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A patient with refractory chronic schizophrenia having severe polydipsia and hyponatremia was treated with clozapine. There followed a dramatic improvement in the polydipsia and correction of the hyponatremia. This improvement has been sustained throughout a 6-month follow-up.
This participant observation study of the first Gamblers Anonymous group in Israel is designed to show (1) the ways in which the group helps it members rehabilitate themselves, (2) the three stages through which they must go in order to ensure success, and (3) the reason why some participants fail to do so. The article concludes with a number of observations concerning the extent of gambling in Israel and the different ways that should be developed for dealing with the problem.
A model depicting 16 varieties of healthy and pathological gambling is presented. The 16 varieties are formed by combinations of 4 variables--money (won or lost), time devoted to gambling (a lot or a little), other people (negatively affected or not affected), and the gambler's feelings (feels good or bad about his gambling). The model has a logical base and is multifaceted. Its purpose is to force the serious student of gambling to consider alll 16 forms, not just the pathological forms. Certain philosophical, ethical, social, and scientific questions arise.
The techniques used for treating compulsive gamblers are reviewed. They include psychoanalytic psychotherapy, aversion therapy, marital therapy, and self-help groups (Gamblers Anonymous). The problems especially important in treating compulsive gamblers include lack of motivation for change and the role of the significant others in maintaining the gambler as the scapegoat of the family. Although therapists report good success in treating gamblers, the sporadic nature of gambling probably inflates "success' rates.
Traditionally, gamblers whose repeated losses have resulted in serious financial, psychological, and social problems have been labeled "compulsive." The prevailing "illness model" of compulsive gambling was developed by clinicians from the reports of those seeking treatment to stop gambling. However, researchers working in natural gambling settings generally have disavowed a compulsion model. Concerns over the efficacy of the traditional model and the therapeutic approach it produces are particularly salient since the proliferation of legalized gambling is expected to fuel a dramatic increase in problem gambling. Drawing upon empirical observations of ongoing gambling groups, a unique and comprehensive model of problem gambling is presented. Treatment plans generated from the new model, unlike prevailing programs, are compatible with a "controlled" regimen.
A simple classification system of overdoses presenting to a hospital emergency department is described. Five major overdose categories were developed (accidental, suicidal behavior, recreational/experimentation, compulsive use, and an indeterminate category), which were divided into 10 subcategories. A prospective survey at an inner-city hospital in Sydney classified 199 consecutive self-poisoning presentations as being due to compulsive drug use in 38% of cases; suicidal gesture as a reaction to stress, 17%; adverse reactions to recreational or experimental use, 15%; suicidal gesture to influence others, 7%; genuine accident or noncompliance with medication, 6%; genuine suicide attempt, 3%; and pseudo-overdose, 3%. The reason for the overdose was uncertain in the remainder of the cases. Additional data are also presented, including the types of drugs involved in each overdose category. Categories of overdose may be useful in psychosocial assessment for follow-up interventions, assist in research, and help reduce negative attitudes toward overdoses.
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The authors report the case of an individual who developed compulsive polydipsia following resection of a left sphenoidal ridge meningioma. The episodic, stereotyped nature of his symptoms, response to treatment, and electroencephalographic and magnetic resonance imaging findings are all highly consistent with temporal lobe-onset epilepsy. The pathophysiology of this underrecognized phenomenon is discussed.
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In spite of multiple authoritative reviews in recent years on the subject of neuroleptic malignant syndrome, the association of neuroleptic malignant syndrome with excessive fluid consumption has received little attention. This association is described and comments are made as to its possible origins. Further investigations are required to determine the strength and nature of the association. Such findings may have implications not only for clinical management but also for the poorly-understood neurochemistry of the neuroleptic malignant syndrome.
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A case of a 12 1/2-year-old female fire-setter is presented. The symptom was the result of long term developmental problems precipitated by the onset of puberty. Psychoanalytically oriented individual psychotherapy combined with marital and family therapy were the modes of treatment. The continuous struggle to establish a therapeutic alliance with an early adolescent is discussed. A patient whose main mechanisms of defense are repression, suppression, denial, and projection presents a challenge for the therapist.
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