Faculty Bibliography

We tested kidney function in 268 patients given lithium treatment for an average period of 37.6 months and in 59 manic-depressive patients never given lithium. No patients suffered serious renal damage during the course of our observations. Maximum concentration capacity was lower and serum creatinine concentration higher in the lithium treated patients than in the controls, but the differences did not achieve statistical significance. Females had poorer concentrating ability than males, both among the control subjects and during lithium treatment. Concomitant antipsychotic drug therapy may affect concentrating ability and possibly glomerular function adversely

Forty-eight consecutive patients treated for panic disorder with alprazolam, but with presumed interdose anxiety symptoms, were switched to clonazepam. Forty-one patients made the 'switch' according to a protocol, and 82% rated clonazepam 'better' because of decreased frequency of administration and lack of interdose anxiety. Both medications seemed effective for panic disorder at comparable doses, and the authors describe how to switch from alprazolam to clonazepam when interdose anxiety is a concern

Five of 29 obsessive-compulsive disorder patients were dexamethasone suppression test (DST) nonsuppressors, all of whom met standard Hamilton Depression Rating scale criteria for at least mild depression. None of 24 nondepressed obsessive-compulsive disorder patients had an abnormal DST. The relationship of the DST to specificity of psychiatric diagnoses is discussed

Rebound--the relative worsening of symptoms on discontinuation of treatment as compared to baseline symptoms--is distinguished from withdrawal. Case reports and a clinical study are presented to illustrate the management of patients with panic disorder who are taking short- and intermediate-acting benzodiazepines and are experiencing rebound anxiety. The authors present the results of switching over to clonazepam 48 patients with panic disorder who were experiencing rebound effects with alprazolam. Eighty-two percent (39) of the patients rated clonazepam as being 'better' than alprazolam due to decreased dosing frequency and lack of interdose anxiety. The authors conclude that clonazepam can be a useful alternative to alprazolam and other short-acting benzodiazepines in the treatment of anxiety disorders. Clonazepam offers the advantage of antipanic efficacy without the relative side effect problems seen with tricyclic antidepressants and monoamine oxidase inhibitors

Three patients with major depression who were pretreated with yohimbine 10 mg p.o. showed a dramatic response without major adverse effects following two electroconvulsive treatments (ECT). The hypothesis that the alpha 2-adrenergic antagonist yohimbine accelerates ECT-induced postsynaptic beta-adrenergic receptor down-regulation is discussed

Two patients are described who illustrate the association between renal abnormalities and eating disorders. The relevant literature is reviewed, and the difficulty in managing these patients on medical and surgical services is highlighted

Six acutely manic patients were openly treated with verapamil, a calcium channel blocker, as part of their medication regimen in an inpatient setting. All patients had a prompt reduction in their manic symptoms and have been maintained on this medication. Further controlled trials of verapamil in acute mania seem warranted

Osteoporosis with pathologic fractures occurred in three patients with chronic anorexia nervosa. The authors discuss the pathophysiology of this rarely reported complication and advise clinicians to thoroughly investigate complaints of bone or back pain from this high-risk population