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Fifty-three psychiatric patients who had been receiving treatment with lithium continuously for more than two years were examined to estimate the prevalence of lithium-induced hypothyroidism. It was found to be 20 per cent among women. No men were affected among these patients. In order to study the characteristics of the disorder further cases were drawn from another population. One third of the patients developed hypothyroidism during their first year of treatment, others not until after 9 years. About two thirds of the female patients with hypothyroidism had thyroid antibodies. All cases with lithium-induced hypothyroidism showed elevated levels of serum thyrotropin, which in our experience is the laboratory examination of choice in these as well as other cases of "primary" hypothyroidism. Since the probability of detecting these cases at a given control visit was found to be low, we feel that such visits need not include extensive laboratory investigations. Hypothyroid patients responding well to lithium treatment should continue their medication combined with appropriate thyroxine substitution.

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SummarySix chronic schizophrenics with stationary symptomatology and treated since more than one year with thioridazine in a fixed dose schedule were examined by means of two different rating scales. The thioridazine dosage was then considerably reduced, leading to reappearance of schizophrenic symptoms. The tyrosine hydroxylase inhibitor, a-methyltyrosine (2 g daily) was then given as additional treatment, and the thioridazine dosage necessary to reattain the we-trial level of symptomatology was titrated. This dosage, as well as the simultaneous thioridazine plasma levels, were found to be considerably reduced by a-methyltyrosine. The efficacy of this agent as an inhibitor of tyrosine hydroxylase was ascertained by demonstrating a marked reduction in cerebrospinal fluid homovaniltic acid.The observations confirm our earlier data and lend additional support for the hypothesis that central catecholamine neurotransmission is involved in the antipsychotic action of neuroleptic agents.

We report three patients with psoriasis and bipolar affective illness who showed marked deterioration of their skin condition when treated with lithium.