Leon J. Hekimian

Controlled evaluation of lithium and chlorpromazine in the treatment of manic states: An interim report

Summary An interim report of a double blind study of the action of lithium and chlorpromazine in manic states is presented. A control group of schizo-affective patients has been included. To date 48 trials of treatment have been undertaken in 42 patients. There were 27 manic depressives, manic phase, one chronic mania and 14 schizoaffective patients. The absence of negro manic depressives is discussed. Total remission in manic patients occurred in 78 per cent with lithium and 36 per cent with chlorpromazine. Significant differences were noted between the two drugs in quality of action. Both agents produced a reduction in overactivity but in optimum doses chlorpromazine tended to produce sluggishness and drowsiness. Lithium produced normalization of affect and ideation; the action of chlorpromazine on affect and ideation was less consistent, less clear and slower in onset. Toxic effects occurred with lithium during periods of stabilization but at optimum doses no significant side effects appeared. The occurrence of late toxic effects in two patients was noted. In the control group of schizo-affectives, 85 per cent of patients on lithium showed deterioration of their clinical condition. Probable reasons for this are discussed. The specific psychopharmacological action of lithium is discussed.

α-Methyl-p-tyrosine (AMT) in schizophrenia

SummaryAlpha-methyl-para-tyrosine, a specific inhibitor of tyrosine hydroxylase, was studied in two groups of 9 and 4 schizophrenic patients. The majority of patients received maximum daily doses in excess of 1000 mg with one patient receiving as much as 3000 mg daily; duration of treatment varied, three patients being treated for 8 weeks. The drug had no demonstrable antipsychotic effects; neither did it evoke mental depression or extrapyramidal syndromes as side reactions. In these nor-motensive patients, no significant changes in blood pressure were noted. Chemical studies in three patients suggested that the drug impaired the biosynthesis of some catecholamines, especially norepinephrine, although such a conclusion must be tentative. The use of AMT as a neuropharmacological tool for testing current biochemical theories regarding the action of antipsychotic drugs, the precipitation of endogenous depressions and the mechanism of drug-induced extrapyramidal syndromes was stressed.