Correlations between mood scores, LH, adrenocortical steroids, and urine volumes in a patient with a history of postpartum depression and monthly psychotic episodes.

A simple semantic differential test was administered twice daily and urinary hormones measured as described previously . The subjects included the patient and two controls, one of whom experienced premenstrual physical, but not mental, discomfort. The test scores of the two controls, administered for five weeks, did not differ significantly from one another but greatly differed from those of the patient. The highest scores in the patient (indicating improved mood) were obtained during the week containing the urinary LH peak, and daily ratings correlated significantly with LH values. Significant, positive, correlations were also found between mood and ratios for aldosterone/cortisol, 18-hydroxydeoxycorticosterone(18-OH-DOC)/cortisol, and 18-OH-DOC/18-hydroxycorticosterone. Urine volumes correlated positively with cortisol, negatively with 18-OH-DOC, and negatively with mood (P<0.01). Urinary hormone assays, affording the advantages of a non-invasive technique may thus reveal relationships of potential interest. Whether these are causal, rather than casual, remains to be assessed.

A controlled study of light therapy for bulimia nervosa.

OBJECTIVE: Winter worsening of mood and eating symptoms, similar to that of seasonal affective disorder, has recently been reported in patients with bulimia nervosa. To assess the effectiveness of light therapy for treatment of bulimia nervosa, the authors conducted a study of light therapy during winter comparing an active (bright white light) condition to a control (dim red light) condition in bulimic patients who were not selected for a seasonal pattern of bulimia. METHOD: After a 2-week baseline assessment, 17 female patients with a DSM-III-R diagnosis of bulimia nervosa underwent early morning light treatment with 2 weeks of bright white light exposure (10,000 lux for 30 min/day) and 2 weeks of dim red light exposure (500 lux for 30 min/day) in a counterbalanced, crossover design. Outcome measures included daily binge/purge diaries, objective and subjective measures of mood, and the Eating Attitudes Test. Expectation of response for each condition was also assessed before treatment. RESULTS: Although pretreatment expectation ratings were similar for each condition, the bright white light condition was superior to the dim red light condition for all mood and eating outcome measures. Patients with "seasonal" bulimia (N = 7) had significantly greater improvement after the bright white light treatment than patients with nonseasonal bulimia (N = 10). No significant order effects were noted, nor differential effects for patients taking concurrent antidepressant medications (N = 4). CONCLUSIONS: These data suggest that bright white light therapy is an effective short-term treatment for both mood and eating disturbances associated with bulimia nervosa, although the therapeutic effect may be greater in those patients with a seasonal pattern.

Experience with cementless Protetim 'M' total hip endoprosthesis (A preliminary report).

A cementless Protetim 'M' endoprosthesis is used as an alternative to the cemented endoprosthesis. In the period from May 1992 to August 1992, 17 Protetim 'M' endoprostheses were implanted in 17 hips in 17 patients in our department. Of these 16 were without complaints after an average follow-up of 6.2 months (range 5-8 months). In one case longitudinal fissuring of the femur immediately distal to the end of the stem was observed in the postoperative X-ray control film. The patient, however, was asymptomatic during the early postoperative and follow-up period. Valgus positioning of the femoral component is essential in order to achieve good stability of the endoprosthesis.

[Reoperation of hip endoprostheses]. / Csípöízületi endoprotézisek reoperációi.

Experiences gained in 106 reoperations of 88 patients following 1968 total and 18 Wagner arthroplasties, performed in the Department of the authors between 30. 05. 1969. and 30. 06. 1991., are described. They think that after the THR yearly control and radiological examinations are necessary. Radiological signs in symptomless patients do not mean operative indication, in these cases regular control is thought to be even more important. Big loss of bone with loosening makes reoperation in symptomless patients necessary as with the progression of bone destruction the danger of fracture increases and the possibility of reimplantation becomes dubious. In dubious cases bone scintigraphy may be of help. The technical solutions used by them are described. At the planning of reoperation the age of the patient, the state of the acetabulum and femur are considered. Under 60 years of age and at loosening with big bone loss cementless prosthesis and bone transplantation are suggested. The most important is thought to be to reach stable fixation. Attention is called that the performance of reoperation needs good technical skills.

