Lithium, polyuria and abnormal diurnal weight gain in psychosis

We evaluated diurnal weight gain and polyuria among 31 institutionalized chronically psychotic patients receiving lithium and 42 controls not receiving this drug. The patients were weighed weekly for three weeks at 7 a.m. and 4 p.m. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. Polyuria was assessed using mean urine creatinine concentration (MUCR). NDWG was abnormal among study patients (1.9 +/- 1.2%) and controls (1.6 +/- 1.5%) independent of lithium treatment. The variation in MUCR explained about 20% of the variation in NDWG in both groups.     

A case of nocturnal polyuria in olivopontocerebellar atrophy

We report a case of olivopontocerebellar atrophy without sleep apnea syndrome who presented nocturnal polyuria. It is considered that a disturbance in the circadian rhythm for arginine vasopressin secretion due to degeneration of suprachiasmatic nuclei and marked increase in the secretion of atrial natriuretic peptide due to abnormal diurnal variation in blood pressure may be involved in the mechanism of nocturnal polyuria.     

Nocturia, nocturnal polyuria, and sleep quality in the elderly

Nocturia is a common symptom in the elderly, which profoundly influences general health and quality of life. One consequence of nocturia is sleep deterioration, with increased daytime sleepiness and loss of energy and activity. Accidents, e.g., fall injuries, are increased both at night and in the daytime in elderly persons with nocturia. Nocturia is caused by nocturnal polyuria, a reduced bladder capacity, or a combination of the two. Nocturnal polyuria can be caused by numerous diseases, such as diabetes insipidus, diabetes mellitus, congestive heart failure, and sleep apnoea. In the nocturnal polyuria syndrome (NPS), the 24-h diuresis is normal or only slightly increased, while there is a shift in diuresis from daytime to night. NPS is caused by a disturbance of the vasopressin system, with a lack of nocturnal increase in plasma vasopressin or, in some cases, no detectable levels of the hormone at any time of the 24-h period. The calculated prevalence of NPS is about 3% in an elderly population, with no gender difference. In NPS, there are serious sleep disturbances, partly due to the need to get up for micturition, but there is also increased difficulty in falling asleep after nocturnal awakenings and increased sleepiness in the morning. The treatment of NPS may include avoidance of excessive fluid intake, use of diuretics medication in the afternoon rather than the morning, and desmopressin orally at bedtime.     

Permanent lithium-induced cerebellar toxicity: three cases and review of literature.

Lithium can have toxic effects on the central nervous system that are both acute and chronic. Uncommonly, a long-lasting cerebellar syndrome follows acute toxicity. The mechanism of cerebellar injury is not well understood. We present 3 cases of this syndrome, with video demonstrating the typical features of this syndrome.     

The association between concomitant use of serotonergic antidepressants and lithium-induced polyuria. A multicenter medical chart review study

BACKGROUND: A previous study aimed at revealing the prevalence and determinants of lithium induced polyuria suggested an increased risk of polyuria (urine volume > or =3 L/24 h) in those using serotonergic antidepressants next to lithium. OBJECTIVE: The objective of our study was to re-evaluate this secondary finding in another study population. METHODS: We performed a multicenter medical chart review study in patients using lithium in whom a 24-hour urine volume had been determined. RESULTS: We included 116 patients, twelve (26%)of the 46 patients with polyuria used serotonergic antidepressants compared to ten (14%) of the 70 patients without polyuria. We found an increased risk of polyuria in lithium users concurrently using serotonergic antidepressants (oddsratio 2.86; 95% confidence interval 1.00-8.21), adjusted for age, gender, use of antiepileptics and thyreomimetics. CONCLUSION: Our results confirm the previous secondary finding of an increased risk of polyuria in patients using serotonergic antidepressants next to lithium. Physicians should take this into account when evaluating polyuria in patients using lithium and when choosing an antidepressant in patients using lithium.     

Distress due to delirium experience

BackgroundVery few studies have evaluated the level of distress due to the experience of delirium in patients who have recovered from delirium.MethodologyFifty-three patients were rated on Delirium Rating Scale-Revised-98 at baseline and were again evaluated on Delirium Experience Questionnaire after recovery for level of distress due to the experience of delirium.ResultsThe mean age of patients was 45.58 (S.D. 19.06) years. Only 15 patients (28.3%) remembered themselves to be confused and rest had no recollection of the same. Those who could remember their experience had moderate (n = 4; 26.7%), severe (n = 6; 40.0%) and very severe (n = 5; 33.3%) level of distress. Of those who could not remember their delirium experience, most of them had moderate (n = 17; 44.7%) to severe (n = 10; 26.3%) distress. Those who remembered their experience in general described it as a state of fearfulness (n = 8), anxiety (n = 4) confusion and feeling strange (n = 7). Other experiences which were recollected were those of visual hallucinations and illusions.ConclusionOverall experience of delirium is distressing for the patients. Most of the patients (those who remembered or who were not able to remember) experienced at least moderate level of distress.     

