Preventing lithium intoxication. Guide for physicians.

Objective: To raise awareness of risk factors for, and symptoms of, lithium intoxication.

Quality Of Evidence: The literature was searched via MEDLINE from January 1970 to December 1999 using the MeSH headings Lithium, Lithium Carbonate, Drug Toxicity, and Aging. Articles were selected based on clinical relevance and design.

Myocardial infarction during sleep deprivation in a patient with dextrocardia--a case report.

A patient with dextrocardia who suffered his first myocardial infarction after approximately 26 hours of a diagnostic sleep deprivation protocol is described. The infarction started about 3 hours after a significant improvement in mood, which persisted during and after infarction. Total sleep deprivation may be an acute risk factor for myocardial infarction.

Successful use of propranolol in migraine associated with electroconvulsive therapy.

To date, there have been no reports on the use of propranolol in electroconvulsive therapy (ECT)-induced migraine; we describe a 32-year-old woman who was successfully treated with propranolol for this condition. Over a course of ECT, the patient developed increasingly severe migraine which was refractory to treatment with acetaminophen, codeine, and naproxen. Sumatriptan did not relieve the headache and aggravated the nausea.

Thyroid function and response to 48-hour sleep deprivation in treatment-resistant depressed patients.

Background: Clinical depression is associated with abnormalities of the hypothalamic-pituitary-thyroid axis. Changes in thyroid function during sleep deprivation may be related to its antidepressant effects.

Methods: Levels of thyroid-stimulating hormone, tri-iodothyronine, tri-iodothyronine uptake, thyroxine, and free thyroxine were measured before, during, and after a 48-hour sleep deprivation in nine treatment-resistant depressed patients.

Valproate prophylaxis for migraine induced by selective serotonin reuptake inhibitors.

We report the successful use of valproate in a 44-year-old woman with migraine induced by selective serotonin reuptake inhibitors. Valproate should be considered for those patients who develop serious migraine for the first time, or worsening of previous migraine, after the initiation of treatment with selective serotonin reuptake inhibitors and for whom continued treatment with this class of drugs is important.

Psychiatric residents' views on their training and experience regarding issues related to child abuse.

Objective: To explore the views of psychiatric residents regarding the prevalence and impact of child physical, sexual, and emotional abuse; the adequacy of their training in these areas; and the sufficiency of treatment resources for abused children and their abusers.

Method: A 97-item survey questionnaire was distributed to 189 psychiatric residents as a section of the 1997 Coordinators of Postgraduate Education (COPE) self-assessment examination.

Results: Estimations of prevalence of child sexual, physical, and emotional abuse among men and women in both general and psychiatric populations were generally accurate according to the literature.

Geriatric psychiatry outreach practices in the province of Ontario: the role of the psychiatrist.

Objective: To determine the mode of practice of multidiscliplinary and interdisciplinary teams in the field of geriatric psychiatry in the province of Ontario with specific reference to the role of the psychiatrist on the teams.

Method: Teams were identified, and a simple questionnaire was developed and submitted to every team at an annual conference.

Results: Responses were obtained from 38 out of 47 teams.

Stress, coping and the job search process: the experience of people with psychiatric disabilities in supported employment.

Ten people with psychiatric disabilities and their supported employment coordinators responded to a standardized, open-ended interview about the stresses experienced during the job search process and the coping strategies used to deal with these stresses. The stress inherent in the potential for rejection and negative valuation was a major theme. The respondents described both problem based and emotion focused coping strategies.

Are the renal effects of lithium modified by frequency of administration?

It has been claimed that the unwanted effects and toxicity of lithium can be minimized by changes in the dosing schedules. Twenty consecutive psychiatrically stable patients were investigated in a cross-over study to determine whether renal function and other biochemical tests change significantly with changes from once to twice or multiple doses per day or vice versa. There were no significant differences between the 3 study conditions on the mood rating scales or a side effect scale (UKU).

Legally untreatable--a new category of long stay patient?

The case is presented of a young and violent chronic schizophrenic patient whose symptoms respond to antipsychotic medication but who was recorded, at a time when he was deemed competent, as expressing a wish that he should not be given antipsychotic treatment. Under the present usage of the Ontario Mental Health Act, substitute consent givers are bound by such a "prior competent wish" and this patient must now be considered one of a growing group of "legally untreatable" psychotic patients.

Predictors of burnout for psychiatric occupational therapy personnel.

Burnout is inherent in many health care professions. This research investigation was conducted to determine if burnout existed at significant levels and if a relationship between burnout, work environment factors and demographic characteristics existed among a group of psychiatric occupational therapy personnel. The study design was a descriptive survey format utilizing mailed questionnaires.

Rapid eye movement latency and mood following a delay of bedtime in healthy subjects: do the effects mimic changes in depressive illness?

The phase advance hypothesis proposes that a phase advance of certain circadian rhythms (such as rapid eye movement (REM) sleep propensity) relative to the sleep-wake cycle is implicated in the pathophysiology and pathogenesis of depression. In an earlier study, we reported that a 6-h delay of sleep in normals produced REM changes that resembled the depressive pattern. Mood change was generally modest, although 2 of the 10 subjects became noticeably depressed.

Cognitive and behavioural impairment among elderly people in institutions providing different levels of care.

Objective: To compare the prevalence and degree of cognitive and behavioural impairment in elderly patients in institutions providing different levels of care.

Design: Prevalence study.

Setting: A nursing home, a home for the aged and psychogeriatric wards in a provincial psychiatric hospital.

The ward milieu and its effect on the behaviour of psychogeriatric patients.

Research relating environment and behaviour indicates that relatively minor changes in the environment, such as restructuring a dayroom, can result in significantly improved psychosocial functioning in psychogeriatric patients. A project introducing multiple changes designed to improve the quality of life on a geriatric ward in a provincial mental hospital is described and discussed in the light of that research and suggestions are made regarding its replication under more rigorous experimental conditions.

Capillary gas chromatography of trihexyphenidyl, procyclidine and cycrimine in biological fluids.

A sensitive (50-100 pg/ml) method is described for the analysis of the anticholinergic drugs cycrimine, procyclidine and trihexyphenidyl by capillary gas chromatography with flame thermionic detection. Since these anticholinergic drugs are frequently administered in combination with antipsychotic medication for the treatment of mental illness, the potential interference by antipsychotic drugs in this assay was examined. No interference was observed from a series of antipsychotic drugs in the quantitation of cycrimine, procyclidine or trihexyphenidyl.

Engineering the behavioral engineer.

Twenty-eight nursing staff members treated, by operant methods, a simulated headbanging patient. They were randomly assigned to four experimental conditions, involving improvement versus non-improvement of the "patient" and promise of reward versus no promise of reward. The promise of reward significantly improved accuracy of treatment.