摘要:

Twenty patients with delirium tremens and related states were investigated from the time of admission until the acute state was over. Using strict diagnostic criteria the material was divided into two groups according to the severity of the clinical condition; nine patients had fully developed delirium tremens (grade 3), 11 patients had a less severe clinical state, known as “Predelirium” (grade 2). The material was found to be representative for the condition under discussion.Patients with grade 2 were admitted during the day and the evening, but not during the night; patients with fully developed delirium tremens (grade 3) were admitted during both the day and the night, and this difference is discussed.The two groups had the same pattern of alcohol abuse, but patients with proper delirium tremens had had a drinking bout preceding the acute state; this was not seen among patients with a less severe clinical state. Patients with grade 2 had had symptoms like sleep disturbances and gastro‐intestinal disturbances for 12–24 hours before the admission, whereas grade 3 patients had had such symptoms for about 48 hours.Patients with grade 2 stopped drinking when the first symptoms of the acute state appeared, whereas patients with fully developed delirium tremens continued to drink in spite of their condition. These anamnestic data were supported by the finding that significantly more patients with proper delirium tremens had alcohol in the blood – several even concentrations about 2 g/l – at the time of admission compared to patients with a less severe clinical state. This lack of “latency period”, which previously has been described as a typical feature in the development of delirium tremens, is discussed.It is concluded that due to the methodology used, it has been possible to point out some of the differences between the milder, often harmless, conditions and the potentially serious, fully developed d

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb00550.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Twenty patients with delirium tremens (grade 3) and a less severe clinical state (grade 2) were investigated thoroughly from the time of admission until recovery from the acute state.A lumbar puncture was performed in the majority of the patients immediately after admission and then repeated after recovery from the acute state. The cerebrospinal fluid was found to be both macroscopically and microscopically normal, as was the spinal fluid pressure.The clinical course was without complications, none of the patients were severely dehydrated. All the patients were treated with barbital, a long acting barbiturate. The duration of the acute state and the total amount of drug necessary in the treatment were equal in the two groups of severity. However, patients with proper delirium tremens needed significantly fewer barbital doses during the first hours after treatment was initiated than did patients with a less severe clinical state. The opposite was seen about 12 hours later. These findings are discussed in relation to the high blood alcohol concentration seen at the time of admission in the majority of the patients with proper delirium tremens, but not in patients with grade 2. It is concluded that barbital exerts its effect due to cross‐dependence properties with alcohol.The majority of the patients had moderately elevated blood pressure, pulse rate and rectal temperature at the time of admission; these variables were to a great extent normalized within 48 hours after admission. No differences in those physical signs were seen between patients with fully developed delirium tremens and patients with less severe clinical states.The patients’condition during the acute state was followed by means of a delirium tremens rating scale. Physical symptoms were similar in various degrees of severity of the clinical condition. 18–24 hours after admission the differences in mental symptoms between patients with grade 3 and patients with grade 2 had disappeared, 48 hours after admission the patients’condition was to a large extent normalized. Methodological problems in using a rating scale in conditions as delirium tremens are discussed.The results are discussed in relation to aetiology and pathogenesis of delirium tremens. It is concluded that it may be that a qualitative, and not only a quantitative, difference exists between a severe withdrawal reaction and fully developed delirium tremens, and a hypothesis about a “point of no return” i

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb00551.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

The relation between serum and saliva lithium concentration was studied in patients treated with lithium carbonate.In 23 patients a highly variable salivaherum ratio was found in simultaneous saliva and serum samples.In five patients studied during a period of 4–8 weeks three patients showed a high fluctuation in saliva/serum lithium ratio. In 20 patients saliva lithium concentrations varied unexpectedly in a second sample produced after 15 min. Although some authors report a high and stable relation between saliva and serum lithium concentration, we consider the saliva lithium level unreliable as a prediction of the serum lithium level in patients treated with lithium carbonat

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb00552.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

342 patients referred to a neurological out‐patient department in North East England between November 1975 and November 1976 were studied prospectively using two methods of psychiatric case identification, by clinical interview and by use of the General Health Questionnaire. The population of psychiatric patients identified by clinical techniques is different from that identified by the GHQ and it is concluded that GHQ cannot be used for routine screening in the neurological clinic. Clinical data were compared with a previous retrospective study.Clinical assessment revealed 27 % with psychiatric disorders whilst GHQ showed a probable psychiatric morbidity of 48 % with a cut off score of 11/12 and 21 % with our best cut off score of 26/27. Statistical problems with this method are discussed and the results of this study compared with others using the same questionnaire.Aspects of organic and psychiatric disorder in a neurological clinic are discusse

