Acta psychiatrica Scandinavica
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Acta Psychiatr Scand · Aug 1993
Thiamine pyrophosphate effect and erythrocyte transketolase activity during severe alcohol withdrawal syndrome.
The thiamine pyrophosphate (TPP) effect and erythrocyte transketolase activity (ETKA) in a group of 28 patients admitted to a psychiatric emergency ward because of severe alcohol withdrawal syndrome were compared with the TPP effect and ETKA in a control group of 20 healthy nonalcoholic volunteers. The patients were treated with 300 mg thiamine 3 times daily as intramuscular injections, and the TPP effect and ETKA were measured after 1 and 4 days of treatment. ⋯ ETKA increased with intensive thiamine treatment, which suggests that ETKA is a sensitive indicator of thiamine deficiency. Serum magnesium, which is a cofactor for thiamine pyrophosphate, decreased significantly with the disappearance of alcohol from the blood in patients with high initial blood alcohol levels, but this shift did not interfere with biological thiamine activity.
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Acta Psychiatr Scand · Jul 1993
Cardiovascular response and seizure duration as determined by electroencephalography during unilateral electroconvulsive therapy.
The effect of pulse unilateral electroconvulsive therapy (ECT) on heart rate, blood pressure and the product of heart rate and systolic blood pressure, an index of myocardial oxygen consumption, was studied during 48 ECT sessions in 7 patients with major depression. Intra-individually, hyperventilation-induced hypocapnia compared with normocapnia markedly augmented the ECT-induced increase in heart rate (47% vs 28%) and the product of heart rate and systolic blood pressure (82% vs 60%). ⋯ However, significant correlations were only present for the seizures during hypocapnia and not during normocapnia. Combining measures of magnitude and length of ECT-induced tachycardia to motor responses may increase the potential for clinical seizure evaluation.
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Acta Psychiatr Scand · Feb 1993
Delirium and dementia in acute medical admissions of elderly patients in Iceland.
A prospective study was carried out in a general hospital in Reykjavík to evaluate the prevalence of delirium and dementia among 331 patients 70 years and older who were admitted as an emergency to the medical department. Cognitive function was screened with Mental Status Questionnaire (MSQ) and Mini-Mental State Examination (MMSE) and diagnosed according to DSM-III-R for delirium and dementia. Other information obtained included social and demographic factors, drug consumption, the main condition underlying the delirium and outcome. ⋯ At follow-up, concurrent dementia was found in 70% of the delirium patients. The main causes for delirium were cardiac failure 27%, stroke 22% and sepsis 16% and the mortality rate was 32% compared with 8% in dementia alone. The prognosis of patients with delirium and dementia depends on detecting these disorders, and the clinical skills of physicians working with acutely ill elderly patients can be improved by relatively simple screening questionnaires such as the MSQ and MMSE.
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The effect of suggestion on suicide is well established. However, the intrapsychic mechanisms of the contagion of suicides are poorly understood. ⋯ In the following clinical vignette I try to understand a patient's suicidal behaviour, referring to William Goldstein's clarifying model of projective identification. I aim to illustrate that his model has heuristic value in the treatment of suicidal patients when the effect of suggestion or identification is suspected.