross-sectional method comparing patients at different stages of treatment combined with a longitudinal method of repeated evaluations over time. Current findings show improved cognitive functioning during at least the first year of treatment and no evidence of cognitive deterioration in patients on dialysis for more than one year (M = 4.3). These findings offer strong evidence that PDE is not necessarily a general phenomenon among patients on chronic hemodialysis.

Intellectual functioning in renal failure and chronic dialysis.

The research literature on intellectual functioning in uremia and maintenance hemodialysis for renal failure is critically reviewed. The most frequently assessed neuropsychological functions have been general intelligence, memory, and attentional processes. Studies have consistently found lowered performance IQ scores compared to verbal IQ scores in renal failure patients prior to dialysis onset, suggesting the presence of intellectual deficit due to cortical dysfunction. The role of intelligence in adjustment to dialysis has not been clearly explicated, due in part to methodological variations among studies. Several studies point to significant improvement in short-term memory both after onset of maintenance dialysis and from one day before to one day after an individual dialysis treatment session. Attentional functions appear to improve after onset of dialysis treatment as well, but small sample sizes limit the conclusiveness of the data on these cortical processes. Future research efforts should be aimed at correlating physiologic with neuropsychological data and at longitudinal study of intellectual functioning in dialysis patients.

Research issues in psychological studies of chronic dialysis.

Research examining the psychological and psychosocial effects of chronic dialysis has produced numerous controversial issues, such as the role of denial in emotional adjustment and the relationship of intelligence of vocational rehabilitation in dialysis patients. Inconsistent findings leading to these controversies are attributable in part to variance in research design and to shortcomings in methodology and reporting of data. The present article briefly reviews methodological factors not previously addressed in critiques of dialysis research, focusing on subject selection, subject description, illness measures, assessment procedures, conditions of testing, comparison groups, and data analysis. It is concluded that consideration of these factors in the design and conduct of studies will enhance the quality of research in this area.

Adverse effects of anticholinergic antiparkinsonian drugs in tardive dyskinesia. An investigation of mechanism.

10 long-term schizophrenic patients with tardive dyskinesia were studied over 14 weeks and maintained on their usual neuroleptic medications while anticholinergic antiparkinson drugs were employed and then discontinued, and the cycle then repeated. Discontinuation of anticholinergic medications resulted in improvement in dyskinetic movements and vice versa. Estimation of haloperidol equivalents in serum at four times suggested that changes in severity of tardive dyskinesia were not caused by changes in blood levels of neuroleptics. Levels of pituitary hormones were also estimated at four times. Prolactin levels tended to diminish in men over the course of the experiment. Growth hormone and thyrotropin values were mainly stable. However, the growth hormone levels peaked during the final 'off anticholinergic' condition and thyrotropin levels were consistently elevated.

Common alcohol-related disorders: recognition and management.

Appropriate medical treatment of alcoholics often falls between the clinical specialties of psychiatry, internal medicine, toxicology, and neurology. All physicians need to have a high index of suspicion for alcoholism, since the diagnosis of alcohol dependence is frequently overlooked. Especially when alcoholics are self-referred to nonmedical agencies, their medical complications may be inadequately treated or unrecognized. Common alcohol-related complications requiring treatment include: (1) clinicopathologic disorders, often associated with the gastroenterologic or cardiorespiratory systems, including alcoholic cirrhosis, (2) peripheral myoneural effects, (3) neuropsychiatric complications (delirium tremens, acute alcoholic hallucinosis, Korsakoff's psychosis, alcoholic dementia), and (4) psychosocial disability.

The assessment of thiothixene in chronic schizophrenia. A double-blind controlled trial.

The results are reported of a double-blind controlled trial of a recently introduced major tranquilizer thiothixene (Navane, Pfizer) against chlorpromazine in 24 chronic schizophrenics in the Royal Edinburgh Hospital, Edinburgh, Scotland. Additionally, a limited experiment in withdrawal of routine tranquilizers in these patients (one month) was carried out prior to the trial. Changes in manifest psychosis (symptoms) and social disability were assessed by the use of the Lorr scale (IMPS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE) at suitable intervals. The results indicated that thiothixene conferred no advantage over chlorpromazine in symptom relief or social improvement. Serial measures showed no significant change in these patients as a group when on active drugs as opposed to placebo, or with the course of time. 12.5% of patients relapsed during the placebo period: these patients were younger than the non-relapsers and had received larger daily doses of phenothiazines prior to the trial.

OSO-5 Dim Light Monitor.

The design, calibration, and operation of the University of Minnesota's experiment on board the satellite OS0-5 are described. The instrument was designed to measure zodiacal light, airglow, and lightning. The orientation and stability of the spacecraft is also discussed as it pertains to the experiment.