Biomedical subjects
Publications and source records attributed to H Munitz.
Two cases of prolonged catatonic states that were part of severe obsessive compulsive disorder (OCD) are described. The catatonic symptoms failed to respond to neuroleptics but were ameliorated by conventional OCD treatments; clomipramine was used in one case, and behavior therapy in the other. Inclusion of severe OCD in the differential diagnosis of catatonia is discussed.
Chlorprothixene is a neuroleptic as well as a potent uricosuric drug that consistently lowers the levels of plasma uric acid (PUA). The usefulness of this relative hypouricemia as an indicator of compliance with treatment was evaluated in 17 outpatients treated from 120 to 600 days. Plasma uric acid values were substantially reduced in all patients with all doses within the therapeutic range. Low levels of PUA remained stable as long as the patients were treated and returned to normal within 7 days after treatment was terminated. The authors discuss the advantages and the limitations of PUA as an indicator of chlorprothixene treatment compliance.
Data were gathered on 479 inpatients of two Israeli general hospitals for whom psychiatric consultations were requested over a 1-year period. The data presented here include age and sex of referred patients, source of referral, reason for referral, psychiatric and physical diagnoses, and consultant's recommendation. Emergency ward consultations are included. Additional data were collected on patients transferred to psychiatric wards. Our findings are similar in general to those reported from other countries, although such comparisons are limited by the lack of uniformity in the classifications used by the various workers.
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Vitamin B12 and folate serum levels were studied in 30 patients with obsessive compulsive disorder (OCD), and in two control groups comprised of 30 chronic schizophrenics and 30 normal healthy subjects. Six patients (20%) of the OCD group had abnormal low levels of vitamin B12. This prevalence was significantly higher than that of the control groups. No clinical neurological or haematological abnormalities accompanied the reduced vitamin B12 levels. Possible implication of this finding for the pathophysiology of OCD in a subgroup of patients and the possibility that the B12 deficiency could be the consequence rather than the cause of OCD are suggested.
During a heat wave three patients developed neuroleptic malignant syndrome. The role of heat load in triggering this syndrome and possible mechanisms behind such a role are discussed. Data concerning the season of occurrence of neuroleptic malignant syndrome are reported.
The occurrence of malignant hyperthermia in 20 patients who had had neuroleptic malignant syndrome and in their 108 first-degree relatives was retrospectively studied. The patients had experienced a total of 20 courses of ECT and 12 surgical operations in which drugs that can cause malignant hyperthermia were used, but no cases of malignant hyperthermia had occurred, and no cases had occurred in the 37 relatives who had undergone surgery or ECT. The authors conclude that patients who have had malignant neuroleptic syndrome are not at considerably greater risk than others for developing malignant hyperthermia during surgery or ECT; the clinical data suggest that the two disorders are not related.
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The hypouricemic effect of chlorprothixene (Taractan), a major tranquilizer from the group of thioxanthenes, was evaluated in 30 psychiatric patients who took the drug as part of their regular treatment. Levels of serum uric acid, urea, and creatinine before, during, and after the treatment were measured, as well as creatinine clearance and uric acid clearance before and during the treatment. A uricosuric effect, resembling that of probenecid, was found that exerts itself in all the patients, regardless of age, sex, diagnosis, and associated drugs. The resulting hypouricemia starts as soon as 24 hours from the beginning of treatment, stabilizes within 10 days, and averages, at that time, 48% of the initial level. It is reversible within 10 days from the end of treatment.
Several neuroleptics recurrently failed to ameliorate psychosis in three schizophrenic patients. Failures were caused by recurrent intractable akathisia, unresponsive to diazepam and trihexyphenidyl. Lacking this extrapyramidal side effect, lithium carbonate was tried and proved an effective antipsychotic. It is suggested that in schizophrenic psychosis lithium is a rational therapeutic option in cases of neuroleptic intolerance and failures due to akathisia.
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Two episodes of urinary retention occurred in a 15-year-old male following administration of clomipramine given for obsessive-compulsive disorder. Improvement of behavioral symptoms along with side effects was clearly correlated with clomipramine dosage. Severity of side effects, and their resistance to bethanechol and to phenoxybenzamine, necessitated a complete withdrawal of clomipramine. This case demonstrates that clomipramine-induced urinary retention is not limited to older individuals. Possible involvement of noncholinergic and nonadrenergic mechanisms in this adverse drug reaction is suggested.
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