The Hillside journal of clinical psychiatry最新文献

A case is presented of a 36-year-old woman who developed a psychosis following an apparent systemic allergic reaction to phenytoin and/or phenobarbital. She was initially diagnosed as having Stevens-Johnson syndrome and toxic epidermal necrolysis with the subsequent development of a psychosis. The authors were able to demonstrate a previously undiagnosed neurological impairment that they feel may be related to both the drug reaction and the psychosis.

Man's attempt to understand mental illness, and especially depression, have historically alternated between two general concepts: a belief in some form of evil spirits that have invaded the body; or of an internal black toxic substance, melancholia. Each age and culture can be found to have devised its own appropriate treatment for depression; to remove the "biochemical" cause of the disease process by means of prayer, exorcism or fire, or to do away with the evil spirit. Psychoanalysis has evolved a concept of depression that deals with ideas about introjects, rather than conceiving of them as concrete toxins or demons. Psychoanalytic treatment is a cognitive technique for "exorcising" certain identifications by delineating them and then neutralizing them through understanding. The superficial similarity of both concepts, albeit substituting a "tangible" substance by an ideational one, helps to explain why it has been so difficult to avoid the temptation to reify psychoanalytic concepts. The Greeks' black humour, the demon, and the mental construct of an ambivalent introject, can be understood as different metaphors of a similar universal concept.

To some extent, drugs with anticholinergic activity will probably retain a place in our therapeutic armamentarium, along with sedating antihistaminic compounds. However, it looks as if we will soon have available antidepressant drugs that produce few, if any, anticholinergic effects. And among antipsychotic agents, the high-potency drugs have given us a low-anticholinergic option. We have even seen the advent recently of cholinomimetic compounds, such as lecithin, which could have some utility in psychiatric practice. Our hope is that, in the future, a better understanding of cholinergic systems will lead to greater clinical options in treating neuropsychiatric disorders.

This pilot study evaluated group therapy and the appetite suppressant activity of phenylpropanolamine in a group of juvenile-onset obese physicians. In spite of their educational level and their medical sophistication, they were not previously successfully motivated to lose weight. Twelve obese but otherwise healthy physicians participated in a program using phenylpropanolamine one or two times per day and attending weekly group therapy that focused on weight reduction, dietary compliance, physical appearance, and psychodynamics of obesity. Those who continued participation in both the medication and group discussions showed significant weight loss, an average of 23.3 pounds at the end of 12 weeks, 33.2 pounds at 22 weeks and continued weight loss maintenance for up to two years.

Extrapyramidal symptomatology has previously been reported in patients on long-term lithium maintenance. This report emphasizes that, in the presence of organic mental disorder, even brief treatment with lithium may induce severe extrapyramidal signs. Furthermore, toxicity to lithium may occur even though serum lithium levels are at therapeutic levels. Following termination of lithium, symptoms subsided quickly in one patient (five days), but more slowly in the other (16 days). Possible pathophysiology of this phenomenon is discussed.