Biomedical subjects
Publications and source records attributed to R Yassa.
Two cases of hair loss attributed to lithium therapy are presented. In one case, lithium did not have to be discontinued, and in the other, hair loss led to noncompliance. This side effect is usually benign. Thyroid function tests should always be performed to exclude hypothyroidism as the underlying factor for this symptom.
One hundred and eighty outpatients at the outpatient services of the Douglas Hospital were evaluated for the presence of tardive dyskinesia. Forty-nine (27%) among them had tardive dyskinesia. In this study, female sex, older age and the current administration of antiparkinsonian medication were found to be significantly related to the occurrence of tardive dyskinesia.
Carbamazepine has been used in the treatment of temporal lobe epilepsy since 1963. It has also been found effective in the treatment of psychiatric disorders accompanying epilepsy. Patients with nonspecific EEG abnormalities without overt epilepsy but with behavioral problems, including gross psychopathology and violent behavior, improve on carbamazepine. These findings prompted us to use it in the treatment of aggressive behavior in a schizophrenic patient. Due to the frequency and severity of aggressive behavior in this patient, maintenance ECT was given. However, when carbamazepine was instituted, ECT was discontinued and the patient has been virtually free from aggressive behavior since this medication has been instituted. The authors conclude that carbamazepine may be used in the treatment of aggressive behavior in schizophrenic patients.
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Of 83 consecutive patients in an affective disorders clinic who were assessed with the Abnormal Involuntary Movement Scale, 35 (41%) were found to have tardive dyskinesia (TD). TD patients were found to be older than affective disorder patients without TD.
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A patient with Kleine-Levin syndrome, typical except that onset was at 39 years of age, died during a symptomatic period. Autopsy disclosed recent and old lesions in the medial thalamus involving intralaminar, medial, and some dorsal nuclei as well as the pulvinar. Despite massive microglial infiltration, there was minimal neuronal loss. The hypothalamus was not involved. The findings suggest a viral cause for Kleine-Levin syndrome.
Clomipramine, a tricyclic antidepressant, has been used in the treatment of obsessive neurosis successfully. In the course of treatment with this medication, sexual disorders in the form of decreased libido and impotence were noticed in three patients whose cases are reported. These disturbances occurred in the first week and lasted during the course of treatment. Upon withdrawal of the medication, the side effects disappeared. These side effects seem to be more common than is usually thought. The physician should be alerted to them as they can be a source of noncompliance.
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The authors surveyed 500 inpatients receiving long-term neuroleptics; 8 had first-degree family members who were also being treated with long-term neuroleptics and suffering from a psychiatric disorder. The 8 patient-relative pairs showed concordance for the presence or absence of tardive dyskinesia.
Based on the finding that lithium carbonate administration can stimulate leukocyte production, six patients were treated with neuroleptic and other drug-induced granulocytopenia with lithium carbonate. The average total leukocyte count of 2500/mm3 increased to 4566/mm3. Similarly the average neutrophil count of 1028/mm3 increased to 2893/mm3 after lithium therapy. In all six patients, neutrophils decreased upon discontinuation of lithium. On the other hand, total WBC count of 4566/mm3 decreased to 2650/mm3, and the total neutrophil count of 2893/mm3 decreased to 966/mm3 after four weeks without lithium. The results suggest that lithium carbonate is effective in the treatment of drug-induced leukopenia.
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In this paper, the efficacy of lithium therapy in the treatment of tardive dyskinesia is reviewed. It is noted that most of the published papers on this topic are anecdotal and single case reports with contradictory results. The well-designed studies indicate that lithium is useful in certain tardive dyskinesia patients and that the red blood cell lithium level may be related to the therapeutic response. Therefore, on the basis of the available information, we conclude that routine clinical application of lithium in the treatment of tardive dyskinesia is not warranted. However, further evaluation of lithium in the treatment of tardive dyskinesia and identification of the responders are extremely useful. In addition, as suggested by animal studies, the prophylactic value of this agent against tardive dyskinesia needs exploration.
The occurrence of a religious phenomenon in Egypt after the 1967 Egyptian-Israeli war is described. It is related to the loss of self-esteem sustained by the demoralized and humiliated nation. The psychological impact of the religious phenomenon is illustrated by successful cures of some formerly hopeless cases.
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