Anthony J. Bouckoms

Treatment of psychiatric illness by stereotactic cingulotomy

The treatment of 198 psychiatrically disabled patients with stereotactic cingulotomy was evaluated prospectively for a mean follow-up of 8.6 years. Patients with major affective disorders and anxiety disorders fared the best, with a return to normal functioning in the majority. Patients with obsessive-compulsive disorders, schizophrenia, and personality disorders improved less predictably, with an uneven improvement in functioning that required active ongoing psychiatric treatment. Low mortality and morbidity, a reduction of violent behavior, a possible reduction of suicidal risk, and a lessening of the intractable suffering of chronic psychiatric illness all indicate that cingulotomy can be an effective, safe treatment for patients with affective disorders that are unresponsive to all other forms of therapy.

Clonazepam in the treatment of neuralgic pain syndrome

Abstract Allodynia is pain elicited by a non-noxious stimulus to apparently normal tissue. It is often present in neuralgic pain syndromes associated with deafferentation of sensory input. Allodynia was initially present in six patients with pain responding to clonazepam treatment. Five of six pain patients with no response to clonazepam did not have allodynia at the initial evaluation. The clinical diagnosis of allodynia in deafferentation neuralgias may be a relatively specific predictor of pain relief with clonazepam.

A prospective multicenter study of competency evaluations by psychiatric consultation services

Psychiatric consultation for assessment of competency is common but infrequently studied. Past studies have used chart reviews. The authors prospectively studied 88 consecutive psychiatric consultations at 3 centers. Competency evaluation was performed to determine whether the patient could 1) sign out of the hospital against medical advice (AMA) (N = 16); 2) give informed consent (N = 16); 3) take care of him-/herself (N = 33); 4) refuse medical care (N = 24); or 5) deal with other matters (N = 12). Patients with a favorable risk-benefit ratio were more likely to be seen in consultation compared with those with an unfavorable ratio. Patients in whom there was concordance in the assessment of the psychiatric consultant and the referring physician (N = 61) were more likely to be male, single, to have psychotropics recommended, to sign out AMA, and to be discharged from the hospital. Patients in whom there was disagreement between the consultee and the consultant merits further study.

Recent developments in the classification of pain

Abstract Current physical, psychiatric, and descriptive classifications of pain lack applicability to most chronic pain patients. The International Association for the Study of Pain (IASP) system of five axes combined with their pain definitions is recommended as a nontheoretical and comprehensive scheme for classifying pain patients. A better pain classification has practical implications in that somatic and deafferentation pain differ in their response to treatment.

Generating and Controlling Multiparameter Data Bases for Biochemical Correlates of Disorders

Perhaps the most powerful potential use of multiparameter biochemical data bases in studies of degenerative disorders is the unique discrimination of categories. The technology of Coulometric Array Electrode Systems (CEAS) can automatically resolve approximately 400 compounds from biological samples at the picogram level. Among these are tyrosine and tryptophan derived neurotransmitters, precursors, metabolites, conjugates and cofactors, certain purines, pterins and neuropeptides. This capability offers the promise of generating enough relevant data to describe disorders.

The Validity of Psychiatric Diagnosis

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