James A. Wilcox

Childhood head trauma and psychosis

The medical histories of 200 schizophrenic patients were compared to those of 203 depressed patients, 122 manic patients, and 134 surgical controls. All subjects were hospital inpatients. Charts were specifically examined to record any head injury before age 10 that had required medical attention or caused loss of consciousness. Schizophrenics had a significantly greater history of head trauma than the manics, depressives, and surgical controls. There were no significant differences between manics and depressives or between affective disorders as a group and surgical controls. Childhood trauma may be a contributing factor to the development of psychosis in some individuals.

Serine metabolism and psychosis

Plasma serine levels (PSL) in a group of patients with the diagnosis of major or atypical psychoses were significantly higher than in patients with nonpsychotic diagnoses or nonpatient controls. The enzyme serine hydroxymethyltransferase (SHMT), which metabolizes serine to glycine, showed abnormal activity in the psychotics compared to nonpsychotics and controls. PSL differentiated psychotics from nonpsychotics with a high (95%) degree of confidence. PSL were highly correlated to SHMT activity, suggesting that the hyperserinemia in psychotics was due to the abnormality of the enzyme. Previously psychotic patients who had been treated and were psychosis free still manifested abnormal high PSL and abnormal enzyme activity. These findings suggest that disturbed serine metabolism may be a biological marker and a vulnerability factor for psychosis.

Divalproex Sodium as a Treatment for Borderline Personality Disorder

Divalproex sodium was given to a series of individuals with the diagnosis of borderline personality disorder. Objective measures of agitation and anxiety were then used to assess the effect of divalproex sodium on such symptoms. Data were collected on the subjects and the amount of time spent in the agitated state was evaluated. We found that divalproex sodium reduced agitation in our subjects.

Perinatal distress and prognosis of psychotic illness

The medical histories of a group of 511 patients hospitalized for schizophrenia were examined for the occurrence of perinatal distress. These patients were part of a 40-year follow-up study, so that their prognostic outcome was known at the time of this study. In this way, 200 cases of chronic schizophrenia were compared with 311 cases of psychotics with good prognosis. It was found that a history of perinatal distress was much more common in the poor prognosis group than in the good prognosis group. This difference could not be accounted for by age or family history of psychiatric illness.

Gender Differences in the Etiology and Symptoms of Schizophrenia Genetic Versus Brain Injury Factors

AbstractA study of the medical and psychiatric history of 199 chronic schizophrenic patients revealed that schizophrenic males were significantly more likely to have had severe brain insult during childhood whereas schizophrenic females were more likely to have a positive family history of chronic psychotic illness. The schizophrenic males were also more likely to have negative symptoms than were the schizophrenic females. The data suggest that there may be genetic and brain injury gender differences in the etiology and symptomatology of schizophrenia.

Psychopathology and Narcolepsy

Twenty-eight patients with narcolepsy are compared to a sex- and age-matched control population with regard to the frequency of psychiatric symptoms. The occurrence of psychiatric syndromes in narcolepsy patients is also examined. The frequency of psychiatric illness in patients with cataplexy or hypnagogic/hypnopompic hallucinations is evaluated as well. Analysis with the Mann-Whitney test found a significant association between narcolepsy and the symptoms of schizophrenia. Premorbid history of organic brain disease was associated with mental illness, but was nonspecific for psychopathology.

Metabolism of an ingested serine load in psychotic and nonpsychotic subjects

Our previous studies have shown that in psychotics, the plasma serine level is abnormally high and that plasma serine hydroxymethyltransferase (which cleaves serine to glycine) activity is abnormally low as compared with that in nonpsychotic subjects. In this study, psychotic and nonpsychotic subjects ingested a large bolus of L-serine (4 mM/kg) at breakfast and blood was drawn before breakfast, 2 hr, 4 hr, and 6 hr after serine ingestion. Baseline serine and SHMT activity differentiated between psychotics and nonpsychotics with high degrees of significance (p less than 0.0001) and p less than 0.01, respectively). Plasma serine levels 2 hr after serine ingestion were significantly higher (p less than 0.01) in nonpsychotics as compared with psychotics. Elimination of serine in psychotics was bimodal and was significantly different from that of nonpsychotics (p less than 0.0079, Moses test). These findings provide additional evidence for abnormal serine metabolism in psychotic patients.

Sydenham’s Chorea and Psychosis

The medical histories of 600 psychotic and 369 nonpsychotic subjects were examined for the occurrence of rheumatic chorea. There was significantly more rheumatic chorea in the histories of psychotic patients than in nonpsychotics (p less than 0.01, chi-square). Neuropathological associations are discussed.

Differentiation of psychotic from nonpsychotic depression by a biological marker

In a study of fasting plasma serine levels (PSL) previously shown to be a biological marker for psychosis, we found significantly higher (P = 0.0008) PSL in 18 psychotic depressives when compared to 22 nonpsychotic depressives. Similarly the activity of the enzyme serine hydroxymethyltransferase (SHMT) which cleaves serine to glycine, was significantly lower (P less than 0.0001) in psychotics than in nonpsychotics. The difference between psychotic and nonpsychotic depressives were not attributable to age, sex or drug intake. This finding is in support of the hypothesis that these two types of depressions are qualitatively distinct from each other.

Pharmacologic approaches to psychogenic polydipsia: Case reports

Psychiatric patients presenting with chronic psychogenic polydipsia are often difficult to treat with standard psychiatric interventions. Pharmacologic intervention was attempted in three patients and was successful in one. One patient had a significant and sustained reduction of water intake while on 160 mg of propranolol. One patient did not improve with either propranolol or captopril while a third patient showed no improvement of serum sodium with demeclocycline nor reduction of water intake with propranolol. The potential mechanisms by which these pharmacologic agents might alter thirst in patients with primary polydipsia are discussed.