No abstract

Erythrocyte membrane adenosine triphosphatase activities were examined in twelve unipolar depressed patients receiving ECT. Eleven patients undergoing diagnostic cystoscopy served as controls for the acute effects of anaesthesia, and sixteen healthy subjects served as non-depressed controls. The unipolar depressed patients had a slight reduction in their (Na+ + K+)-ATPase activity but effective ECT treatment was not associated with any increase in this activity. This approach is unlikely to cast further light on the membrane phenomenology of depressive illness.

SYNOPSISThe concentrations of total and free plasma tryptophan were measured in 12 unipolar depressed patients before and after a course of electroconvulsive therapy (ECT) and before and after single ECTs during the course of treatment. Eleven patients undergoing diagnostic cystoscopy served as controls to examine the acute effect of anaesthesia. Total and free plasma tryptophan concentrations in the depressed patients were not significantly different from control values and were not changed by the course of ECT. Free plasma tryptophan varied considerably within individual patients. Total plasma tryptophan was reduced acutely by ECT/anaesthesia in the depressed patients (P < 0·05) and by anaesthesia in the cystoscopy controls (P < 0·01). Free plasma tryptophan was not significantly altered. This reduction in total plasma tryptophan could be secondary to an effect of thiopentone on albumin binding of tryptophan.

Animal studies have suggested that the mechanism of the antidepressant action of ECT may be to increase monoaminergic post-synaptic receptor sensitivity. We have tested this hypothesis in 12 drug-free patients suffering from severe depression, 11 of whom had depressive delusions. The responses of growth hormone, prolactin and cortisol to 0.75 mg subcutaneous apomorphine were examined before and after a successful course of ECT. There were no significant differences between hormonal measurements on the two occasions, with the exception that basal plasma cortisol concentrations were significantly lower following ECT and recovery from depressive illness. These results do not support the hypothesis that ECT increases dopaminergic post-synaptic receptor sensitivity.

haemolysis (which may affect the rate). Serum is fibrinogen-free, and it is simple to measure the viscosity of plasma and serum separately. We investigated the value of paired plasma viscosity and serum viscosity measurements in predicting the development of chronic rheumatic disease in a population with acute symptoms attending a special early-arthritis clinic. Patients, methods, and resultsWe investigated 115 consecutive patients attending a clinic specifically for patients with early rheumatic complaints. All had had symptoms for less than three months, and in most cases it was impossible to make a diagnosis at the initial attendance. The group was reassessed at a minimum six-month follow-up and a diagnosis established. Plasma and serum viscosities were estimated at first attendance and then related to the subsequent diagnosis. Blood was collected into two tubes; one plain, the other containing EDTA. Both samples were spun simultaneously and the viscosity of the supernatants measured on a Harkness viscometer under standard conditions. Normal plasma viscosity is 1-52-1-72 mPa s (cP) and normal serum viscosity 1-40-1-60 mPa s (cP).Plasma viscosity was raised in 72 patients, 35 of whom subsequently developed chronic arthritis (table). The remaining 37 did not develop chronic arthritis but had varied diagnoses, including polymyalgia rheumatica, synovitis associated with infection, etc. Only 29 patients showed raised serum viscosity. Of these, 28 subsequently developed chronic arthritis. The remaining patient had an underlying carcinoma of the bronchus.Of those patients with chronic arthritis, eight had Reiter's disease and 29 classical or definite rheumatoid arthritis (ARA criteria), of whom five were seronegative. Fifteen patients (eight with an increased plasma viscosity) included in the group with transient synovitis could have been diagnosed as possible rheumatoid arthritis by ARA criteria at presentation, but at sixmonth follow-up were completely asymptomatic. The diagnosis of infectionassociation synovitis was based primarily on a strong clinical history and where possible supported by appropriate laboratory tests. On occasions, however, diagnosis was based on a strong history alone, and we suspect that many of the "transient synovitis" group would also have had precipitating infection.From the clinical standpoint, plasma viscosity was normal in two patients who subsequently developed chronic arthritis, and serum viscosity in eight. Serum viscosity is highly specific in predicting subsequent chronicity but has a higher false-negative rate.