Bibliotheca psychiatrica最新文献

This report deals with answers to a questionnaire given by 69 parents of retarded adolescents living in a community which, at the time of the study, offered little in terms of concrete services to mentally retarded persons. The inquiry concerned basically the parents' evaluation of the support they received from services or other sources and their concern about the child's future.

For safe and effective lithium prophylaxis the following points should be given attention: (1) selection of patients, (2) treatment management, (3) treatment monitoring, and (4) information and instruction. Indications for lithium treatment depend not only on diagnosis but also on factors predicting the extent to which the patient would be at risk of relapse without lithium. The criteria used for prophylactic trials seem too narrow, since they exclude patients who might benefit from the treatment. Treatment management involves gradual adjustment of doses and 12-hour serum lithium levels to values that for the individual patient give a maximum of prophylactic protection and a minimum of side effects. In some patients serum lithium may with advantage be maintained around 0.6-0.8 mmol/l instead of the usually recommended 0.8.-1.1 mmol/l. Patients, relatives and health personnel should be carefully instructed about the aims, the management, and the risks of lithium treatment.

Many patients have now been given lithium for 10-15 years, and the overall picture as regards late side effects is not alarming. Changes of renal morphology and function currently attract interest. Histologically demonstrate interstitial nephropathy may be observed in 10-15% of patients, but glomerular filtration rate is little affected or unaffected, and the risk of progressive renal failure with terminal azotemia is remote even in patients given lithium for many years. Renal water reabsorption is often impaired, and the patients may develop polyuria or lowered concentrating ability. These changes are not in themselves dangerous, but since dehydration may lead to lithium poisoning, the patients should drink extra water during situations with risk of a negative water balance.

603 schoolchildren of the greater Athens area were screened for psychiatric disorders as expressed by a total score of 13 or more in the Rutter parents' questionnaire, and 10 or more in the Rutter teachers' questionnaire. Psychiatric disorder was negatively correlated with school marks. IQ (vocabulary, draw-a-man, visual-motor integration), motor coordination, and achievement in reading and arithmetic, and positively with size of family. The incidence of disturbance as assessed by the teachers' questionnaire was similar to that in other big cities in other countries, while the incidence of disturbance as assessed by the parents' questionnaire was greater in comparison to that of other countries. The incidence of hyperkinesis in our sample was considerably greater in comparison to other studies in other countries. Boys were found to be generally more disturbed than girls with the exception of neurosis.

The validity of various criteria for a prophylactic lithium indication was examined by means of the natural course of 356 unipolar depressive, bipolar manic-depressive, and schizoaffective patients. The prerequisite for a lithium prophylaxis was the occurrence of two or more episodes (excluding the index episode) within a 5-year's follow-up. The so far applied criteria for a lithium indication mentioned in the literature have proven to be too restrictive as far as this study is concerned, as the majority of the patients in need of lithium have been excluded from such a treatment. In this study new criteria have been deduced from the hypothetical examination of observed courses.

The effect of lithium on the histochemistry of blood granulocytes was studied in 16 manic-depressive patients during lithium prophylaxis. Blood smears obtained before, at 2 months and at 12 months after initiation of treatment showed that lithium caused condensation of the chromatin in granulocytes, conformation changes in eosinophilic granules and the disappearance of basic proteins found in the cytoplasm of eosinophils in the drug-free patients. The latter findings are interpreted as indicating the involvement of lithium in histamine metabolism.

Certain aetiological factors related to prognosis of the post-traumatic syndrome are presented. The organic vs. psychological controversy and the principal risk factors, namely the pre-traumatic personality, psychological state, social and occupational influences and the compensation issue are discussed in relation to management and prevention.