Treatment of acute mania.

Treatment of acute mania requires attention to both specific and nonspecific antimanic medications. The choice of specific agents now includes lithium, carbamazepine, and valproate; and nonspecific agents include benzodiazepines, calcium channel blockers, alpha adrenergic agonists, as well as neuroleptic drugs. Treatment-resistant manic states are best treated by careful sequential strategies that may include polypharmacy and electroconvulsive therapy.

CSF and endocrine studies of premenstrual syndrome.

Eight women with prospectively documented premenstrual syndrome (PMS) underwent multiple samplings for estradiol, progesterone, prolactin, cortisol, and plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) during an asymptomatic midcycle (late follicular) and a symptomatic premenstrual (late luteal) phase of the menstrual cycle. Cerebrospinal fluid (CSF) was collected for analysis of MHPG, norepinephrine (NE), 5-hydroxyindoleacetic acid (5-HIAA), dihydroxyphenylacetic acid (DOPAC), gamma-aminobutyric acid (GABA), homovanillic acid (HVA), tyrosine, tryptophan, beta-endorphin, prostaglandins, adrenocorticotropic hormone (ACTH), and arginine vasopressin (AVP). In subsequent months, a dexamethasone suppression test (DST) and a thyrotropin-releasing hormone (TRH) stimulation test were performed during midcycle and premenstrual phases. Significant results included increased CSF concentrations of MHPG in the premenstrual, as compared with the midcycle, phase of the cycle, and increased plasma cortisol concentrations during the midcycle phase. The DST showed a 62% overall rate of nonsuppression, irrespective of menstrual cycle phase. Though there were no abnormalities of thyrotropin-stimulating hormone (TSH) after TRH stimulation, the mean delta maximum prolactin values after TRH stimulation were higher than reported normal values both at midcycle and premenstrually. These pilot data suggest hormonal axes that might be worthy of further systematic investigation in future studies of PMS.

Oral S-adenosylmethionine in depression: a randomized, double-blind, placebo-controlled trial.

Methylation has been implicated in the etiology of psychiatric illness. Parenteral S-adenosylmethionine, a methyl group donor, has been shown to be an effective antidepressant. The authors studied the antidepressant effect of oral S-adenosylmethionine in a randomized, double-blind, placebo-controlled trial for 15 inpatients with major depression. The results suggest that oral S-adenosylmethionine is a safe, effective antidepressant with few side effects and a rapid onset of action. S-Adenosylmethionine induced mania in a patient with no history of mania. S-Adenosylmethionine may be useful for patients who cannot tolerate tricyclic anti-depressants. These findings support a role for methylation in the pathophysiology of depression.

Cerebrospinal fluid cholecystokinin, bombesin and somatostatin in schizophrenia and normals.

Cerebrospinal fluid from 31 normals and two groups of phenomenologically similar schizophrenics (n = 72) were collected by identical methods. Radioimmunoassay of CSF was carried out for somatostatin, bombesin, and cholecystokinin. One group of schizophrenics had increased baseline somatostatin and cholecystokinin, and decreased bombesin. No CSF gradient effect was found for the peptides nor were their levels affected by probenecid or pimozide treatment. An inverse correlation was found between bombesin and psychosis rating. Intercorrelation between the peptides and HVA, 5-HIAA, and MHPG were not significant.

Neuroendocrine abnormalities in bulimia.

The authors examined the relationship of clinical variables, family history, and neuroendocrine function in 18 bulimic patients. Twelve of 18 patients (67%) showed abnormalities of cortisol suppression, and 8 of 10 (80%) showed blunted thyrotropin-releasing hormone (TRH) tests. These findings suggest that neuroendocrine abnormalities identified previously in anorexia nervosa are not solely an artifact of low weight and, further, that eating disorders and affective disorders may share neurochemical similarities.

Altered neuropeptide concentrations in cerebrospinal fluid of psychiatric patients.

Immunoreactive somatostatin, bombesin, and cholecystokinin were measured in cerebrospinal fluid of normal subjects and patients with anorexia nervosa, depression, mania, and schizophrenia. Somatostatin-like immunoreactivity was decreased in anorexic and depressed patients. Bombesin-like immunoreactivity tended to be decreased in schizophrenics. Cholecystokinin-like immunoreactivity did not differ between groups. These data suggest a possible function for neuropeptides in regulation of human behavior.

Legal restrictions on the use of ECT in California: clinical impact on the incompetent patient.

Current laws regulating ECT use in the severely ill, incompetent patient are so cumbersome that many patients who may only respond to ECT are denied the treatment. Several cases are presented that illustrate the inability of the current California law to effectively deal with complex clinical situations and the subsequent social, financial, and personal harm incurred by patients. It is suggested that the decision regarding use of ECT for incompetent patients can be best made through a medical, nonjudicial process, while protecting all the patient's rights--both to be treated as well as from inappropriate treatment.

Lithium does not inhibit the parathyroid hormone-mediated rise in urinary cyclic AMP and phosphate in humans.

To test the hypothesis that lithium is a general inhibitor of hormone-activated adenylate cyclase, we infuse parathyroid hormone (PTH) into human subjects prior to and during lithium carbonate administration. PTH infusion caused a significant increase in urinary cyclic AMP and urinary phosphate excretion. There was no significant difference in these responses in the lithium compared to the control period. In four patients with primary hyperparathyroidism, lithium had no significant effect on serum calcium or phosphate or on tubular reabsorption of phosphate. The data do not substantiate the hypothesis that lithium (at therapeutic concentrations) is a general inhibitor of hormonally-activated adenylate cyclase, nor do they support its potential clinical utility in primary hyperparthyroidism.