INDIAN JOURNAL OF PSYCHIATRY. 2003. 45(1). ... psychiatric illness: a comparison of schizophrenic. (66) ... Institute of Mental Health and Neurosciences.
I N D I A N JOURNAL OF PSYCHIATRY. 2003. 45(1). 66-67
and neurotic families. British Journal of Psychiatry,
Letter to Editor
129. 125-137. Vaughn C . E , Snyder K.S, Jones S, F r e e m a n W.B, Flloon
IRH (1984)
Family factors in
schizophrenic relapse: replication in California of the
British
research
on
expressed
emotion.
Archives of General Psychiatry, 41, 1169-1177.
SUBSYNDROMAL SYMPTOMS IN BIPOLAR DISORDER : ROLE OF LITHIUM Sir, In a cross sectional study on a purposive sample, Kumar et al.(2001) assessed the r e l a t i o n s h i p between psychosocial variables, subsyndromal affective psychopathologv, and psychosocial functioning in 68 bipolar patients stabilized on prophylactic lithium. They found that higher daily hassles and life events scores were associated with higher depression ratings, while lower perceived social support scores were associated with higher general psvchopathology ratings. T h e psychosocial measures, however, explained only 7-23"'.i of the variance in psychopathology and global functioning. In an earlier series of randomized, controlled, prospective studies on bipolar 1 patients, Gelenberg and his co-workers (C.elenberg et al., 1989; Keller et al.,1992; Solomon et al., 1996) showed that the risk of relapse, occurrence of subsyndromal symptoms, and impairments in psychosocial and occupational functioning were alike associated with lower (razcpam has potent anxiolytic and sedating properties; and, from a pharmacological point of view, lorazepam may be especially suitable for several reasons:l. It has a mach shorter half-life than cither chlordiazepoxide or diazepam; for this reason, and because it has no active metabolites (Psychotropic Drug Guidelines Sabcommittee, 1995), it is a safer agent in the presence of liver or renal disease. Thus, in alcoholic patients, it reduces the risk of hepatic eacephalopathy.2. In contrast with diazepam, lorazepam minimally depresses respiration and circulation (Leppik et aL 1983) .3. In comparison with diazepam, it is distributed in tissues less rapidly and less extensively; therefore, therapeutic levels remain high, and its ability to
(67)
drug slowly lest the patient untoward
withdrawal
experience
phenomena.
REFERENCES Andrade C (2003) Psychopharmacology In: Bhugra D (ed) : Handbook of Psychiatry. New Delhi: Oxford University Press (Ln press). D'Onofrio G, Rathlev NK. Ulrich AS, Fish SS, Freedland ES (1999). Lorazepam for the prevention of recurrent siezures related to alcohol. New England Journal of Medicine, 340, 915-919. Leppik IE, Derivan AT, Homan RW, Walker J, Ramsay RE, Patrick B (1983) . Doubleblind study of lorazepam and dLazapam in status epilepticus. Journal of the American Medical Association, 219, 1452—1454. Psychotropic Drug Guidelines Subcommittee. Psychotropic Drug Guidelines. Victoria: Victorian Drug Usage Advisory Committee, 1995. Treiman DM (L.990). The role of benzodiazepines in the management of status epilepticus. Neurology, 40 (suppi 2), 32-42. •CHITTARANJAN ANDRADE. Department of Psychopharmacology National Institute of Mental Health and Neurosciences Hangalore 560 029, India.
