Craig Van Dyke

Intranasal Cocaine: Dose Relationships of Psychological Effects and Plasma Levels:

We compared the psychological effects of three doses of intranasal cocaine hydrochloride (.2, .75, and 1.5 mg/kg) with cocaine plasma concentrations in four volunteers. Intranasal lidocaine hydrochloride (.2 mg/kg) was used as a topically active placebo. Peak “high” ratings were related to both dose and peak plasma concentrations. At a given plasma concentration, “high” ratings were greater when plasma levels were increasing than when they were decreasing. This indicates that acute tolerance by tachyphylaxis occurred after single doses. The cocaine “high” was a pleasant feeling but was without distinctive sensations. The dramatic effects of intranasal cocaine on the street may be related to larger or repeated doses as well as the setting.

The auditory P50 response is normal in Alzheimer's disease when measured via a paired click paradigm ☆

Recent findings of missing or markedly attenuated P50 (or P1) auditory ERPs in Alzheimers disease (AD) patients suggest this may be a useful diagnostic and/or prognostic marker of AD cholinergic deficits. Those studies used repetitive 1/sec clicks. Given P50s long recovery time, all but the first click in that paradigm was presented during the recovery of the P50 generation system from the response to the prior click. We studied 8 AD patients and 17 elderly controls using a paradigm incorporating 7-8 sec intervals between clicks, which allows examination of P50 generation separate from P50 recovery. With the long inter-click interval, we identified P50 responses in most AD patients and controls, and found no difference in P50 amplitude between groups. These results suggest that if there is a P50 deficit in AD patients, it is the result of the accumulative effect of repetitive stimulation, rather than a primary deficit in P50 generation.

Psychological Reactions to Continuous Ambulatory Peritoneal Dialysis

The first twenty patients who entered our continuous ambulatory peritoneal dialysis (CAPD) program from March, 1979 to February, 1981 were interviewed to assess their psychological reactions to CAPD. Six patients were successfully maintained on CAPD for more than one year. CAPD provided patients with a greater sense of well-being, strength, and independence. This independence required adherence to a strict schedule of exchanges. Reactions to the loss of CAPD followed the pattern of a grief reaction. Those patients who were self-disciplined and comfortable assuming active control of their health care proved to be the best candidates for CAPD.

The Mental Health Education Gap among Primary Care Providers in Rural Nepal

ObjectiveIn low- and middle-income countries, the majority of individuals with mental illness go untreated largely because of a severe shortage of mental health professionals. Global initiatives to close the mental health treatment gap focus on primary care providers delivering this care. For this to be effective, primary care providers require the skills to assess, diagnose, and treat patients with mental illness.MethodsTo assess primary care providers’ training and experience in caring for mental health patients, the authors conducted five focus groups at three isolated district hospitals in rural Nepal where there was no access to mental health professionals.ResultsPrimary care providers reported limited training, lack of knowledge and skills, and discomfort in delivering mental health care.ConclusionTo address the mental health education gap, primary care providers in Nepal, and perhaps other low- and middle-income countries, require more training during both undergraduate and graduate medical education.

Legal and Ethical Changes in Consultation Psychiatry

To illustrate how legal and ethical issues have changed over the past decade for the psychiatric consultant, we thought it would be instructive to compare how consultations on equivalent patients were handled in 1980 and 1990.