David Raft

Effects of intravenous tetrahydrocannabinol on experimental and surgical pain; Psychological correlates of the analgesic response

Two intravenous doses of tetrahydrocannabinol (THC) (0.022 mg/kg and 0.044 mg/kg) were compared to intravenous diazepam (0.157 mg/kg) and to placebo (Ringers lactate) as premedication for dental extraction in 10 healthy volunteers. Pain detection and tolerance thresholds were measured and psychiatric interviews were supplemented by Minnesota Multiphasic Personality Inventories (MMPI), the Zung Depression Scale (ZDS), Beck Depression Inventories (BDI), and the State‐Trait Anxiety Inventory (STAI). Pain detection thresholds were altered unpredictably with high THC doses, but analgesia as indicated by pain tolerance was less than that after diazepam and placebo. In three subjects low‐dose THC (0.022 mg/kg) was a better analgesic than placebo but not diazepam. Six subjects preferred placebo to low‐dose THC as an analgesic; this group experienced increases in subjective surgical pain and were submissive, rigid, and less introspective with high State Anxiety and MMPI profiles that differed from subjects whose pain was not increased. STAI following THC presaged a poor analgesic response in this group.

Longitudinal study of neuropsychological functioning in patients on chronic hemodialysis: A preliminary report ☆

This study is part of a five-year project to investigate the long term effect of chronic hemodialysis on patients with end-stage renal failure. Previous research has associated hemodialysis with progressive dialysis encephalopathy (PDE), which is characterized by speech disturbances, cognitive impairment, myoclonus and behavioral changes. Little is known about the cause or the course of this syndrome except that it begins 14-36 months after treatment onset and usually culminates in death. The purpose of this study was to investigate neuropsychological (cognitive and behavioral) functioning in dialysis patients over a period of years. To date, 34 patients have been studied for 22 months utilizing a cross-sectional method comparing patients at different stages of treatment combined with a longitudinal method of repeated evaluations over time. Current findings show improved cognitive functioning during at least the first year of treatment and no evidence of cognitive deterioration in patients on dialysis for more than one year (M = 4.3). These findings offer strong evidence that PDE is not necessarily a general phenomenon among patients on chronic hemodialysis.

The detection of depression by patient self-report in women with gynecologic cancer

We examined the utility of patient self-report forms in identifying those gynecologic oncology patients who would be diagnosed by an experienced consultation-liaison psychiatrist as suffering from major depression. Sixty-five women with gynecologic tumors were evaluated by a consultation-liaison psychiatrist, using standardized (DSM-III) criteria. Each patient also completed a Carroll Rating Scale for Depression (CRS). The CRS demonstrated sensitivity and specificity of 87 percent and 58 percent, respectively. Used as a screening instrument to rule out depression, the CRS yielded a negative predictive value of 94 percent. We identified a priori forty items from the CRS which should not be influenced by the non-psychiatric biologic effects of gynecologic tumors, and compared the performance of this non-cancer related symptoms subscale (NCSG) to that of the CRS. The NCSG did not significantly outperform the CRS; its sensitivity and specificity were 87 percent and 62 percent, respectively. Because our study population was relatively homogeneous (i.e., non-ovarian gynecologic oncology patients without severe debilitation who were not receiving chemotherapy, radiation therapy, or other invasive procedures), the findings should not be generalized to other oncologic populations at this time. Our results suggest that patient self-report forms can be effective screening devices for identifying those non-ovarian, gynecologic oncology patients who should then be carefully evaluated for coexisting clinical depression.

Life adaptation after percutaneous transluminal coronary angioplasty and coronary artery bypass grafting

Life adaptation of 32 patients who had undergone percutaneous transluminal coronary angioplasty (PTCA) for coronary stenosis was compared with that of 15 patients who had coronary artery bypass grafting (CABG). Patients were matched for psychosocial, anatomic and cardiac functions. Life adaptation was measured at 6 and 15 months after PTCA or CABG by the Psychosocial Adjustment to Illness Scale (PAIS), a multidimensional instrument that evaluates change in 7 primary life domains. The overall PAIS scores for patients who had undergone PTCA were significantly better (p less than 0.04) than the scores for those who had undergone CABG after 6 months, and this superior functioning continued after 15 months (p less than 0.05). After 6 months patients who had undergone PTCA functioned better at work (p less than 0.005), in sexual performance (p less than 0.0001) and with their families (p less than 0.002). The improvement in work functioning continued at 15 months (p less than 0.04), but the differences in sexual and family domains became nonsignificant.

Relationship between Response to Phenelzine and MAO Inhibition in a Clinical Trial of Phenelzine, Amitriptyline and Placebo

This report examines the hypothesis that for phenelzine to be more effective than placebo it is necessary to achieve at least 80% inhibition of platelet MAO activity. This hypothesis was examined in the context of a double-blind comparison of phenelzine, amitriptyline and placebo in depressed patients. When phenelzine became significantly more effective than placebo at 4 weeks, the average MAO inhibition was 85%. By the 5th week, with MAO inhibition greater than 90%, phenelzine was significantly more effective than amitriptyline. A highly significant correlation was noted between improvement and MAO inhibition within the phenelzine group.

