Biomedical subjects
Publications and source records attributed to S Lippmann.
The prevalence of alcohol abuse among the fathers, and ADD in family members, of 22 adult psychiatric patients with persistent attention deficit disorder was found to be significantly higher than in 20 matched controls. Further research is necessary to determine the reasons for, and clinical implications of, these associations.
Hyperthyroidism is often confused with psychiatric illnesses. Undiagnosed hyperthyroidism sometimes results in inappropriate use of psychotropic medications. Delay in therapy markedly worsens the prognosis for recovery, but complications can be prevented by early treatment. Prompt recognition of hyperthyroidism through thyroid function screening is good medical practice in the evaluation of patients with psychiatric symptoms.
Although lithium was known to cause changes in renal physiology, it was considered safe until reports in late 1977 suggested that it may induce chronic irreversible nephropathy. Later reports documented similar lesions in non-lithium-treated patients with affective disturbances. Thus, the data are inconclusive. Concern for the kidney during lithium therapy is now greater than it was originally, but confidence in lithium's safety is higher than it has been for the past four years. Physician appreciation of the foregoing factors, careful patient selection, and informed consent are important in lithium therapy. An understanding of lithium use in patients in a low-sodium state or on diuretic therapy and avoidance and treatment of lithium intoxication are advocated. Good prelithium workups and closer monitoring of patients on long-term lithium therapy are recommended.
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Antidepressant drugs are indicated for prolonged depression accompanied by the typical physiologic dysfunctions. They are not recommended for grief reactions. Suicide potential is actively monitored. Pregnancy requires special attention. The most significant risks of antidepressant therapy are cardiac conduction prolongation and anticholinergic effects. Overdoses are dangerous. Antidepressants are prescribed only after a careful work-up, and therapy is continued in a supervised manner with close observation for side effects.
Lithium alters renal physiology (e.g. polyuria) and is nephrotoxic in severe intoxications. With proper precautions, lithium was otherwise presumed safe through the mid-1970's. In 1977, the controversial question arose whether lithium may induce a chronic renal disease documented by biopsy. Later, similar lesions were demonstrated in affective disturbance patients never exposed to lithium. The possible role of lithium as an inducer of kidney damage is undetermined; but concern for the kidney in lithium patients is expressed. Better pre-lithium patient selection and renal work-up, lower serum lithium levels, and closer clinical and laboratory follow-up are advised.
Trimipramine was found safe, effective, and free of complications when used in combination with the MAOI phenelzine in the treatment of a case of refractory depression. Trimipramine co-administration with phenelzine may be an efficacious alternative pharmacotherapy for selected cases when synergistic antidepressant therapies are indicated.
Principles of sound research design are inconstantly applied to scientific investigations. Quality research depends on good study design. Many research groups appear to favor quick publishable experiments over more rigorously controlled ones. Clinicians seem inadequately prepared to critically evaluate journal articles for quality of research, clinical relevance, and comparability of reports. Clinicians and researchers alike are increasingly aware of these problems, and are calling for greater attention to research design in scientific work. Authors should explain their procedures and the study's relevance to clinical practice. Educators are encouraged to increase teaching of research design and interpretation of scientific writing.
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Hypothyroidism can often be misdiagnosed as psychiatric illness. The hypothyroid patient may present with depression, an organic mental disorder, apathy and/or frank psychosis (usually with paranoid symptoms). Psychiatric manifestations of the endocrinopathy will abate with thyroid hormone replacement therapy, unless the disease state has been sufficiently prolonged to cause some irreversible brain damage. This irreversibility mandates prompt diagnosis and specific hormonal replacement therapy. Thus, thyroid function screening is recommended for patients presenting with depression, psychosis or organic mental disorder.
Lithium therapy concurrent with hyponatremia, thiazides and possibly other diuretics and/or chronic renal failure has generally been avoided. However, despite greater risk for lithium toxicity, such combinations are feasible with appropriate precautions, especially lower lithium dosage and closer follow-up. Under the right circumstances hyponatremia, diuretics, and/or chronic renal failure are only relative lithium contraindications.
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Children of alcoholic mothers are at increased risk for various social and metabolic problems. They are also likely to develop fetal alcohol syndrome: a variable pattern of growth retardation, mental retardation, neurologic dysfunction and congenital dysmorphology. Linear growth is retarded more than weight. Craniofacial anomalies, including microcephaly, are most common. Malformations appear to be related to heavy ethanol intake during the first trimester of pregnancy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.