Electrolyte metabolism in blood and cerebrospinal fluid in psychoses.

Abstract

Summary Measurements were performed on Na, K and Ca contents with flame-photometer, and on CI content with electro-photometer both in serum of 464 cases (frequency of examinations was 1.077 times) of various psychotics (mainly consisted of schizophrenics) and in cerebrospinal fluid of 303 cases (frequsncy of examinations 909 times). Following results were obtained. 1. In schizophrenia, as a whole, Na, K, Ca and CI contents both in serum and CSF were almost within normal limits, but only K in CSF was increased, so the Na/K decreased as compared with those in the normal group. Comparison between the diseased and improved periods showed that Na and K in serum had tendencies to decrease, while Na and CI in CSF increased in the improved period, thereby the decrease of K in CSF was marked. 2. Under the classification of schizophrenia into hebephrenia and catatonia, it proved that both types exhibited almost the same inclinations as mentioned above. Moreover, comparison between the fresh and chronic groups of schizophrenia as a whole revealed that, in the fresh group there were observed the decrease of Na and CI and the increase of Ca in serum, and the decrease of K and increase of Na/K in CSF in the course of improvement, while in the chronic group, there were the decrease of Na in serum, the decrease of K and Ca in CSF, and increase of Na/K in CSF in the course of convalescence. On the contrary, in the unchanging group, variations of electrolytes were hardly observable both in serum and CSF. 3. In the comparison between the fresh and chronic groups in each type of schizophrenia, both groups displayed almost identical trends, thereby most marked was the increase of K in CSF in the diseased period. Moreover, in CSF, Na contents were decreased in the fresh groups of both types of schizophrenia, CI increased in fresh hebephrenia, and Ca decreased in chronic catatonia. As the result of comparison between the fresh and chronic cases, it proved that, in hebephrenia, Na and Na/K in CSF increased more but K and Ca in CSF decreased more in the chronic cases than in the fresh ones; while, in catatonia, K in serum increased more in the chronic cases. 4. Schizophrenia was, furthermore, divided tentatively into 6 groups according to the symptoms, and comparisons of these groups proved that Na both in serum and in CSF tended to decrease but CI slightly increased under the hypo-and akinesis, while K in CSF increased in case of marked emotional changes. 5. In the chronic schizophrenics hospitalized for a long time, both Na and K in serum and CSF were within normal sphere, and there were observed almost the same inclinations as mentioned above, in the results of the frequent examinations made in the course of time, some on the same cases of this group. 6. In the other various psychotics, each value was almost within normal range, although the cases were few in number. Mania displayed almost identical tendency in electrolytes variations, but depression displayed somewhat different inclinations where Na in CSF was decreased. As for general paresis and senile psychosis as organic mental diseases, there were observed the increase of K in CSF in both diseases, the decrease of Ca and Na/K in the latter, and with convalescence, the decrease of Na and K in CSF in both. Epilepsy cases exhibited the increasing tendency of Na, K and CI in CSF, and of slight decrease of Ca in CSF of after-convulsive seizures, therefrom marked was the increase of K in CSF. Alcoholic psychosis had characteristic variations of electrolytes, that is, the decrease of Na and increase of CI in CSF together with the unique tendency of variations in the course of improvement. In psychoneurosis, each value, both in serum and in CSF, was within normal limits without marked variations. 7. Concerning the percentage of CSF/serum of each electrolyte, Na was 100.6%, K 66.8%, Ca 48.2% and CI 115.0% in the normal group. Observing the variations of the percentages in all cases, the result showed that Na had tendency to increase or decrease, K and CI to increase, and Ca to decrease in CSF as a whole. 8. The electrolytes metabolisms both in serum and CSF were considered from the viewpoints of both the blood-brain barrier permeability and the intracerebral electrolytes metabolisms. The sighificance of electrolytes in psychosis was also discussed.