Albert A. Kurland

LSD-assisted psychotherapy in patients with terminal cancer.

The paper describes the results of a clinical study exploring the potential of a complex psychotherapeutic program utilizing psychedelic compounds to alleviate the emotional and physical suffering of cancer patients. A total of 60 cancer patients participated in this experimental study. In 44 of these patients, LSD (200-500 p%per os) was administered as an adjunct to psychotherapy; in 19 patients, a new psychedelic compound, dipropyltryptamine (DPT) was administered (60-105 mg i.m.). Three of these patients received both LSD and DPT administered on different sessions. The therapeutic results were assessed by means of a rating scale reflecting the degree of the patients’ depression, psychological isolation, anxiety, difficulty in management, fear of death, and pain. The ratings were done by attending physicians, nurses, family members, LSD therapists and cotherapists, and independent raters. In addition, the amount of narcotics required in the management of the patient was measured before and after the psychedelic sessions. Systematic rating was carried out in a group of 31 cancer patients treated by LSD. The comparison of the means of individual ratings from pre- to posttreatment showed significant improvement in all the measured parameters for most of the raters. There was a definite reduction of the narcotic medication; it did not, however, reach the level of statistical significance. The pre- to post-treatment comparison of the global indexes used as gross indicators of the degree of emotional and physical distress, indicated that approximately 29 % of the patients showed dramatic improvement, and another 41.9 % moderate improvement, with 22.6 % essentially unchanged. In 6.4 % of the patients, global indexes showed a decrement in the posttherapy ratings.

MDA-assisted psychotherapy with neurotic outpatients: a pilot study.

Ten neurotic patients (five males and five females) were treated over a period of 2 to 6 months (mean, 4.1) as outpatients. The study allowed for a maximum of 75 hours of psychotherapy (mean, 51.55 hours). During the course of treatment, two to four (mean, 3.5) administrations of MDA (3,4-methylenedioxyamphetamine) were employed as adjunctive aids in an effort to enhance the psychotherapeutic process. The mean duration of the drug sessions was 8 hours (range, 6 to 14 hours). The first administration of MDA took place when, in the therapists judgment, sufficient rapport had been established with the patient. All patients received an initial dose of 75 mg of MDA; subsequent dosage was allowed to range up to 200 mg. On these occasions, the drug appeared to be well tolerated with no serious side effects or complications observed. Psychometric assessments were obtained pre- and post-treatment, employing the Minnesota Multiphasic Personality Inventory (MMPI), Wittenborn Psychiatric Rating Scales (WPRS), and Brief Psychiatric Rating Scale (BPRS). In addition, follow-up evaluations were obtained 6 months after the termination of therapy by the use of the MMPI, WPRS, BPRS, and a Social History Questionnaire (SHQ) which had also been administered before treatment was initiated. Clinically, the impression was obtained that psychotherapy and the adjunctive use of MDA appeared to facilitate improvement in these patients. This impression was substantiated by significant reductions in scores on the psychometric assessments measuring depression, anxiety, and obsessive-compulsive traits. The measures evaluating the sense of well-being and self-actualization also were encouraging. Although some of the patients were not as responsive as others, there were no observations to suggest that the condition of any of these patients had become worse.

Viloxazine and the Depressed Schizophrenic—Methodological Issues

Abstract: A pilot study of a small group of schizophrenic patients manifesting symptoms of a depressive nature was treated in a double‐blind study in which viloxazine or a placebo was administered in combination with either chlorpromazine or haloperidol. There appeared to be no difference between the viloxazine‐treated group and the placebo‐treated group, although the study raised some question as to the adequacies of the dosage utilized since there was an absence of any apparent side effects. In view of these issues concerning the clinical merit of the combination, this obviously requires further investigation.

The comparative effectiveness of eight phenothiazines

SummaryIn a double-blind study of the comparative effectiveness of eight phenothiazines, 322 newly-admitted state psychiatric hospital patients requiring tranquilizing drug therapy were randomly assigned to treatment with one of the following drugs: chlorpromazine, thioridazine, triflupromazine, prochlorperazine, perphenazine, thiopropazate, trifluoperazine, and fluphenazine. The design of the study permitted flexible dosages, and treatment, unless prematurely terminated, lasted 30 days. Psychological and/or psychiatric assessments were made prior to treatment and at the end of 5, 15, and 30 days.Although results again substantiated the effectiveness of the phenothiazine compounds as a whole, evidence of differential drug effectiveness was equivocal using raw scores derived from standard rating scales and traditional methods of statistical analysis. Such analyses suggested negligible treatment differences in terms of means. Non-constant, non-additive treatment effects were greatly in evidence, however; and the high incidence of heterogeneity of variance and of regression indicated that the drugs were neither equivalent nor interchangeable.Subsequent analyses of MSRPP Total Morbidity, involving the more severely ill patients and using a scale transformation to achieve homogeneity of variance, yielded significant treatment differences at every evaluation period. In these analyses, the drugs found to be consistently effective over the 30-day treatment period were prochlorperazine, perphenazine, and fluphenazine. Those found to be less effective were thioridazine, triflupromazine, and thiopropazate. For the less severely ill patients, significant mean differences among the eight drugs were not obtained; however, there was a tendency for the rank order of drug efficacy in this group to be the reverse of that obtained with the severely ill patients.

