Biomedical subjects
Publications and source records attributed to J Ananth.
The authors surveyed 500 inpatients receiving long-term neuroleptics; 8 had first-degree family members who were also being treated with long-term neuroleptics and suffering from a psychiatric disorder. The 8 patient-relative pairs showed concordance for the presence or absence of tardive dyskinesia.
Based on the finding that lithium carbonate administration can stimulate leukocyte production, six patients were treated with neuroleptic and other drug-induced granulocytopenia with lithium carbonate. The average total leukocyte count of 2500/mm3 increased to 4566/mm3. Similarly the average neutrophil count of 1028/mm3 increased to 2893/mm3 after lithium therapy. In all six patients, neutrophils decreased upon discontinuation of lithium. On the other hand, total WBC count of 4566/mm3 decreased to 2650/mm3, and the total neutrophil count of 2893/mm3 decreased to 966/mm3 after four weeks without lithium. The results suggest that lithium carbonate is effective in the treatment of drug-induced leukopenia.
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Various drugs including antihypertensives, anxiolytics, antibiotics, antidepressants, corticosteroids, choline, indomethacin, levodopa, metronidazole, neuroleptics, oral contraceptives, sulphonamides and physostigmine have been reported to produce depression as a side effect. Clinically, these drug-induced depressions may go unnoticed and thus create therapeutic problems. Although causal relationship is difficult to establish, depression occurring during the course of drug treatment needs an evaluation of all the medications that the patient has been receiving. We believe that postpsychotic depressions include three types of depression: pendular depression--primarily disease related; chronic depression--primarily environment related, and amine-depletion depression--drug related. Thus, drug-induced depressions constitute a subgroup of postpsychotic depression. Clinically, it is essential to carefully monitor patients receiving drugs known to produce depression. Thus, prompt recognition of the drug-induced depressions may assist in initiating proper therapeutic measures.
In this paper, the efficacy of lithium therapy in the treatment of tardive dyskinesia is reviewed. It is noted that most of the published papers on this topic are anecdotal and single case reports with contradictory results. The well-designed studies indicate that lithium is useful in certain tardive dyskinesia patients and that the red blood cell lithium level may be related to the therapeutic response. Therefore, on the basis of the available information, we conclude that routine clinical application of lithium in the treatment of tardive dyskinesia is not warranted. However, further evaluation of lithium in the treatment of tardive dyskinesia and identification of the responders are extremely useful. In addition, as suggested by animal studies, the prophylactic value of this agent against tardive dyskinesia needs exploration.
The authors describe 13 psychotic patients who had Capgras syndrome. Only 4 patients had evidence of organicity. The authors conclude that Capgras syndrome occurs equally in functional psychosis and in the presence of organicity and recommend that the presence or absence of organicity be determined in every patient with Capgras syndrome.
Fifty-nine lithium treated patients were administered the MMPI test to differentiate the responders from the non-responders. The non-responders obtained higher scores on the Psychopathic Deviate, Paranoid and Mania Scales while the responders obtained higher scores on the Hypochondriasis, Psychasthenia and Social Introversion scales. Further work with pre- and post-treatment MMPI administration may provide additional and more definitive results.
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Even though lithium has been established as an effective agent in the management of primary affective disorders, not all manic-depressive patients respond favourably to lithium therapy. Therefore we attempted to delineate lithium responders from non-responders in a group of 54 manic-depressive patients on the basis of an assessment which included 64 variables and the results showed that only two thirds were pure responders. Females, patients with prior manic episodes, onset of the illness initially with a manic episode, and premorbid psychothymic personality were all indicators of favourable long-term lithium response. Patients with retarded depression, severe anxiety, though disorder and those with higher scores on the Psychopathic Deviate and Paranoia scales of the MMPI were poor lithium responders. It should be noted, however, that only a few of the differences between responders and non-responders were statistically significant. Our study suggests a number of predictive variables for the identification of lithium responders.
Tardive dyskinesia (TD) has been reported to occur after the long term administration of neuroleptics. Its prevalence has been reported to vary from 0.5-56%. However, no clear relationship is established between a particular neuroleptic, its dosage and duration of administration and the diagnosis and occurrence of TD. Neuropathological investigations have not provided any definitive lessons. in addition, TD can be produced by a number of drugs of different chemical classes. Similarly, the evidence for dopaminergic hypersensitivity is equivocal. The only definitive feature seems to be an individual predisposition, the nature of which needs to be elucidated. Of course, basic to any future research into new insights regarding etiology, the fundamental problem of definition and identification based on the accepted definition are most essential. This solid foundation is necessary for the resolution of any conflicting results that may be reported in the future.
Twenty patients with a history of treatment-resistant obsessional neurosis underwent a 4-week clinical trial of chlorimipramine. Scores on the Psychiatric Questionnaire for Obsessive Compulsive Neurosis, the Leyton Obsessional Inventory, and 3 self-assessments indicated that although there was no significant change in obsessive ruminations, obsessive rituals, horrific temptations, or pervading doubt, there was a substantial significant improvement in the obsessive symptom item and severity of obsessions, as well as anxiety, depression, and phobia. Side effects were mild. The authors believe that chlorimipramine is the most promising treatment for obsessive-compulsive neurosis.
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Depression is not a unitary disease and not all cases of depression can be treated alike. Therefore, predictors of antidepressant response to different drugs need to be identified. Premorbid personality, age and sex and family history are useful in prediction. As an example, only females respond to the addition of triiodothyronine to the antidepressant therapy. Endogenous depressions respond favourably to antidepressants, so also do psychotic depressions. On the other hand, delusional depressions do not respond to antidepressants. While atypical depressions are best treated with MAOI, motor retardation improves with imipramine and obsessive symptoms with chlorimipramine. In addition to clinical variables, biochemical and statistical approaches have also yielded significant results in prediction.
Neuroleptics, antidepressants, lithium, anxiolytics, and hypnotics may be excreted in breast milk. Because of the danger to the neonate, drugs such as diazepam, lithium, bromides, reserpine, and opium alkaloids should not be given to lactating women, and barbiturates, haloperidol, and penfluridol should be administered with caution. The side effects produced as a result of breast-feeding of the infant by mothers consuming psychotropic drugs are reviewed and possible preventive measures are discussed.