SUMMARY
A total of 519 consecutive patients, admitted to psychiatric wards of two different hospitals, were screened for evidence of increased excretion of porphobilinogen in the urine by original Watson Schwartz test and modified Watson Schwartz test supported with quantitative estimation of porphobilinogen by Remington's method in search of cases of acute porphyria amongst psychiatric patients. An additional 273 normal healthy volunteers were also screened as controls. Two cases (0.38%) were found which could be unequivocally diagnosed to be suffering from acute intermittent porphyria amongst psychiatric patients. These cases belonged to the category of missed diagnosis being labelled as hysterical. Seven more cases were positive by modified Watson Schwartz test but the test was only transiently positive and the Ehrlichaldehyde reactor substance was unstable. In the absence of detailed enzymatic and family studies, these cases have been kept under the category of suspected prophyria. A significant number of psychiatric patients (12.9%) gave positive original Watson-Schwartz test but were negative for modified test. Similar reaction was seen in 2.6% of healthy controls. The significance of this finding needs to be evaluated.
Full Text
The Full Text of this article is available as a PDF (191.0 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- CASHMAN M. D. Psychiatric aspects of acute porphyria. Lancet. 1961 Jan 14;1(7168):115–116. doi: 10.1016/s0140-6736(61)92169-9. [DOI] [PubMed] [Google Scholar]
- Carney M. W. Hepatic porphyria with mental symptoms. Four missed cases. Lancet. 1972 Jul 15;2(7768):100–101. doi: 10.1016/s0140-6736(72)91594-2. [DOI] [PubMed] [Google Scholar]
- MARKOVITZ M. Acute intermittent porphyria: a report of five cases and a review of the literature. Ann Intern Med. 1954 Dec;41(6):1170–1188. doi: 10.7326/0003-4819-41-6-1170. [DOI] [PubMed] [Google Scholar]
- Macalpine I., Hunter R. The "insanity" of King George 3d: a classic case of porphyria. Br Med J. 1966 Jan 8;1(5479):65–71. doi: 10.1136/bmj.1.5479.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McEwen J., Paterson C. Drugs and false-positive screening tests for porphyria. Br Med J. 1972 Feb 12;1(5797):421–421. doi: 10.1136/bmj.1.5797.421. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McEwin R., Lawn J., Jonas C. T. A survey of porphyria among psychiatric patients. Med J Aust. 1972 Aug 5;2(6):303–306. doi: 10.5694/j.1326-5377.1972.tb47304.x. [DOI] [PubMed] [Google Scholar]
- Stein J. A., Tschudy D. P. Acute intermittent porphyria. A clinical and biochemical study of 46 patients. Medicine (Baltimore) 1970 Jan;49(1):1–16. [PubMed] [Google Scholar]
- WALDENSTROM J. The porphyrias as inborn errors of metabolism. Am J Med. 1957 May;22(5):758–773. doi: 10.1016/0002-9343(57)90126-2. [DOI] [PubMed] [Google Scholar]
- WATSON C. J., BOSSENMAIER I., CARDINAL R. Acute intermittent porphyria. Urinary porphobilinogen and other Ehrlich reactors in diagnosis. JAMA. 1961 Mar 25;175:1087–1091. doi: 10.1001/jama.1961.63040120001010. [DOI] [PubMed] [Google Scholar]
- WATSON C. J., TADDEINI L., BOSSENMAIER I. PRESENT STATUS OF THE EHRLICH ALDEHYDE REACTION FOR URINARY PORPHOBILINOGEN. JAMA. 1964 Nov 9;190:501–504. doi: 10.1001/jama.1964.03070190021004. [DOI] [PubMed] [Google Scholar]