Fluoxetine treatment of obsessive-compulsive disorder.

Two patients suffering from severe obsessive-compulsive disorder which had proven refractory to clomipramine and/or phenelzine treatment were successfully treated with fluoxetine, a new drug with a strong serotonin uptake inhibiting action. Outcome of treatment was measured on psychometric tests including the Leyton Obsessive Inventory, Hopkins Symptom Checklist-90, Beck Depression Inventory, and daily self-reports of the duration and degree of discomfort of their most severe obsessions. The delay in responding to fluoxetine, the continuing improvement even after one year on the drug, and the prompt relapse with abrupt withdrawal of treatment were noted.

Seasonal mood symptoms in bulimia nervosa and seasonal affective disorder.

Mood and appetite disturbances are commonly found in bulimia nervosa and seasonal affective disorder (SAD). To investigate seasonality of mood symptoms, we administered the Seasonal Pattern Assessment Questionnaire (SPAQ) to 38 consecutive bulimic patients, 38 age- and sex-matched SAD patients, and 25 age- and sex-matched normal controls. The SPAQ is a reliable, retrospective, self-rated questionnaire that assesses seasonal changes in mood, sleep, weight, and social activity. The SAD patients had significantly higher Global Seasonality Scores (GSS) than the bulimic patients, who had higher scores than the control group (F = 78.6, df = 2.98, P less than .0001). Forty-two percent of bulimics met case-finding SPAQ criteria for SAD, compared with none of the control group (chi 2 = 14.1, df = 1, P less than .0005). These data suggest that a significant number of unselected bulimic patients have seasonal mood symptoms as severe as that seen in SAD. We propose that a common neurobiologic abnormality, such as serotonergic dysfunction, may underlie the common symptoms found in bulimia and SAD.

The structure of phobias in panic disorder.

Fear and avoidance of individual phobic situations were measured in 1168 patients with panic disorder suffering current attacks. Correlation and principal-components analyses give components of agoraphobia, illness phobia, and social phobia in panic disorder. Agoraphobia does not stand out so clearly as illness phobia and social phobia as a separate factor; 'fear of open spaces' shows some separation from other agoraphobic situations. Frequency of panic attacks and changes associated with their remission have no special relationship to agoraphobia. Closer attention to social and illness phobia may be fruitful in discerning the evolution of panic disorder.

Fluoxetine in panic disorder.

This paper presents the cases of two patients who suffered from panic disorder with agoraphobia and depression. One had been refractory to alprazolam and tricyclics and to behaviour therapy; she had responded to phenelzine, but due to a weight gain of 50 lbs, had discontinued treatment and she relapsed. The second patient, who also suffered from post-traumatic stress disorder, did not respond to alprazolam, imipramine or to phenelzine, but gained weight (33 lbs) on phenelzine. Both patients responded to fluoxetine 80 mg per day without concomitant weight gain.

A case of obsessive-compulsive disorder related to AIDS: psychopharmacologic treatment.

It is well known that delusions, obsessions and phobic reactions may centre on items which are of current topical interest. We report a case of obsessive-compulsive disorder manifested primarily by intrusive thoughts about AIDS. The patient eventually responded to an unusual combination of medications.

An unusual case of pica.

This paper presents the case of a 29 year old woman who compulsively ate rocks and pebbles, a habit developed in childhood. Extensive psychometric testing did not demonstrate phobias, obsessions, tendency to increased anxiety, depression or anorexic or bulimic disorder. The development of pica is partially explained by a childhood eating disorder, obsessive personality traits, cultural factors and specific (personality induced) stresses. Stress-reducing measures were successful in eliminating the eating disorder.

The fluoxetine treatment of low-weight, chronic bulimia nervosa.

