Joe P. Tupin

The long-term use of lithium in aggressive prisoners.

Abstract Lithium was given to 27 recurrently violent convicts for 3–18 months. Characteristics of the population included inability to delay expression of aggressive feelings, strong suggestion of brain damage and a long history of violent behavior both in and out of prison. Assessments of change were composed of incidence and type of disciplinary actions and the number and type of security changes for identical time periods before and during lithium plus subjective reports by staff and subject. As a group, the average number of disciplinary actions for violent behavior decreased significantly whereas the average number of disciplinary actions for non-violent behavior did not decrease significantly. Individually considered, subjects received fewer disciplinary actions for violence. Security classifications improved. Subjective reports included: (1) An increased capacity to reflect on the consequences of actions; (2) increased capacity to control angry feelings when provoked; (3) diminished intensity of angry affect; and (4) generally a more reflective mood.

DSM III: a new nomenclature for classifying patients with chronic pain

Over the past several decades significant progress has been made to elucidate the neurophysiologic basis of pain and its treatment. There still exists, however, the need for a standardized diagnostic nomenclature to categorize patients with chronic pain, taking into account both the physical and behavioral components which comprise the chronic pain syndrome. To categorize chronic pain patients merely in terms of their prime physical complaints has obvious shortcomings: for instance, a patient with chronic low back pain and a mild affective disorder is distinctly different from an individual with the same physical complaint but having a borderline personality disorder. The treatment plans and respective therapeutic outcomes for the two patients would differ markedly. Accurate diagnoses can be expected to be Less precise in those instances where there is no uniform diagnostic nomenclature. This identical problem has occurred in psychiatry and for many years hindered its development. Until recently, the reliability of psychiatric diagnoses has been exceedingly poor. Spitzer and Fleis [3], in 1974, found only three specific psychiatric diagnoses (alcoholism, organic brain syndrome and mental retardation) with a high degree of reproducibility. Consequently, the American Psychiatric Association in a 5-year effort has had a task force at work developing a new diagnostic taxonomy. Their efforts have culminated in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition [ 11, better known by its initials DSM III. Although developed for use in psychiatry, the DSM III nomenclature can be used to categorize patients with chronic pain and should do so with a greater degree of reproducibility than the current descriptive method. DSM III represents a major innovation in the manner that a patient’s medical and psychological problems are described. Instead of randomly listing the physical,

Lithium use in nonmanic depressive conditions.

Abstract This review of the clinical literature related to lithium reveals a number of diverse conditions that have been reported to respond favorably to lithium. Most studies are uncontrolled, anecdotal reports. These conditions are characterized by aggressiveness and an episodic course. It is suggested that these parameters are the common denominator of the various lithium responsive conditions. These observations are discussed and hypothesis for further research presented.

Lithium in hazardous circumstances with one case of lithium toxicity

Abstract The ever widening use of lithium by numerous investigators and practitioners in an unusually broad array of patients presents a rich opportunity for unfortunate experiences with patients, particularly since lithium has a narrow range between therapeutic and toxic serum levels. Given a reasonably healthy and reliable patient, the risk is minimal if the dose, serum level, and clinical course is carefully monitored by a person experienced in the use of lithium, however if the situation warrants, lithium can be used in those patients who present an increased risk as a result of renal disease, cardiovascular disease, sodium depletion or other hazards. These conditions represent substantial arguments against the routine use of lithium in such patients, however, the personal, social, or physical complications of recurrence may counterbalance the risk of lithium. Extreme caution must be exercised and exceptional justification must exist before lithium is used in these hazardous situations. An assessment of the balance of hazards must be made continuously: does the risk of recurrence overweigh the risk of giving lithium under the conditions?

Comparison of depot fluphenazines: duration of action and incidence of side effects.

LUPHENAZINE ENANTHATE (FE) and fluphenazine deconoate (FD) are two long-acting injectable neuroleptics. Their outstanding advantage traditionally has been with chronic ambulatory psychotic patients who take their oral neuroleptics irregularly. More recently, the effectiveness of FE for acute psychosis has been demonstrated by Chien and Cole, who conclude that the therapeutic efficacy of FE is greater than that of moderate dose chlorpromazine.’ Comparison data on the differences in clinical effectiveness, duration of action, and incidence of extrapyramidal symptoms (EPS) between FE and FD have been less well documented. These data nonetheless are important clinically so that one particular agent can be selected more precisely. Numerous investigators contend that FD has a longer duration of action and fewer EPS.2*3 However, with the exception of one study with acute psychotic patients that supported this clinical impression, other studies tend to be poorly controlled or without a double-blind technique, thus weakening these conclusions. At the Sacramento Medical Center we have developed a rapid neuroleptization (“digitalization”) method for administering both oral and long-acting depot neuroleptics to decompensated schizophrenic patients.5 The method allows for administering initial high doses to promote the patient’s rapid improvement. In our hospital practice, long-acting depot neuroleptics are administered predominantly to psychotic patients who are irregular about taking medication immediately following discharge. Using depot neuroleptics we find that we can promote continuity of outpatient care following hospital discharge. Guidelines for dosage adjustments for the rapid neuroleptization method are the emergence of side effects, especially sedation and pseudoparkinsonism, and clinical remission. Our standard parenteral injection for both FE and FD is 50 mg given two to three times weekly until reintegration occurs. Furthermore, doses are made dependent on drug history, age, body weight, and severity of symptoms. Subsequent injections are withheld until reappearance of decompensation symptoms which include increased anxiety, dream and sleep disturbances, dysphoria, increased cognitive disorganization, perceptual distortions, and idiosyncratic thought.6

Multivariate prediction of hospital readmission

Abstract To enhance understanding of the processes of posthospitalization recovery and relapse, demographic and symptom-severity data collected from 1,919 adults admitted to the psychiatric inpatient unit of a large urban hospital were examined in relation to readmission. For individuals diagnosed schizophrenic as well as for those given other diagnoses at index admission, multiple regression analyses produced equations that could explain only 3% of the variance in rehospitalization. The data are veiwed as consistent with prior research attributing minimal prognostic validity to demographic and symptom-related variables in contrast to such robust prehospitalization indicators as premorbid status and time of onset.

Physiologic changes with a simple relaxation method.

Abstract This paper reports changes in galvanic skin resistance (GSR) in subjects using a clinically effective relaxation method. A highly predictable effect was found in a single session with naive subjects. Several hypotheses regarding predictability of responses and correlations between GSR and independently rated clinical responses are examined.

An experimental test of two opposing theories of the perception deficit in schizophrenia.

Devised the experiment to test two alternate theories of the etiology of the perceptual defect in schizophrenia: The theory supported by Searles and Hartmann that it is a secondary recation to defense and that proposed by McGhie that it is a primary defecrt. Two groups (N = 32) of schizophrenic patients were compared, one of which was administered low doses and the other hight doses of fluphenazine HCL. Both groups were given before medication and 7 days after medication a batery of five-digit span tests. The tests differed in that they were accompanied by orally presented distracting words presented with varying combinations of emotional and neutral content and affect or with no distracting stimuli. Results indicated that patients administered high as compared to patients administered low doswages of medication performed significantly better on two-digit span tests, the test comprised of words with emotional content presented. with neutral affect, and the test with no-distracting stimuli. Because the higher dosage did not produced greater improvement on the test that utilized emotional-distracting stimuli than on the test accompanied by no distracting stimuli, the results are interpreted as supporting the theory of McGhie.