ABSTRACT
Psychotic episodes and epilepsy can occur without mental retardation in tuberous sclerosis. The diagnosis may depend on elucidating the family history since physical signs may not be obvious. Establishing the diagnosis makes genetic counselling possible.
Subject(s)
Epilepsy/etiology , Neurocognitive Disorders/etiology , Tuberous Sclerosis/psychology , Adult , Humans , Male , Tuberous Sclerosis/geneticsABSTRACT
Tests of thyroid function and pathology were carried out on 133 patients before they were treated with lithium (Li+). Of the 12 patients who subsequently became hypothyroid during treatment with lithium 9 had, before the commencement of treatment, thyroid autoantibodies and/or an exaggerated thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH), whereas 3 patients had neither of these indicators. Lithium administration was accompanied by a rise in thyroid antibody titre in 20 patients but a fall in only 5, a statistically significant difference. Evidence that it may be an immunostimulant is discussed. Li+-induced thyroid failure cannot be accurately predicted, and may occur suddenly. The best minimum safeguard, therefore, is serial thyroxine (T4) (or free T4) estimation, supplemented if equivocal by a free thyroxine index (FTI), a basal TSH and, if doubt remains, by a TRH test.
Subject(s)
Autoantibodies/analysis , Lithium/adverse effects , Psychotic Disorders/drug therapy , Thyroid Function Tests , Thyroid Gland/immunology , Antibodies, Antinuclear/analysis , Bipolar Disorder/drug therapy , Depressive Disorder/drug therapy , Follow-Up Studies , Humans , Hypothyroidism/chemically induced , Lithium/therapeutic use , Thyrotropin/blood , Thyrotropin-Releasing HormoneABSTRACT
Thirty-eight depressed patients who were treated with ECT were randomly assigned to receive lithium therapy or identical-looking placebo tablets for one year after clinical recovery in a double-blind trial. The patients who received placebo tablets spent an average of 7.8 weeks with an episode of depression (either as in-patients or day-patients) during the year. In comparison, patients who received lithium spent on average 1.7 weeks with an episode (P less than 0.02). The trial confirms the high rate of relapses after ECT and suggests that lithium considerably reduces this morbidity. It is suggested that ECT without continuation therapy is not a satisfactory treatment of depressive illness.
Subject(s)
Depressive Disorder/therapy , Electroconvulsive Therapy , Lithium/therapeutic use , Adult , Aged , Clinical Trials as Topic , Double-Blind Method , Humans , Lithium Carbonate , Middle AgedABSTRACT
The present study is concerned with the outcome of long-term lithium maintenance therapy administered to 107 manic-depressive patients after more than 12 months. Nine patients failed to respond despite having met the criteria for maintenance within the therapeutic range of lithium. This group, termed "lithium non-responders", had all shown bipolar illness with gross morbidity with frequent cycles, greater than 4 per year, seven had a family history of affective illness (six bipolar). The study did not demonstarte any other clear factors common to the "non-responders" group.
