Biomedical subjects
Publications and source records attributed to R Yassa.
A patient developed neurotoxicity after 2 years of treatment with a lithium-chlorpromazine combination. Symptoms consisted of confusion, extrapyramidal symptoms, and slow-wave EEG disturbances. The lithium ratio (red cell/plasma lithium) was consistently low. The possible mechanisms of this interaction are considered.
Thirty-five bipolar outpatients treated with lithium carbonate were followed for up to 5 years with the aim of studying the relation of the lithium ratio (LR) and its predictive value. Only male responders were found to have higher LR than male nonresponders. No difference was found between the mean LR of men and women, as a group. Aging also had no effect on LR. Positive family history of affective disorders was correlated with high LR, irrespective of response.
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Tardive dyskinesia (TD) is an involuntary movement disorder predominantly the result of long-term neuroleptic administration. Several factors have been studied with conflicting results. In this paper, the authors compare a group of 17 TD patients with 17 non-TD controls to delineate possible etiological factors in the development of this syndrome. Factors like total neuroleptic and antiparkinsonian medication intake and organicity were not different in the groups. Only drug-free periods in the past history of TD patients were found to be statistically more significant (P less than 0.025) in these patients than in non-TD controls.
Three patients are presented in whom TD either disappeared (2 cases) or improved (one case) after discontinuing antiparkinsonian medication without changing the concurrent neuroleptic treatment. In addition, two of the patients presented some "complications" secondary to the TD in the form of frequent falling, psychosocial impairment and suicidal ruminations. The implications of these findings are discussed in the light of the current literature.
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Agranulocytosis developed in three patients subsequent to chlorpromazine therapy and in one patient following treatment with methotrimeprazine and trifluoperazine. Although three of these four patients developed agranulocytosis within the expected time lapse (6 weeks), one patient developed the condition 12 years after the initiation of therapy. In one patient there was a recurrence of the agranulocytosis following reinstitution of chlorpromazine therapy. The subsequent treatment of psychosis is safer if another neuroleptic is substituted for the one that caused the agranulocytosis.
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Lithium carbonate has been used in the treatment of tardive dyskinesia (TD) with conflicting results. In this study, six patients with a diagnosis of manic depressive illness were followed in the Affective Disorders Clinic of Douglas Hospital for one year. None of the patients showed improvement of their TD in this study. Possible reasons for this lack of response are discussed.
The recommended prophylactic lithium levels in the treatment of manic depressive patients differ from study to study. In this paper, we present a patient who was maintained euthymic on lower plasma levels than those recommended. However, we theorize that the reason for this may be due to the fact that she had a high RBC/plasma ratio. We recommend that in those patients whose plasma lithium levels are consistently low, this point should be kept in mind before considering them as noncompliant.
The paper describes an informal, open trial of the effect of clomipramine on 8 patients with repetitive behaviors which were not part of a classical obsessive-compulsive neurosis. Six chronic schizophrenics had obsessions, compulsions and rituals in addition to their schizophrenic symptoms. Four of the six showed reduction in the repetitive behavior with clomipramine. Two cases in which the target symptom and overall clinical picture had little in common with obsessive compulsive neurosis, are reported in detail. Both improved with clomipramine. It is suggested that clomipramine may be useful in the treatment of a broad range of psychiatric disorders characterized by repetitive mental or behavioural phenomena, but which do not fulfill criteria for obsessive-compulsive neurosis.
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