Persistent cognitive deficits associated with lithium intoxication: a neuropsychological case description

We present the case of a 51-year-old patient with an acute lithium intoxication associated with several cognitive deficits. During the acute phase of intoxication the patient displayed general psychomotor slowing, dysarthric speech, mood changes, and incoherent discourse. Neuropsychological assessment revealed ideomotor apraxia, profound deficits of visuospatial processing, an impairment of memory and of frontal-executive functions. Other cognitive abilities, such as orientation, spontaneous speech, comprehension, naming, reading, writing, and working memory remained intact. An electroencephalogram revealed diffuse slowing with rhythmic trains, whereas MRI showed no cerebral abnormality. Follow-up examinations at 4 and 14 weeks with lithium levels in the normal range showed substantial recovery of memory abilities and executive functions, whereas praxis and visuoperceptual functions remained impaired, despite the fact that lithium was immediately withdrawn after the intoxication became manifest. We conclude that lithium intoxication may be associated with variable behavioural and cognitive impairments, some of them potentially persistent. Different from other case studies our findings suggest that lithium intoxication may cause a combined, multifocal functional impairment of subcortical and cortical neural mechanisms in both hemispheres.     

Distress tolerance and obsessions: an integrative analysis

Background: Recent research implicates a potential relationship between poor distress tolerance (DT) and obsessive–compulsive disorder (OCD) and obsessions in particular, though this evidence has been largely indirect. We sought to examine the incremental and specific associations between DT and obsessions using multiple methodologies. Methods: We conducted three separate studies using independent nonclinical samples (total N =558) that involved cross‐sectional (Study 1) and prospective self‐report designs (Study 2), as well as the use of an in vivo neutralization task (Study 3). Results: Poor DT was specifically associated with obsessing but not other OCD symptoms, even when covarying for several theoretically relevant constructs. Further, poor DT was predictive of residual change in obsessing symptoms 1‐month later. Poor DT was also associated with neutralization in response to an OCD‐like intrusion and postneutralization period anxiety. Conclusions: These consistent findings provide support for an important relationship between DT and obsessions and suggest that interventions targeting DT may have special benefit for the treatment of obsessions. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Neuropsychological profile in bipolar disorder: a preliminary study of monotherapy lithium-treated euthymic bipolar patients evaluated at a 2-year interval

Objective: To investigate the cognitive impairment of a sample of euthymic bipolar patients treated with lithium monotherapy at baseline in a 2‐year longitudinal study. Method: Fifteen DSM‐IV‐TR bipolar out‐patients and 15 healthy‐matched controls were cognitively assessed twice over a 2‐year follow‐up. All patients underwent lithium monotherapy on the first evaluation, and they were euthymic in both evaluations. Cognitive assessment was performed by means of a neuropsychological test battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory). Results: Repeated measures multivariate analysis of variance showed that the bipolar disorder group was cognitively impaired in the executive domain, attention and processing speed, and such deficits were maintained over time. Conclusion: Our results showed that executive dysfunction is the main long‐term neuropsychological deficit of bipolar disorder. Also, the persistence of these deficits did not seem to be influenced by any clinical or pharmacological variables.     

Delirium‐Related Distress in Caregivers: A Study From a Tertiary Care Centre in India

PURPOSE: To study the caregiver's distress with symptoms of delirium. DESIGN AND METHODS: Consenting adult caregivers (>18 years of age) of patients with delirium were evaluated for the distress due to symptoms of delirium. RESULTS: The study included 72 primary caregivers of patients with delirium. Symptoms of delirium that led to severe or very severe distress in more than two thirds of the caregivers included decreased sleep, increased motor activity, attempts to remove intravenous lines, tubings, etc., and attempts to get out of bed when they were actually required to lie down. CONCLUSIONS: Overall experience of delirium was very distressing for the caregivers.     

