Wilford W. Spradlin

Treatment of psychosis, intermittent hyponatremia, and polydipsia (PIP Syndrome) using lithium and phenytoin

Six patients [5 men and 1 woman, mean age 37.3 +/- 8.2 (SD) years] with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent a sequence of treatments in an effort to normalize basal serum sodium levels and thereby protect the patients against complications, including hyponatremic seizures and coma. The morning baseline group mean basal serum sodium value was 132.5 +/- 3.8 meq/liter. Over a 20-month period, the sequence of treatments was salt-added diet, lithium and phenytoin, and lithium alone. Each treatment program yielded morning group mean basal serum sodium determinations superior to baseline values, except for the program of lithium alone, which could not be tolerated. The combination of lithium and phenytoin provided a morning group mean basal serum sodium level of 140.6 +/- 3.2 meq/liter, which was superior (p less than 0.01) to all other treatment modalities. Early morning hyposthenuria persisted throughout the 20-month period of observation.

Diurnal variation of urinary excretion for patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome)

Ten patients [8 men and 2 women, mean age (SD) 37.6 +/- 6.5 years] with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent serial determinations at 6:00 AM, 12 noon, 6:00 PM, and 12 midnight of levels of urinary creatinine concentration (UCR), urinary specific gravity (SPGR), and urinary osmolality (UOSM) on 8 consecutive Thursdays. Diurnal variation (p less than 0.015) was present in the case of each parameter of urinary excretion (UCR, SPGR, and UOSM). These three parameters remained very low throughout the day (mean UCR 19.0 mg/dl, mean SPGR 1.0033, and mean UOSM 112.6 mosmol/kg), which is consistent with severe and persistent hyposthenuria, and each parameter correlated well with the other two parameters (r between 0.78 and 0.93, p less than 0.001). The 6:00 PM (UC6PM) value for UCR correlated best with the daily mean UCR (UCM), providing the simple linear regression UCM = 0.7615 X UC6PM + 6.1503 (r = 0.912, p = 0.0005) for the 10 PIP patients. Twenty-four-hour urinary volume (24UV) could then be estimated using UCM and values of 17.5 and 12.5 mg creatinine/kg body weight for male and female PIP patients, respectively, to calculate the daily urinary excretion of urinary creatinine. The group mean 24UV was 6963 ml, with a range of 4934-9884 ml. We hope that information about the diurnal variation of urinary excretion (21.6%, 20.5%, 27.4%, and 30.4% of 24UV excreted in consecutive quartiles commencing with the 12 midnight to 6:00 AM quartile), coupled with the utilization of the equation UCM = 0.7615 X UC6PM + 6.1503 (r = 0.912, p = 0.0005) to estimate UCM as an index of 24UV in the PIP syndrome, will provide tools to better elucidate the relationship between psychosis and water dysregulation.

The search for certainty

1. The Birth of Certainty.- Civilization and Its Concepts.- Language and the Concept of Self.- Construction of the Word World.- The Anthropomorphic World of Words.- 2. Spirits and Gods.- The Creation of Spirits as Causal Agents.- Differentiation of Spirits into Polar Opposites.- Magic and Religion.- A Reverence for Words.- Greek Gods Made in Mans Image.- The Gods of Rome.- 3. Christian Concepts.- The Rise of Christianity.- Reward and Punishment.- Witchcraft and the Persecution of Witches.- Modern Religion and Magic.- 4. Self, Soul, and Psyche.- The Homunculus Within.- Science and the Soul.- The Unconscious.- From Soul to Psyche.- In Search of the Psyche.- The Anthropomorphic World of Words.- Benediction.- The Mechanical World of Form and Function.- 5. Knowledge in Numbers.- The Language of Numbers.- Harmony in Form and Function.- Natural Periodicities.- Science as Master-The Reign of Certainty.- Scientific Discovery and Technology.- Instruments of Change.- 6. Living Machines.- Early Views of Man as a Biologic Organism.- The Biologic Sciences from the Medievalists to Darwin.- The Building Blocks of Life.- What Controls the Machinery of the Body?.- The Building Blocks of Behavior.- The Mechanical World of Form and Function.- Commencement Remarks.- The Relative World of Process.- 7. The Return of Uncertainty.- The Relativity Theories.- The Quantum Theory and Quantum Mechanics.- Systems or Patterns.- Reducing the Uncertainty.- Practical Considerations.- 8. The Emergence of I.- Life as Process.- Living Systems and Information Processing.- The Nature of Mind.- Mind in Society.- The Relative World of Process.- Seminar Conclusion.- Conclusion.- 9. The Death of Certainty.- Increasing Uncertainty-An Overview.- A New Concept of Mind and Body.- Two Modes of Organizing Information.- The Self-A Wave or a Particle?.

