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Antidepressants reportedly increase appetite, carbohydrate craving and weight in some patients with depression and panic disorder. This paper presents the results of changes in appetite and weight in patients with panic disorder treated with imipramine, diazepam or placebo in a double-blind prospective study. Forty-four patients with panic disorder were randomly assigned imipramine, diazepam and placebo. The investigators monitored weight and the patients rated their appetite and cravings during the eight week study. No significant increases in weight or appetite were found in the patients with panic disorder patients.

A 37 year old patient with chronic schizophrenia developed polydipsia and hyponatremia induced by several neuroleptics. We treated the patient successfully with molindone. The etiology of polydipsia with hyponatremia is discussed.

Studies on dexamethasone suppression test (DST) and schizophrenia are reviewed and the incidence of nonsuppression in the group of studies on schizophrenic patients is compared to that in the group of studies on normal controls from a previous review article. The incidence of nonsuppression in schizophrenic patients (26.4%) is significantly higher than that in normal controls (5.0%). There may be a subgroup of schizophrenic patients with an increase in cholinergic functioning. The variance of the nonsuppression rates of DST were also significantly higher in patients with schizophrenia compared to normal controls. This may be due to a heterogeneity of mechanisms that is responsible for the DST non-suppression due to the heterogeneous nature of the diagnosis of schizophrenia. The possible mechanisms of abnormal and varied DST results in schizophrenia are discussed.

The symptom of carbohydrate craving and increased appetite (CHH) was studied in 180 outpatients receiving antidepressant treatment. One hundred and fifty-eight of these patients had a DSM-III diagnosis of panic disorder and 17, major depression. The incidence of CHH was similar in both diagnostic groups. Thus, antidepressant treatment is associated with CHH in patients with diagnoses, other than depression. Desipramine was least likely to induce CHH compared to imipramine, amitriptyline and doxepin. Most patients who developed CHH on imipramine no longer experienced this side effect when switched to desipramine. CHH was not more frequent among women and not associated with antidepressant dosage or treatment response. Histamine H-1 receptor blockade may be an important factor in the etiology of CHH.

This article reports the case of a 41 year old female with a history of acute intermittent porphyria who presented with exacerbation of a chronic psychotic illness. Though the evaluative studies for an acute porphyric episode were negative, psychological testing was consistent with an organic patchy cognitive decline. This finding is discussed in relation to the reported assymetric neuropathic lesions reported in porphyria.

The authors thought it would be of interest to present this case which proved to be Klinefelter's syndrome with "xxy" pattern, as the patient presented with episodes of abnormal behaviour lasting for a few minutes. Ho would suddenly become anxious, look perplexed, start clenching his fists and at times complain of thoughts tha some persons were trying to attack him. He also felt as if he were hearing voices talking to him. Observation in the hospital and EEG recording helped to rule out temporal lobe epilepsy and a diagnosis of Klinefelter's syndrome with personality disorder and psychogenic attacks of abnormal behaviour was made at the time of discharge.

A history of thyroid dysfunction has been reported in patients with phobic disorders. There is also evidence of a blunted TSH response to TRH stimulation in patients with panic disorder. In this study, values of T3, T4 and T7 were compared between 26 patients with panic attacks and 20 normal controls. Patients were diagnosed according to DSM-III criteria and those with a clinical history of thyroid dysfunction were excluded. Patients were not on any medication when the blood samples were drawn. The mean values of T3, T4 and T7 did not significantly differ between the two groups, suggesting no evidence of hypo or hyperthyroidism; however, the variance of distribution of T3, T4 and T7 values was significantly different between the two groups (Fmax values for T3: 2.55, p value less than 0.05; T4: 3.15, p value less than 0.01; T7: 2.55, p value less than 0.05).

Withdrawal from long-term treatment with benzodiazepines was followed in three patients by a severe delusional depression. The delusional depression may be related to the neurotransmitter changes accompanying benzodiazepine withdrawal. Caution should be exercised in long-term use of benzodiazepines in susceptible individuals.