Search

In the midst of recent preparations to move the Phipps Psychiatric Clinic at Johns Hopkins University School of Medicine in Baltimore to a new building, Joseph H. Stephens opened an unused locked closet and, much to his surprise, stepped into the lives of thousands of former psychiatric patients. Stephens, a Hopkins psychiatrist, discovered more than 10,000 5-by-8-inch cards neatly filed in the closet. The cards were the remnants of a project conducted from 1936 to 1950, in which detailed clinical descriptions and follow-ups were prepared for all patients admitted to the Phipps Clinic between 1913 and 1940. A rare opportunity was at hand individuals unexposed to the modern arsenal of psychoactive drugs could be tracked over decades for clues to the natural ebb and flow of psychiatric symptoms. Stephens and his colleagues sorted the 8,172 patients portrayed on the cards into eight groups based on current psychiatric diagnoses. The long-term outlook for those who were manic depressive was examined first, reported Stephens at the recent American Psychiatric Association meeting in Chicago. And the results were not encouraging. As many as 2 million people in the United States are estimated to suffer from manic depression, a condition marked by periods of severe depression interspersed with episodes of uncontrollable elation, restlessness, racing thoughts and delusions of grandeur. There are indications that specific genes may predispose some people to manic depression (SN: 2/28/87, p.132). For more than 30 years, the basic treatment for this disorder has been lithium carbonate, a drug that often dampens manic and depressive mood swings. In the past decade, research has suggested that, even with lithium, manic depression is usually more persistent and severe than depression alone. Among 234 pre-lithium manic depressives followed for an average of 15 years after discharge from the Phipps Clinic, the Hopkins researchers found that one-third continued to suffer from severe symptoms and ended up back in the hospital for long stretches. Another 39 percent were moderately disturbed and reentered the hospital once or twice. The remaining 28 percent were not rehospitalized, but only half of them suffered no further episodes of mania or depression.

A total of 573 patients hospitalized in National Seoul Mental Hospital and 76 of healthy persons as control were examined by indirect latex agglutination test in order to evaluate Toxoplasma antibody titers in mental patients. Throughout this survey, 1:32 or more titers of diluted sera were regarded as positive. The 573 samples of test sera showed negative in 386 cases (67.4 %), 1:2 in 93 cases (16.2 %), 1:4 in 57 cases (9.9 %), 1:8 in 14 cases (2.4 %), 1:16 in 12 cases (2.1 %), 1:32 in 5 cases (0.9 %), 1:64 in 1 case (0.2 %), 1:128 in 3 cases (0.5 %) and 1:256 in 2 cases (0.3 %) respectively. Among total 573 mental patients, 11 cases (19 %) showed positive, and they were 9 cases (1.8 %) of schizophrenia and 2 cases (7.4 %) of manic depression. One case (1.3 %) out of 76 control sera showed positive result.

To the Editor.— Although lithium salts have become valuable psychopharmacotherapeutic agents, their use is limited by numerous adverse effects. 1 In a survey 2 of 123 patients with lithium intoxication, mild hypertension was reported in only two patients. We wish to describe a patient with severe hypertension that occurred during acute lithium intoxication. Report of a Case.— A 36-year-old woman with long-standing manic depression was hospitalized because of worsening of her depression. During previous admissions and in the course of two pregnancies she had been normotensive. At the time of admission she was receiving lithium carbonate, 1,200 mg daily; therapy had been started three months earlier. Admission BP was 110/55 mm Hg, and her plasma lithium level was 0.5 mmole/L (therapeutic range, 0.5 to 1.5 mmole/L). Because of her psychiatric deterioration, the lithium dose was doubled to 2,400 mg. One week later, the patient became confused, dysarthric, and ataxic and

To the Editor: —About two weeks ago I received by mail a pamphlet, on the cover page of which was printed "Report of the Treatment with Manganese Chloride of 181 Cases of Schizophrenia, 33 of Manic Depression and 16 of other Defects or Psychoses, at the Ontario Hospital, Brockville. By W. M. English, M.D., Superintendent. Reprinted from the American Journal of Psychiatry: Vol. IX., No. 3, Nov. 1929." On the second, third and fourth pages of the cover were advertisements of a laboratory and its preparations for intravenous injection.I at once wrote the laboratory in question, asking on what authority it had reprinted a paper from the American Journal of Psychiatry and used it to advertise the laboratory and its products.In due time I received a letter regretting that any "offense" had been committed but stating that, as some time had elapsed since the article had been printed