Acute Psychotic State Research Articles

Haloperidol服用中の精神分裂病患者の血中抗ドパミン力価,抗ノルアドレナリン力価,抗セロトニン力価

Most antipsychotic drugs share similar pharmacological properties in that they cause anti-dopaminergic, anti-noradrenergic and anti-serotonergic activities. Using a radioreceptor assay, these anti-aminergic activities were measured in the serum of 34 schizophrenics receiving haloperidol medication.The anti-dopaminergic activity was determined as a value of haloperidol equivalent and chlorpromazine equivalent. The anti-noradrenergic and anti-serotonergic activities were based on the chlorpromazine equivalent. The schizophrenics were divided into two groups (group 1:16 out-patients, group 2:18 hospitalized acute psychotic patients). Most of the patients in group 1 showed low anti-dopaminergic activity (below 10 ng/ml haloperidol equivalent or 100 ng/ml chlorpromazine equivalent). Anti-noradrenergic and anti-serotoninergic activities could be measured in only two patients. Fifteen patients in group 2 responded well to haloperidol. There was a positive correlation between anti-dopaminergic activity, plasma HPD concentration and daily haloperidol dose in all the group 2 patients. Clinical improvement was positively correlated with anti-noradrenergic activity, but not with anti-dopaminerigic activity in the group 2 patients. These findings suggest that anti-noradrenergic activity plays an important role in clinical improvement of schizophrenic patients in an acute psychotic state.

Psychotic exacerbation attributed to low‐dose bromocriptine treatment of galactorrhea and hyperprolactinemia

Low-dose bromocriptine administered for antipsychotic drug-induced hyperprolactinemia and galactorrhea precipitated an acute psychotic state in a female patient. Discontinuation of the bromocriptine and increase in antipsychotic dosage resulted in complete remission. We advise caution in the use of bromocriptine especially in patients with a pre-existing psychiatric history and recommend monitoring for changes in mental status when bromocriptine is prescribed.

What are the psychiatric manifestations of vitamin B12 deficiency?

Psychiatric symptoms attributable to vitamin B12 deficiency have been described for decades. The earlier reports are for the most part in accord with more recent ones, despite being diagnostically less specific in psychiatric and hematologic terms. These symptoms seem to fall into several clinically separate categories: slow cerebration; confusion; memory changes; delirium, with or without hallucinations and/or delusions; depression; acute psychotic states; and (more rarely) reversible manic and schizophreniform states. While there still remain abundant hematologic, psychiatric, neurologic, or nutritional reasons for obtaining a serum vitamin B12 level, its use in the investigation of the etiology of a patient's dementia seems unjustified. However, acute or subacute changes in a demented patient's mental status, specifically a clouding of their consciousness, may make such testing advisable as part of the complete workup of their delirium regardless of a normal hematologic picture.

Water and the Psychotic World

Water, in the acute psychotic state on the behavioral level, represents a means of controlling anxiety and/or a sign for the situation. On the verbal level there is a lack of integration between its value as sign and as symbol. It is not invested with any new significance, and its appearance is not coincidental.

Der Genesene und seine Psychose

Patients in complete or partial remission were shown a videotape of their acute psychotic illness, if possible in the presence of one of their relatives. The tape was then discussed with the patients and their relatives. The videotape and the discussion were recorded again, thus allowing for an analysis of verbal and nonverbal reactions and attitudes of the participants. The psychologically unique situation of direct confrontation with the acute psychotic state enables certain problems in this area to be more closely examined and indirectly highlights possibilities of different therapeutic approaches. The investigations will be continued.

Treatment of chronic schizophrenia.

The comprehensive treatment of schizophrenia requires the full resources of a clinical team that is able to offer treatment for the acute psychotic state in a hospital environment, and appropriate rehabilitation following resolution of the florid symptoms. Following a second or subsequent relapse, maintenance therapy with long-acting injections of depot antipsychotics will be required for an unknown period. Although drugs form an essential part of all treatments, it is essential to examine the environment for precipitating factors and to involve the patient's family in the rehabilitation. Recent studies have reported that some patients still have a relatively poor prognosis; although this proportion may be in the minority, the strain on the whole family of an even moderately handicapped patient can be enormous, and it is important to examine the needs of the whole family in evaluating care within the community. The effect of antipsychotic drugs is much wider that the mere control of acute symptoms and can influence the patterns of social behaviour and rehabilitation, in addition to offering protection against stress. The proper use of depot injections requires that they be kept under constant review. The current widespread practice of prescribing anti-cholinergic drugs on a prophylactic basis, or even as the inital treatment of extrapyramidal side-effects, needs revision.

