Thyroid function in depression and alcohol abuse: a retrospective study.

Admission thyroid function tests were reviewed in 115 euthyroid patients with depression (66), depression and alcohol abuse (30), or alcohol abuse (19). Estimated free thyroxine (EFT) levels ranged from 0.7 to 2.7 ng/100 ml (normal, 1.0 to 2.1). Levels above 2.1 ng/100 ml were associated with agitation and values under 1.1 with alcohol abuse. Mean EFT levels differed significantly among six diagnostic subgroups and paralleled rank order for severity of depression (none, secondary, reactive, single uncategorized, recurrent, psychotic). Alcohol abuse negatively affected EFT: there was a significant decrease of mean EFT level from nonabusers to abusers and, further, to intoxicated abusers. A positive association between EFT level and severity of depression, and a negative one with alcohol use, were significant when other variables considered were controlled. These two factors accounted from 28.2% of variability in EFT levels, with a minimal additional contribution of medication effect.

Plasma catecholamine metabolites and treatment response at neuroleptic steady state.

Using either haloperidol or perphenazine in a fixed-dose protocol, plasma free homovanillic acid (HVA) and methoxyhydroxyphenethylglycol (MHPG) were decreased in 37 nonorganic psychotic inpatients at neuroleptic steady state (7-9 days) in comparison with pretreatment values. The data indicate that the magnitude of the decline in HVA and MHPG was associated with treatment response and not with neuroleptic plasma levels.

CT scan studies of superficial cerebral regions: frequency and distribution of abnormalities in elderly psychiatric patients.

The CT scans of 50 elderly psychiatric patients were evaluated for the presence of discrete cerebral abnormalities. The prefrontal, superior temporal and inferior parietal areas showed the most frequent occurrence of defects. Motor, sensory and tertiary visual cortical regions, on the other hand, did not commonly exhibit signs of atrophy or sulcal widening. Clinical diagnoses of depression and dementia occurred in patients whether or not specific gyral defects were present, and therefore did not predict their presence. Patients with regional cerebral defects, however, were more likely to be older and to have sustained severe neurological insults. Patients with affective disorders who were treated with ECT showed no differences in the occurrence of superficial cerebral defects.

Characteristics of patients with the highest plasma catecholamine metabolite levels.

The authors measured plasma levels of free homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenyl-glycol (MHPG) in 350 consecutive psychiatric patients. Among the 22 patients with the highest values for both HVA and MHPG, the primary diagnoses were psychotic disorders, eating disorders, and major depression.

Ratio of serum prolactin to haloperidol and early clinical outcome in acute psychosis.

The ratio of the increase in serum prolactin concentration to steady-state haloperidol concentration in acutely psychotic women correlated with early clinical improvement. Correction of prolactin response for neuroleptic concentration may provide a better clinical predictor than either measure alone.

Plasma catecholamine metabolites and early response to haloperidol.

Plasma homovanillic acid (HVA) and methoxyhydroxyphenyl glycol (MHPG) as well as serum haloperidol and prolactin were measured in patients admitted to a general hospital psychiatric service for treatment of acute psychosis. At 10 days, good responders compared to poor responders had higher mean plasma HVA values before and during the first week of treatment with 0.2-0.4 mg/kg haloperidol per day. MHPG values showed a similar pattern, although no significant differences were obtained between or within the two groups. Females predominated among good responders; neither DSM-III diagnoses nor steady state haloperidol levels differed significantly between the two groups. Significant correlations within some patients were obtained between prolactin and haloperidol (positive), prolactin and MHPG (negative), and HVA and MHPG (positive). Plasma catecholamine metabolites deserve further study as possible markers of early response to the treatment of acute psychosis with modest doses of neuroleptic drugs.

Behavioral correlates of computed tomographic (CT) scan changes in older psychiatric patients.

Fifty psychiatric inpatients aged 50 and over, with no hard neurologic findings, and with a variety of DSM-III diagnoses (adjustment disorder, affective illness, and dementia), were rated for behavioral and psychiatric symptoms using the Geriatric Rating Scale and the Nurse's Assessment of Global Symptomatology-Elderly. These clinical ratings were correlated with computed tomographic (CT) scan assessments of various superficial cerebral regions as well as with linear measures of ventricular size. Behavioral deficits in activities of daily living (ADL) plus an interactional variable, inability to respond to requests, were correlated with superior temporal and inferior parietal CT abnormalities, particularly on the left side. Suspiciousness and peculiar thinking, mood lability and irritability, as well as impaired memory with confusion, perplexity, and disorientation were also associated with atrophy in these same regions. Prefrontal area defects correlated with mood lability and deficits in visual-interactional responsiveness. Statistically controlling for effects of age and alcohol abuse did not alter the basic nature of these results. Regional cerebral specialization in relation to these results are discussed using concepts developed by Luria.

"Superwarfarin" ingestion. A new problem in covert anticoagulant overdose.

For the attention of psychiatric consultants, brodifacoum, a new longer-acting, warfarin-like oral anticoagulant rodenticide, has been used for suicide attempts. The overdose potential with brodifacoum is serious since it is readily available without prescription, and bleeding complications last for weeks to months after a single ingestion. This article reports a case of ingestion and reviews four similar cases from medical literature. Also reviewed are details about mechanism of action, procedures for diagnosis, and treatment requirements. Also, characteristics of persons who ingest long-acting anticoagulants appear to differ from those who ingest short-acting anticoagulants reported from earlier literature.

