LE1TERS
Mama
TO THE
During
EDITOR
Hemodialysis:
Causal
or Casual
Association?
her dog in her deluded
oped bizarre SIR: Hemodialysis
is listed
by Kaplan
and
Sadock
Ms. A, an 83-year-old years,
satisfy the criteria manic syndrome ium or dementia
for mania secondary to hemodialysis: 1) appearing during hemodialysis, 2) no delir(to rule out dialysis disequilibrium, uremic
encephalopathy, causes of mania,
and dialysis dementia), 3) no other organic 4) no past history of affective illness, and 5)
history
of bipolar
so that
the dog
itself
devel-
(1) among
the causes of secondary mania. However, this is based on scant evidence. I have found nine single case reports of mania during hemodialysis (list available on request), of which only three
no family
behavior,
behavior.
complained
widow
that
who had lived alone for 15
the occupant
of an upstairs
flat was
excessively noisy and that he moved furniture around late at night to disturb her. Over a period of 6 months, she developed delusional persecutory ideas about this man. He wanted to frighten her from her home and had started to
a
transmit
“violet
rays”
through
the
ceiling
to harm
her
and
her 10-year-old female mongrel dog. Ms. A attributed a sprained back and chest pains to the effect of the rays and had become concerned that her dog had started scratching at night when the ray activity was at its greatest. For protection, she had placed her mattress under the kitchen table and slept there at night. She constructed what she called an
disorder.
A retrospective study was carried out in the hemodialysis unit of a public hospital in Italy to ascertain the incidence of mania during hemodialysis since the opening of the unit. Case notes were reliable because a case of mania (DSM-III-R)
would have led to psychiatric consultation, which would appear in the notes. I found 30 cases of acute renal failure (21 male patients and nine female) and I 03 cases of chronic renal
“air
raid
shelter”
of suitcases visited
for
and
Ms.
her
dog
insisted
A at her
from
that
home,
a small
the dog it was
table
and
a pile
in it. When
sleep
apparent
that
the
I
dog’s
failure (62 male patients and 41 female). In the chronic group 51 patients had died and 52 were still alive. They had started hemodialysis at a mean age of 55 years. The mean age at death was 6 1 years. The mean age of the patients still alive was 60 years. Patients with acute renal failure were treated for a total of 446 days. Patients with chronic renal failure were treated
behavior had become so conditioned by that of its owner that upon hearing any sound from the flat upstairs, such as
for a total of 492.6
history, and apart from bilateral sensonineural deafness, there was no physical abnormality. A diagnosis of late paraphrenia (ICD-9, 297.2) was made. She had no insight and refused admission to a psychiatric facility.
a door closing,
person-years.
I found only one case of mania, which did not meet the criteria for mania secondary to hemodialysis. In this patient with chronic renal failure, whom I have previously described (2), mania had started weeks before the beginning of the first hemodialysis session, soon after abrupt nicotine withdrawal. During
hemodialysis
the
clinical
picture
worsened,
with
the
appearance
of psychotic symptoms. The incidence (new cases per year) of mania is 1.2/100 for men and 1.8/100 for women (3). I expected to see, for 492.6 person-years of hemodialysis, between five and eight cases of mania; I found only this one.
One possible of hemodialysis
over
90,000
expect
many
patients
more
have
than
undergone
hemodialysis
alone. My results suggest that there is no causal between mania and hemodialysis.
system
as a result
a deux,
ses are rare, but abnormal behavior panions of the mentally ill is probably nized.
that
appears
Castiglione
psychosis,
to have
by the
True induced
psycho-
in the nonhuman corncommon but unrecog-
1 . Enoch MD, Trethowan WH: Uncommon Bristol, England, Wright, I 979
SIR: Most
BENAZZI, di Cervia,
RA,
to explain
Psychiatric
and
Jung’s
Concept
Syndromes.
of the Collective
developed
is a paranoid
M.D. I7 Italy
delu-
in an individual
with a person
(orthodox)
psychiatrists
who has an
accepted life. They
Uncon-
the mechanism
and
psychologists
of intergenerational
to be dealt with, and Jung’s
approach
transmission,
could
generally known, Freud’s concept of the purely individual one, at least in its definite, ance. Jung, in contrast, described a kind of is common to all humans. The entities that is
are primarily
have
Jung’s ideas of the collective have, however, not been able
through which tendencies such as antisemitism lent. The reasons for the persistence of such destructive social phenomena as antisemitism
archetypes
of a close relationship
as delu-
conditioned
REFERENCE
never wholeheartedly unconscious psychic
a Dog or induced
be considered
responses
beliefs and behavior.
