In an attempt to evaluate retrospectively the three‐year course and outcome of treated adolescent schizophrenics, the medical data of 19 patients were collected from the first admissions over a period of 10 years (1971‐1981). According to the DSM‐III criteria, 17 were diagnosed as having schizophrenic disorders and the remaining 2 were schizophreniform disorders. The outcome at the time of first‐ to third‐year follow‐up was assessed on the outcome rating scale. The three‐year outcome was favorable with respect to both the length of hospitalization and the presence of psychotic symptoms. However, there was a sustained impairment in occupational (or scholastic) functioning throughout the three‐year follow‐up period. The female sex and the initial diagnosis of schizophreniform disorder might be factors affecting the good third‐year clinical (or symptomatic) outcome. The younger age at onset, the longer duration of the prodromal phase, and the longer period of time between the onset and the first presentation appeared to predict the poor third‐year occupational outcome.
A lithium and carbamazepine combination was reported in five patients with bipolar disorder (DSM-111), who had not received benefits from conventional treatments. Patients 1, 2 and 4 showed favorable antimanic responses to carbamazepine used in combination with lithium carbonate. Patient 3 did not respond well to either lithium or carbamazepine alone, but improved dramatically on the simultaneous administration of the two drugs. The prophylactic benefit was observed in two patients. These clinical results suggest that a lithium and carbamazepine combination may be more efficacious in the treatment of acute manic episode and the prevention of affective recurrences than each drug alone.
This is a report on the clinical experience in consultation‐liaison psychiatric service for patients with end‐stage renal disease undergoing renal transplantation. Among a total of 30 patients (23 men and 7 women) 13 (43%) developed psychiatric disturbances: depressive state, 8; anxious‐irritable state, 5; and delirious state, 1 (One patient had both depressive and delirious states). Five patients got depressed following the episodes of a rejection reaction. Three of them had a graftectomy which exacerbated their depressions. The occurrence of rejection reaction was thought to be a major precipitating factor. Four patients became anxious‐irritable within a week following transplantation. Patient's intolerance to stressors seemed more responsible for the anxious‐irritable state than stressors per se. Steroid medications were thought to be a predisposing, not a causal, factor to psychiatric disturbances in transplant patients. In the 21 patients who were assessed preoperatively and who had no rejection reactions, the Basic Rorschach Score of less than – 20 was a predictor of posrtransplant psychiatric disturbances. Psychiatric interventions were done for the 13 mentally ill patients in collaboration with the surgeons in charge and ward nurses. For the patients with the anxious‐irritable state, listening, reassurance, and anxiolytics (sometimes with additional antipsychotics) were effective. For those who had a depressive state and who became uncooperative, “conjoint” sessions with the patients and their family members (e.g. spouses) were of therapeutic use.
This is a report on six psychiatric patients who indulged in excessive ingestion of water and subsequently developed tonic‐clonic seizures in the course of the underlying mental disorders. On the basis of the DSM‐III criteria, they were diagnosed as follows: schizophrenic disorder, 4; schizoaffective disorder, 1; borderline personality disorder, 1. The levels of serum electrolytes were estimated during five episodes of seizures in three patients. Hyponatremia was a consistent finding (serum sodium: mean = 120.6 mEq/liter). Plasma osmolality and plasma levels of arginine vasopressin (AVP) were determined during two episodes in two patients. The inappropriately high circulating levels of AVP relative to plasma hypoosmolality were documented. However, the response to the overnight fluid deprivation and acute water load during the period of no seizures in two patients revealed no evidence of the persistent SIADH, suggesting the temporal association of hyponatremic encephalopathy with inappropriate AVP secretion. It is not conclusive whether the transient SIADH is the cause or the consequence of hyponatremic encephalopathy, although a delusion or an auditory hallucination could play a critical role in drinking water excessively in three patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.