Bibliotheca psychiatrica最新文献

Questionnaires referring to application of lithium, range of indication, combination with other drugs, side effects and patients' data were sent to all Austrian psychiatrists, psychiatric wards and clinics. Questionnaires gathering basic laboratory data on the subject were sent to all diagnostic laboratories. Both forms being constructed in a way to facilitate filling in, gathered data must be reviewed with extreme caution. Results of psychiatric answers (30%) and returns of laboratory data (60%) are presented and discussed with relevant data from other authors.

The findings of morphological changes in the kidneys of some patients given long-term treatment with lithium and indications that lithium intoxications frequently are preceded by alterations in water and electrolyte metabolism have generated new interest in the effect of long-term lithium treatment on kidney structure and function. Today it is not firmly established to which extent renal morphological changes are present in unselected groups of patients given long-term treatment with lithium. Neither is it clear what is the clinical significance of these changes and what are the relative roles played by lithium, concomitant and previous treatment with other psychotropic drugs, previous occurrence of lithium intoxications, and coexistence of somatic illness for their development. Studies on kidney function in long-term lithium-treated patients, however, have revealed that affection of GFR was either moderate or absent indicating that the risk of renal insufficiency and terminal azotemia is remote even when lithium is given for many years. A large number of patients have altered water excretion with polyuria or lowered urine concentrating ability or both. Due to the extra fluid loss these patients are apt to develop dehydration, and they may then be in danger of lithium intoxication. We hypothesize that lithium-induced changes of kidney function may become less frequent and less pronounced if patients are maintained at serum lithium levels somewhat lower (0.5-0.8 mmol/l) than those commonly employed. We recommend careful monitoring of serum lithium levels, regular control of kidney function, and extra caution when physical illness or additional drug treatment may lead to disturbance of fluid and electrolyte balance.

The organizational profile of the mental health care delivery system in Greece is mainly characterized by centralization which is reflected in various functional parts of the system (uneven distribution of psychiatric beds and manpower, absence of psychiatric units in general hospitals serving a certain catchment area, lack of community-based psychiatric services, etc.) As a result of this centralized structure there is a centrifugal flow of the mentally ill patients toward Athens and Thessaloniki and consequently the existing possibilities for community-based care as an alternative to inpatient treatment are rather limited. Future immediate objectives of the national social policy planning should be based on decentralization and reorganization of the psychiatric services in order for the mental health delivery system to respond more effectively to the mental health needs of the Greek population.

Within the context of psychological research on the mechanism of lithium prophylaxis mainly three questions are to be raised and hopefully answered: a) Can psychic effects of lithium be demonstrated during the free interval of manic-depressive patients under long-term lithium medication? b) Supposed that such lithium-induced effects could be demonstrated during the free interval, do they possess any significance for the prophylactic effect? c) Supposed that such prophylactically significant effects exist, do they refer to typical properties of the premorbid personality in which subjects with affective psychoses differ from normal subjects? A double-blind study in 14 manic-depressive patients during the free interval showed effects of lithium on learning, free recall, experience of time, and visual perception. The direction of the effects, i.e, increase or decrease versus corresponding values obtained under placebo, seems to be determined by the individual personality.

The role of genetic factors in the etiology of psychiatric disorders is one that has been long debated. Three 'families' of psychiatric disorders--which 'run' in families--have been observed: the schizophrenias, the affective disorders, and the St. Louis 'family of disorders' which includes antisocial personality, alcoholism, Briquet's syndrome and the hyperactive child syndrome. Such familial clustering could obviously occur on the basis of genetic transmission or on the basis of social learning within the family. Beginning in the 1960's, a number of adoption studies have been conducted. These studies permit an assessment of the relative contributions of genetic and environmental factors to the disorders mentioned above. This paper briefly reviews the strategy of these studies and the results they have obtained. An awareness of these studies and their results is essential to those concerned with the primary prevention of psychiatric disorders.

Neuroleptics induce hypersensitivity reactions, and toxic, systemic and extrapyramidal manifestations. The latter mainly include acute dystonic reactions, other early dyskinesias, akathisia, parkinsonism and TD. These drugs have been implicated for DA antagonism exerted by an adenylate cyclase inhibition. Prolonged blockade of DA receptors is considered as the motivation for a counterbalancing mechanism inducing the DA supersensitivity from which TD results. Recent reports suggest cholinergic and GABA ergic insufficiency as secondary participants. The increasing frequency of TD calls for prevention by modifying treatment practices and searching for effective measures to combat the symptoms.

The pharmacokinetics of lithium is reviewed in regard to the pattern of lithium concentration in plasma, red blood cells, saliva and urine and to a four-compartmental model of lithium distribution. An overview of lithium toxicology is given summarizing the gastrointestinal, cardiovascular, endocrine, hematological, dermatologic, teratogenic and neurological side effects of lithium. The results of two controlled studies are described in detail. The investigation of thyroid function in 88 patients under lithium treatment revealed abnormally high values of TSH and/or of TSH response to TRH in 50% of the subjects. By use of daily protocols of eating and drinking over a period of 14 days, a distinctly higher caloric intake (from solid food, not fluids) was found in 10 patients who gained weight during lithium therapy as compared to 10 lithium-treated patients without weight gain.