Javad Razani

Family management in the prevention of exacerbations of schizophrenia: a controlled study.

Environmental stress has been implicated as an important factor in the relapse of schizophrenic patients receiving optimal drug therapy. In a randomized controlled study, we compared at-home family therapy with clinic-based individual supportive care in the community management of schizophrenia in 36 patients taking neuroleptic maintenance medications. The family-treatment approach sought to enhance the stress-reducing capacity of the patient and his or her family through improved understanding of the illness and training in behavioral methods of problem solving. The results at the end of nine months revealed the superiority of this approach in preventing major symptomatic exacerbations. Only one family-treated patient (6 per cent of all patients) was judged to have had a clinical relapse, as compared with eight patients (44 per cent) treated individually. Family-treated patients averaged 0.83 days in the hospital, as compared with 8.39 days for the comparison group. Significantly lower levels of schizophrenic symptomatology on blind rating-scale assessments supported these clinical observations of the superiority of family management.

Tranylcypromine vs nortriptyline vs placebo in depressed outpatients: a controlled trial

This study was designed to compare the therapeutic and adverse effects of tranylcypromine (a monoamine oxidase inhibitor), nortriptyline (a tricyclic antidepressant), and placebo. A total of 122 depressed outpatients randomly assigned to double-blind treatment with one of these agents completed the 4-week protocol. Treatment groups were balanced for proportions of endogenous versus nonendogenous depressions, defined according to the Research Diagnostic Criteria; however, nonendogenous depressions outnumbered endogenous depressions by such a large proportion (4:1) that meaningful statistical comparisons were limited to the nonendogenous group. In this group, both active drugs proved more effective than placebo, with little differences between the two active drugs except in the areas of side effects and of differential sensitivity of the outcome scales to a given drug. It was concluded that tranylcypromine, a drug which has received relatively little use and study in recent years, represents an effective and reasonably safe treatment for nonendogenous depression, although significant advantages over tricyclics with this disorder remain to be demonstrated.

Ejaculatory Incompetence Treated by Deconditioning Anxiety

In contrast with the excellent results in treatment of premature ejaculation reported by most sex therapists, ejaculatory incompetence has usually been found to be very difficult to treat. In this chapter, Razani describes the use of systematic desensitization in treatment of one case of ejaculatory incompetence. While this case was successfully treated, the sexual inexperience of this patient is not necessarily typical of ejaculatory incompetence patients, many of whom have been married and having intercourse for years. Sexual anxiety seems to be a less central element in such cases, which suggests that desensitization would not be as effective as Razani reports it was with this patient. Even in this case, it is difficult to attribute the success to systematic desensitization, as a number of other procedures were used concurrently, including training the sexual partner in providing penile stimulation for the patient. Given, however, the lack of success that characterizes treatment of ejaculatory incompetence, even single case reports of successful treatment are valuable.

Covert Drug Abuse among Patients Hospitalized in the Psychiatric Ward of a University Hospital

Fourty-four consecutive admissions less than 41 years of age to the Psychiatric Ward of Temple University Hospital were screened by urine chromatographic analysis for detection of amphetamines, barbiturates, and narcotics. The survey showed a majority of the patients (66%) had detectable levels of drugs of abuse in their urine at least once. As many as 52 % had evidence of covert drug abuse while in the hospital. The amphetamines were, by far, the most frequently abused drugs. Abuse was episodic and no obvious dependence was encountered. The value of urine screening in hospitalized psychiatric patients, especially with regard to its usefulness in evaluation of unexpected changes in their moods and behavior on the ward, is noted. Routine urine chromatographic screening for drugs commonly abused by hospitalized psychiatric patients is recommended.

Side effects of brevital-aided desensitization: Some clinical impressions

The side effects encountered with the intravenous administration of methohexital sodium (Brevital), using a maximum of 60 mg during 1 hr treament sessions, are reported for 17 neurotic patients treated with Brevital-aided desensitization. It is concluded, that while side effects are moderately common, they are so mild as to pose no significant treatment obstacle. The drug is sufficiently safe, at low dosages, to allow in vivo treatment with rapid re-exposure to anxiety-eliciting stimuli without causing the patients undue distress.

Electrocardiographc effects of tranylcypromine vs. amitriptyline

The authors compared ECG changes during the course of treatment with a tricyclic antidepressant (amitriptyline) or a monoamine oxidase inhibitor (tranylcypromine) in 22 adult psychiatric patients. Amitriptyline-treated patients showed increased heart rate, PR, QRS, and QTc intervals. Tranylcypromine-treated patients showed no significant changes in ECG parameters. The clinical significance of the differing pattern of ECG effects for tricyclic antidepressants and monoamine oxidase inhibitors is discussed.

Platelet MAO activity in depressed patients

A number of investigators have studied platelet monoamine oxidase (MAO, E.C.1.4.3.4) activity in schizophrenia, affective disorders, alcoholism and other psychiatric illnesses. Although some of these results are still controversial, the majority of studies have shown lower MAO activity in schizophrenia (Murphy, 1972, Wyatt, 1979) and in bipolar manic-depressive illness (Landowski, 1975) when compared with normal subjects. In contrast, higher than normal MAO activity has been reported mainly in depressed patients outside the bipolar group (Klaiber, 1972, Robinson, 1975, Landowski, 1977, Edwards, 1978, and Orsulak, 1978). However, patients with unipolar depression comprise a large, heterogeneous group, and which of these patients may show elevated enzyme activity remains a major question. In an attempt to answer this question, we have previously studied platelet MAO in nonendogenous depression and found that platelet MAO increased in female nonendogenous patients (White, et al., 1980). In order to confirm this finding, we have increased the number of nonendogenous patients from 35 to 75, and the total number of patients from 96 to 180 in this study.S