Haim Dasberg

Serum and CSF levels of haloperidol by radioimmunoassay and radioreceptor assay during high-dose therapy of resistant schizophrenic patients

Serum and cerebrospinal fluid (CSF) levels of haloperidol were measured in 12 chronic neuroleptic-non-responsive schizophrenic patients after 1 month on 60 mg haloperidol daily and then again after 1 month on 120 mg haloperidol daily. Serum haloperidol and CSF haloperidol rose with increasing dose. Serum and CSF levels were significantly correlated. No clinical improvement was achieved despite the high serum and CSF drug levels.

The collapse of a structure: A structural approach to trauma

Applying an analytic approach to the concept of trauma, the authors differentiate trauma from other stress disorders and define trauma as the collapse of the structure of self along all its referential planes, resulting from the encounter of a catastrophic threat and a chaotic response, producing the unique traumatic experience. The post-traumatic state is conceptualized as a reorganizing transitional state, aimed at restoring autonomy, which can proceed by encapsulation only. The post-traumatic stress disorder is regarded as the manifest clinical syndrome of the post-traumatic state. By providing a systematic conceptual framework, the analytic structural approach to trauma allows clearer guidelines for the diagnosis and treatment of traumatized patients.

The effect of propranolol treatment in schizophrenia on CSF amine metabolites and prolactin

Recent reports have suggested that high doses of propranolol may be an effective treatment in schizophrenia. To determine whether such treatment has effects on cerebrospinal fluid (CSF) amine metabolites and prolactin similar to the effects of the neuroleptic drugs, we studied CSF from ten patients before and after propranolol therapy. The initial CSF sample was removed after a drug-free period and propranolol dosage was then increased over 1 week to 1000 mg daily in all ten patients. A second CSF sample was removed after 3 weeks of propranolol therapy. Propranolol levels and prolactin in CSF were measured by radioimmunoassay. Homovanillic acid, 5-hydroxyindoleacetic acid, and 3-methoxy-4-hydroxyphenylethylene glycol were measured by gas chromatography-mass spectrometry. Propranolol had no effect on the prolactin or amine metabolite concentrations. CSF propranolol levels averaged 40 ng/ml (range <1–78).

Pharmacotherapy Trials in Posttraumatic Stress Disorder: Prospects and Problems

Although a clinical symptom picture resembling the currently accepted DSM-III diagnosis of posttraumatic stress disorder (PTSD) has been recognized for decades, focused trials of psychopharmacological agents are a relatively recent development. The initial report by Hogben and Cornfield1 of a dramatic effect of treatment with the monoamine oxidase inhibitor phenelzine in patients with “traumatic war neurosis” has been followed by a spate of positive reports. These reports have attributed beneficial effects to a variety of drugs including tricyclic antidepressants,2,3 the limbic anticonvulsant carbamazepine,4 and the β-receptor blocker propranolol.5 Contrary to these generally optimistic reports, our experience with psychotropic agents in Israeli samples of PTSD patients has been less encouraging. This experience has been for the most part prospective and, in two studies, double-blind in nature using a drug/placebo crossover design.