Lithium studies

511

AESTRACTS

associated abnormalities chemical with these disorders. This paper will summarize our studies of the effects of these drugs (which produce alterations of mood in man) on the metabolism of biogenic amines (particin norepinephrine ) , both ularly animals and in man. Correlative clinical neurochemical studies of patients with affective disorders will also be presented. The possibility that these neuropharmacological findings may provide clues to the etiology of the affective disorders will be discussed. Neurophysiology Significance for Psychosis

of Induced Convulsions: a Theory of Depressive

MAX FINK, M.D., New York Medical College, New York, N.Y. The alteration of cyclothymic disorders by induced convulsions, thymoleptics or lithium depend on the rapid development of changes in the central nervous system. Successful convulsive therapy requires repeated grand ma1 seizures. When convulsions are induced infrequently, when electrical currents are applied without inducing convulsions, or when convulsions fail to produce persistent changes in the CNS, the behavioral changes are minimal and do not materially affect the psychotic process, and the EEG changes, characteristic of the therapy process, are not elicited. Slow wave activity in the postconvulsive EEG may be modified by a variety of experimental drugs and

reduced by the administration of anticholinergic drugs. These observations have been interpreted as consistent with a cholinergic mechanism underlying the ECT process, and suggest that disordered metabolism of acetylcholine is a factor in the etiology of cyclothymic disorders. Sourcesof Contribution ing of the Etiology

to the Understandof Mood Disorders

MORRIS A. LIPTON, PH.D., ARTHUR J. PRANGE,JR., M.D.,

M.D., AND

IAN C. WILSON, M.B., D.P.M.,

University of North Chapel Hill, N.C.

The Carolina,

There is no known necessary or sufficient cause for either mania or depression. Even amine depletion, as from reserpine, is effective in causing depression in only a minority of cases. Findings in depression that may reflect contributions to cause are biochemical (amines, hormones, electro(muscle lytes ) , neurophysiological tone, sedation threshold, sleep), and whole-organismic (genes, experience, life situation). We shall examine each of these findings for its possible causal significance and shall indicate whether its acquisition is mainly the result of naturalistic observation or of active intervention. On balance, it appears that information of greater causal import has come from the latter technique. In particular, inferences from new treatments have told us most about what we may be treating.

SATURDAY MORNING, 9:00 a.m., February 14, 1970 Session III. Therapy in Mood Disorders Chairman: JOEL ELKES, M.D. Lithium Studies RONALD ,FIEVE, M.D.,

State Psychiatric York, N.Y. Lithium’s

New Institute,

well-established

York New thera-

peutic efficacy against certain affective disorders has moved research to examine more deeply other aspects of its use. Among these are its possible prophylactic properties in preventing

512

ABSTRACTS

the recurrence

of manic-depressive

ill-

use in screening out and suppressing manic features in a variety of other diagnostic categories. The heated intemational debate over lithium’s efficacy, as well as the controversy over marketing it in the U.S., are overshadowed by the fact that it has opened diverse new areas of psychopharmacologic research. Original studies of lithiuminduced effects on catecholamine metabolism, in vitro biological systems, endocrine systems, the EEG, electrolyte metabolism, and intermediary metabolism will be reviewed at the symposium to elucidate some of lithium’s possible modes of action. ness,

as well

as its possible

Pharmacogenic Mood Disorders PROF. DR. H. H~PPIUS, Freie Universitiit Berlin, Berlin, Germany

Affective syndromes are frequently caused by cerebral dysfunction. Depressive states on such a basis may imitate completely the clinical picture of endogenous depressions. Up to 1900 psychiatry operated on the premise of specific etiologies for brain syndromes. The work of Bonhoeffer revealed that psychiatric syndromes SATURDAY

AFTERNOON,

could not be separated on the basis of specific etiologies, but that the clinical manifestations were common syndromes for multiple causes. Not only the so-called exogene Reaktionstypen (such as delerium, amentia, and hallucinosis, etc. ) are psychopathological expressions of brain syndromes, but schizophrenic states and depressive syndromes may be caused in the same manner as well. For the purpose of this symposium special attention will be devoted to those depressive syndromes which develop in the treatment with psychoactive drugs, and neuroleptic compounds in particular. Modem drug treatment of schizophrenia provides favorable conditions for investigations of the development and symptomatology of drug-induced depressions. Results of clinical investigations in this field will be presented. PRESIDENTIAL The

ADDRESS

Psychopathologist-What

Man

of

Science? A. FREYHAN, M.D., St. Vincent’s Hospital and New York University Medical Center, New York, N. Y. FRITZ

2:00 p.m., February

14,19’70

Session IV. Critique of Current Theories and Research Chaiman: Clinical

Research

GJQ-+ALDL.

FRITZ A. FREYHAN,

in Depression

KLERMAN, M.D.,

pitalized Yak

University, New Haven, Conn. Despite impressive advances in research and therapy, our theories of clinical depression remain rooted in nineteenth century concepts derived from studies of psychotic and hos-

M.D.

patients.

Current

clinical

experience, however, is mainly with non-psychotic and non-institutionalized patients. Unresolved problems include: the role of life experience in depression, delineation of psychopathologic states from normal emntional reactions, classification and differentation of types of depression, the