Diagnosis of Schizophrenia: Pathognomonic Signs or Symptom Clusters

LTHOUGH A it has long been a focus for professional concern, psychiatric diagnosis remains the greatest impediment to investigative work in schizophrenia. Feighner et al.’ l discussed the difficulties involved in arriving at a research definition of schizophrenia, while the unreliability of the psychiatric diagnosis of schizophrenics has been documented thoroughly.8*‘7 DS M-II,2 revised to alleviate some of the vagueness and ambiguity of DSM-I,’ has led to even more controversy regarding objective criteria for the diagnosis of schizophrenia.32 The inadequacies of DSM-II, especially with regard to its lack of specificity in the definition of terms used to define schizophrenia and its inadequacy as a nomenclature, have been discussed extensively.1s.17 Many investigators beginning with Kraepelin”’ have attempted to establish pathognomonic criteria that brought together patients with varied phenomenology under the same diagnostic class. For example, Bleuler5 described four general primary symptoms of schizophrenia which included loose associations, flat affect, autism and ambivalence as well as secondary symptoms called ego functions. However, this system has been considered inadequate since it uses imprecise terminology, mixes theoretical concepts with observations and because such symptoms also are prevalent to some degree in other physical and psychiatric disorders.32 While initially considered to have some basic validity and explanatory power, Bleuler’s concepts now receive little support.12 The most impressive effort to date in describing pathognomonic symptoms of schizophrenia has been described by Schneider. 27 This phenomenologic system includes 11 first rank order symptoms (FRS) which include three forms of auditory hallucinations, delusions, somatic passivity, thought insertion, thought withdrawal, thought broadcasting, and affect impulses or motor activity experienced as imposed and controlled from the outside. A detailed explanation of each symptom can be found elsewhere. g These FRSs are regarded as pathognomonic of schizophrenia when one is present in the absence of somatic illness. While the FRSs were chosen pragmatically according to their ease of identification, with no relation to theory, no empirical tests of the predictive validity of these concepts were conducted until recently. Mellor2’ found that 72% of 166 newly admitted schizophrenics demonstrated

Objectives For Residents In Consultation Psychiatry: Recommendations Of A Task Force

Abstract The authors briefly describe the work of the Association for Academic Psychiatry Task Force on Consultation/Liaison Objectives and discuss the principles behind the development of a proposed set of training objectives for residents in consultation psychiatry. These proposed objectives are presented in their complete form, followed by an elaboration of the knowledge objectives concerning the consultation process.

Selection of imagery in the relief of chronic and acute clinical pain

This study examined the effects of pleasant imagery and type of pleasant imagery on the relief of acute and chronic pain. Two images were used in alternation, both selected from five images generated by the patient. The first image was the one most preferred by the patient; the second was the one determined by the experimenter to represent the most successful mastery of developmental stages according to the schemata outlined by Erickson (International Encyclopedia of Social Sciences, Vol. 9, McMillan, 1968). It was hypothesized that an image associated with successful phases of life would be less likely to provoke anxiety disruptive of the relaxation procedure and thus be more effective in the relief of pain. Both images were successful in reducing reported pain relief over a three-day period, but as predicted, the developmentally-selected image was more effective. The general effectiveness of these images held only for patients with acute pain.

THE STANDARDIZED VIDEO-TAPE INTERVIEW AS AN OBJECTIVE DEPENDENT VARIABLE IN PSYCHOTROPIC DRUG RESEARCH

Literature is reviewed concerning the development and present status of the standardized video-tape interview. The paper concludes that since this interview technique shows promise of being a highly reliable and clinically valid instrument for assessing clinical changes in a behavioral, objective and parsimonious manner, and because of its demonstrated ability to reflect meaningful change based on specific experimental and therapeutic conditions, it would seem to be a useful dependent variable in psychotropic drug studies.

Clinical Aspects of Neuropeptide Research

Increasing evidence suggests that depression is found in a high percentage of patients with cancer (Petty and Noyes 1981; Buckberg et al. 1984), but depression appears to be both underdiagnosed and inadequately treated in cancer patients. There is also a growing body of evidence suggesting that experimentally induced stress in animals as well as psychiatric illness and stressful life experience in humans are associated with alterations in both neuroendocrine and immune function. Alterations in immune function have been found in patients with major depression (Kronfol et al. 1983; Schliefer et al. 1984,1985), and there is one report suggesting an epidemiologic relationship between depression and cancer (Shekelle et al. 1981). However, it is not known whether the alterations in immune function found in depression are of clinical significance, and there have been no comprehensive studies of both neuroendocrine and immune function in depressed cancer patients.