William A. Price

Treatment of Depression in Chronic Cocaine and Phencyclidine Abuse With Desipramine

An open field trial was conducted comparing desipramine and an active placebo in separate populations of chronic cocaine and phencyclidine (PCP) abusers, who discontinued their abuse. Subjects who received desipramine showed a decrease in depressive symptoms after a 20–40 day period regardless of whether they abused PCP or cocaine.

Comparison of antimanic efficacy of clonidine and verapamil

The standard treatment for mania has been lithium carbonate, alone or in combination with neuroleptics. Unfortunately, lithium is refractory in some patients and may possess potential thyroid and renal toxicity.1 Neuroleptics also are not without risks and can cause extrapyramidal symptoms as well as tardive dyskinesia.2 As a result, other less potentially troubling agents have been sought to control the symptoms of mania. Two such drugs are the antihypertensive agent, clonidine, and the antianginal drug, verapamil.

Anorexia nervosa in the elderly

Anorexia nervosa is generally considered a disease that affects young women. Though the exact etiology of this peculiar disorder is not yet known, several features are characteristic and include a relentless pursuit of thinness with a morbid fear of fatness, disturbance of body image, and a refusal to maintain a minimal body weight that eventually leads to a 20 to 25 per cent weight loss. Several researchers have attempted to use stringent criteria for diagnosis that include specific demographic factors such as gender and age of onset as well as duration and percentage of weight lost. Feighner and associates’ insist upon onset prior to age 25 and Dally2 uses an age limit of 35 as a bar to the diagnosis. Indeed, most published series suggest a mean age of onset for the disorder of approximately 17 years. Even Sir William Gull in his initial de‘scription of the disease in 18743 pointed out that the victims were chiefly between the ages of 16 and 25. Furthermore, the DSM-111“ categorizes anorexia nervosa and other eating disorders such as bulimia as disorders occurring during infancy, childhood, or adolescence. It too points out that this is a disorder that usually occurs in early or late adolescence, although the usual age of onset ranges from pre-puberty to the early thirties. Nonetheless, cases of anorexia nervosa have appeared in the literature in women up to the age of with several other reports occurring in women in their fifties and sixties.”-0 The following case report further illustrates the necessity to include anorexia nervosa in the differential diagnosis in patients over the age of 50.

β-Endorphin withdrawal: a possible cause of premenstrual tension syndrome

The authors propose that premenstrual tension syndrome (PMS) is the result of beta-endorphin withdrawal. Sixteen women were included in this study which measured beta-endorphin levels on the 7th and 24th day of each womans menstrual cycle. A significant decline in beta-endorphin levels was noted during the progression of the cycle. The severity of symptoms, however, was inversely proportional to the amount of decline in beta-endorphin levels. It is hypothesized that the attenuation of endorphin decline may be a compensatory mechanism to moderate the severity of PMS symptoms.

A Paradoxical Response to Chlorpromazine—A Possible Variant of the Neuroleptic Malignant Syndrome

T HE neuroleptic malignant syndrome (NMS) is an uncommon but potentially lethal complication of the major tranquilizers. First defined by Delay and Deniker’ as a rare and sometimes fatal complication of oral phenothiazine therapy, the neuroleptic malignant syndrome is characterized by hypertonicity, hyperthermia (temperature elevations as high as 41#{176}C), altered consciousness, and autonomic dysfunction. Autonomic dysfunction includes pallor, diaphoresis, sialorrhea, hypertension, tachycardia, and tachypnea. Haloperidol and the piperazine phenothiazines have been implicated most often as the causative agents of the NMS. Even though there are well over 60 cases reported in the world literature, the exact incidence of the neuroleptic malignant syndrome is unknown.2 Considering the widespread use of neuroleptics in medical practice, this could be a problem of immense proportion and one requiring extra care when prescribing these medications. The authors would like to describe a case of a 40-year-old white male who developed dyskinesia, increased feelings of anxiety, and autonomic dysfunction following the initiation of oral chlorpromazine therapy. This case represents either a unique form of the neuroleptic malignant syndrome since no change in body temperature occurred or

