LETIERS
10
THE
EDITOR
the symptomatology chiatry
ofepidemic
8:40-46,
encephalitis.
Kruse
C.
cited
and analysis
Neuroh
Psy-
by
she
1968,
Fink
EB:
ofnecropsy
aspects 1928
Diabetes
reports.
ofchronic
insipidus:
Arch
epidem-
clinical
Pathoh
she with
SIR:
The
recent
articles
Associated
with
by
Alan H. Rosenbaum, and Maurice J. Barry. Jr. . M.D. . regarding “Positive peutic Response to Lithium in Hypomania Secondary ganic Brain Syndrome” (October 1975) encouraged
in patients
with
organicity.
she
sponded to this treatment well. The patient is a 61-year-old nun nurse. She was admitted in December time
to St.
Louis
for continuing
State
illness
Hospital
with
seems
M.D., Therato Orme to re-
trained
as
1973
Complex.
main
to have
for St.
symptoms
re-
a practical the Louis.
and
depression.
Her psychiatric sode of depression 1939, the patient
illness started that did not was hospitalized
in 1937. with a short require hospitalization. for depression with
epiIn “so-
matic fixation. withdrawal, and inability to take care of her personal appearance. ‘ ‘ She had several short hospitalizations for essentially similar complaints in the next 2 years.
In 1941, the possibility ofmultiple ered. The patient had undergone ness of legs disappearance
with
The patient
incontinence of neurologic
continued
pression until used a number 1963 she was
paraesthesia.
extensor venous
plantar. histamine
noted
of
talkative, argumentative, considered hypomanic In 1964 the patient treatment,
and
anxiety.
236
personal
periods
ECT
and
antidepressants
resulted
in the
and belligerent and treated with was readmitted There was
J Psychiatry
and
included the patient
behavior that chlorpromazine. for
little
complaints improvement
institutional
characterized withdrawn. having a clouded
133:2,
were
development
Fehruart
care
of dewas In nys-
a urinary
have
mild
sign,
rigidity.
tract
In
scanning
unsteady
gait,
resting
tremors,
fine
On She
infection.
dysarthria,
1972,
,
to care
In her
admissions
patient zines
infections
small
doses
The
for
essentially
poor
coordi-
weakness
herself.
patient’s
were
blood rate =
limits.
negative.
for
revealed mm/hour,
X ray
skull,
were essentially within normal limits. examination revealed mild elevation showed generalized dysfunction. EKG, carotid angiogram were tests showed nonlateralizing
In view neurologic she
was
also with
within
anemia
serum
fohic
serum
B12,
tolerance
disease
ofchest,
mild
patient’s glucose
Venereal
the
phenothiaand urinary
Parkinsonism.
of
and
spells.
1973,
She was given
her
count
urinalysis,
crying
various chest
to 12). The
2.5
and
antibiotics.
28
affect,
incontinence,
1968 until
with recurrent drugs
complete
normal
from
with
sedimentation
within
to eat,
hospital
treated
acid 2.4 g/ml (normal thyroid function test,
urinary
refusal
to this
were
for depressed
retardation,
of antichohinergic
g/IOOml).
tests
1973
was treated symptomatically and antidepressants. Her
tract
(12
and
and and
test
tuberculin
cervical
spine
Cerebrospinal fluid of proteins. EEG brain scan, and right
normal limits. Psychological organic brain impairment.
of the patient’s history of repeated episodes of dysfunction with resolution over a period of time, considered
to have
to have recurrent or uncovered by renal,
or
multiple
affective multiple
hepatic
treatment and complications
DINE5H
seemed
for
lithium
has now been and is doing
some patients with affective disorder
with
She
either associated As she had no
contraindication
she was put on this 20 months without
well. It would appear that impairment and recurrent from lithium.
sclerosis.
illness, sclerosis.
intrawas
on it quite
organic brain might benefit
B. MEHTA, St. Louis,
M.D. ltlo.
not Correction
of
was There
final-
as being “conand careless of sensorium. ‘ ‘ In
/976
and to
Romberg’s
inability
therapy, for some
of defrom
was
bladder noted
psychomotor
cardiac,
complete
on the left side
patient was depressed.
hygiene
Am
frequent
management However,
in 1967 long-term
hy considered. The tinuoushy psychotic,
her
from
subsequent and signs.
hyperreflexia
medical steroids.
depressed.
