Large oral doses of l-tryptophan yielded negligible antidepressant effects in unipolar depressed patients, but partial antidepressant and antimanic effects in some patients with bipolar affective disorder. Marked changes in cerebro-spinal fluid, platelet and urinary levels of serotonin and 5-hydroxyindoleacetic acid in these patients during l-tryptophan administration suggest that the low response rate of severely depressed patients is probably not attributable to impaired l-tryptophan metabolism during depression.

Of 35 patients with systemic lupus erythematosus (SLE) studied for up to 18 months, 6 had acute neurologic disease and 3 had acute psychiatric syndromes attributed to SLE during which the mean hemolytic titer of the fourth component of complement in the cerebrospinal fluid (CSF C4) did not differ significantly from the mean of 50 titers in control SLE patients. However, in 4 patients serial determinations disclosed a depression of titer at the time of acute central nervous system involvement ( P < 0.01). Hemolytic C4 was unstable in CSF stored at -45°C. Two decay patterns were noted in SLE patients; titers fell more rapidly in patients with more active lupus ( P < 0.001). The findings support the postulate that immune injury underlies the neurologic manifestations of SLE.

A consecutive series of 17 patients with systemic lupus erythematosus were evaluated psychiatrically. Specific criteria were used for diagnosis. In addition to a systematic retrospective analysis of the past psychiatric complications in these patients, they were also followed personally during the duration of their index admission. Follow-up evaluations were done in some patients. Serious psychiatric syndromes were observed in 41% of the patients. Of 11 episodes observed, a mixed syndrome (characterized by a combination of organic symptoms and either affective or schizophreniform symptoms) was the most common type of psychopathology and occurred in 45% of the episodes. Pure affective syndromes, pure organic brain syndromes, and pure schizophreniform syndromes occurred in 36, 9, and 9% of episodes, respectively. Psychiatric treatment was most frequently required for the mixed syndromes.

A consecutive series of 17 patients with SLE were studied psychiatrically in a prospective manner with semistructured interview techniques and mental status observation. Patients with and without psychiatric syndromes complicating their SLE were compared as to neurological observations, laboratory test findings, and corticosteroid administration.