Correlates of early neuroleptic response using a uniform haloperidol dose.

Twenty-one patients hospitalized for acute non-organic psychosis were treated with a fixed daily dose of haloperidol (0.2 mg/kg) for 10 days. Serum levels of haloperidol were significantly lower in the male patients at steady state as compared to females. Serum levels at 24 h and 48 h were highly correlated steady-state levels. Haloperidol levels at steady state were significantly correlated with global outcome at 10 days. Prolactin at haloperidol steady state was significantly related to global outcome at 10 days in the males. Pretreatment plasma free HVA but not MHPG was significantly related to outcome in males and females.

Vulnerability to psychosis associated with hallucinogen use.

Ninety-five patients hospitalized for acute psychosis were reviewed with respect to hallucinogen use and family history of mental illness. Sixty-three percent of admissions had used hallucinogens to some degree within 3 years of the index admission. Drug users were predominantly male, although no age or diagnostic differences with the nondrug group were found. The incidence of hospitalized first degree relatives was approximately 30% and equal for both drug and nondrug groups. Male drug users and female nondrug users were more likely to have had first degree relatives hospitalized. For male psychotics only, lower degrees of drug use were associated with a greater number of hospitalized first degree relatives. For female psychotics only, drug use was positively associated with full scale IQ. The findings suggest sex differences in vulnerability to psychoses associated with hallucinogen use.

Single and repeated admissions to a mental health center: demographic, clinical and use of service characteristics.

Eight hundred and forty one patients with 1,135 consecutive admissions to a university-affiliated mental health center were studied to examine patterns of treatment program use. Twenty two percent of patients had repeat admissions accounting for 42% of hospital episodes. Single admission and repeater groups are compared, and differences among repeater subgroups with progressively greater numbers of admissions per patient are described. Only 10 patients with the highest number of admissions during the study period also were very high utilizers of all services (inpatient, crisis, day hospital, regional chronic state hospital). These patients' characteristics are discussed with implications for future study.

Psychotic patients who become worse on neuroleptics.

We describe a group of psychotic patients who became worse early in the course of neuroleptic treatment. Characteristics of this group were: predominantly female sex, relatively brief onset, family history of affective disorder, hypomotoric presentation, and severe neuroleptic side effects. We propose that some patients with affective psychoses are uniquely susceptible to profound blockade of the nigrostriatal dopaminergic system by neuroleptics.

Thyroid function screening in psychiatric patients.

Abnormalities in levels of total thyroxine and thyroxine binding capacity were common in a group of 480 newly admitted psychiatric patients. The estimated free thyroxine (EFT4) level was elevated in 43 patients (9%). In 27 of these patients, the level of EFT4 became spontaneously normal, usually within a two-week period (acute "stress hyperthyroidism"). The level of EFT4 was decreased in 42 patients (9%). In 16 of these patients, the level became spontaneously normal; the etiology of this apparent acute hypolhyroidism is unclear. The yield of new cases of primary hyperthyroidism and hypothyroidism was low, but a presumptive diagnosis of secondary hypothyroidism was made in eight patients. In addition, nine patients with known thyroid disease were taking inadequate or excessive replacement therapy. Thyroid function screening tests are of value in psychiatric patients.

Depression and normal pressure hydrocephalus. A dilemma in neuropsychiatric differential diagnosis.

Normal pressure hydrocephalus (NPH) is a surgically correctable syndrome of progressive dementia, gait abnormalities, and urinary incontinence resulting from an occult hydrocephalus in association with normal cerebrospinal fluid pressure. Occurring most frequently in midlife and often idiopathic in origin, the early course of the illness may be characterized by symptoms of apathy, inattentiveness, agitation, and poverty of thought which mimic a depressive illness and may delay the recognition and treatment of the underlying structural defect. A review of the literature reveals that this association of depressive symptomatology and NPH has received little attention in the psychiatric literature, and the authors describe a case of NPH which presented as a severe, agitated depression. Clinical findings which suggest the presence of NPH are discussed, and the need to include NPH in the differential diagnosis of depression in the presenium is emphasized. The authors believe such diagnostic vigilance is necessary if the needless deterioration of potentially salvageable individuals is to be prevented.

A retrospective study on the perceived need for and actual use of psychiatric consultations in older medical patients.

OBJECTIVE: The authors examined the (under) utilization of the psychiatric consultation service for patients aged sixty to seventy-five who were hospitalized for medical reasons, and explored whether one could retrospectively document and identify a greater need for psychological support than the one reflected in the number of actual consultations requested. Three questions were addressed: 1) the psychiatric consultation rate; 2) the frequency of unrecognized medical, psychiatric, and psychosocial complicating factors; and 3) whether the distribution of these factors differed by gender. METHOD: Records of 203 consecutively-admitted elderly patients hospitalized on medical wards were reviewed by two experienced general hospital psychiatrists for any indication of medical, psychiatric, and psychosocial risk factors. The frequency of actual psychiatric consultations was also recorded. RESULTS: Three or more risk factors were noted in the records of 36 percent of all patients. Consultation was sought for only 3 percent. Gender differences in type and distribution of risk factors were identified. CONCLUSIONS: Indicators and profiles that define probable need for psychiatric consultation were identified and briefly discussed. More well-designed, prospective studies testing these indicators and profiles are needed.