Increased pituitary volume in antipsychotic-free and antipsychotic-treated patients of the Æsop First-Onset Psychosis Study

Subjects at their first psychotic episode show an enlarged volume of the pituitary gland, but whether this is due to hypothalamic–pituitary–adrenal (HPA) axis hyperactivity, or to stimulation of the prolactin-secreting cells by antipsychotic treatment, is unclear. We measured pituitary volume, using 1.5-mm, coronal, 1.5 T, high-resolution MRI images, in 78 patients at the first psychotic episode and 78age- and gender-matched healthy controls. In all, 18 patients were antipsychotic-free (12 of these were antipsychotic-naý¨ve), 26 werereceiving atypical antipsychotics, and 33 were receiving typical antipsychotics. As hypothesized, patients had a larger pituitary volume than controls (+22percent , p=0.001). When divided by antipsychotic treatment, and compared to controls, the pituitary volume was 15 percent larger in antipsychotic-free patients (p¼0.028), 17 percent larger in patients receiving atypicals (p¼0.01), and 30 percent larger in patients receiving typicals (p=0.001). Patients receiving typicals not only had the largest pituitary volume compared to controls but also showed a trend for a larger pituitary volume compared to the other patients grouped together (11 percent, p¼0.08). When divided by diagnosis, and compared to controls, the pituitary volume was 24 percent larger in patients with schizophrenia/schizophreniform disorder (n¼40, p=0.001), 19 percent larger in depressed patients (n¼13, p¼0.022), 16 percent larger in bipolar patients (n¼16, p¼0.037), and 12 percent larger in those with other psychoses (n¼9, p¼0.2). In conclusion, the first-episode of a psychotic disorder is associated with a larger pituitary independently of the presenceof antipsychotic treatment, and this could be due to activation of the HPA axis. Typical antipsychotics exert an additional enlarging effecton pituitary volume, likely to be related to activation of prolactin-secreting cells...

An analysis of psychiatric inpatient admissions from a defined geographic catchment area over a one-year period

The psychiatric inpatients from a defined geographic catchment area of 100,159 were analysed for the year 1986. The inpatient treated prevalence was 5 per 1,000 the population over 15 years of age. There were 85 long-stay patients and 413 admissions during the year. Thirty-eight per cent of all admissions for 1986 had schizophrenic psychoses, 34 percent had alcohol and drug disorders, and 15 percent had affective disorders. Forty-nine per cent of first admissions had alcohol and drug disorders, and 28 per cent had schizophrenic psychoses. Schizophrenic psychosis was the diagnosis in 61 per cent of those patients who had more than 3 previous admissions. Substance abuse, acute schizophrenic psychosis and chronic schizophrenic psychosis accounted for 72 per cent of admissions for 1986. The duration of stay in hospital was longer for female patients than for male patients for each of the main diagnostic categories. The need for epidemiological and hospital utilization studies to provide essential data for the rational planning of psychiatric services in Trinidad and Tobago is emphasized (AU)

Neurological sequelae of lithium therapy

A case of lithium toxicity is reported even though very close monitoring of blood lithium levels was maintained. Blood lithium levels continued to rise after oral medication was discontinued. Regular clinical assessments and facilities for forced alkaline diuresis are as important as facilities for blood lithium levels (AU)

First admissions and planning in Jamaica

An unselected sample of 90 first admissions (66 male and 24 female) to the only mental hospital in Jamaica is described. Over 60 percent were less than 35 years of age with a younger age of onset in the males. Half the admissions were schizophrenics, a fifth affective disorders, a quarter of organic disorders, and none psychoneurotic. The sex distributions of these groups showed a marked male excess for schizophrenia and organic disorders which was not present for affective disorders. In addition to the effects of introducing psychiatric care in general hospitals, factors of selection, social stress and protection are discussed to explain these findings. The implications for planning and research are noted. It is recommended that nurses be given authority as Mental Health Supervisors to cope with the problems in this rural society (Summary)