Lithium-Carbamazepine Neurotoxicity in the Elderly

To the Editor:-Several repor.ts on the neurotoxic side effects associated with lithium-carbamazepine combinations have appeared in the literature. l v 2 Recently Sliukla and co-workers’ suggested that those at an increased risk for developing this reaction are those with a history of neurotoxicity during lithium therapies and those with the presence of concurrent compromised medical or neurologic functioning. These risk factors take on much meaning when one is dealing with a geriatric population. We recently had the opportunity to treat an elderly white woman with a rapid cycling, refractory, bipolar disorder who became toxic on this combination. This case clearly demonstrates the risk factors reported by Sliulka et al.,l and serves to further highlight other aspects of the patient’s illness that may be important in the pathogenesis of this adverse reaction. The patient, a 71-year-old white woman with a long history of bipolar affective disorder with frequent exacerbations, presented with a two-week history of manic behavior that included pressured speech, intrusiveness, and lack of sleep. Medications prescribed at admission included lithium carbonate 150 mg twice a day, haloperidol 0.5 mg twice a day, nortriptyline 20 mg twice a day, quinidine 324 mg twice a day, digoxin 0.125 mg daily, and levothyroxine 0.1 mg a day. She had been taking all her medications as prescribed. Her medical history is remarkable for congestive heart failure, atrial fibrillation, partial thyroidectomy, and mild hypertension. Routine laboratory examinations including complete blood count with differential, serum electrolytes, glucose, liver and thyroid hnctions, rapid plasma reagin test, and urinalysis all were normal except for the urinalysis, which revealed numerous white cells and bacteria. Urine culture and sensitivity revealed Eschericlzia coli sensitive to ampicillin, which was started at this time. Her urinary tract infection promptly resolved. Electrocardiogram and electroencephalogram were both within normal limits. Lithium carbonate level on admission was 0.41 mEq/L. Quinidine and digoxin levels were within the therapeutic range. Physical examination was unremarkable except for some mild buccal-lingual dyskinesia. Shortly after admission the haloperidol was discontinued and perphenazine was started and gradually increased to 8 mg at bedtime for its sedating effects. Nortriptyline also was discontinued. Sev-

Antidotal Strategies in Phencyclidine Intoxication

The authors present different antidotal strategies in treating phencyclidine (PCP) intoxication based upon specific symptomatic presentation. Evidence exists for dopaminergic, cholinergic and opiate-like activity of PCP in both laboratory and clinical studies. Reviewing these studies, clinical interventions are recommended according to various symptom clusters.

TREATMENT OF PHENYLCYCLOHEXYLPYRROLIDINE (PHP) PSYCHOSIS WITH HALOPERIDOL

Twenty white males who presented with psychosis were later found to have ingested PHP. Treatment with haloperidol 5 mg IM caused significant improvement while placebo treatment did not. Results of haloperidol treatment of PHP psychosis were similar to previously published reports with phencyclidine (PCP) psychosis.

The Use of Clonidine in Premenstrual Tension Syndrome

p REMENSTRUAL tension syndrome (PMS) is a collection of behavioral, psychological, and physical symptoms that includes irritability, fatigability, hyperphagia, increased libido, abdominal cramping, bloating, and headaches, occurring repetitively approximately every 28 days, following by periods of relatively normal behavior.”2 The cyclical nature of this disorder is strikingly similar to that of a rapidly cycling bipolar affective disorder. This comparison has been strengthened recently by research showing that there is a statistically significant increase in 3-methoxy-4hydroxyphenylethylene glycol (MHPG) excretion during the late luteal phase of a woman’s menstrual cycle followed by a rapid decline two days prior to the menses and subsequent elevation during the menses.3 MHPG, the principal metabolite of central nervous system norepinephrine, has been shown, in some cases, to be elevated during manic states and low during depressed states.4 Researchers have also discovered that the endogenous opioid peptides, the endorphins, rise and fall throughout women’s reproductive cycles, with the endorphin elevations especially marked in those women experiencing the most severe PMS symptoms.5 These similarities have prompted researchers to attempt to control the symptoms of premenstrual tension with lithium, the standard treatment for bipolar affective disorders. This form of treatment, however, has a number of drawbacks. First of

Anxiogenic Effects of Generated Ambient Cations—A Preliminary Study

The existence of the putative “serotonin irritation syndrome” (SIS) was tested in a human population. Volunteers were exposed to a highly cationized environment for two hours. Symptoms of anxiety and excitement significantly increased. During the time of exposure serum serotonin levels also increased significantly. These results support the existence of SIS as a clinical entity.