A course
and
to suffer
and Her and
to be quite
pression
and had symptoms
was first considepisodes of weak-
1961. Ehectroconvulsive therapy (ECT) of times with apparent favorable results. rehospitalized for extreme exhaustion,
tagmus,
effective.
sclerosis repeated
in 1971
were
fourth Mo.,
of confusion
to St. Louis State Hospital. with feces from head to foot.
cogwheel
withdrawal,
Organic
port the following case. I think this patient is unique in severah ways and although lithium would generally be used with reluctance
admitted covered
of muscles, and diminished deep reflexes. In 1970, the patient was reported to have become withdrawn, confused, and depressed. She also had frequent slips and falls and was generally clumsy. She had further admis-
N. Y.
sions
Disorders
was
positive
nation
M.D.
BARTON.
first was
a neurogenic
speech,
1928
Roe/tester,
had 1969,
review
6:102-120,
RUSSELL
Lithium and Affective Brain Impairment
was she
admission
6. McCowan PK, Cook LC: The mental ic encephalitis: Lancet 1:1316-1320, 7.
Arch
1922
in
is an error
Adolescence:
in the Behavioral
article
‘ ‘
and
A Hierarchy Attitudinal
of Drug Correlates
Use of
by Beatrix A. Hamburg, M.D. , HelKraemer, Ph.D. , and William Jahnke (November 1975 issue). In figure 1, page 1159, the authors inadvertently interchanged the labels of the curves representing hard hiquor and tobacco usage. Substantial ena C.
Drug
Use.”
10
THE
EDITOR
the symptomatology chiatry
ofepidemic
8:40-46,
encephalitis.
Kruse
C.
cited
and analysis
Neuroh
Psy-
by
she
1968,
Fink
EB:
ofnecropsy
aspects 1928
Diabetes
reports.
ofchronic
insipidus:
Arch
epidem-
clinical
Pathoh
she with
SIR:
The
recent
articles
Associated
with
by
Alan H. Rosenbaum, and Maurice J. Barry. Jr. . M.D. . regarding “Positive peutic Response to Lithium in Hypomania Secondary ganic Brain Syndrome” (October 1975) encouraged
in patients
with
organicity.
she
sponded to this treatment well. The patient is a 61-year-old nun nurse. She was admitted in December time
to St.
Louis
for continuing
State
illness
Hospital
with
seems
M.D., Therato Orme to re-
trained
as
1973
Complex.
main
to have
for St.
symptoms
re-
a practical the Louis.
and
depression.
Her psychiatric sode of depression 1939, the patient
illness started that did not was hospitalized
in 1937. with a short require hospitalization. for depression with
epiIn “so-
matic fixation. withdrawal, and inability to take care of her personal appearance. ‘ ‘ She had several short hospitalizations for essentially similar complaints in the next 2 years.
In 1941, the possibility ofmultiple ered. The patient had undergone ness of legs disappearance
with
The patient
incontinence of neurologic
continued
pression until used a number 1963 she was
paraesthesia.
extensor venous
plantar. histamine
noted
of
talkative, argumentative, considered hypomanic In 1964 the patient treatment,
and
anxiety.
