Effect of Chlorpromazine on the Behaviour of Chronically Overactive Psychotic Patients

MEDICAL JOURNAL sodium-retainer to correct quickly any serious depletion of this ion.*If there is excessive water retention cortisone will correct this by allowing the selective excretion of water in excess of sodium (Garrod and Wynn, 1954).Since coma occurs in patients with hypopituitarism who are already receiving thyroid extract and testosterone, it is doubtful whether these hormones are of much value in the acute management of this condition.However, if there is obvious myxoedema, L-thyroxine or thyroid extract should be given as well as cortisone and D.C.A., with full aware- ness that their metabolic effects will be delayed. SumnaryDisturbances of consciousness which varied from hypersomnia, mild confusion, and impaired cerebration to stupor and profound coma were encountered in 17 patients with hypopituitarism.There were many factors which precipitated coma, and these included cerebral surgery, pituitary apoplexy, infections, hypoglycaemia, drugs and anaesthetics, elec- trolyte disturbances, water intoxication, and cerebral anoxia.Except in some of the post-operative cases, severe endocrine failure, especially of the adrenal cortex, seemed to be an essential factor in lowering the threshold of consciousness.Cortisone was more effective than thyroxine or testosterone in the prevention and correc- tion of coma.In obscure cases of coma the possibility of hypo- pituitarism should always be considered.The diagnosis, prevention, and treatment of " hypopituitary coma " are discussed in the light of further experience.We are grateful to many physicians in New Zealand and the United Kingdom who have given us access to their cases; to Mr. Anthony James, neurosurgeon of the Dunedin Hospital; and to Dr. C. L. Cope and Dr. T. Russell Fraser, under whose care some of these patients