Abstract

136:12,2. Gershon 5, Shaw to organophosphateFH: Psychiatric insecticides.sequelae of chronic Lancet 1:1371-1374, ROBERT I. PARY.exposure 1961 M.D.day untilthe astenxishalf-life was days. On thewas no longer present. The 36 hours. Astenxis persistedplasma Li terminal for 4 consecutiveArlington,Va.fourth and last day plasma Li was 0.73 mEq/liter and RBC Li was 1.03 mEq/liter RBC (ratio= 1.41). The next day theasterixis Li was was gone; plasma Li was 0.39 mEq/liter and RBC 0.66 mEq/liter (ratio= I .69). Although these last twoDr.the patient’ssteady-statera-SIR: Dr. Pary is quite correct in stating that therapeutic improvement does not equal diagnostic confirmation. This is true in all fields of medicine. An analogy would be the patient who has fever. chest pain, a productive cough, and radiographic findings compatible with an infiltrate. These findings are compatible with. but not diagnostic of, pneumonia; a response to antibiotics again would not establish a diagnosis of pneumonia, but an experienced clinician would certainly lean toward a diagnosis of pneumonia given the clinical facts at hand.one’sfeel-ings-if the psychiatrist has enough self-understanding to trust such feelings-may be very valuable in charting a presumptive treatment course. This treatment course with these particular patients did produce therapeutic progress. Certainly. that progress does not prove the