Personality changes in patients with periodic psychoses.

The author studied some personality changes in 35 patients with psychoses of periodical development (affective and schizoaffective psychoses), which are important for the rehabilitation period. It was demonstrated that following acute psychotic states there may be a significant distortion of the personality traits giving ground to qualify this state as "a defect", which in the opinion of the author is not justified. Adequate treatment to a large degree removes the personality changes. However, during the remission period there may be some irreversible changes of the personality. The author believes that in some cases there may be peculiar postpsychotic reactions and personality development.

Letter: The Jimson-weed high.

To the Editor.— Published cases of stramonium intoxication date back to 1676. 1 Dean 2 reported in 1963 the first cases of deliberate ingestion of stramonium in the recent American literature. These three cases involved the consumption of Asthmador, a stramonium-belladonna mixture prepared from the leaves of the Jimson weed. Since then, there have been numerous reports of ingestion of Asthmador for hallucinogenic effects. However, there are no reports of intentional self-ingestion of seeds from the Jimson weed for mind-altering or psychedelic purposes. Five such cases are described here. Report of Cases.— Five adolescents between 14 and 16 years old were seen in the emergency department of Kent General Hospital after ingesting seeds from the Jimson weed. Three patients were in an acute psychotic state; each was confused, agitated, disoriented, and hallucinating. Abnormalities included tachycardia, dry oral mucosa, widely dilated pupils unresponsive to light, and flushed skin. These three male

Beta blockers in psychiatric illness

β-Adrenoceptor blocking drugs (β-blockers) have been used to treat neurotic anxiety, drug withdrawal symptoms, heroin addiction and acute psychotic states, though they are not usually regarded as pyschotropic agents.

Identification and treatment of acute psychotic states secondary to the usage of over-the-counter sleeping preparations.

Within eight months, 36 patients seen at the Washington Hospital Center, Washington, D.C., presented the problem of differentiating between a toxic psychosis caused by ingestion of over-the-counter sleeping medications containing scopolamine and a schizophrenic episode. Clinical evaluations, case histories, and thin-layer chromatography were used to identify these patients. Urinalysis revealed the presence of at least two ingredients of over-the-counter sleeping medications in ten patients. Intramuscular injections of physostigmine salicylate reversed the toxic psychosis presumed to be the result of the scopolamine content in these preparations.

The use of molindone in the treatment of acute psychotic states: comparison of two dosage schedules.

The Journal of Clinical Pharmacology and The Journal of New DrugsVolume 10, Issue 5 p. 349-355 The Use of Molindone in the Treatment of Acute Psychotic States: Comparison of Two Dosage Schedules I. S. Turek M.D., I. S. Turek M.D. Maryland State Psychiatric Research Center and the Spring Grove State Hospital, Research Department, Baltimore, Md.Search for more papers by this authorK. Y. Ota Ph.D., K. Y. Ota Ph.D. Maryland State Psychiatric Research Center and the Spring Grove State Hospital, Research Department, Baltimore, Md.Search for more papers by this authorM. De La Rocha M.D., M. De La Rocha M.D. Maryland State Psychiatric Research Center and the Spring Grove State Hospital, Research Department, Baltimore, Md.Search for more papers by this authorD. Agallianos M.D., D. Agallianos M.D. Maryland State Psychiatric Research Center and the Spring Grove State Hospital, Research Department, Baltimore, Md.Search for more papers by this authorA. A. Kurland M.D., A. A. Kurland M.D. Maryland State Psychiatric Research Center and the Spring Grove State Hospital, Research Department, Baltimore, Md.Search for more papers by this author I. S. Turek M.D., I. S. Turek M.D. Maryland State Psychiatric Research Center and the Spring Grove State Hospital, Research Department, Baltimore, Md.Search for more papers by this authorK. Y. Ota Ph.D., K. Y. Ota Ph.D. Maryland State Psychiatric Research Center and the Spring Grove State Hospital, Research Department, Baltimore, Md.Search for more papers by this authorM. De La Rocha M.D., M. De La Rocha M.D. Maryland State Psychiatric Research Center and the Spring Grove State Hospital, Research Department, Baltimore, Md.Search for more papers by this authorD. Agallianos M.D., D. Agallianos M.D. Maryland State Psychiatric Research Center and the Spring Grove State Hospital, Research Department, Baltimore, Md.Search for more papers by this authorA. A. Kurland M.D., A. A. Kurland M.D. Maryland State Psychiatric Research Center and the Spring Grove State Hospital, Research Department, Baltimore, Md.Search for more papers by this author First published: September‐October 1970 https://doi.org/10.1177/009127007001000509Citations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume10, Issue5September‐October 1970Pages 349-355 RelatedInformation

The seemingly ubiquitous depression following acute schizophrenic episodes, a neglected area of clinical discussion.

