Biomedical subjects
Publications and source records attributed to P L Rabin.
In four patients, each of whom displayed overt signs and symptoms of a delirious state, the delirium was overlooked. We describe in detail the features of delirium because this syndrome is protean in its etiology and clinical presentations. It can be life-threatening, and it may not be recognized because the behavioral correlates are often attributed to a functional disorder.
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We describe two patients whose initial clinical presentation was that of nephrolithiasis. Eventually, an incontrovertible diagnosis of factitious illness was established. We describe this syndrome, review the underlying psychodynamics, and suggest an approach to treatment, with a plea to physicians to recognize the compulsive behavior as a sign of a disordered psyche and the need for some form of psychotherapy.
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The situational crisis is a period of acute disorganization of affective cognitive and behavioral function precipitated by a traumatic life experience. We review the clinical features of a situational crisis and the four phases of the crisis sequence. Special emphasis is placed on the practical principles of treatment. Recognition of a situational crisis in a patient presenting to the emergency department provides an opportunity for using the initial evaluation as the first step in crisis intervention therapy. This approach often obviates the need for acute hospitalization.
A case of acute mania in a 50-year-old woman who had received hemodialysis treatment for 2 1/2 years is described. The patient's presentation with secondary manic and associated psychotic features was the initial symptom of the syndrome of progressive dialysis encephalopathy (PDE). Shortly thereafter, an abnormal EEG tracing was obtained. Several months later she developed dysarthria and muscular twitchings and EEG changes persisted, a symptom complex characteristic of PDE. The appearance of psychiatric symptoms among patients receiving chronic dialysis treatment may herald the onset of PDE.
We describe the onset of psychotic depression in a young man receiving intensive therapy for Hodgkin's disease. We have found other examples of psychiatric disturbance in the course of reviewing the charts of 40 men with Hodgkin's disease and 20 with testicular cancer. We propose that patients with oncologic disease and their families receive counseling before initiation of treatment and be advised about the availability of psychiatric help should it become necessary.
Four normal subjects received lecithin supplements sufficient to elevate serum choline levels 3-fold. Despite persistent hypercholinemia over 48 hours of close observation, no increase was observed in serum ACTH, cortisol, and insulin concentrations, or in free urinary catecholamine excretion. Screening of a large group of other pituitary and gonadal hormones also failed to reveal any influence of lecithin supplements. EEG patterns and results of psychometric tests were also unaltered.
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Although goiter formation and hypothyroidism are not infrequent following lithium therapy, the association of exophthalmos and/or elevated thyroxine levels with lithium is uncommon. We describe a 62 year old man who rapidly developed exophthalmos, elevated circulating thyroxine, elevated TSH levels and elevated radioiodine uptake within six weeks of reexposure to lithium carbonate. When the medication was stopped, all indices of thyroid function returned to normal and the proptosis receded from 22 to 17mm. Lithium decreases secretion of preformed thyroid hormone and the secondary elevation of TSH levels usually restores euthyroid status. We propose that in our patient, because triiodothyronine levels remained normal, the pituitary was refractory to the normal inhibitory feedback effect of thyroxine and that continued hypersecretion of TSH resulted in hyperthyroidism
Dialysis encephalopathy (DE) is a distinct neuropsychiatric syndrome typically occurring in patients undergoing longterm hemodialysis. It is characterized by electroencephalographic abnormalities in association with disturbances of speech, cognition, movement, affect, or behavior. Previously thought to be relentlessly progressive, recent evidence linking the illness to aluminum overload has led to advances in prevention and treatment. Early diagnosis aids in the reversal or amelioration of the syndrome and can be of immense value to the patient, the family and involved health personnel. The general features of the syndrome, etiologic considerations, differential diagnosis and treatment are discussed. Three case studies are included to illustrate salient features of the syndrome.
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