Acute psychiatric admission related to the menstrual cycle

A study of menstrual cycle phase on the day of acute admission to a psychiatric hospital for 121 women aged 20-39 showed an unequal distribution of admissions. More admissions than expected took place in the menstrual period, and correspondingly fewer intermenstrually. The difference was significant, and points to a certain degree of cyclicity in female psychiatric disturbance. This cyclicity was not significantly influenced by age, diagnosis, oral contraceptives or tendency for premenstrual symptoms. In the age group 20-39 one and a half times as many men as women are admitted to Danish psychiatric departments. Thus, in view of a common baseline, the most conspicuous feature is, that remarkably few women were admitted intermenstrually.     

Crossed aphasia in right-handed patients. I. Review of the literature

More than 70 cases of crossed dextral aphasia have been reported in the literature since the end of the XIXth century. If a genetic, environmental or even pathological factor--or lack of information about it--could be suspected to be responsible of a majority of these cases, 10 of them in which all these factors were eliminated still remain. A summary of the neurological, neuropsychological and neurolinguistic features of these 10 cases shows, among other things: 1. that nearly all of them present a (left) motor deficit associated with a quite large and deep right-hemispheric lesion; 2. that most of them also report the presence of one or the other of the neuropsychological signs usually seen in right hemisphere lesions in dextrals; 3. that if reduction and agrammatism are frequent aphasic signs, fluent jargon is also reported, more so in written than in oral expression. Some of the hypotheses put forward to explain crossed aphasia in dextrals are discussed in the light of these facts. It appears that none of these hypotheses can satisfactorily account for the occurrence of a right hemisphere aphasia in some dextrals.     

The pineal gland and the menstrual cycle.

The menstrual cycle reflects the expression of a cyclical process involving the interaction between the hypothalamic-pituitary axis and the ovaries. This complex process requires an integrated neural and humoral control mechanism. It is now well established that a hypothalamic "transducer" located in the medial basal hypothalamus integrates neural and humoral information and translates it into an oscillatory signal which eventually results in the release of the gonadotropin releasing hormone (GnRH), triggering the secretion of gonadotropins from the pituitary gland. Recent animal studies indicate that melatonin influences the functions of the hypothalamic-pituitary-gonadal axis by modifying the firing frequency of the hypothalamic GnRH pulse generator. Consequently, the pineal gland, through the action of melatonin, may exert an important modulatory effect on the mechanisms controlling menstrual cyclicity. Furthermore, abnormal melatonin functions may be involved in the pathogenesis of several disorders of the menstrual cycle including some forms of hypothalamic amenorrhea such as exercise and malnutrition-induced amenorrhea. Consideration of pineal melatonin functions provides a new dimension into the understanding of the neuroendocrine mechanisms governing the cyclical phenomena of the female reproductive system.     

Smoking and movement disorders in psychiatric patients.

Previous studies have suggested that tardive dyskinesia may occur more frequently in patients who smoke. Further evidence of an interaction between smoking and movement disorders includes the low lifetime exposure to cigarettes found in Parkinson's disease patients. In this study 126 patients with chronic psychiatric illnesses were blindly evaluated for tardive dyskinesia, neuroleptic-induced parkinsonism, and akathisia. Patients who smoked received significantly higher doses of neuroleptics but did not have significantly more frequent or more severe tardive dyskinesia or parkinsonism. Female smokers did have significantly more akathisia. These results are discussed with regard to interactions between smoking, central dopaminergic tone, and the psychopathology of extrapyramidal syndromes. The effect of smoking on neuroleptic blood levels as well as clinical symptomatology is also discussed.     

Axis I and Axis II psychiatric disorders in patients with fibromyalgia

ObjectiveTo determine the current prevalence of Axis I and Axis II psychiatric disorders in patients with fibromyalgia.MethodThe study sample includes 103 patients with fibromyalgia and 83 control subjects. Axis I and Axis II disorders were determined by structured clinical interviews.ResultsThe rate of any Axis I psychiatric disorder (47.6% vs. 15.7%), major depression (14.6% vs. 4.8%), specific phobia (13.6% vs. 4.8%), any Axis II disorder (31.1% vs. 13.3%), obsessive–compulsive (23.3% vs. 3.6%) and avoidant (10.7% vs. 2.4%) personality disorders were significantly more common in the patient group compared to the control group.ConclusionOur results suggest that a considerable proportion of patients with fibromyalgia also present with Axis I and Axis II psychopathologies.     

Dissociative disorders among psychiatric patients.

The aim was to determine the rate of dissociative disorders among psychiatric in- (n = 34) and out-patients (n = 37) and to compare the rate to that of nonclinical subjects (n = 297). Dissociative disorders (17% of patients) could be grouped according to the severity of the symptoms and their relation to affective disorders.     

The impact of epilepsy surgery on sex hormones and the menstrual cycle in female patients.

