ABSTRACT
Seven patients (6 men and 1 woman, mean age 39.1 +/- SD 6.9 years) with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent serial determinations of serum sodium (SOD), plasma atrial natriuretic peptide (ANP), and urinary osmolality (UOSM) at 7 AM and 4 PM. There was a diurnal increase in ANP (7 AM 17.9 +/- 5.1 pg/ml and 4 PM 27.7 +/- 9.0 pg/ml, p = 0.02), a diurnal decrease in serum sodium (7 AM 141.1 +/- 1.7 mEq/l, 4 PM 129.9 +/- 3.2 mEq/l, p less than 0.0001) and no diurnal change in UOSM. The diurnal increase in ANP in the the PIP syndrome contrasts to the diurnal decrease in ANP reported in normal subjects. Our data, while preliminary, suggest that patients with the PIP syndrome have increased intravascular volume leading to ANP secretion, natriuresis, and hyponatremia.
Subject(s)
Circadian Rhythm , Hyponatremia/physiopathology , Psychotic Disorders/physiopathology , Thirst/physiology , Adult , Atrial Natriuretic Factor/blood , Female , Humans , Hyponatremia/metabolism , Male , Middle Aged , Osmolar Concentration , Psychotic Disorders/metabolism , Sodium/blood , Syndrome , Urine/chemistryABSTRACT
Ten male patients (mean age 37.3 +/- 6.4 years) with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent measurement of weight, sitting and standing blood pressure, and serum sodium concentration at 7 a.m. and 4 p.m. weekly for 8 consecutive weeks. Blood pressure was higher in the afternoon than in the morning. The diurnal decrease in serum sodium (141.4 +/- 2.8 to 134.2 +/- 4.8 mEq/l) was associated with a diurnal increase in weight (78.4 +/- 9.7 to 80.0 +/- 10.3 kg). When the weight increase was normalized by dividing by 7 a.m. weight (NDWG), the following relationship evolved: diurnal serum sodium decrease = 3.060 + [201.728 x NDWG]. Therefore, NDWG accounted for 63.1% of the variability of serum sodium. Using the known relationship of plasma water, total body water, and total body weight, we calculated that antidiuresis (afternoon weight gain) accounted for 62.5% of afternoon hyponatremia. Thus, two separate methods of calculating the relationship between antidiuresis and hyponatremia provided remarkably similar findings. We derived a table to predict 4 p.m. serum sodium values based on 7 a.m. weight, 7 a.m. serum sodium, and 4 p.m. weight.
Subject(s)
Circadian Rhythm , Drinking , Hyponatremia/psychology , Psychotic Disorders/psychology , Sodium/blood , Weight Gain , Adult , Bipolar Disorder/psychology , Humans , Hyponatremia/blood , Male , Psychotic Disorders/blood , Schizophrenic Psychology , SyndromeABSTRACT
Behavior change through psychotherapy is frequently accomplished through the use of homework assignments conducted by patients between treatment sessions. There has been little attention directed at adherence to such behavioral prescriptions. This study compares the effects of Verbal versus Written behavioral prescriptions on recall of self-reported adherence to therapeutic homework assignments. Thirty subjects were randomly assigned to the Verbal and Written conditions in a counterbalanced, within-subjects, crossover design. Written prescriptions led to significantly better recall of and adherence to homework assignments.
Subject(s)
Behavior Therapy/methods , Patient Compliance , Psychophysiologic Disorders/therapy , Adult , Female , Follow-Up Studies , Humans , Male , Psychophysiologic Disorders/psychologyABSTRACT
From a study population of 29 institutionalized chronically psychotic patients, 70% of whom had schizophrenic or schizoaffective disorders, nonpolyuric and polyuric patients had similar diurnal patterns of urine excretion. Patients excreted a larger portion of daily urine volume after noon (55%) than before noon (45%).
Subject(s)
Psychotic Disorders/urine , Schizophrenia/urine , Adult , Chronic Disease , Female , Humans , Male , Middle Aged , UrodynamicsSubject(s)
Circadian Rhythm , Hyponatremia/physiopathology , Polyuria/physiopathology , Psychotic Disorders/physiopathology , Weight Gain , Adult , Bipolar Disorder/physiopathology , Blood Pressure , Creatinine/urine , Humans , Male , Neurocognitive Disorders/physiopathology , Schizophrenia/physiopathology , Water Intoxication/physiopathologyABSTRACT
A speech and hearing-impaired adult male received social skills training consisting of modeling instruction and behavior rehearsal in a controlled multiple baseline design to increase his nonverbal interpersonal communication skills. Treatment resulted in improvement in objective behavioral components during role-played interactions and generalized to untrained situations. Issues related to the importance of interpersonal social skills training for the speech- and hearing-impaired are discussed.
Subject(s)
Hearing Loss, Sensorineural/rehabilitation , Social Behavior , Speech Disorders/rehabilitation , Adult , Behavior Therapy , Humans , Interpersonal Relations , Male , Social Adjustment , Speech , Speech Disorders/psychologyABSTRACT
Dental school and professional practice are well-documented sources of stress. Although students and dentists risk developing stress-related disorders, no empirically evaluated method for helping dental students cope with stress has been reported. A group of 17 dental students participated in a six-session program that included instruction in self-relaxation and time management; exercise and leisure planning; and cognitive modification techniques. From pre- to post-training, subjects showed improvement on a variety of self-report and physiological measures relative to a waiting-list control group. A three-month follow-up assessment revealed continued reductions in stress-related behavior. The importance of stress-management training for dental students is discussed as well as suggestions for future research.