Patterns of Urinary Excretion Among Patients With Self- Induced Water Intoxication and Psychosis

Parameters of water metabolism were measured serially in nine patients with the syndrome of self-induced water intoxication and psychosis (SIWIP). Clinical and laboratory findings indicated that SIWIP patients are type A of the syndrome of inappropriate antidiuresis. Estimated 24-hour urinary excretion of creatinine and early morning urinary creatinine concentration measurements were used to calculate 24-hour urine volumes. Polyuria was considered present for male patients when excretion was estimated to be greater than 2,600 ml of urine/24 hours or early morning urinary specific gravity was less than or equal to 1.003. Male patients with a specific gravity of less than or equal to 1.003 predictably excreted 28,000 ml of urine/day. Severe hyposthenuria may be a biological marker for a population at risk to develop complications of SIWIP, including seizures, coma, and death.

Correlation of cigarette-induced increase in serum nicotine levels with arginine vasopressin concentrations in the syndrome of self-induced water intoxication and psychosis (SIWIP)

Ten patients [9 men and 1 woman; mean age 42.4 ± 8.5 (± SD) years] who were smokers and who suffered the complications of self-induced water intoxication and psychosis (SIWIP) (8 patients with schizophrenic disorders, 1 patient with manic-depressive illness, 1 patient with dementia) are reported. Each patient underwent serial determinations of parameters of water metabolism including plasma and urine osmolality and plasma arginine vasopressin (AVP). The syndrome of inappropriate antidiuresis (SIAD) was found in each patient. Because of the reported effect that cigarette smoking has on anti-diuresis, we correlated serum nicotine (NIC) levels with plasma and urine osmolality, AVP, and 24-hour urine volume (24°-UV). We found no relationship between NIC and plasma or urine osmolality, AVP, or 24°-UV. In the presence of SIWIP and SIAD, we infer the limbic-hypothalamic neurotransmitters in these psychotic patients are sufficiently powerful in stimulating both compulsive water drinking and inappropriate release of AVP so as to overshadow any effects that NIC may have on water metabolism.

The “Mini-Mental State” Examination in the Syndrome of Self-Induced Water Intoxication and Schizophrenic Disorders (SIWIS): A Pilot Study

A quantitative assessment of cognitive state (Folsteins “mini-mental state” scores) was correlated with serum sodium concentration in four patients with the syndrome of self-induced water intoxication and schizophrenic disorders (SIWIS). Diagnostic studies that demonstrated inappropriate antidiuresis in these patients are reported also. Neither absolute serum sodium concentrations nor their daily changes correlated significantly (p > .05) with the cognitive state of any patient. The authors conclude that serial laboratory determinations of serum electrolytes remains the only satisfactory method of monitoring body tonicity in SIWIS patients.

The Death of Certainty

In the previous chapters we have attempted to illustrate the progress of a conceptual evolution, a search for certainty. This search began with a rather nebulous, poorly differentiated animistic or anthropomorphic way of viewing our world, through progressive differentiation via linguistic tools and other cultural instruments, to a religious conceptual frame in which man and his gods were differentiated from the world. With religion came ritual, dogma, and increased certainty. From the misty continuum of the beginning we became convinced of a standardized reality. Our certainty was bolstered by revelation and reified by a specialized social segment dominated by priests and shamen whose power rested heavily on words.

The Emergence of I

What are the implications of the recent advances in physics and systems and information theories for our concepts concerning life? They are, as we shall see, enormous. Although the implications are clear, however, the final impact upon biology is still to be felt, for the biological sciences are just now beginning to apply the theories emanating from the momentous changes that have occurred in related fields. While physicists have become increasingly concerned with the role of the human mind in defining all physical events in a relative world of process, biologists have until recently tended to be even more involved in the reductionistic approach to life and have concentrated on determining our place in the mechanical world of form and function. During the twentieth century, physicists have focused on relationships within systems and among systems, defining the human mind as an integral aspect of those relationships. “It is,” says Harold J. Morowitz, “as if the two discplines were on fast-moving trains, going in opposite directions and not noticing what is happening across the tracks” [27:p. 34].

Knowledge in Numbers

Using our ability to differentiate became one of our great passions. By using word tools, we began to differentiate or interrupt the continuum of being into discrete units. We dissected our world into blocks and then attempted to put the blocks back together again. The inclination to analyze, synthesize, to interrupt the continuum, is so pronounced that we might term it an innate human property. We see small children dissecting their new toys, sometimes with disastrous consequences, attempting to reduce them to the smallest possible units and then rebuilding them so that the parts at least resemble the original wholes.

The Birth of Certainty

The study of humanity and civilization is the study of evolving conceptual frames. During the centuries many conceptual frames have evolved that have revolutionized our view of ourselves and the universe as each age and each culture attempt to organize their own particular speculations concerning our place in nature.