The case notes of all 67 manic patients admitted to the psychiatric wing of a District General Hospital over a period of two years were screened for evidence of independent life events during a four week period prior to admission. The nature of such events and of the underlying stresses was examined and the data obtained were compared with data from a control group of acute surgical admissions. Four times as many manic patients had an independent life event closely preceding their admission. It is concluded that stress in the form of loss or threat is a common precipitant of mania. Some surprising findings are focused upon and discussed.
The notion of a subclinical preschizophrenic condition already present in childhood is given further support by the findings of this follow-back study, which also brings into sharper focus the childhood profile of the likely adult schizophrenic.
Fifty patients in their first manic episode were compared retrospectively with groups of (a) manic patients in other than first admissions and (b) acute surgical cases. They were then followed up for 3–8 years. First manic admissions were linked to life events far more frequently – 66%vs20% and 8% respectively for the other groups. Within-group comparisons showed patients with life events were much younger. The link between life events and manic episodes appeared immediate and selective, a view further supported by the findings of the follow-up. Later episodes precipitated by life events seem to require smaller amounts of stress. The possible role of life events in relation to mania is discussed.
A B S T R A C TRecognizing that child and adolescent psychiatry operates in the context of opinions, we set out to discover GPs' views and prescribing practices in connection to adolescent depressive presentations. Two-thirds of respondents felt there had been a recent increase in presentations and their views on the reasons were further examined. However, only one third have been prescribing more often and the reasons for this were also examined. It is clear that although they recognize increased unhappiness among youngsters this is not often seen as 'illness depression'. The implications are further discussed.
Cyclic psychosis, menstrual cycle and adolescence Sm: Stein et a! (BJP, December 1993, 163, 824â€" 828) referred to the paucity of reported cases of cyclic psychosis associated with menstruation. I would like to add two further case reports to the existing meagre pool. Case 1. B was a 14-year-old referred urgently, havingbecome acutely disturbed. She had menarche seven months earlier, but had seen no period subsequently. The initial symptoms were manic with loss of sleep, excess activity, pressure of talk, loosening of associations, and a belief that she had been given special discounts from a local shop, whichhad led her to knockingon neighbours' doors, offering to buy things for them. This picture altered within 48 hours, without treatment, to one of depressed mood, crying easily, sleeplessness, and a sense of anguish relating to vivid depersonalisation and derealisation phenomena. She could not tolerate her mother leaving her side. This picture lasted two more days, and resolved completely in another two days, to be followed by total remission for 22 days. It then recurred, lasting a further six days. On this occasion, phenothiazines were used and the overall intensity was reduced. Total remission followed again. Electroencephalography was performed twice, dur ing the remissionand during the acute phase, but proved negative.Having been informed of the existence of previous episodes, we checked for dates with the school and it became clear, from her attendance records, that there had been in total fiveepisodesoccurringexactlyevery28 days and lasting for a week on every occasion. On the basis of this information, phenothiazines were withdrawn and treatment with progestogen instituted. The patient experi enced no psychotic episodes in the next six months, her periods reappeared,and the patient was discharged from clinic.
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