Mineral metabolism in mania.

Abstract

In a previous paper (Coppen and Shaw, 1963) we showed that depressive illness is associated with a considerable increase in residual sodium (intracellular and a small amount of bone sodium), which returns to normal after recovery. We have now extended these investigations to patients suffering from mania. This paper reports our findings in this condition and also in some of these patients who had recovered from their illness or who had swung from mania into depression. We have also compared these findings with our previous results in depression.Methods Twenty-two patients suffering from mania who were admitted to Graylingwell Hospital during a 12-month period were selected for this investigation on the basis of the diagnosis of mania which was made by the consultant psychiatrist in charge of the case and was confirmed by another consultant psychiatrist. Details of age and sex of the patients are shown in Table I. Those patients who were suffering from physical illness, or were over the age of 75, or had taken lithium during the six weeks prior to admission were excluded from the study. One woman who developed diarrhoea and vomiting during the initial illness tests has been rejected from the series. All patients ate a normal ward diet and were up and about the ward and hospital for at least three whole days prior to the initial biochemical test.The biochemical tests were carried out on the first Friday after admission and were repeated four weeks later if the patient was still in hospital. Height was measured on admission and the weight was recorded on the morning of the tests. Clinical assessments were made at the same time as the biochemical tests, but the results were analysed in different centres and were not compared until the investigations on all patients had been completed.Two methods of assessment were employed on the first and fifth Tuesday and Friday after admission. One of us (R. C.) assessed each patient for mood, activity, and talk by means of a nine-point scale for each factor. The second method was to give part of the Hildreth feeling and attitude scales (Hildreth, 1946). As the two feeling scales are the most effective in discriminating between normal and affectively disturbed patients (Fisher, 1949 ;Campbell, 1957 ; Shapiro, Campbell, Harris, and D)ewsbery, 1958), we used these in the assessment of mood. Each scale consists of 10 statements: the patient was asked to tick the phrases which described his feelings most closely at that particular time. The statements in the feeling scales contain ones which would be chosen by depressed, normal, and elated subjects. Each choice has an empirically determined weight ranging from 0.1 to 9.6.In feeling scale 1 we found that one of the higher-scoring "manic " responses-" swell "-was not used at all by the patients, probably because it was an Americanism avoided by even the most exuberant patient. This disturbed the balance of the scale, so the results were analysed on feeling scale 2 alone. Patients scoring between approximately plus or minus one stand...

Plasma and Erythrocyte Cations in Affective Illness

“…They found that there was no overall change in Na balance, but that residual Na (comprised of intracellular Na and exchangeable bone Na) was elevated by 50% in depressed subjects, and that it returned to normal levels upon remission of the illness. They also found an increase in residual Na of about 200% above normal levels in manic pa tients (Coppen et al, 1966). Naylor et al (1970) reported a series of studies of erythrocyte Na concentration in a mixed group of depressed patients.…”

Sodium and Depression: Hypothetical Associations

“…The rise of the residual sodium in depressive patients is illustrated by the ratio of sodium in the extracellular water to residual sodium (14). Decreased excretion of sodium in individuals during periods of depression has also been reported (13).…”

“…The effects of lithium treatment on the distribution of electrolytes suggests that changes of sodium may be of great importance in the etiology of affective disorders. Lithium carbonate alters sodium transport and distribution (14).…”

Vanadium in psychiatry

“…How the increase in 'residual sodium' is associated with manic-depressive illness has previously been discussed by Coppen et al (1966). In order to prove that raised vanadium levels inhibit Na'/ K'-ATPase resulting in manic-depressive illness two further pieces of evidence are required: ( I ) R a i s e d v a n a d i u m levels c a n i n h i b i t (2) Reduced Na'/Ka'-ATPase activity can lead to…”