Gary J. Tucker

Neurology and psychiatry

There has been a long historical relationship between neurology and psychiatry. This relationship has been nurtured by the common interest in the central nervous system and disturbed behavior associated with dysfunctions of the nervous system. This paper reviews the formal relationships between neurology and psychiatry and particularly looks at the behavioral aspects of neurological disease. For the past 10 years, both from a clinical and a theoretical viewpoint, the importance of understanding central nervous system functioning and dysfunctioning has become increasingly apparent to psychiatrists.

TRH effects on arousal, locomotor activity and spontaneous alternation in ECS post-ictal state.

Thyrotropin-releasing hormone (TRH) is a short acting tripeptide with multiple actions in the CNS (Horita et al. 1986). Aside from its effects on the endocrine system, it appears to be an analeptic and to increase locomotor activity in animals. Recent data suggest that TRH may have additional CNS effects, including acute beneficial effect on memory and related functions in patients with Alzheimers Disease (Lampe et al. 1991). We explored the specific effects of TRH on cognition using electroconvulsive therapy (ECT) as an experimental paradigm, since ECT results in profound and transient alterations on mental functioning. We infused small doses of IV TRH to patients after ECT and measured its effects on mental functions (Khan et al. submitted). Our results suggest that TRH has significant beneficial effects on auditory attention span and verbal fluency. The effect of TRH on memory functions were minimal. Concurrently, we conducted a study to clarify the effects of TRH on cognition using an animal model following ECS. Our hypothesis was that TRH transiently enhances arousal and locomotor activity as well as memory and spatial orientation (spontaneous alternation behavior, SAB, Douglas 1989) during ECS post-ictal state. To indicate arousal, we used the duration of loss of righting reflex, and to indicate locomotor activity, the time required to explore a T-maze. The study design consisted of male Long-Evan rats which were randomly assigned to four experimental groups. All of the rats were given IP pentobarbital, had their ears clipped when they were anesthetized and 5 min later were given an IP injection of TRH (5 mg/kg) or placebo. Nineteen of the 35 rats received true ECS and the rest sham ECS (using MECTA SR1 machine that delivers brief-pulse stimulus, modified for animal use), whereas 18 rats received TRH and the rest placebo, Evaluation and measurement of righting reflex, locomotor activity, and SAB were conducted by investigators

Somatization, paranoia, and language

Somatization and paranoia are circumscribed distortions of reality that are impervious to the normative process of consensual validation. These distortions are often postulated as a means of bolstering lowered self-esteem. We used computerized content analysis of the free speech of patients with these disorders in order to identify and compare dimensions of self-concept reflected in their lexical choices. Interestingly, patients with these disorders differed in the themes prominent in their speech. The higher frequency categories used by the somatization disorder group conveyed an overwhelming sense of negativism, distress, and a preoccupation with an uncertain self-identity. In contrast, the categories used by the paranoid patients portrayed an artificially positive, grandiose self-image and a defensive abstractness. Our exploratory analysis suggests that circumscribed distortions of reality in somatization and paranoid disorders are not associated with the same common defensive style attempting to bolster self-esteem.

Language dysfunction in schizophrenia

Twenty-four medicated schizophrenic subjects participated in a study aimed at assessing language dysfunction in schizophrenia. Two groups of subjects participated: schizophrenic responders and non-responders to treatment with antipsychotic medication. All subjects were tested on The Western Aphasia Battery test (WAB), the Cookie Theft picture descriptions task, and the Wechsler Adult Intelligence Scales--Revised (WAIS-R) block design and picture arrangement subtests. All verbal and non-verbal assessments were compared between groups. The three main findings of this study were: 1. Severe language of dysfunction among schizophrenic patients who do not respond to medication treatment. That is, therapeutic response to medication was the major predictor of the severity of language dysfunction in schizophrenia. 2. A group profile of language dysfunction differed in severity but not in shape between responders and non-responders to treatment with antipsychotic medication. 3. Schizophrenic responders and non-responders to medication treatment did not differ in their performance on a standardised picture description task and failed to reach low-moderate aphasia level. Secondary findings suggest that non-verbal aspects, such as attention and logical sequencing, may be influenced by treatment. This study represents an assessment of schizophrenic language function in relation to known language deficits of neurological patients, lending further support for the role of central nervous system (CNS) dysfunction in schizophrenia, and the importance of assessing language dysfunction as a sensitive gauge to treatment response.

How Many Psychiatrists Do We Need

Projections of manpower needs based on population growth and possibly improving access are unconvincing because of rapid changes in psychiatric practice and because complex social and political forces are influencing the psychiatrist’s role in the mental health system. Given this basic uncertainty, attempts at filling residency positions at all costs are less than responsible. To serve our field well, efforts should be focused on recruiting “the best and the brightest” of our medical students and on providing quality training that stays in tune with the developments of the field and the evolution of the role of the psychiatrist.

The Future of Psychiatric Research

The psychiatrist and philosopher Karl Jaspers has described four types of science: the physical, biological, psychological, and mind sciences—as exhausting the content of all existents... in each of the four realms, actuality has a different mode of objectiveness; and the actualities mesh. Physics (together with chemistry) is relatively an internally coherent field of study. So is biology, although the coherence is due to its relation to the exact natural sciences, on which it draws at each step while its own roots remain obscure. Psychology is far more questionable; in fact, it strays into the realms of life and the mind, or else it poses as a universal science. Mind science, finally, is actual only as a multiplicity resulting from research into the documents, works, deeds or institutions of Man; by no means has it produced a kind of unity we see in physics and biology. It is the arena for the battles of differing world views, battles which decide, radically and without appeal, about the meaning and value of proposed inquiries and modes of research. (Jaspers cited in Ehrlich, Ehrlich, & Pepper, 1986, p. 360)