Lithium incorporation in the fibroblasts of manic-depressives.

Lithium incorporation in cultured human skin fibroblasts was measured in a group of 10 manic-depressives and 10 controls. This system was believed to eliminate many of the sources of variability to which measurement of the lithium ratio in erythrocytes (RBCs) is subject. A fibroblast lithium ratio calculated from 1-hr lithium incorporation studies correlated highly with an in vitro RBC lithium ratio in medication-free controls. Manic-depressives and controls did not differ in lithium incorporation or fibroblast lithium ratio, leading to the conclusion that the lithium ratio is probably not a good measure for differentiating the two populations.

alpha-Methyldopa and depression: a clinical study and review of the literature.

A review of the literature showed that a high incidence or prevalence of depression in patients being treated with alpha-methyldopa has never been documented. In their study of hypertensive patients in a general medical clinic the authors found that symptoms of depression were no more common in 42 patients treated with alpha-methyldopa than in 38 patients treated with other antihypertensive agents. As with other centrally active agents, alpha-methyldopa appears able to produce many different behavioral symptoms, including mood changes, in predisposed individuals. Because alpha-methyldopa is a DOPA decarboxylase inhibitor but does not consistently affect mood or induce depression, its effects do not support a catecholamine hypothesis of depression.

The elicitation of a movement disorder by trazodone: case report.

A 65-year-old woman with bipolar disorder and complicated cardiovascular disease who was on maintenance lithium therapy developed a movement disorder following high doses of trazodone for treatment of an acute depression. When the trazodone was reduced, the involuntary movements promptly ceased. Although the movement disorder could not with certainty be attributed to trazodone alone, the drug at least acted as an eliciting agent.

Self-amputation and restitution.

This paper reports two cases of psychotically induced self-amputation of the hand, and discusses the psychological issues for the patient and staff involved in replantation and adaptation. The psychiatrist's role in facilitating patients' and staffs' utilization of restorative innovative techniques is also addressed.

Academic difficulty of women, minority, and older medical student subgroups: a study of incidence and recovery.

Despite many retention studies, little is known about the performance of students in academic difficulty (SDs) who recover and graduate. In this study (1973-1982), the authors tracked 213 women, minorities, and older students in academic difficulty, those with three or more failures. Improvement measures were retention, National Board scores, and class rank at graduation.Minority students had significantly more difficulty, lower retention, and impaired recovery. Older students had considerable difficulty, but those who survived did well. Sixty-eight percent of majority women, 54 percent of all majorities, and 14 percent of minority women SDs recovered completely, graduating with a class rank of average or above. Minority men made significantly better recovery than minority women. Minority women's complete recovery rate rose from 6 to 23 percent. Incidence of difficulty for minorities decreased, though not significantly.Results suggest that many minority students, especially women, experience academic difficulty and have trouble recovering, but that the situation is ameliorating over time.

Care of the psychotic self-amputee undergoing replantation.

The acutely psychotic self-amputee may be brought to the emergency room out of control, refusing treatment. Although these conditions make it difficult for the surgeon to provide restorative surgery, these patients may be quite grateful when resolution of psychosis restores realistic thinking and better judgment. This article describes the treatment of two such patients and provides practical guidelines for general behavioral management. The focal point of the approach is the formation of a surgeon/psychiatrist team that actively and consistently confronts and manages the disturbed behavior from the time the patient arrives in the emergency room until after discharge. Responsibility for deciding to operate when the patient is verbally refusing must be shared by surgeon and psychiatrist. Both surgeon and psychiatrist must be active in the treatment, each contributing his particular expertise to the collaborative effort.