An analysis of reported deaths following electroconvulsive therapy in Texas, 1993-1998.

Since 1993, Texas law has required that all deaths that occur within 14 days of electroconvulsive therapy (ECT) be reported to the Texas Department of Mental Health and Mental Retardation. This study attempted to differentiate deaths that may have been due to ECT or the associated anesthesia from those due to other causes. Among more than 8,000 patients who received 49,048 ECT treatments between 1993 and 1998, a total of 30 deaths were reported to the mental health department between 1993 and 1998. Only one death, which occurred on the same day as the ECT, could be specifically linked to the associated anesthesia. An additional four deaths could plausibly have been associated with the anesthesia, for which the calculated mortality rate is between two and ten per 100,000, but probably not with the stimulus of the ECT or seizure. The mortality rate associated with ECT (less than two per 100,000 treatments) in Texas is extremely low.

Treatment of major depression complicated by bilateral foot drop and double incontinence with ECT.

This report describes a 56-year-old man with severe depression who developed bilateral foot drop, dual incontinence, and swallowing difficulties, which required several physical investigations and consultations before an excellent response to electroconvulsive therapy occurred with reversal of all symptoms.

A survey of psychiatrists' attitudes toward electroconvulsive therapy.

Sixty-seven psychiatrists who were employed in state hospitals in Texas were surveyed about their attitudes toward use of electroconvulsive therapy (ECT) and the laws and regulations associated with its use. The majority of respondents agreed with accepted professional guidelines on ECT usage and had a positive attitude toward ECT treatment. However, the number of referrals for ECT by these psychiatrists was low, perhaps due to the view that Texas laws and policies about ECT are restrictive and limiting to patient care. The majority of respondents indicated that more professional education about laws and policies related to ECT is needed.

Treatment of an unusual case of masochism.

Masochistic sexual activity is potentially dangerous, rarely reported voluntarily, and hard to treat. This article describes a masochist patient who received sexual gratification from being burnt or crushed. Antiandrogen medication, serotonin uptake inhibitor, and psychodynamic psychotherapy along with sexual education and social-skills training and aversive behavior therapy were all tried over a period of 9 months. The response was measured by effects of treatments on the frequency of erotic fantasies and masturbation. Antiandrogens and aversive behavior therapies may be the most effective treatments for such cases, at least in the short term, although the underlying social deficits and the need to reshape the sexual behavior ought to be addressed in the long term.

Autoenucleation--a culture-specific phenomenon: a case series and review.

Cases of autoenucleation may provide a good example of the pathoplastic effects of culture. To further characterize this phenomenon, the author reviewed the medical literature and conducted a retrospective search of the local psychiatric hospital records. Medline search did not show a single case of autoenucleation in the non-European Christian culture. Descriptive accounts of the identified seven patients show they were all psychotic at the time of the act, and five had a history of prior drug abuse. Most were religiously preoccupied before the act and displayed prominent affective symptoms, and they all interpreted the Biblical text literally. The association of sight and the concept of sin is discussed in a wider cultural context, and it is proposed that autoenucleation may be unique to the Christian West.

Prolactogenic effects of risperidone in male patients--a preliminary study.

This preliminary study describes a case of a male patient who developed gynaecomastia and sexual difficulties whilst taking risperidone for chronic paranoid schizophrenia. Laboratory tests showed raised prolactin levels and depressed testosterone levels which were reversed on cessation of medication. A small study was subsequently conducted on male psychotic patients to compare the prolactogenic effects of risperidone (n=14) with traditional antipsychotic medication (n=15). The results showed a greater but non-significant prolactogenic effect of risperidone.

Monozygotic twins, folie à deux and heritability: a case report and critical review.

A case report of shared delusional disorder, with a primary diagnosis of delusional disorder, is described in identical twins of proven zygosity. A review of literature shows that the primary diagnosis in identical twin pairs, suffering from folie à deux, is delusional disorder. This is in contrast to the reported excess of schizophrenia, as a primary diagnosis, in non-twin cases of folie à deux. Moreover, schizophrenia is poorly related to delusional disorders on the basis of demographic and familial studies. In the light of this paradox, nosological status of this disorder and the sociogenic and genetic factors are critically discussed.

Delusional disorder in a boy with phenylketonuria and amine metabolites in the cerebrospinal fluid after treatment with neuroleptics.

A case report of a 16-year-old boy with the classical form of phenylketonuria (PKU) and suffering from a delusional disorder is presented. He did not respond to a traditional antipsychotic medication but improved on an atypical antipsychotic, risperidone. The cerebrospinal fluid metabolites of the biogenic amines were measured and are also reported in the context of a recent interest in the ratios of these amine metabolites in schizophrenia. It is proposed that such dually diagnosed patients with PKU may provide a model in which to test the prevalent biogenic amine theories in psychiatric disorders.

Delusional pregnancy with polydipsia: a case report.

We report a case of delusional pregnancy with polydipsia in a female patient with paranoid schizophrenia. The contribution of psychological and physiological factors in the development of the delusion of pregnancy and polydipsia and the possible interactions between the two phenomena are discussed.

A controlled psychiatric study of individuals at risk for Huntington's disease.

BACKGROUND: The study tested specific hypotheses that (a) there is an increased incidence of psychiatric disorders in asymptomatic heterozygotes for Huntington's disease (HD) compared with the normal homozygotes, and (b) there is an increased incidence of psychiatric disorders in the adult offspring of Huntington's disease patients compared with their partners. METHOD: A controlled study was made of 93 apparently healthy individuals (at 50% risk), who had given DNA samples for the predictive test, and 70 of their partners. Current and past psychopathology was assessed and compared with the DNA predictive test results based on linkage analyses. The results of psychiatric assessments of the two groups were compared. RESULTS: DNA test results were available for 53 subjects (of 93). Five subjects at risk for HD were omitted from the study. The asymptomatic heterozygotes (n = 20) showed no significant increase in the incidence of any psychiatric episode, depression, schizophrenia or behavioural disorder when compared with the normal homozygotes (n = 33). The whole tested group showed a significantly greater number of psychiatric episodes than their partners (n = 43). CONCLUSIONS: Asymptomatic HD gene carriers do not have a greater incidence of psychiatric disorders than the non-gene carriers born to a HD parent.

Aggressive behaviour in Huntington's disease: a cross-sectional study in a nursing home population.

We describe a cross-sectional study of aggressive behaviour in a sample of patients suffering from Huntington's disease in a residential nursing home. Data were obtained using the RAGE, a behaviourally oriented rating scale for measuring aggressive behaviour in cognitively impaired patients. Nursing staff rated 27 patients after a 3 day observation period. A third of the sample were rated to be at least mildly aggressive; the frequencies of some specific types of aggressive behaviour were high. In contrast, the frequency of injuries sustained and the use of restraints and medication for aggressive behaviour were low. Aggressive behaviour was found to be significantly related to the degree of functional impairment. These data are compared with those reported in a study using the RAGE to assess aggressive behaviour in a sample of elderly patients with dementia.