Anne H. W. Smith

Vanadium: a possible aetiological factor in manic depressive illness.

The effect of Vitamin C in manic-depressive psychosis was assessed by a double-blind, placebo controlled, crossover trial. Both manic and depressed patients were significantly better following a single 3 g dose of Vitamin C than following a placebo. Preliminary results of a double-blind, crossover comparison of normal vanadium intake with reduced intake in manic and depressed subjects are reported. Both manic and depressed patients were significantly better on reduced intake. These results are in keeping with the suggestion that vanadium may be an aetiological factor in manic depressive illness.

The treatment of men with a learning disability convicted of exhibitionism

This paper reviews work on the treatment of men convicted of exhibitionism or indecent exposure. Recidivism is extremely high after treatments, with true figures on recidivism unavailable until 4 years after conviction. It is extremely difficult to control for treatment effects because of the ethical issues surrounding withholding of treatment, but cognitive techniques provide a promising treatment approach. The present study attempted to address all these issues for men with a learning disability. A cognitive treatment is presented and data are available for at least 5 years after conviction. An AB design was used and treatment effects were monitored carefully. Treatment dealt with the issues of accepting that the offense took place, taking responsibility for the offense, accepting the intention of the offending behavior, victim awareness, and behavior consistent with offending for four offenders. All the men responded to treatment, although one offender with only 1 year of probation responded less convincingly than others. Beliefs relating to indecent exposure being fun or not causing harm to women seemed most open to alteration. The beliefs in which the perpetrator thought that the victim shared responsibility for the offense and that women may take a long while to recover from such an incident, seemed the most difficult to alter. Individual characteristics of the case examples are discussed in terms of these general trends.

Erythrocyte membrane cation carrier in manic-depressive psychosis

Erythrocyte Na-K ATPase and sodium pump site numbers were estimated in groups of depressed, manic and recovered patients. The activity of Na-K ATPase per pump site was lower in the depressed group than in the recovered group. In the manic group Na-K ATPase was lower than that of the recovered group, whereas there was no difference in the pump site numbers. In the more severe manics the activity of Na-K ATPase per pump site was significantly lower than that of the recovered patients. Therefore, the change occurring in the erythrocyte membrane cation carrier in manic-depressive psychosis is probably in the activity of individual Na-K ATPase molecules and not in the number of Na-K ATPase molecules per cell.

Lithium and erythrocyte membrane cation carrier studies in normal and manic depressive subjects.

Changes in the erythrocyte membrane cation carrier following lithium ingestion in normal human subjects were studied; ouabain sensitive potassium influx fell significantly during the lithium treated phase. Lithium was fed to rats and no change in erythrocyte Na-K ATPase was shown. These findings contrast with studies of lithium in manic depressive psychosis. The fluctuations in the erythrocyte membrane cation carrier were studied in 5 normal subjects over 12 weeks and the correlations between the parameters calculated. The erythrocyte sodium concentration correlated positively with the ouabain sensitive potassium influx. This too contrasts with findings in manic depressive psychosis.

Tissue vanadium levels in manic-depressive psychosis

The vanadium content of hair, whole blood, serum and urine was estimated by neutron activation analysis in samples from manic patients, depressed patients, recovered manic patients, recovered depressed patients and normal controls. The results suggest that manic patients have significantly raised vanadium levels in hair which fall towards control levels with recovery, but there are no significant differences in the mean vanadium content of whole blood or serum. In contrast, depressed patients have raised levels of vanadium in whole blood and serum which appear to fall with recovery. Levels of vanadium in serum correlate strongly with those in whole blood, but neither shows significant correlation with vanadium in hair for either patients or controls. Hair and blood probably serve as indicator tissues for differing aspects of vanadium metabolism.

The therapeutic effect of ascorbic acid and EDTA in manic-depressive psychosis: double-blind comparisons with standard treatments

The effect of ascorbic acid and ethylene diamine tetra acetic acid (EDTA) in the treatment of manic-depressive psychosis was compared, using double-blind procedures, with recognized treatment regimes. There was no significant difference between the response of depressed patients to amitriptyline or ascorbic acid and EDTA. Manic patients responded significantly better to lithium than to ascorbic acid and EDTA. These results are in keeping with the suggestion that vanadium may be of aetiological importance in depressive psychosis, but do not support such a suggestion for mania.

Tissue aluminum concentrations stability over time, relationship to age, and dietary intake

Aluminum concentration was measured in serum, whole blood, hair, and urine by neutron activation analysis. Seventy-six nondemented subjects were investigated. Not all assays were done on all subjects (e.g., serum aluminum on 76 subjects, whole blood aluminum on 42 subjects), but tissue aluminum concentrations were estimated on more than one occasion on 32 subjects. The mean +/- SD aluminum concentration in serum was 0.219 +/- 0.063 micrograms/ml (N = 76), in whole blood 0.368 +/- 0.091 micrograms/ml (N = 42), in urine 0.092 +/- 0.076 micrograms/ml (N = 42), and in hair 6.42 +/- 2.22 micrograms/g (N = 42). Using product moment correlation coefficient there was no significant correlation between age and tissue aluminum concentrations, nor between dietary intake of aluminum and tissue aluminum. The tissue aluminum concentrations were not stable over time even when dietary intake was constant. Tissue aluminum concentrations were measured in 14 patients after 7 days of dietary control and repeated approximately 6 weeks later, again after 7 days of dietary control. There was no significant correlation between the two estimations in any tissue measured. These results suggest that raised tissue aluminum concentrations reported in Alzheimers disease are not an exaggeration of a normal ageing process, are not likely to be simply secondary to increased dietary aluminum intake, and that Alzheimers disease does not represent the chronic toxic effect of moderately raised aluminum levels at the upper end of the normal distribution.

The effect of digoxin on the response to lithium therapy in mania

Patients suffering from manic-depressive psychosis, manic type (ICD 296.0), were treated with lithium carbonate and randomly allocated to two groups, one received digoxin and the other matching placebo for 7 days. Severity of mania was rated by psychiatrists on the Manic Rating Scale and Analogue Line on days 0 and 7 and by nurses daily on the Hargreaves Rating Scale, Psychotic Rating. Fourteen patients received digoxin and lithium carbonate and 14 patients received placebo and lithium carbonate. Improvement in the placebo lithium group was significantly greater than that in the digoxin lithium group. This trial suggests, therefore, that the effect of inhibition of membrane cation carrier is to reduce the response to lithium. This result is in keeping with our hypothesis that an increase in Na-K ATPase is essential to the therapeutic effect of lithium carbonate. It does not, however, exclude the possibility that the observations resulted from the inhibition by digoxin of lithium entry into the brain.

Changes in Erythrocyte Membrane Cation Carrier with Age in Women

Erythrocyte Na-K ATPase and specific ouabain binding (sodium pump site numbers) were estimated in 21 normal female subjects. The Na-K ATPase activity and the number of pump sites in the older women were significantly lower than those of the younger women, but there was no evidence of change in activity at individual pump sites. When divided into pre- and post-menopausal groups there was no correlation within each group between biochemical parameters and age.