Ten low-weight (mean, 87.8% of ideal), chronic bulimic patients, seven of whom were previously unsuccessfully treated with antidepressant drugs, received fluoxetine 80 mg/day for 3 months. Endpoint analysis showed a significant decrease in bulimic episodes (p = 0.01), vomiting frequency (p less than 0.05), and depression scores (Hamilton Rating Scale for Depression, p less than 0.04; Beck Depression Inventory, p = 0.05; Hopkins Symptom Checklist-90 depression subscale, p less than 0.05). In addition, trait anxiety (State-Trait Anxiety Inventory trait: p less than 0.002), obsessive symptoms (Leyton Obsessional Inventory symptom: p = 0.01; Symptom Checklist-90 obsessive-compulsive disorders subscale: p = 0.02), and traits (Leyton Obsessional Inventory trait: p = 0.005) also decreased significantly. There was no change in state anxiety or in Leyton Obsessional Inventory interference and resistance scores. There was no significant increase in weight. Two patients were in remission, two were much improved, two improved, and four showed no change. Side effects were minimal. There were no dropouts.

Successful fluvoxamine treatment of a case of refractory obsessive-compulsive disorder.

Fluvoxamine, a potent and selective serotonin uptake inhibitor, effectively reduced compulsive handwashing and other rituals in a patient previously refractory to behaviour therapy, clomipramine, MAO inhibitors and other pharmacotherapy. Treatment effect was delayed but broadly patholytic, reducing anxiety and depression scores as well as ratings of obsessiveness.

A treatment program for functional paraplegia/Munchausen syndrome.

Two patients, referred following lengthy, extensive and frequent medical evaluations, were diagnosed as suffering from chronic factitious disorder with physical symptoms (DSM III). A treatment plan to eliminate the positive reinforcements apparently operating in the hospital and home environment, while preventing "loss of face" of the patient, was formulated and successfully carried out. Two detailed case histories to provide evidence for the diagnosis, the "faradic massage" treatment, patient response, and follow-up are documented.

Trazodone treatment of bulimia nervosa.

Thirteen consecutive referrals of bulimic patients who met DSM-III criteria for bulimia were treated in an open-label, flexible-dose study with trazodone. Three of the 13 dropped out before the fourth week of treatment, the minimum duration of treatment for evaluable subjects, and hence were not included in the analyses. For the 10 evaluable patients, the mean duration of treatment was 6.9 weeks and the mean maximum dose of trazodone was 410 mg (range, 250-600 mg). The number of binge eating and vomiting episodes was significantly decreased (p = 0.05 and 0.06, respectively). These episodes were reduced to zero in four patients and by 55-99% in two patients. Carbohydrate cravings and urges to binge eat were significantly diminished in intensity (p less than 0.02 and 0.008, respectively). The total score (p = not significant) and three subscale scores (p = 0.04, 0.09, and 0.10) of the Eating Disorders Inventory decreased. The mean Hamilton Depression Scale score fell from 10.4 to 3.3 (p = 0.002). Only mild side effects were noted: five subjects complained of morning drowsiness and two of headache. Mean weight was essentially unchanged: pretreatment, 58.5 kg; posttreatment, 57.3 kg. The lack of weight gain represents an advantage of trazodone over other currently prescribed antidepressants, particularly for this group of patients whose fear of becoming fat is a part of their basic pathology.

[Experience with total hip prosthesis]. / Totalis csípöendoprotézisekkel szerzett tapasztalataink.

Authors report on their material of total hip endoprosthesis, performed 30 May 1969--31 August 1988 on the Department of Orthopaedics of the Semmelweis University of Medical Science. In this period 1480 operations were made. The formerly and recently used operative technique and the types of the prostheses are described. The intraoperative, the early and the late complications and their treatment are also described. The formerly and recently used tactics of reoperation is reported and attention is called to the fact that the success rate of the replantation can be increased by an adequate technical skill.

A case of self-inflicted leucotomy.

A suicide attempt with a gun resulted in left frontal lobe damage in a 19-year-old obsessive man. While intelligence did not suffer and no frontal lobe syndrome emerged, the patient's obsessive rituals were significantly reduced.