Psychiatric disorders in patients with spinal cord injuries.

Although previous studies have reported that all patients with spinal cord injuries experience depression, they have not distinguished between despondency and depressive disorder. Of 30 patients with spinal cord lesions and depressive disorders diagnosed using the Schedule for Affective Disorders and Schizophrenia and the Research Diagnostic Criteria (RDC). 15 patients had RDC diagnoses before or after their injury. A depressive disorder developed in nine after injury. Eight depressive disorders developed within a month of the injury. Postinjury depressive disorders were more common in patients with complete spinal cord lesions but were divided equally between paraplegics and quadriplegics. Only one patient received antidepressants. The remainder recovered without treatment other than the rehabilitation program. The accident causing the injury seemed related to a psychiatric disorder before injury in six patients (four alcoholics and two hypomanics) and to drinking before the accident in 15 patients.

Results of a token economy.

A token economy for chronic psychiatric patients (average hospital stay of ten years) is reported. One hundred seventy-four patients were treated. Follow-up data were obtained on 173 patients who had been discharged from the hospital for an average of three years at the time of follow-up. One hundred twenty-five patients completed the program, which featured a graduated method for shaping behavior (functional levels). Ninety-one of the 125 patients who completed the program and were living in the community were employed. The program was most effective with patients who had been in the hospital for less than ten years and had an IQ above 80.

Utilization of prepaid services by patients with psychiatric diagnoses.

The authors document and discuss the utilization of psychiatric services in a rural group practice before and after the institution of a prepaid health plan. They found that the utilization of psychiatric services increased dramatically during the first year of the plan's operation. The increase in outpatient utilization continued throughout the 3 years studied, but inpatient utilization decreased after the first year and later reached a level lower than that seen before the plan was instituted. One possible reason for the decline in inpatient utilization is that increased outpatient care prevents hospitalization.

Sugar, opioids and binge eating.

There is evidence that endogenous opiates are involved in the control of feeding in experimental animals. Several types of experimental obesity are associated with increased opiate production and/or increased numbers and sensitivity of opiate receptors. Research with experimental animals suggests that nutrients, particularly sugar, have an effect on feeding behavior that is mediated by opiates. For instance, the obesity-producing effect of a palatable diet in rodents is blocked by opiate antagonists. Stress induced feeding in rodents leads to preferential sucrose ingestion and is blocked by opiate antagonists and beta-endorphin. The effect of nutrients on the endogenous opiate system of humans is less clear. Clinical experience suggest that carbohydrates (sugar in particular) play a role in binge eating and obesity. Many binge eaters preferentially eat sweets during a binge. Many obese individuals consume more than half of their total daily calories as carbohydrates. Sweet snacking is a frequent behavior at times of stress. Recent evidence suggests that sugar can lead to increased beta-endorphin production in obese subjects.

Immunoreactive beta-endorphin increases after i.v. glucose in obese human subjects.

The plasma beta-endorphin of obese human subjects and non-obese controls was compared following the intravenous infusion of 25 grams of glucose. The plasma beta-endorphin of the obese subjects was significantly higher than controls one hour and four and one half hours after glucose infusion. The increased beta-endorphin of the obese subjects was associated with falling blood sugar.

Plasma immunoreactive beta-endorphin response to glucose ingestion in human obesity.

Following the oral administration of 100 g of glucose, morbidly-obese subjects and non-obese controls demonstrated increased levels of plasma immunoreactive beta-endorphin. There was a slow rise in plasma immunoreactive beta-endorphin in the non-obese controls throughout the 3-h observation period. The obese subjects demonstrated a delayed and significantly greater rise of plasma immunoreactive beta-endorphin, when compared to the controls. These findings may have implications for further research in human obesity.

Clinical characteristics of eating disorder patients who report sexual or physical abuse.

At initial contact in an eating disorders clinic, 712 female eating disorder patients were asked if they had been physically or sexually abused as children. They also completed a Beck Depression Inventory (BDI) and an Eating Disorders Inventory (EDI). Their eating disorder symptom frequency and severity was determined. They were asked if they had alcohol problems, had attempted suicide, or had shoplifting problems. Twenty-nine percent reported sexual abuse. Twenty-five percent reported physical abuse. There was no correlation between reports of abuse and symptom frequency or severity. The abused subjects were more depressed on the BDI and showed more psychological disturbance on the EDI. Abused subjects were much more likely than nonabused subjects to report alcohol problems, suicide attempts, or shoplifting.

Catecholamine metabolites in spinal cord injury.

Previous reports of catecholamine metabolism in spinal cord injury (SCI) have found elevated levels of urinary norepinephrine metabolites. These data have been cited as evidence of a sustained increase in peripheral norepinephrine activity in this population. A study was designed to test this hypothesis and to control for the effect of affective disorders on catecholamine metabolism. Determinations were made of the level of urinary 3-methoxy-4-hydroxyphenylethylglycol (MHPG) and vanillylmandelic acid (VMA) in 30 patients with SCI. Urinary MHPG and VMA were not significantly higher than normal in the total sample. However, in spastic quadriplegia, urinary MHPG was lower than normal, and a calculated VMA:MHPG ratio was higher than normal in complete quadriplegia and spastic quadriplegia. This high ratio was due primarily to decreased MHPG. The authors suggest that these changes are due to decreased norepinephrine turnover in the damaged SC and that a VMA:MHPG ratio is the most useful measure of norepinephrine activity in SCI.

Plasma immunoreactive beta-endorphin in bulimics.

The plasma beta-endorphin response to glucose ingestion was compared in 8 bulimics and 8 controls. The bulimics demonstrated a sustained elevation of plasma beta-endorphin unrelated to glucose ingestion throughout the 5-hour study period. It is hypothesized that such an elevation of beta-endorphin is the result of stress and that it may play an important role in the perpetuation of the binge-vomiting cycle.

Depression in spinal cord injured patients.

Many regard depression as an inevitable psychological sequela of spinal cord injury. This assumption, if inaccurate, may confound the rehabilitation process. We evaluated 22 patients with recent spinal cord injuries (less than 6 months), using a standardised interview and diagnostic process. Five patients (22 per cent) had diagnosable depressions after their injury. This is higher than the incidence of depression in the general population, but less than anticipated.