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Biomedical subjects

J F Neil

Publications and source records attributed to J F Neil.

47 records · Page 3Linked to original sources
PubMed1977

Thiazide-lithium synergy in refractory mood swings.

The unfortunate experience with lithium chloride as a salt substitute in the 1940s still directs the clinical usuage of lithium carbonate to a certain extent. We are still warned that lithium salts should never be used in low-sodium situations (e.g., with thiazide diuretics or salt-restricted diets); however, it has recently been shown that thiazide diuretics may be safely used in the treatment of lithium-induced nephrogenic diabetes insipidus (NDI). The authors recapitulate the dangers inherent in the use of this drug combination and present detailed clinical-pharmacologic data on 13 patients which suggest that thiazides are useful in the treatment of lithium-induced NDI and may actually synergize with lithium to produce improved mood control in some lithium-refractory manic-depressive patients.

Ambulatory Care↗
PubMed1977

Psychotic pica, nicotinism, and complicated myocardial infarction.

The authors report a case of a schizophrenic patient who repeatedly consumed a wide variety of inedible materials, including significant quantities of tobacco. The phenomenology of this behavior, as well as its psychiatric and medical complications are discussed. It is probable that chronic nicotinism contributed to this patient's refractoriness to psychiatric treatment and to his eventual cardiovascular crisis. The occurrence of pica as a manifestation of severe psychopathology was vividly described by the early pioneers of neuropsychiatry, but has received little attention in recent psychiatric literature. This is in marked contrast to the syndrome of psychogenic water intoxication which continues to be reported frequently. The majority of descriptions of pica have dealt with its occurrence in children, in pregnant women, and as a societal practice in certain cultures studied from a medico-anthropologic point of view. The toxic organic brain syndrome caused by chronic ingestion of nicotine-containing products has also been neglected in psychiatric publications. Descriptions of the neuropsychiatric complications of subacute and chronic nicotinism have been restricted to textbooks of toxicology, where greater emphasis has been given to the acute effects of large quantities of nicotine, often in forms other than tobacco. The following case illustrates the near-fatal practice of tobacco pica in a psychotic patient and dramatically demonstrates the systemic and central nervous system effects of nicotinism.

Adult↗
PubMed1976

Incidence and signficiance of mixed affective states in a bipolar population.

The simultaneous existence of manic and depressive symptoms in a manic-depressive patient was first described by Kraepelin. This so-called mixed state has come to have much theoretical significance in recent hypotheses about the nature of bipolar affective disorders. In this investigation a mixed state is shown to be the initial episode in 31% of 84 manic-depressive outpatients. Moreover, the presence of "mixed" features does not correlate with severity of illness or mood circularity, but does correlate with sedative abuse and poor response to psychopharmacologic treatment. These results suggest that the "continuum hypothesis" and its satellite theories represent viable conceptualizations of the nature of manic-depressive illness.

Adult↗
PubMed1976

Emergence of myasthenia gravis during treatment with lithium carbonate.

In a patient with recurrent episodes of severe mania, classical manifestations of myasthenia gravis developed for the first time during treatment with lithium carbonate. Four episodes were recorded in which the appearance of progressive weakness coincided with subacute or long-term lithium carbonate administration during periods of psychiatric remission. In each instance, neurologic symptoms were ameliorated or disappeared shortly after the drug was discontinued or its dosage was reduced. There was no evidence of lithium carbonate toxicity or electrolyte disturbances at any time during treatment. Based on a literature review of animal studies and related clinical reports, a mechanism of peripherally mediated neuromuscular cholinergic insufficiency is proposed. In addition, the differential diagnosis of muscle weakness during lithium carbonate administration is discussed.

Adult↗
PubMed1976

Effect of chlorothiazide on the pharmacokinetics of lithium in plasma and erythrocytes.

The effect of chlorothiazide on the pharmacokinetics of lithium in both plasma and RBCs was studied in normal adult males. This was accomplished by administering single, 300 mg. doses of lithium carbonate alone and concurrently with chlorothiazide (0.5 grams/day for one week). Thiazide administration resulted in increases in plasma and RBC concentrations of 26.2 and 25.4%, respectively, as well as a 26.5% decrease in renal lithium clearance. The data were analyzed in terms of a two compartment pharmacokinetic model as previously reported (8). The results of this analysis showed that the change in renal lithium clearance could be accounted for by a 24.1% reduction in the value of ke, the excretion rate constant. It was also shown that changes in plasma lithium concentration during chronic lithium therapy would be expected to increase by 25-30% when chlorothiazide therapy is employed. The model also predicts that changes in RBC concentrations would parallel those occurring in plasma and thus no change in the RBC/plasma lithium ratio would be expected.

Adult↗