Anorexia nervosa: a group case conference.

Four patients with primary anorexia nervosa were interviewed in order to demonstrate some of the characteristic features of this disorder. Although this disorder occurs only rarely in males, one of these four patients was a young man. Primary anorexia nervosa is discussed from a variety of perspectives, including descriptive, psychodynamic, and hormonal. A brief review of the theoretical rationale underlying a variety of psychotherapeutic approaches is offered, and reports of their effectiveness are considered. Primary anorexia nervosa is probably best conceptualized as a complicated disorder with an admixture of serious psychological and somatic components, including the characteristic approach-avoidance conflict over eating. The authors speculate on the possibility of an underlying disorder of central catecholamine metabolism, particularly in relationship to dopamine transmission.

Psychiatric consultation to a general hospital medical evaluation service.

Psychiatric consultation to a general hospital medical evaluation service was reviewed and compared with consultation patterns for general hospital inpatients and psychiatric emergency service patients. Results of a questionnaire survey indicated nearly 1 in 5 patients admitted to this acute medical service (24-hour maximum stay) required psychiatric consultation. A study of those patients seen by psychiatric consultants is reported. The prevalence of depressive illness as well as the psychiatric hospitalization referral rate was substantially greater than in general hospital inpatient or psychiatric emergency service evaluations. The implications of this relatively new area of consultation-liaison for hospital staffing and medical education are discussed.

Therapeutic failure of oral thyrotropin-releasing hormone in depression.

A double-blind investigation of the psychological and hormonal responses to orally administered thyrotropin-releasing hormone (TRH) in a dosage range of 200 to 300 mg daily was conducted in a group of 11 depressed patients hospitalized for an initial 10-day period and followed as outpatients for the balance of a 30-day period of observation. The study was purposely restricted to depressives conventionally classed as reactive, neurotic, or characterologic, the groups most commonly encountered clinically. Contrary to some reports of TRH as an effective antidepressant, our results indicated not only failure of benefit but actual antitherapeutic effects in 3 of 6 treated patients as compared with placebo controls. Excessive CNS arousal with psychomotor activation produced dysphoric mental and behavioral effects in these patients.

Antinuclear antibodies in chronic psychotic patients treated with chlorpromazine.

The authors found a significantly higher incidence of antinuclear antibodies (ANA) and positive lupus erythematosus cell tests in chronic psychotic patients who received 400 mg a day or more of chlorpromazine (CPZ) for at least 7 weeks than in those who had taken 50 to 300 mg a day for varying periods or those who had received no CPZ for at least 3 months. Despite the high incidence of ANA, there was no observed development of lupuslike syndrome. The authors suggest that CPZ in high doses may induce ANA in humans.