psychiatric
DR. ROBERT HOWARD London, England
established delusional system. Induced psychosis is rare (1). I report a case in which an elderly psychotic woman involved
414
as behavioral
previous
scious
Via Pozzetto
Involving
A had
of Ms. A’s dog cannot
rather
delusional
Antisemitism
FRANCO
sional
owner’s
Ms.
in Europe
3. Kaplan HI, Sadock BJ: Pocket Handbook of Clinical Psychiatry. Baltimore, Williams & Wilkins, 1990, p 88 4. Stone K: Mania in the elderly. BrJ Psychiatry 1 989; 155:220-224
SIR: Folie
but
ceiling.
relationship
1 . Kaplan HI, Sadock BJ: Synopsis of Psychiatry, 6th ed. Baltimore, Williams & Wilkins, 1991, p 260 2. Benazzi F: Severe mania following abrupt nicotine withdrawal (letter). AmJ Psychiatry 1989; 146:1641
Folie a Deux
and
no
at the
The behavior
since
REFERENCES
4801 0
go to the kitchen
directed
sional
in old age is not induced mania,
nine case reports,
immediately
in the living room, the with agitated barking
explanation is that the mean age at the start was 55 years. The mean age at onset of mania
is 30 years (3). However, onset of mania unusual (26% of cases) (4). If hemodialysis
one would
would
it
enter the shelter. When restrained dog reacted to noises from upstairs
of a religious
remain irrational urgently
prove
viruand need
useful.
As
unconscious is a concrete appearunconscious that he designated as
nature.
The
manner
in
which they are transmitted from generation to generation eludes rigorous experimental analysis. Jung once wrote of a “precipitation from the primeval ancestors,” and this kind of rather metaphysical explanation can be frequently encountered in his works.
Am
J
Psychiatry
1 49:3,
March
1992
Mama
TO THE
During
EDITOR
Hemodialysis:
Causal
or Casual
Association?
her dog in her deluded
oped bizarre SIR: Hemodialysis
is listed
by Kaplan
and
Sadock
Ms. A, an 83-year-old years,
satisfy the criteria manic syndrome ium or dementia
for mania secondary to hemodialysis: 1) appearing during hemodialysis, 2) no delir(to rule out dialysis disequilibrium, uremic
encephalopathy, causes of mania,
and dialysis dementia), 3) no other organic 4) no past history of affective illness, and 5)
history
of bipolar
so that
the dog
itself
devel-
(1) among
the causes of secondary mania. However, this is based on scant evidence. I have found nine single case reports of mania during hemodialysis (list available on request), of which only three
no family
behavior,
behavior.
complained
widow
that
who had lived alone for 15
the occupant
of an upstairs
flat was
excessively noisy and that he moved furniture around late at night to disturb her. Over a period of 6 months, she developed delusional persecutory ideas about this man. He wanted to frighten her from her home and had started to
a
transmit
“violet
rays”
through
the
ceiling
to harm
her
and
her 10-year-old female mongrel dog. Ms. A attributed a sprained back and chest pains to the effect of the rays and had become concerned that her dog had started scratching at night when the ray activity was at its greatest. For protection, she had placed her mattress under the kitchen table and slept there at night. She constructed what she called an
disorder.
A retrospective study was carried out in the hemodialysis unit of a public hospital in Italy to ascertain the incidence of mania during hemodialysis since the opening of the unit. Case notes were reliable because a case of mania (DSM-III-R)
would have led to psychiatric consultation, which would appear in the notes. I found 30 cases of acute renal failure (21 male patients and nine female) and I 03 cases of chronic renal
“air
raid
shelter”
of suitcases visited
for
and
Ms.
her
dog
insisted
A at her
from
that
home,
a small
the dog it was
table
and
a pile
in it. When
sleep
apparent
that
the
I
dog’s
failure (62 male patients and 41 female). In the chronic group 51 patients had died and 52 were still alive. They had started hemodialysis at a mean age of 55 years. The mean age at death was 6 1 years. The mean age of the patients still alive was 60 years. Patients with acute renal failure were treated for a total of 446 days. Patients with chronic renal failure were treated
behavior had become so conditioned by that of its owner that upon hearing any sound from the flat upstairs, such as
for a total of 492.6
history, and apart from bilateral sensonineural deafness, there was no physical abnormality. A diagnosis of late paraphrenia (ICD-9, 297.2) was made. She had no insight and refused admission to a psychiatric facility.
a door closing,
person-years.
