The prevalence of late-onset schizophrenia in a psychogeriatric population.

Of 288 patients admitted to our psychogeriatric unit during a 4-year study, seven patients were diagnosed as having symptoms of paranoid schizophrenia (2.4% of all admissions). All the patients were women. Their symptoms included bizarre delusions and auditory hallucinations. Negative symptoms were rare. Attempts to reduce the dosage of neuroleptic medication led to reappearance of the symptoms in six patients and readmission of the seventh.

Tardive dyskinesia in elderly psychiatric patients: a 5-year study.

OBJECTIVE: The authors investigated the prevalence of tardive dyskinesia among elderly psychiatric patients who had never received neuroleptic medication before their first hospitalization. METHOD: The study was performed in the geriatric psychiatry unit of a university-affiliated hospital in Canada and involved all first-admission patients admitted from September 1984 through August 1989 who had never taken neuroleptic drugs. In September and October 1989, the patients who were available for follow-up were examined and given ratings on the Abnormal Involuntary Movement Scale to establish the presence or absence of tardive dyskinesia. The patients' records were reviewed for information on age, diagnosis, duration of hospitalization, neuroleptic treatment received after admission, anticholinergic drugs received, and drug-free periods. RESULTS: Of the 162 patients who were available and whose data were analyzed, a total of 99 had been treated with neuroleptics, and 35 (35.4%) of these were found to have tardive dyskinesia. Two of the 35 also had tardive dystonia. Significantly more patients with major depression than patients with primary degenerative dementia or delusional psychosis had tardive dyskinesia. CONCLUSIONS: This study confirms the higher vulnerability of elderly psychiatric patients treated with neuroleptics to the development of tardive dyskinesia. The authors stress that caution is especially necessary when neuroleptics are prescribed for older patients with major affective disorders.

Propranolol in the treatment of tardive akathisia: a report of two cases.

The authors present two patients suffering from tardive akathisia. They also review the available literature on the subject. Propranolol was found to be an effective treatment of tardive akathisia in both patients. The implications of this finding are discussed.

Prevalence of bipolar disorder in a psychogeriatric population.

Bipolar affective disorder arising for the first time in old age (60 years and over) has not been extensively studied. The authors present a prevalence study of mania arising after age 60. Of 217 patients admitted to our unit in a 2-year period, 10 (4.7%) showed symptoms of mania, using the DSM-III criteria. This constitutes 9.3% of 108 affective disorder patients admitted during the same period. An important factor in the precipitation of these attacks was marital discord, leading, in several cases, to separation, even in this age group.

Carbamazepine and hyponatremia in patients with affective disorder.

The authors assessed 20 carbamazepine-treated patients for the development of hyponatremia. None of the patients had readings below 135 meg/liter of sodium before carbamazepine therapy, but five (25%) did have such readings after carbamazepine therapy. Three of these patients developed frank symptoms of hyponatremia within 1-3 months of the start of therapy. In one patient, hyponatremia developed after rechallenge with carbamazepine. The authors suggest that caution be used in prescribing carbamazepine to patients with low or borderline low sodium values.

Lithium-induced thyroid disorders: a prevalence study.

A group of 116 lithium-treated patients (53 men, 63 women) with predominant diagnoses of affective disorders were systematically examined for the presence of thyroid disorders. Nine (7.8%) patients (2 men, 7 women) were found to suffer from hypothyroidism after a mean of 3.4 years of lithium therapy. An increase in thyroid-stimulating hormone without clinical hypothyroidism was noted in 2 (1.7%) patients (both men). Hyperthyroidism with a full-blown picture of thyrotoxic nodular goiter was noted in 1 woman, and temporary increases in thyroxine and triiodothyronine were noted in another woman. These findings are discussed in light of other studies.

Carbamazepine, diuretics, and hyponatremia: a possible interaction.

Although carbamazepine is known to cause hyponatremia, no previous reports have indicated an interaction between carbamazepine and a diuretic. Two patients are described who were treated with this combination and developed symptomatic hyponatremia, which cleared when both drugs were discontinued in one patient and when the diuretic was discontinued in the second patient. The possible mechanisms of action of carbamazepine-induced hyponatremia are discussed.

Hepatic glucose extraction in normal and diabetic man.

Fractional hepatic extraction of glucose was determined from the appearance in the systemic circulation of ingested 3-[3H]glucose. Using the glucose clamp technique, studies were done under steady-state conditions of basal glycemia and insulinemia, normoglycemia (0.8 mg/mL) and mild hyperinsulinemia (approximately 40 microU/mL), hyperglycemia (2 mg/mL-1) and hyperinsulinemia (approximately 100 microU/mL). Based on previous results in the dog, an oral glucose load of 2 g was used to label the portal vein glucose; this amount was chosen so as to minimize disturbance of the portal steady state but still avoid excessive loss during absorption. Additional subjects with hyperglycemia and hyperinsulinemia received an oral load of 50 g of glucose. Fractional extraction in normal subjects under near-basal conditions of glycemia and insulinemia was 19% in normal subjects and in patients with noninsulin-dependent diabetes mellitus (NIDDM) elevation of serum insulin, with or without hyperglycemia, which led to an average extraction rate of 32% of the ingested glucose. Absolute hepatic glucose uptake, calculated from the fractional extraction the plasma glucose concentration, and hepatic plasma flow accounted for 50% to 72% of total glucose use during the various steady states and following ingestion of 50 g of glucose. It is concluded that hepatic uptake or extraction, as opposed to net uptake, proceeds actively even when plasma glucose and insulin are within the normal basal range; it is increased in the presence of hyperinsulinemia, with or without hyperglycemia; and it is unaltered in NIDDM.

Study of the incidence and prevalence of children bronchial asthma in a Romanian town.

The incidence of bronchial asthma was investigated in a population of 4,486 schoolchildren aged 6 to 14 years from Rîmnicu Vîlcea, a Romanian town in the meridional sub-Carpathian zone of the country. The incidence of "probable asthma" was found to be 2.45% and that of confirmed asthma 1.62%. These percentages are among the highest ever encountered in Romania, in both children and adults. A family history of atopy was observed in 42.3% of the children and of asthma in 28.7%. Such big figures have never been found in adults in Romania.