236
personal
periods
ECT
and
antidepressants
resulted
in the
and belligerent and treated with was readmitted There was
J Psychiatry
and
included the patient
behavior that chlorpromazine. for
little
complaints improvement
institutional
characterized withdrawn. having a clouded
133:2,
were
development
Fehruart
care
of dewas In nys-
a urinary
have
mild
sign,
rigidity.
tract
In
scanning
unsteady
gait,
resting
tremors,
fine
On She
infection.
dysarthria,
1972,
,
to care
In her
admissions
patient zines
infections
small
doses
The
for
essentially
poor
coordi-
weakness
herself.
patient’s
were
blood rate =
limits.
negative.
for
revealed mm/hour,
X ray
skull,
were essentially within normal limits. examination revealed mild elevation showed generalized dysfunction. EKG, carotid angiogram were tests showed nonlateralizing
In view neurologic she
was
also with
within
anemia
serum
fohic
serum
B12,
tolerance
disease
ofchest,
mild
patient’s glucose
Venereal
the
phenothiaand urinary
Parkinsonism.
of
and
spells.
1973,
She was given
her
count
urinalysis,
crying
various chest
to 12). The
2.5
and
antibiotics.
28
affect,
incontinence,
1968 until
with recurrent drugs
complete
normal
from
with
sedimentation
within
to eat,
hospital
treated
acid 2.4 g/ml (normal thyroid function test,
urinary
refusal
to this
were
for depressed
retardation,
of antichohinergic
g/IOOml).
tests
1973
was treated symptomatically and antidepressants. Her
tract
(12
and
and and
test
tuberculin
cervical
spine
Cerebrospinal fluid of proteins. EEG brain scan, and right
normal limits. Psychological organic brain impairment.
of the patient’s history of repeated episodes of dysfunction with resolution over a period of time, considered
to have
to have recurrent or uncovered by renal,
or
multiple
affective multiple
hepatic
treatment and complications
DINE5H
seemed
for
lithium
has now been and is doing
some patients with affective disorder
with
She
either associated As she had no
contraindication
she was put on this 20 months without
well. It would appear that impairment and recurrent from lithium.
sclerosis.
illness, sclerosis.
intrawas
on it quite
organic brain might benefit
B. MEHTA, St. Louis,
M.D. ltlo.
not Correction
of
was There
final-
as being “conand careless of sensorium. ‘ ‘ In
/976
and to
Romberg’s
inability
therapy, for some
of defrom
was
bladder noted
psychomotor
cardiac,
complete
on the left side
patient was depressed.
hygiene
Am
frequent
management However,
in 1967 long-term
hy considered. The tinuoushy psychotic,
her
from
subsequent and signs.
hyperreflexia
medical steroids.
depressed.
A course
and
to suffer
and Her and
to be quite
pression
and had symptoms
was first considepisodes of weak-
1961. Ehectroconvulsive therapy (ECT) of times with apparent favorable results. rehospitalized for extreme exhaustion,
tagmus,
effective.
sclerosis repeated
in 1971
were
fourth Mo.,
of confusion
to St. Louis State Hospital. with feces from head to foot.
cogwheel
withdrawal,
Organic
port the following case. I think this patient is unique in severah ways and although lithium would generally be used with reluctance
admitted covered
of muscles, and diminished deep reflexes. In 1970, the patient was reported to have become withdrawn, confused, and depressed. She also had frequent slips and falls and was generally clumsy. She had further admis-
N. Y.
sions
Disorders
was
positive
nation
M.D.
BARTON.
first was
a neurogenic
speech,
1928
Roe/tester,
had 1969,
review
6:102-120,
RUSSELL
Lithium and Affective Brain Impairment
was she
admission
6. McCowan PK, Cook LC: The mental ic encephalitis: Lancet 1:1316-1320, 7.
Arch
1922
in
is an error
Adolescence:
in the Behavioral
article
‘ ‘
and
A Hierarchy Attitudinal
of Drug Correlates
Use of
by Beatrix A. Hamburg, M.D. , HelKraemer, Ph.D. , and William Jahnke (November 1975 issue). In figure 1, page 1159, the authors inadvertently interchanged the labels of the curves representing hard hiquor and tobacco usage. Substantial ena C.
Drug
Use.”