When the treatment of an acute schizophrenic episode is considered, prime emphasis is usually placed on the acute psychotic state as the major occurrence. The author stresses the need to focus also on what he calls the "compensated-transition" phase and the "depressive-neurasthenic" phase, which follow. The importance of treating these latter phases effectively, preferably by the same physician who treated the acute stage, should be given more attention in residency training programs, he believes.

Brief sleep treatment with chlorpromazine

A technique utilizing brief periods of sound narcosis (24–48 hours of sleep treatment) induced by chlorpromazine is described. It proved to be an effective and efficient therapeutic-diagnostic-management tool for severely behaviorally-disturbed and uncontrolled patients in an open, crisis-oriented milieu ward in Vietnam where no other facilities for managing such patients existed. The patient's behavioral state (assaultive, agitated, excited, disruptive manifestations) rather than a nosological diagnostic category constituted the indication for a trial of brief sleep treatment. The success of the treatment could usually be predicted from the promptness with which the patient succumbed to the soporific effects of chlorpromazine upon its initial administration and from the “soundness” of his sleep. Thus it became particularly helpful in differentially diagnosing acute or transient psychotic stress states from the more entrenched, persistent ones. The degree to which this therapeutic tool may have aborted more lasting psychotic reactions was not assessed through the use of control patients, nor was the possible efficacy of drugs other than the antipsychotic, chlorpromazine, determined. No hypothesis for the possible specific therapeutic effects of chlorpromazine-induced sleep is advanced, though some appear in the world literature. 8,9,16,29 Because the usual complications of sleep treatment have been minimized by the particular form in which it was used here and because of the potential implications of this relatively simple and safe technique for the crisis management of severely disturbed psychiatric patients in the civilian community (secondary prevention), especially for settings which have limited psychiatric treatment resources, a description of this technique and a discussion of its results have been presented.

Parenteral Vitamin Therapy

To the Editor:— In the above letter, in which it is stated that I saw reason for administering the B vitamins parenterally unless parenteral feeding was necessary, I am misquoted. My statement was that I saw no reason for administering these vitaminsintravenously. There are a number of indications for the intramuscular administration of vitamins of the B complex. I agree that there are certain acute psychotic states in which parenteral (usually intramuscular) administration of B vitamins is useful. At times the vitamins are given with glucose by vein. Many of these psychotic states are associated with alcoholism, and there is reason to believe that vitamin B-complex deficiency is playing a role in these syndromes. The psychotic state itself may increase metabolism and, hence, requirement of some of the B vitamins. Some psychoses in non-alcoholic patients also respond to vitamins of the B complex in therapeutic doses. In such

Perphenazine; observations on the clinical effects of a new tranquillizing agent in psychotic conditions.

1. The planning and results of an investigation of perphenazine, a new phenothiazine derivative have been presented; this study was carried out with 84 psychotic patients in a mental hospital. 2. The chemistry, pharmacology and psychophysiology of this drug are briefly described, as well as the selection of patients, the setting, administration and dosage. 3. The clinical results were similar to those one would expect to obtain with chlorpromazine, using one-sixth to one-seventh of the dose of chlorpromazine. Good to excellent results were observed in acute psychotic states except depressions. Perphenazine is also a potent therapeutic agent in the management of chronic psychotic patients. 4. Untoward reactions may occur if perphenazine is combined with large doses of reserpine, or patients are immediately changed from perphenazine to chlorpromazine. Caution might be indicated with the use of the drug in obese patients. 5. The principal clinical differences between perphenazine and chlorpromazine as observed in our series were: more frequent and earlier extrapyramidal symptoms (well controlled by various anti-Parkinsonian drugs), fewer autonomic and allergic side effects, less drowsiness, and less pain on intramuscular injection.

Aliens' paranoid reactions.

Psychotic states due mainly, but not exclusively, to unusual external circumstances are well known, and are commonly exemplified by such mental disorders as are occasionally met with in persons in prison, or those morbidly homesick, or suffering under the strain and stress of advanced deafness. In the great majority of these instances, however, the external conditions represent only an additional, precipitating aetiological factor which is operating as a trigger mechanism to a mental derangement of non-specific character already present in a latent state. It may therefore be of some theoretical and practical interest to report on a group of acute and subacute psychotic states whose history, features, course and outcome characterize them as constituting a readily recognizable clinical entity of purely psychological, situational origin.