Distress and functioning in mixed anxiety and depressive disorder

The aim of the present study was to evaluate the validity of mixed anxiety and depressive disorder (MADD) with reference to functional characteristics and symptomatic characteristics in comparison with anxiety disorders, depressive disorders, and groups showing subthreshold symptoms (exclusively depressive or anxiety related). The present study was carried out in the following three medical settings: two psychiatric and one primary care. Patients seeking care in psychiatric institutions due to anxiety and depressive symptoms and attending primary medical settings for any reason were taken into account. A total of 104 patients (65 women and 39 men, mean age 41.1 years) were given a General Health Questionnaire (GHQ-30), Global Assessment of Functioning (GAF) and Present State Examination questionnaire, a part of Schedules for Clinical Assessment in Neuropsychiatry, Version 2.0. There were no statistically relevant differences between MADD and anxiety disorders in median GHQ score (19 vs 16) and median GAF score (median 68.5 vs 65). When considering depressive disorders the median GHQ score (28) was higher, and median GAF score (59) was lower than that in MADD. In groups with separated subthreshold anxiety or depressive symptoms, median GHQ scores (12) were lower and median GAF scores (75) were higher than that in MADD. The most frequent symptoms of MADD are symptoms of generalized anxiety disorder (GAD) and depression. Mixed anxiety and depressive disorder differs significantly from GAD only in higher rates of depressed mood and lower rates of somatic anxiety symptoms. Distinction from depression was clearer; six of 10 depressive symptoms are more minor in severity in MADD than in the case of depression. Distress and interference with personal functions in MADD are similar to that of other anxiety disorders. A pattern of MADD symptoms locates this disorder between depression and GAD.     

Suicidal Behavior and Psychological Distress in University Students: A 12-nation Study

This study investigated the prevalence of suicidal behavior and psychological distress in university students across 12 nations. A total of 5,572 university students from 12 countries were surveyed about suicide ideation, suicide attempts, and psychological distress by means of a self-administered questionnaire. Almost 29% of the samples reported having contemplated suicide and 7% reported attempting suicide. Of the total sample, 51.1% scored above the General Health Questionnaire-12 ≥ 3 cut-off points, 41.6% above the GHQ-12 ≥ 4 cut-off points, and 33.8% scored above the GHQ-12 ≥ 5 cut-off points. While odds of suicide ideation were elevated in Austria and the UK, reduced ORs were detected for China, Italy, Saudi Arabia, Tunisia, and Turkey. Similarly, while odds of suicide attempt were high in Jordan, Palestine, Saudi Arabia, and to some extent in Turkey, reduced ORs were observed for Austria, China, Italy, Japan and the United States. Elevated ORs for psychological distress were seen in Japan, Jordan, Palestine, Saudi Arabia, Tunisia, and Turkey but reduced ORs were noted in Austria, China, Iran, Italy, and the United States. Psychological distress was strongly associated with reports of suicide ideation and attempts. Suicide ideation, suicide attempt, and psychological distress are common in university students but their rates vary depending on the sociocultural context. Due attention should be devoted to the mental health needs of young adults enrolled in higher educational institutions and more cross-cultural research is warranted to better understand the etiology of the observed intersocietal variations in suicidal behavior and psychological distress.     

Lithium isotopes: differential effects on renal function and histology

Objectives: Reduction in renal concentrating ability has been reported in patients undergoing chronic lithium treatment. Prior work has demonstrated differences in physiological effects of the stable lithium isotopes, ⁶Li and ⁷Li. Here, we measured the degree of polyuria, polydipsia and kidney histological changes induced in rats by equimolar amounts of ⁶LiCl, ⁷LiCl and the commercially available mixture of both isotopes.

Methods: Rats were given 1.0 mEq/kg of either ⁶LiCl, ⁷LiCl or ‘ⁿLiCl’ (isotope mixture, 93% ⁷LiCl) by subcutaneous injection twice daily for up to 49 days. Twenty‐four‐hour urine volume and water intake were measured daily. Kidneys from rats treated for 7 days with 1.5 mEq/kg ⁶LiCl, ⁷LiCl and vehicle were examined under light microscopy and histopathologic changes graded on a 4‐point scale of severity.

Results: All rats showed loss in renal concentrating ability manifested by increasing urine volume and water intake. Peak effects occurred after 9–13 days treatment, then declined to stable levels at two to three times pre‐treatment level. Mean peak effect was significantly greater for ⁶LiCl than for ⁷LiCl. Chronic effects of ⁶LiCl (weeks 3–7 of treatment) on polyuria and polydipsia were persistently higher than that of ⁷LiCl. ⁿLiCl effect was intermediate. Kidneys from rats treated for 7 days with ⁶LiCl showed more frequently severe lesions in renal tubules than did ⁷LiCl‐treated rats.

Conclusions: Our current data and prior studies suggest that elimination or reduction of ⁶Li from pharmaceutical preparations may merit further evaluation as a possibly less potentially nephrotoxic form of lithium treatment.     