I found only one case of mania, which did not meet the criteria for mania secondary to hemodialysis. In this patient with chronic renal failure, whom I have previously described (2), mania had started weeks before the beginning of the first hemodialysis session, soon after abrupt nicotine withdrawal. During
hemodialysis
the
clinical
picture
worsened,
with
the
appearance
of psychotic symptoms. The incidence (new cases per year) of mania is 1.2/100 for men and 1.8/100 for women (3). I expected to see, for 492.6 person-years of hemodialysis, between five and eight cases of mania; I found only this one.
One possible of hemodialysis
over
90,000
expect
many
patients
more
have
than
undergone
hemodialysis
alone. My results suggest that there is no causal between mania and hemodialysis.
system
as a result
a deux,
ses are rare, but abnormal behavior panions of the mentally ill is probably nized.
that
appears
Castiglione
psychosis,
to have
by the
True induced
psycho-
in the nonhuman corncommon but unrecog-
1 . Enoch MD, Trethowan WH: Uncommon Bristol, England, Wright, I 979
SIR: Most
BENAZZI, di Cervia,
RA,
to explain
Psychiatric
and
Jung’s
Concept
Syndromes.
of the Collective
developed
is a paranoid
M.D. I7 Italy
delu-
in an individual
with a person
(orthodox)
psychiatrists
who has an
accepted life. They
Uncon-
the mechanism
and
psychologists
of intergenerational
to be dealt with, and Jung’s
approach
transmission,
could
generally known, Freud’s concept of the purely individual one, at least in its definite, ance. Jung, in contrast, described a kind of is common to all humans. The entities that is
are primarily
have
Jung’s ideas of the collective have, however, not been able
through which tendencies such as antisemitism lent. The reasons for the persistence of such destructive social phenomena as antisemitism
archetypes
of a close relationship
as delu-
conditioned
REFERENCE
never wholeheartedly unconscious psychic
a Dog or induced
be considered
responses
beliefs and behavior.
psychiatric
DR. ROBERT HOWARD London, England
established delusional system. Induced psychosis is rare (1). I report a case in which an elderly psychotic woman involved
414
as behavioral
previous
scious
Via Pozzetto
Involving
A had
of Ms. A’s dog cannot
rather
delusional
Antisemitism
FRANCO
sional
owner’s
Ms.
in Europe
3. Kaplan HI, Sadock BJ: Pocket Handbook of Clinical Psychiatry. Baltimore, Williams & Wilkins, 1990, p 88 4. Stone K: Mania in the elderly. BrJ Psychiatry 1 989; 155:220-224
SIR: Folie
but
ceiling.
relationship
1 . Kaplan HI, Sadock BJ: Synopsis of Psychiatry, 6th ed. Baltimore, Williams & Wilkins, 1991, p 260 2. Benazzi F: Severe mania following abrupt nicotine withdrawal (letter). AmJ Psychiatry 1989; 146:1641
Folie a Deux
and
no
at the
The behavior
since
REFERENCES
4801 0
go to the kitchen
directed
sional
in old age is not induced mania,
nine case reports,
immediately
in the living room, the with agitated barking
explanation is that the mean age at the start was 55 years. The mean age at onset of mania
is 30 years (3). However, onset of mania unusual (26% of cases) (4). If hemodialysis
one would
would
it
enter the shelter. When restrained dog reacted to noises from upstairs
of a religious
remain irrational urgently
prove
viruand need
useful.
As
unconscious is a concrete appearunconscious that he designated as
nature.
The
manner
in
which they are transmitted from generation to generation eludes rigorous experimental analysis. Jung once wrote of a “precipitation from the primeval ancestors,” and this kind of rather metaphysical explanation can be frequently encountered in his works.
Am
J
Psychiatry
1 49:3,
March
1992
