Serum melatonin and 6-sulfatoxymelatonin in end-stage renal disease: effect of hemodialysis.

The pineal hormone melatonin plays a role in the regulation of hypothalamic-pituitary axis, target gland function, sleep pattern, mood changes, cellular immunity, antibody response, and skin pigmentation, nearly all of which are also affected by renal insufficiency. We measured serum melatonin and its main urinary metabolite, 6-sulfatoxymelatonin (6-SM), by radioimmunoassay in 11 patients with end-stage renal disease (ESRD) between the hours of 6 and 9 a.m.

Behavioral correlates and staff recognition of alcohol use in a university hospital trauma service.

Hospital course and admission blood alcohol levels were compared in 242 consecutive adult trauma admissions. A 33% overall intoxication rate was found. Intoxicated patients were more likely to be young, male, and Hispanic or black and to be involved in fights, stabbings, and automobile accidents in which they were presumed to be at fault.

Rapid, psychopharmacologically induced improvement can produce new psychological symptoms.

The advent of improved diagnostic criteria, coupled with a refined psychotropic armamentarium, can now produce rapid clinical improvements in clinical psychiatric conditions for which both patients and therapist may be unprepared. The following case report illustrates this problem which will become increasingly important in the practice of psychiatry as further improvements in psychopharmacological therapy occurs.