Psychological Distress and Non-Suicidal Self-Injury: The Mediating Roles of Rumination,Cognitive Reappraisal,and Expressive Suppression

This study sought to explore the relationships between depression, anxiety, stress, and non-suicidal self-injury (NSSI), and the mediating roles of rumination and emotion regulation in this relationship. The sample comprised 1,586 Australian university students who completed a self-report questionnaire assessing the relevant variables. Of the sample, 8.9% engaged in NSSI in the 4 weeks prior to the survey. Depression, anxiety, and stress each exerted a direct effect on NSSI, and each relationship was mediated by cognitive reappraisal. The relationship between stress and NSSI was also mediated by expressive suppression. The results imply intervention efforts aimed at teaching adaptive emotion regulation strategies for students experiencing high levels of psychological distress may reduce the frequency of NSSI.     

Normal cognition in Parkinson's disease may involve hippocampal cholinergic compensation: An exploratory PET imaging study with [18F]-FEOBV

BackgroundSevere cholinergic degeneration is known to occur in Parkinson's disease (PD) and is thought to play a primary role in the cognitive decline associated with this disease. Although cholinergic losses occur in all patients with PD, cognitive performance remains normal for many of them, suggesting compensatory mechanisms in those.ObjectivesThis exploratory study aimed at verifying if normal cognition in PD may involve distinctive features of the brain cholinergic systems.MethodsFollowing extensive neuropsychological screening in 25 patients with PD, 12 were selected and evenly distributed between a cognitively normal (PD-CN) group, and a mild cognitive impairment (PD-MCI) group. Each group was compared with matched healthy volunteers (HV) on standardized cognitive scales (MoCA, PDCRS), and PET imaging with [¹⁸F]-FEOBV, a sensitive measurement of brain cholinergic innervation density.Results[¹⁸F]-FEOBV uptake reductions were observed in PD-CN as well as in PD-MCI, with the lowest values located in the posterior cortical areas. However, in PD-CN but not in PD-MCI, there was a significant and bilateral increase of [¹⁸F]-FEOBV uptake, exclusively located in the hippocampus. Significant correlations were observed between cognitive performance and hippocampal [¹⁸F]-FEOBV uptake.ConclusionThese findings suggest a compensatory upregulation of the hippocampal cholinergic innervation in PD-CN, which might underly normal cognitive performances in spite of cortical cholinergic denervation in other regions.     

Disability and Health Service Utilization Associated With Psychological Distress: The Influence of Ethnicity

This study examined levels of disability and use of health services, as a result of psychological distress, across various ethnic groups after taking into account selected sociodemographic factors such as age, gender, education, and employment. We have analyzed data from the 1997–1998 New South Wales Health Survey, Australia. A telephone interview of 35,025 adults aged 16 years and over selected from each of the 17 Health Service Areas in the state. While people from non-English speaking backgrounds were more likely to suffer high levels of disability as a result of psychological distress, they were less likely to utilize health services compared to those from English speaking backgrounds. This was particularly true for those born in Southern and South-East Asia as well as the Middle East and Africa. Further research into the reasons underlying these findings for each ethnic group is warranted.     

An exploratory study to identify neonatal arterial ischemic stroke: A single-center study

BackgroundNeonatal arterial ischemic stroke (NAIS) presents as seizures, including convulsions, subtle seizures, and apnea, and most patients experience neurological sequelae. Diagnosis is often delayed owing to low test sensitivity. The present study aimed to identify the early clinical diagnostic factors for NAIS in neonates with seizures.MethodsThe present study included 54 patients born at ≥36 weeks of gestation during the last 15 years who presented to the neonatal intensive care unit with neonatal seizures and underwent brain magnetic resonance imaging (MRI), 6 of whom were diagnosed with NAIS. Maternal background, clinical characteristics, and transcranial pulsed Doppler sonography results were retrospectively reviewed.ResultsOf the 24 patients who presented with convulsions or subtle seizures, 3 (13%) were diagnosed with NAIS and 3 of 30 patients (10%) presented with apnea. Maternal premature ventricular contraction complications were higher in the NAIS group than in the non-NAIS group (p = 0.01). NAIS group showed lower mean middle cerebral artery (MCA) resistance index (RI) was lower the non-NAIS group (p = 0.009), while the left–right RI difference (p = 0.019), mean MCA blood velocity (MnV; p = 0.04), and left–right MnV difference (p < 0.001) in cerebral blood flow velocities (CBFVs) were higher in the NAIS group.ConclusionsOur results revealed that maternal arrhythmia may be a diagnostic factor for NAIS in neonates with seizures. Early brain MRI is essential in neonates with seizures and findings of low MCA-RI, high MCA-MnV, or high left–right difference in CBFVs to distinguish between NAIS and non-NAIS.