The American journal of psychiatry
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Case Reports
Amitriptyline-perphenazine overdose producing delayed hypomania in manic-depressive illness.
The authors describe a 26-year-old woman who became hypomanic after awakening from a semicomatose state induced by an overdose of amitriptyline-perphenazine (Triavil). She had been depressed and had a strong family history of manic-depressive illness. The case is reported to support previous evidence that dopamine is a mediator for mania.
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The authors found that 14 individuals who had attempted suicide by self-immolation all had psychiatric illness (most were psychotic), and many had religious preoccupations. There was a reversal of the usual male to female ratios for burn injury and for successful suicide--all 5 completed suicides were women. Although self-immolation as social protest was widely publicized during the years surveyed, the authors note that these individuals all attempted suicide for personal and irrational rather than morally idealistic reasons.
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The 143 cases of lithium use during pregnancy collected by the Register of Lithium Babies show that infants exposed to lithium appear to have a higher than expected ratio of cardiovascular anomalies to all anomalies and may have an increased risk of congenital heart disease. The authors believe that these findings justify a conservative policy on the use of lithium with fertile and pregnant women.
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Two patients with severe Parkinson's disease were treated with electroconvulsive therapy for a supervening depression. Not only did the symptoms of depression clear up after only four treatments, but the parkinsonian signs also showed striking and sustained improvement. ⋯ Parkinsonism does not appear to be a contraindication to ECT. On the contrary, ECT may be the treatment of choice for certain patients with Parkinson's disease, whether nor not it is complicated by intractable depression.
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In 1972, the mental health services in the Veterans Administration were reorganized in a manner designed to increase the probability of interdisciplinary collaboration. VA hospitals were urged to form multidisciplinary mental health committees to advise on local programs and practices. This "corporate" approach has led to significant changes in the use of staff and in the physical and psychological environment in some hospitals. While it is too early to evaluate the full impact of the changes on patient care, waiting lists have been reduced and length of hospital stay has decreased.