Is brain damage the cause of "pink spot"?

Abstract

RECENT reports on the occurrence of “pink spot” in the urines of schizophrenics are somewhat conflicting and cast doubt on its chemical identity and its relationship to schizophrenia1–6. In this hospital we began an experiment earlier in the year to isolate “pink spot” in milligram amounts with the intention of establishing its chemical structure by mass spectroscopy and nuclear magnetic resonance, but we soon found difficulty in finding “pink spot” excreters7. The urines from ten chronic schizophrenics were examined by the method of Friedhoff and Van Winkle1 but only one (J.W.) “pink spot” excreter was found, although four of our patients were “Schneider-positive non-paranoid” schizophrenics3. Admittedly, J.W. was one of these four, but our failure to find a higher incidence led us to examine the clinical records of our series of patients in greater detail, and it then became evident that patient J.W. differed from the other nine patients in several respects. She was 69 years of age and had had a leucotomy in 1947. Her symptoms had improved temporarily after the operation, but had then worsened, so that she needed massive and prolonged treatment with phenothiazines (mainly chlorpromazine) until early in 1966. Dyskinesia was first noticed in 1963 and by 1966 it became severe with choreiform movements of the mouth and tongue, jerky breathing and speech, opisthotonos and oculogyral spasm. Severe dyskinesia is well known in leucotomized patients after prolonged phenothiazine treatment. It is thought that leucotomy causes secondary changes in the basal ganglia which render them susceptible to toxic damage by these drugs8.