We investigated the impact of temporal lobe epilepsy surgery on sex hormones and menstrual cycles. Sixteen female patients with temporal lobe epilepsy were investigated prior to surgery and 3, 6, and 12 months after surgery. The patients received carbamazepine (CBZ) as monotherapy (10 patients) or in combination with other antiepileptic drugs (six patients). Antiepileptic drugs were maintained after surgery. During the 1-year follow-up after surgery eight patients (50%) remained completely free of seizures. In another four patients (25%) only rare disabling seizures occurred. There were no significant differences between pre-surgical and post-surgical serum concentrations of testosterone, free testosterone, prolactin, dehydroepiandrosterone sulfate, growth hormone, cortisol and sex hormone binding globulin. There was, however, a significant increase in serum androstenedione concentration 6 months post-surgically (P < 0.02). Documentation of menstrual cycles in addition to laboratory parameters revealed individual post-surgical changes of the menstrual cycle in eight patients. Four patients had a change in menstrual periodicity: two patients with complete seizure control had regular cycles instead of oligomenorrhoea and two patients with incomplete seizure control had oligomenorrhoea instead of regular cycles. These data indicate that at least in some patients with temporal lobe epilepsy surgical treatment influences menstrual periodicity.     

Calcium channel blockers in psychiatric disorders: a review of the literature.

OBJECTIVES: To review the published literature of the past 15 years regarding use of calcium channel blockers (CCBs) in psychiatric practice. These drugs, especially verapamil, have been recommended as possible treatments for mania and other disorders. METHODS: The Cumulative Medical Index and other databases were searched and back-tracked to locate relevant articles. Sixty-one such articles were uncovered: 37 anecdotal reports, 7 partially controlled reports, and 17 controlled trials. RESULTS: Most studies involved treatment of mania using verapamil. Although anecdotal reports were generally favourable, results from partially controlled reports or controlled clinical trials were mixed. Generally, verapamil was less effective than was lithium or placebo. Treatment of depression with CCBs was not very successful, regardless of the type of trial; the best trial was negative. The same was true for the treatment of schizophrenia, although the cases studied were extremely chronic and treatment-resistant. Evidence for efficacy in other illnesses, such as Alzheimer's disease or tardive dyskinesia was scanty but suggested that further trials might be in order. CONCLUSIONS: CCBs do not at present have an established place in psychiatric treatment. Nonetheless, clinicians faced with a manic patient not responsive to other antimanic drugs, either alone or in combination, might consider adding verapamil as an adjunct. A study bearing on this specific issue is needed to determine whether or not such off-label use would really be justified.     

Psychophysiological aspects of the menstrual cycle.

After a survey of literature on electrolyte changes associated with the varying excretion of hormones during the menstrual cycle, a study of 30 women aged 18-33 is reported. Measurements of sodium and potassium ions in the saliva were made at 4 points in the menstrual cycle and, since previous work had shown bilateral asymmetry in sodium reabsorption in the eccrine sweat glands, samples were collected from both the right and left sides of the mouth. The smallest sodium/potassium (Na+/K+) ratios were found at ovulation and the premenstruum. This fits 2 sets of facts: 1) during stress Na+/K+ ratios decrease and 2) this decrease comes exactly when most women report feelings of irritability, anxiety, and such. Differences in Na+/K+ ratios over points in the cycle were significant at p less than .001. Differences between right and left side were significant during the premenstruum (p less than .05). K+ was highest at ovulation (p less than .001) and the left side produced higher values (p less than .05). Na+ was lowest at ovulation, highest at menstruation (p less than .001) with concentration on right side higher at menstruation (p less than .05). This seems to indicate that the right side not only reabsorbs Na+ more efficiently but it can also excrete more efficiently and maintains homeostasis more effectively. Estrogen seems to play a major role in initiating these variations in body electrolytes, which are similar to stress reactions. It is also suggested that salivary electrolytes, recorded for parotid saliva, reflect readings similar to that of plasma with Na+ and K+ tending to move in opposite directions.     

Screening psychiatric patients for Axis II disorders.

This study examined the usefulness of the SCID-PQ on a sample of 82 inpatients as a screening measure for Axis II disorders. The SCID-PQ proved effective (i.e., resulted in a very low false negatives and moderate false positives) in screening for seven of the 11 DSM-III-R personality disorders. Of the four remaining disorders, minor modifications were suggested which resulted in improved classification rates for dependent and schizoid personality disorders.     

Parasuicide and the menstrual cycle

A study of 74 patients admitted to the Regional Poisoning Treatment Centre at the Royal Infirmary, Edinburgh, failed to reject the null hypothesis that parasuicide occurs at random in relation to the menstrual cycle.     

Self-poisoning and the menstrual cycle

A study of the menstrual cycle phase on day of admission was conducted on 156 women with regular menstruation admitted for self-poisoning to a medical department. No relation of statistical significance was found between the day of self-poisoning and the menstrual cycle phase. This was also the case when a distinction was made between suicidal and non-suicidal attempts and between the main toxic agents taken. The findings are partly in contrast to earlier investigations.