Thirty-six chronically psychotic patients (nine men and 27 women, mean age 56.7 +/- S.D. 13.4 years) were found to have elevated thyroid stimulating hormone (TSH) levels during review of thyroid function screening tests of 1150 patients over a 15 month period in a 700 bed state mental hospital. This study population of 36 patients was more likely to be female and older than the general hospital population. The spectrum and frequency of psychiatric diagnoses included dementia (3); schizoaffective disorder (12); bipolar disorder (6); schizophrenic disorder (4); organic affective disorder (7); major depression (3); and mental retardation (1). Only nine of these 36 patients failed to receive the goitrogens lithium (LI), carbamazepine (CBZ) and/or phenytoin (PTN) and five of those nine patients had a history of thyroid disease. Sex did not predict age, thyroxine (T4) level, triiodothyronine (T3) uptake, or TSH. The distribution of psychiatric diagnoses were the same for both sexes. Expectedly, there was an inverse relationship between TSH and T4 and T3 uptake. Using T4 to separate grades 1 and 2 hypothyroidism revealed that six (17%) patients had grade 1 disease. Men were more likely to have a seizure disorder and receive LI, CBZ, and PTN. Women were more likely to have a history of thyroid disease. The goitrogenic effects of LI + CBZ seemed additive compared with patients receiving LI alone. While T4, T3 uptake, and LI levels were the same for the two groups, patients receiving LI + CBZ had higher TSH values (p = 0.028) than did patients receiving LI alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Increase in white blood cell count and serum sodium level following the addition of lithium to carbamazepine treatment among three chronically psychotic male patients with disturbed affective states.

Three male chronically psychotic patients (mean age 33.0 +/- S.D. 7.2 years), two with schizoaffective disorder and one with organic affective disorder, received carbamazepine (CBZ) because of affective symptoms (and, in one case, partial complex seizures) refractory to management with antipsychotic drugs. Coincident with CBZ administration (and clinical improvement), hyponatremia developed thought to be due to the antidiuretic effect of this drug. Lithium was added to counteract the antidiuretic effect of CBZ. Further clinical improvement ensured, serum sodium levels became normal, and there was an increase in the white blood cell count in each patient. The clinical implications of our findings are discussed.

Adult↗

PubMedDate not supplied

Similarity of patterns of urine excretion among nonpolyuric and polyuric patients with thought disorders.

From a study population of 29 institutionalized chronically psychotic patients, 70% of whom had schizophrenic or schizoaffective disorders, nonpolyuric and polyuric patients had similar diurnal patterns of urine excretion. Patients excreted a larger portion of daily urine volume after noon (55%) than before noon (45%).

Adult↗

PubMedDate not supplied

Abnormal diurnal weight gain among long-term patients with schizophrenic disorders.

We found diurnal weight gain to be abnormal among 65 long-term patients with schizophrenic disorders. Patients were weighed at 7 a.m. and 4 p.m. serially and diurnal weight gain was normalized (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.2 +/- 1.5% for 47 male patients compared (P = 0.001) with 0.6 +/- 0.4% for 11 male controls. NDWG was 1.7 +/- 0.7% for 18 female patients compared (P less than 0.0001) with 0.5 +/- 0.3% for 14 female controls. We hypothesize that NDWG may be an index of both the severity and duration of the schizophrenic disorder.

Adult↗

PubMedDate not supplied

Diurnal variation in water homeostasis among schizophrenic patients subject to water intoxication.

Among seven schizophrenic patients subject to water intoxication (six men and one woman, mean age 39.1 +/- 6.9 years), we measured serum sodium, plasma arginine vasopressin, and urine osmolality at 7 a.m. and 4 p.m. on eight consecutive Thursdays. On the days of greatest diurnal change in serum sodium, the 7 a.m. serum sodium was 141.1 +/- 1.8 mEq/l and the 4 p.m. value was 129.9 +/- 3.2 mEq/l. Plasma vasopressin also tended to be lower at 4 p.m. but, in many cases, was inadequately suppressed for the level of hyponatremia. The urine was dilute at both 7 a.m. and 4 p.m. and mean urine osmolality did not differ at the two times. In three patients, urine osmolality was consistently subnormal relative to plasma vasopressin at both 7 a.m. and 4 p.m. This abnormality was consistent with nephrogenic diabetes insipidus secondary to lithium and, possibly, phenytoin which the patients received to protect them against hyponatremia. We conclude that the combination of polydipsia and abnormal osmoregulation of vasopressin secretion contributes importantly to the afternoon hyponatremia found in schizophrenic patients subject to water intoxication.

Adult↗

PubMedDate not supplied

Distribution of coronary artery disease in patients with isolate aortic valve disease.

Forty-four adult patients with isolated aortic valve disease underwent coronary arteriography. Seventy precent of patients required aortic valve replacement (AVR). Of 28 men who underwent AVR, 59 percent of those with severe aortic stenosis, 33 percent of those with severe aortic regurgitation and 50 percent of those with mixed aortic stenosis/aortic regurgitation had associated coronary artery disease. Thirty-six percent of men with aortic valve disease not requiring AVR had significant coronary artery disease (CAD). CAD was not found in the 5 female patients studied. In the patients with CAD, the left anterior descending artery was involved 84 percent of the time. Next in frequency were the right coronary artery, the proximal left circumflex artery, and the obtuse marginal artery. Multivessel disease was the rule. All but one patient with significant CAD had angina pectoris, but many patients with angina had normal coronary arteries. The frequent occurence of significant CAD in adult male patients with isolated aortic valve disease argues for the performance of selective coronary arteriography in all such patients in whom AVR is a consideration.

Adult↗

PubMedDate not supplied

Combined valvular aortic stenosis, hypertrophic subaortic stenosis and coronary artery disease: successful surgical correction.

A 51 year old woman with angina pectoris due to combined valvular aortic stenosis, hypertrophic subaortic stenosis and coronary artery disease is described. The diagnosis was first suspected following echocardiography. Discussed is the importance of excluding associated coronary artery disease and hypertrophic subaortic stenosis in patients with valvular aortic stenosis. A pre- and post-PVC aortic pressure response is described pathognomonic of coexistent valvular and hypertrophic subaortic stenosis. The patient underwent successful surgical correction of all three lesions.

Aortic Valve Stenosis↗