Naloxone and the Narcotic Abuser: A Controlled Study of Partial Blockade

Within the framework of an ongoing urine monitoring program, 119 paroled narcotic addicts were randomly assigned to either urine monitoring alone (concurrent control) or to double-blind treatment with either placebo or Naloxone at a partial blockade dosage level (200 to 800 mg daily). Outcome assessments at 6 and 9 months tended to favor “pill-takers” over concurrent controls. Although there were no significant differences between placebo and Naloxone in terms of retention rates and the maintenance of complete abstinence, there was considerably less narcotic drug use by Naloxone-treated subjects. Side effects were judged to be minimal and of little consequence. The importance of motivation on the part of the addict in the narcotic antagonist approach is stressed.

Intravenous nialamide in the treatment of depressed female patients

Summary Thirty-five white, depressed, female patients were randomly assigned to double-blind intravenous nialamide (500–750 mgs.) or placebo treatment administered in (or as) infusions of 1000 cc. of 5 per cent glucose in normal saline on four consecutive days. The 16 drug and 14 placebo patients completing treatment were evaluated in terms of global pathology and certain target symptoms of depression before and after treatment and at the end of a ten-day follow-up period during which most patients received oral nialamide. Contrary to previous clinical findings, no differential treatment effects were noted. Side effects were again found to be negligible.

A Comparative Study of Two Long Acting Phenothiazine Preparations, Fluphenazine-Enanthate and Fluphenazine-Decanoate

SummaryNineteen chronic, hospitalized, male schizophrenics requiring phenothiazine drug therapy were parenterally administered the long acting preparations, fluphenazine-enanthate and fluphenazine-decanoate, in a double-blind crossover fashion for two consecutive 12 week periods. On both of these fluphenazine preparations, all of the patients either maintained their original clinical state or improved. Little difference could be found between the two preparations in terms of the number of injections necessary or in the incidences of neurological complications observed.

The psychopathology and measurement of environmental stress.

Recent research on environmental stress is reviewed with emphasis on human subjects and on psychopathology. Theoretical and methodological issues are considered with reference to the need for increased attention to stress in clinical research. A new brief interview procedure for measuring recent and current environmental stress is described. It has been used with recently released mental hospital patients and qualified informants in a longitudinal follow-up study. Despite the provisional status of the stress inquiry, it yielded promising early results in discriminating between patients who were later rehospitalized and those who continued living in the community.

The Therapeutic Efficacy of Hemodialysis in Schizophrenia

Prompted by previous reports of substantial clinical improvement in most schizophrenic patients given hemodialysis for their psychiatric condition, we studied the efficacy of hemodialysis in 15 schizophrenic outpatients, under double-blind, controlled conditions. The patients were randomly assigned to either a real-sham or sham-real sequence of dialysis treatment. Results of repeated measurement and other analyses of data on symptoms and behavior that were collected before study treatment, at crossover, and at the end of treatment revealed no difference between the effects of real and sham dialysis. These results provide important experimental evidence of the lack of therapeutic efficacy of hemodialysis in schizophrenia.

Naloxone and the Narcotic Abuser: A Low-Dose Maintenance Program

Naloxone (n-allyl-noroxymorphone), a narcotic antagonist, was administered orally, once daily, in a dosage of 200-800 mg to parolees with a history of narcotic abuse in an aftercare facility abstinence program. Among these, 23 displaying evidence of increasing decompensation into episodic opiate usage were transferred to the naloxone program (the transfer group). Another group of 52 was admitted directly to the naloxone program immediately following their release from a correctional institution (the direct admissions group). In the transfer group there were 8 (34.7%) who remained in the program for a period of six months following their transfer and 1 (4.7%) who remained in the program for a period of 12 months. In the direct admissions group there were 31 (59.6%) who remained for six months and 7 (13.4%) who remained for a period of 12 months. The various courses pursued by these subjects and their implications are discussed.