Teruo Okuma

Anti‐Manic and Prophylactic Effects of Carbamazepine (Tegretol) on Manic Depressive Psychosis A Preliminary Report

1).  The anti‐manic, anti‐depressive and prophylactic effects of carbamazepine (CAZP, Tegretol‐Ciba Geigy) on the endogenous mani‐depressive psychosis (MDP) were investigated on 50 MDP cases. The dosage of the drug ranged from 200 to 1,200 mg daily (usually 400 to 600 mg). 2).  The effect of CAZP on 33 manic states was: “markedly effective” seven (23%), “effective” six (19%), “slightly effective” five (16%), “ineffective” 13 (42%), whereas the effect on six depressive states was: “markedly effective” one and “ineffective” five. No definite relationship was found between the kinds of drugs in combination use and the effect of CAZP. No significant difference of the CAZP effect was found in the four patient groups with different age of onset of the illness, nor among the “continuous,”“frequent” and “periodic” type cases. 3).  The prophylactic effect of CAZP on 27 cases in which the assessment of the effect on the manic episode was possible was: “markedly effective” 13 (48%), “effective” seven (26%) and “ineffective” seven (26%), whereas that for depressive episode was: 12 (45%), two (7%) and 13 (48%), and the result of the general assessment on each patient was 14 (43%), 10 (30%) and nine (27%), respectively. The kinds of drugs in combination use, age of onset and type of course of the illness did not have any influence on the prophylactic effect of CAZP. 4).  The prophylactic effect on MDP of CAZP did not parallel that of lithium salt, but CAZP may be effective on cases which did not respond to lithium and vice versa. 5).  Side‐effects such as ataxia, dizziness, exanthema, drowsiness and headache were observed in five of the cases, and the CAZP was discontinued in four of them. 6).  The mechanism of effectiveness of the CAZP on MDP was discussed.

Combined Thyroid (Triiodothyronine)-Tricyclic Antidepressant Treatment in Depressive States

It has been known as a result of experiments on animals that a part of the effect of imipramine, a tricyclic antidepressant, is enhanced in hyperthyroid mice compared with mice with normal thyroid function (Prange et al.? 1962). Prange et al. further observed in one case of hypothyroidism with a depressive state, that paroxysmal auricular tachycardia which was not found in single use of thyroid hormone occurred when they combined imipramine with thyroid hormone. Thus, the possibility that the hyperthyroid state or the administration of thyroid hormone enhances the effect of imipramine was suggested. Based upon these facts, Prange etal. (1 969) attempted to treat depressive patients with normal thyroid function, with a combination of the therapeutic dose of imipramine with a small dose of thyroid hormone (triiodothyronine, abbreviated as TS hereafter) and found that the effect appeared earlier than in the case of administration of imipramine alone. Since then, a number of evidences supporting this finding have been reported (Wilson et al.,13 1970; Earle,5 1970; Coppen et a1.,3 1972), but it has been reported also that there is no significant differ-

On the Psychophysiology of Dreaming: A Sensory Image ––– Free Association Hypothesis of the Dream Process

Abstract: A psychophysiological hypothesis of the dream process during REM sleep called “a sensory image‐free association hypothesis” is proposed. It is assumed that a state with a sustained EEG pattern of drowsiness (non‐REM stage‐1) and muscle atonia produces a stream of disorganized and vague thinking as a background mentation during the REM sleep. The phasic excitation of the brain occurring concurrently with the burst of rapid eye movements (REMs) activates the hippocampal‐neocortical memory system and draws out sensory images from the memory reservoir of the brain. The dreamer makes a freely organized association about the successive sensory images and makes up a dream story. This hypothesis is compatible not only with the recent neurophysiological findings but also with traditional psychological interpretation of the dream content.

Affective Disorders in Mentally Retarded Adolescents —Report of Two Cases with Lithium Treatment—

Abstract: Two cases of moderately retarded adolescents with affective disorders have been treated for nine and five years, respectively. Rapid cycling episodes were seen in early adolescence and a long duration of episodes appeared in late adolescence. A two‐year lithium therapy was able to control them fairly well but did not work as a prophylaxis. Lithium carbonate induced polydipsia or personality change.

An Electroencephalographic Study on the Tolerance of Psychiatric and Neurologic Patients to the Hypnotic Effect of Diphenhydramine

1) The tolerance to the hypnotic effect of the diphenhydramine (Dph), one of anti‐histaminics, of normal subjects and psychiatric and neurologic patients was investigated on EEG data obtained in the routine EEG examination including Dph activation on 392 patients and 69 adult normal controls. EEG was recorded for 30 min following intravenous injection of 1 mg/kg body weight of Dph, and the time occupied by the stage of wakefulness and by each sleep stage were measured. The percent time waking EEG (% W‐EEG) was used as an index of the tolerance to the hypnotic effect of Dph.

THE EFFECT OF SOME PSYCHOTROPIC DRUGS ON THE ELECTRIC ACTIVITY OF THE BRAIN AND SLEEP CYCLE PATTERN OF THE CAT

1) The effects of chronic administration of psychotropic drugs such as imipramine, atropine sulfate, chlorpromazine, perphenazine, levomepromazine, pentobarbital sodium, chlordiazepoxide, neostigmine and reserpine on the electric activity of the brain and sleep cycle pattern were investigated using adult cats carrying chronically implanted electrodes.

A Comparative Study of Benzodiazepine Hypnotics and Zopiclone in Schizophrenia: Effects on Polysomnograms and BPRS Scores

Abstract: Sleep variables and psychiatric symptoms during benzodiazepine (BZD) hypnotic therapy and during zopiclone (ZPC) treatment were investigated in 6 male chronic schizophrenics. The amount of stage 1 was smaller and that of stage 2 was larger during treatment with ZPC than BZDs. However, no significant difference was shown in the amount of slow‐wave sleep (SWS) between the treatments. Both the total and negative‐symptom scores in the Brief Psychiatric Rating Scale (BPRS) were lower, and the soundness of sleep in the subjective sleep assessments was better evaluated during treatment with ZPC than BZDs. These results suggest that ZPC may be more beneficial in treating schizophrenic insomnia than BZDs.

Three cases of Acute Diffuse Lymphocytic Meningo-encephalitis

Clinical and pathological descriptions were made on the three cases of acute diffuse lymphocytic meningo‐encephalitis.

CHANGE OF PLASMA CORTICOSTERONE DURING SLEEP IN CATS

The relationship between the course and depth of sleep and pituitary‐adrenocortical activities was studied using adult cats. Metal electrodes were fixed on the skull and in the dorsal hippocampus for recording EEG. A serial collection of 2 ml of blood was performed at 15 minute intervals using a cardiac polyethylene catheter during sleep of the animal without anesthesia or restraint. Polygraphic recordings of EEG, ECG, EMG and eye movement were made simultaneously to determine the depth of sleep, which were classified into 4 stages of A, S‐1, S‐2 and S‐A stages. Plasma corticosterone was determined using a fluorometric technique. Two conditions were studied; one during natural sleep without previous sleep deprivation, and the other following 24 hours of sleep deprivation using the pool method. The following results were obtained: