Normal thyroid function in desipramine nonresponders converted to responders by the addition of L-triiodothyronine.

The results of complete thyroid function testing were normal in four desipramine nonresponders who were converted to responders by addition of L-triiodothyronine (T3). These findings suggest that the effectiveness of T3 is not due to correction of subtle thyroid deficiencies.

Comparative cardiac effects of maprotiline and doxepin in elderly depressed patients.

In a double-blind study, 49 elderly patients with primary major depression, with or without cardiovascular disease, were treated with maprotiline or doxepin. Holter monitors, 12-lead ECGs, and orthostatic blood pressure measurements were used. Maprotiline was associated with decreased PVCs in patients with a "high" baseline rate, while doxepin was associated with increased PVCs in this group. There were no significant differences in orthostatic blood pressure changes between treatment and nontreatment phases or between the two drugs. Small but significant increases in heart rate and prolonged PR interval were noted with both drugs. QRS interval was prolonged by maprotiline but decreased by doxepin. Neither drug produced untoward effects in patients with stable angina or an old myocardial infarction. Maprotiline may have an antiarrhythmic effect which could be beneficial in the treatment of depression with concomitant PVCs. Conversely, doxepin may be more appropriate for depressed patients with heart block or intracardiac conduction delays. Further research is necessary to confirm these suggestions.

Identifying and managing borderline personality patients.

Individuals with the borderline personality disorder are less stable than neurotics but do not have sustained psychotic decompensations. These patients are socially insensitive, impulsive, resentful and chronically depressed, and may display fits of anger. Borderline patients experience the greatest difficulty in dealing with intense relationships. Medical problems that require sustained follow-up may bring about a doctor-patient relationship intense enough to stir up turmoil. The cornerstone of treating such patients is maintaining a limited relationship.

Pre-existing uninhibited bladder facilitating drug-induced enuresis: four case reports.

The author presents four cases of antipsychotic drug-induced enuresis preceded by occult symptoms of mild uninhibited bladder. Pre-existing uninhibited bladder may facilitate some cases of antipsychotic drug-induced enuresis.

A rational ordering of the actions of antipsychotic drugs.

Most major actions of the antipsychotic drugs stem from one of the four antagonistic functions common to all these drugs. Antidopaminergic activity in the mesolimbic system results in the primary desired effect, control of psychosis. Antidopaminergic activity also occurs in other brain areas. Dopamine blockade in the nigrostriatal pathway results in extrapyramidal symptoms and tardive dyskinesia. Blockade in the tuberoinfundibular tract of the hypothalamus causes elevated circulating prolactin. Central H1 histaminic receptors are also blocked by these drugs, causing sedation. The anti-alpha adrenergic activity of the antipsychotics results in orthostatic hypotension, and antimuscarinic activity results in the atropinic picture commonly seen with these drugs. The mnemonic "the anti-fours" is used to order the four major pharmacological effects: anti-dopaminergic, anti-H1 histaminic, anti-alpha adrenergic, and anti-muscarinic.

Superimposed encephalopathy in the psychotic patient.

Encephalopathy (acute organic brain syndrome) superimposed on functional psychosis may be overlooked because the physician assumes that any exacerbation is due to fluctuation in the psychosis. Correct diagnosis requires a high index of suspicion and a firm knowledge of the signs of encephalopathy. A careful diagnostic approach permits the recognition of encephalopathy and separates it from functional disorders such as schizophrenia.