It’s not easy being emperor

What claudius can teach us

Although Claudius’ symptoms cannot be diagnosed with certainty, the information and perspective available today offer insight into his likely psychiatric problems. His case reminds us that:

• Patients often have multiple diagnoses. Bipolar disorder is strongly associated with substance abuse disorder—particularly alcoholism.
  
• Lead-containing alcoholic beverages are still a public health concern. Morgan et al¹³ tested 115 samples of moonshine from nine southeastern, south central, and north central U.S. states. One-third of samples contained lead >300 μg/dL. The authors estimated that excessive consumption of 25% of the samples could lead to blood lead levels consistent with lead poisoning (≥25 μg/dL).
  

Lead poisoning is pernicious and still occurs in the United States. Persons who work with lead, live in an old house painted with a lead-based paint, or drink water transported in old pipes with lead solder are at high risk for lead exposure. Children are particularly vulnerable. Some herbal medications also contain lead.¹⁴

Related resources

• Schwartz BS, Stewart WF, Bolla KO, et al. Past adult lead exposure is associated with longitudinal decline in cognitive function. Neurology 2000;55:1144-50.
  
• Canfield RL, Henderson CR Jr, Cory-Slechta DA, et al. Intellectual impairment in children with blood lead concentrations below 10 microg per deciliter. N Engl J Med 2003;348:1517-26.
  
• Salloum IM, Thase ME. Impact of substance abuse on the course and treatment of bipolar disorder. Bipolar Disord 2000;2:269-80.
  
• Nriagu JO. Lead and lead poisoning in antiquity. New York: John Wiley and Sons; 1983.
  

Drug brand names

• Lithium • Eskalith, others
  
• Valproate • Depakene
  

Disclosure

Dr. Frankenburg reports no financial relationship with any company whose products are mentioned in this article, or with manufacturers of competing products.