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb00553.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Discriminant function analyses were applied to data obtained from anxious psychiatric outpatients treated with either chlordiazepoxide (n = 353) or placebo (n = 259) and depressed outpatients treated with either amitriptyline (n = 310) or placebo (n = 328), who had participated in controlled drug trials of 4 weeks’duration, in an attempt to identify factors associated with complaints of drowsiness made by these patients. Although the magnitude of the relationships between individual predictors and drowsiness was small, several factors emerged which had consistent impact across treatment groups. Predictors of complaints of drowsiness attributed to active drugs arose primarily from demographic attributes probably reflective of life style, and from illness and treatment history. In contrast, predictors of drowsiness attributed to placebo were almost exclusively confined to indices of the severity of several aspects of presenting symptomatology. In particular, more frequent complaints of drug‐induced drowsiness were found among better educated individuals with an illness of long duration. Complaints of placebeinduced drowsiness were more common among patients with more severe emotional (phobic‐obsessive) symptomatology and more frequent headaches and among those individuals in whom hypochondriasis was less s

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb00554.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

The diagnostic issues, classification, incidence, genetic factors, and theories of etiology of psychiatric illness associated with childbirth are reviewed. Psychologic influences, psychosocial factors and the concept of biologic maladaptation associated with prospective motherhood are discussed.Postpartum mental distress is not a unitary phenomenon. The physiology of the puerperium is thus not a cause in itself of any of the symptoms, but rather must be regarded as a contributing or triggering factor acting upon an underlying predisposition.Clinical research of postpartum psychiatric syndromes (PPS) and animal behavior studies are inconclusive.It is suggested that major neuroendocrine research strategies currently used in studying affective disorders and schizophrenia should be applied in studying PPS.

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb00555.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Twenty‐nine children who during 1956 through 1970 were hospitalized for borderline psychosis were followed up in 1975. Twelve of them had received inpatient psychiatric treatment for 1–3 years. Seventeen were sent home for local, nonspecific help. At follow‐up 67% of the treated group were no longer considered psychotic, compared with 70% of the untreated group. The two groups differ somewhat in a series of parameters, the treated group showing more severe psychopathological symptoms. The differences do not reach significant levels. No useful prognostic criteria were obtained from the study. The prognosis seems to be much better than for other types of psychosis in chi

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb00556.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

A survey conducted by pharmacists working in four psychiatric hospitals in Israel to assess the prescribing of psychotropic drugs revealed that polypharmacy was common: patients were receiving up to 11 different drugs and up to six different psychotropic drugs. The average number of psychotropic drugs per patient was two. The most popular combinations of drugs used were; one containing an antipsychotic drug(s) and an antiparkinson drug(s) and the other was a combination of more than one antipsychotic agent. Up to 30 doses per day were taken orally by one patient. Drugs that could have easily been administered on a once‐a‐day time schedule were often administered several times a day. Differences in prescribing patterns in the various hospitals and often times on different wards of the same institution could more easily be attributed to different educational backgrounds, habits and personal beliefs and perhaps the physician's experience as well, rather than to the types of patients trea

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb00557.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Fertility and sibship size of 2,518 psychiatric inpatients during 1968–1975 were compared with national census data and examined according to psychiatric diagnoses, psychiatric diseases in first‐degree relatives, early psychic disturbances, duration of disease, and school achievement. Fertility is markedly reduced in all diagnostic subgroups, though particularly in schizophrenia. While psychic disturbances before the age of 15, as an index of a severe disturbance of personality, reduced fertility even further, no significant correlation was found with the duration of the patients’actual disease. Less than ordinary schooling, but also higher qualifications led to a further reduction in fertility. This is particularly so in schizophrenia. Schizophrenics have their children at a later stage of their reproductive career. The psychological and biological consequences of this fact for the transmission of schizophrenia are discussed in detail. No change of fertility relative to the normal population was detected during the observed 8 years. There is suggestive evidence that patients stem from families smaller than expected from the national data. The inherent methodological problems are discussed. The results do not favour the hypothesis of a balanced polymorphism as a mechanism which could explain the constant incidence of psychoses in spite of the severe selection pressure against

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb00558.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Kidney function has been examined in 237 patients who in the autumn of 1977 were in lithium treatment at the Psychiatric Hospital in Risskov, most of them as outpatients. The average age was 42 years. The patients had been given lithium treatment for 0.5–17 years, mean duration 5 years. The mean lithium dosage was 33 mmol/day and the mean 12‐hour serum lithium concentration 0.85 mmol/1. Glomerular filtration rate was assessed through determination of 24‐hour creatinine clearance and serum creatinine, in some cases iothalamate clearance. Water excretion was assessed through determination of 24‐hour urine volume and in some cases urine osmolality after 26 hours of fluid deprivation. Creatinine clearances, serum creatinine concentrations, and urine volumes were subjected to multiple regression analysis with various clinically relevant predictor variables.Affection of glomerular filtration rate was only moderate and progressed slowly. The data indicate that the risk of renal insufficiency and terminal azotemia is remote even when lithium is given for many years. A large number of the patients had altered water excretion with polyuria or lowered urine concentrating abiliy or both. Due to the extra fluid loss these patients are apt to develop dehydration, and they may then be in danger of lithium poisoning.We hypothesize that lithium‐induced changes of kidney function may become less frequent and less pronounced if patients are maintained at serum lithium levels somewhat lower than those employed in the group studied here. We recommend careful monitoring of serum lithium levels, regular control of kidney function, and extra caution when physical illness or additional drug treatment may lead to disturbance of fluid and electrolyt

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb00559.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY