Andrew W. Brotman

Self-reports of childhood abuse in chronically psychotic patients

A heterogeneous sample of 61 chronically psychotic patients were subgrouped according to the presence or absence of a self-reported history of childhood abuse. Patients reporting childhood abuse (n = 27) had an earlier age of onset, scored higher on the Dissociative Experiences Scale, reported more amnesia, and relapsed more frequently than patients not reporting abuse histories. Histories of childhood abuse and of past stimulant abuse predicted the score on the Dissociative Experiences Scale. A history of childhood abuse may thus contribute to the symptomatology and course of illness in some chronically psychotic patients.

An open trial of buspirone added to neuroleptics in schizophrenic patients.

Twenty chronic schizophrenic patients completed at least 2 weeks of a 6-week trial of buspirone (mean dose 23.8 mg/day) added to a stable dose of neuroleptic. At week 6, mean scores were significantly improved (p less than 0.01) on the Brief Psychiatric Rating Scale, the Simpson Angus Scale for Extrapyramidal Symptoms and the Global Assessment Scale. Overall measures of akathisia and tardive dyskinesia were not significantly changed at week 6. In the 7 patients taking oral haloperidol, mean plasma concentrations of haloperidol were significantly increased (p less than 0.05) by 26% 6 weeks after adding buspirone.

A clinical guide to antipsychotic drugs.

SummaryAntipsychotic medications have altered the treatment of psychosis. The effect of typical agents is presumed to be associated with dopamine D2-receptor blockade. Response to these drugs can be evaluated by measuring target symptoms. Behavioural symptoms are generally first to respond, followed by affective symptoms, and then symptoms of disturbed cognition and perception. Predictors of response include age of onset, premorbid function, family history, cognitive function, ventricle size, and levels of homovanillic acid. As all conventional antipsychotic medications of comparable dose are generally of equivalent efficacy (with the exception of clozapine), choice is based on past response and the patient’s tolerance of adverse effects.When antipsychotic agents are administered in the short term to control agitated dangerous behaviour, they can be given intramuscularly and augmented with benzodiazepines. For the ongoing treatment of psychosis, haloperidol 5 mg/day, or its equivalent, is usually sufficient.Continuation of treatment after an acute episode may be decided on the basis of chronicity of the psychotic illness. Relapse rates are higher when patients do not continue to receive medication. Lower maintenance doses may result in higher relapse rates but fewer adverse effects. Long-acting intramuscular depot preparations may be used to aid compliance in long term therapy.Adverse reactions correlate with potency. High potency drugs (i.e. those with greater D2 postsynaptic receptor affinity) are generally associated with extrapyramidal symptoms, including acute dystonic reactions, akathisia, tardive dyskinesia and Parkinsonism. Neuroleptic malignant syndrome is associated with all neuroleptic drugs. Low potency agents may cause orthostatic hypotension, sedation and anticholinergic effects.Clozapine has been shown to be effective in 30 to 40% of patients resistant to previous treatment. It does not cause extrapyramidal symptoms, but does have side effects similar to those of low potency agents and may cause agranulocytosis; it is therefore reserved for those patients who have not responded to therapy with 2 other agents. Several other atypical drugs are currently being investigated.

Emotional reactions of house officers to patients with anorexia nervosa, diabetes, and obesity

The authors present the results of a preliminary study measuring dysphoria in house officers toward patients with anorexia nervosa, diabetes, and obesity. Case vignettes are presented to demonstrate how negative affects in clinicians can interfere with the delivery of goal clinical care. Patients with anorexia nervosa tended to generate more anger, stress, and helplessness in house officers than other groups of patients did. Hypotheses are presented to explain those findings and questions are posed to stimulate future research.

MEDICATIONS IN THE TREATMENT OF EATING DISORDERS

Effective planning for medication treatment in patients with bulimia nervosa and anorexia nervosa is based on a comprehensive clinical assessment, including a careful review of comorbid psychiatric disorders and response to treatments for previous episodes of the disorder. Although most patients with bulimia nervosa are offered a trial of psychotherapy, significant results of controlled trials have contributed to an increased role for medications in the treatment of patients with this disorder. Pharmacologic treatment of anorexia nervosa has similarities to that of treatment-resistant depression, with the clinician turning to open trials and clinical reports for clues to rational management. As described in this article, considerations of potential side effects and medical complications are likely to play an important role in guiding the choice of medication used for treatment of patients with eating disorders.

Medical complications of eating disorders: Outpatient evaluation and management

Abstract Anorexia nervosa and bulimia are psychiatric disorders that often lead to serious medical complications. The authors review the medical complications of anorexia nervosa by organ system and of bulimia by purging behavior. Guidelines are offered for medical hospitalization and for an outpatient treatment plan coordinated by the internist and psychiatrist.

The delusion of possession in chronically psychotic patients

Sixty-one chronically psychotic outpatients were grouped according to the presence or absence of a history of delusional possession. Compared with patients without a history of delusional possession (N = 36), possessed patients (N = 25) had significantly more self-reported childhood sexual abuse, higher dissociation scores, more cannibis abuse, more experiences of thought control, and more voices heard inside their heads. These findings support the hypothesis that in some psychotic patients, possession beliefs may reflect childhood trauma and dissociation.

Cocaine abuse and treatment

Abstract In this article we review the neuropharmacology, clinical symptomatology, and consequences of cocaine abuse and discuss management and treatment approaches to the cocaine abuser.

Effects of lithium on the kidney

ABSTRACT— We tested kidney function in 268 patients given lithium treatment for an average period of 37.6 months and in 59 manic‐depressive patients never given lithium. No patients suffered serious renal damage during the course of our observations. Maximum concentration capacity was lower and serum creatinine concentration higher in the lithium treated patients than in the controls, but the differences did not achieve statistical significance. Females had poorer concentrating ability than males, both among the control subjects and during lithium treatment. Concomitant antipsychotic drug therapy may affect concentrating ability and possibly glomerular function adversely.

Pharmacologic Approaches in the Treatment of Eating Disorders

&NA; Important advances in the treatment of eating disorders, particularly bulimia nervosa, have been made during the past decade. Controlled trials for bulimia nervosa have demonstrated significant benefit from short‐term pharmacotherapy with antidepressant medications and from short‐term individual and group psychotherapies. Despite these advances, treatment of a patient often involves complex clinical decisions around such issues as choice of initial treatment modality, incomplete resolution of symptoms, and the role of long‐term maintenance treatment. To address these questions, this review focuses primarily on summarizing results of published controlled trials of pharmacotherapy in patients with bulimia nervosa. In addition, it outlines the more limited literature on controlled pharmacotherapy trials for anorexia nervosa and for the provisionally identified syndrome of binge eating disorder.