Jonathan A.E. Fleming

Smooth-Pursuit Eye Tracking in First-Episode Psychotic Patients and Their Relatives

We wished to determine the specificity of smooth-pursuit eye tracking dysfunction to schizophrenia and the prevalences of dysfunction among functionally psychotic and normal individuals. Therefore, we investigated pursuit tracking in a large sample of psychotic patients, normal subjects, and first-degree relatives (N = 482). Patients were recruited as part of an epidemiological study of first-episode psychosis that used a broadly based referral network to identify all cases in a major metropolitan area over a 2 1/2-year period. Patients received diagnoses of schizophrenia, schizophreniform disorder, psychotic mood disorder, and paranoid or other psychotic disorder based on the third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980). The distribution of tracking performance was bimodal for the schizophrenic patients and their relatives, perhaps reflecting major gene action. Moreover, poor tracking ran in families. Pursuit tracking dysfunction was relatively specific to schizophrenic patients and their relatives and occurred infrequently in other psychotic patients and normal subjects.

Effects of diazepam and methylphenidate on the electrodermal detection of guilty knowledge

S i x t y male undergraduate students p a r t i c i p a t e d i n an experiment designed to i n v e s t i g a t e the e f f e c t s of a n t i a n x i e t y and s t i m u l a n t drugs on p o l y g r a p h i c i n t e r r o g a t i o n . Subjects were randomly a s s i g n e d to one of four groups. Three of the groups watched a 12 minute videotape d e p i c t i n g the b u r g l a r y of an apartment through the eyes of the t h i e f . Each s u b j e c t was asked to imagine that i t was he who was committing the crime and was given i n s t r u c t i o n s to encourage h i s becoming absorbed i n the videotape. Afterwards, they were accused of commiting t h i s crime. Each subject r e c e i v e d one of three l o o k a l i k e c a p s u l e s c o n t a i n i n g a drug which, they were t o l d , would h e l p them to escape d e t e c t i o n . Capsules f o r the f i r s t group c o n t a i n e d 10 mg of diazepam; those f o r the second group, 20 mg of methylphenidate; a placebo was given to the t h i r d group. S u b j e c t s i n the f o u r t h group, the innocent c o n t r o l c o n d i t i o n , viewed a 10 minute videotape sequence showing the i n t e r i o r of another apartment, t h i s time with no crime committed. They d i d not r e c e i v e any medication or placebo a f t e r they were accused of committing the crime. A f t e r a one hour wait, a l l s u b j e c t s were i n t e r r o g a t e d by the experimenter, who was b l i n d to both t h e i r g u i l t or innocence and drug s t a t u s . Skin conductance, heart r a t e and r e s p i r a t i o n were monitored; a l l c h a r t s were scored b l i n d l y . No drug e f f e c t s were found i n the g u i l t / i n n o c e n c e c l a s s i f i c a t i o n or i n any of the p h y s i o l o g i c a l channels

A sleep laboratory evaluation of the long-term efficacy of zopiclone.

Six patients between the ages of 25 and 59, with chronic, primary insomnia received the new, non-benzodiazepine, hypnotic zopiclone continuously for 17 weeks after a drug free interval of 12 nights. To qualify for the study, sleep efficiency, determined by a sleep study on two, consecutive, placebo-controlled nights, had to be less than 75%. Patients evaluated their sleep by questionnaire and had sleep studies completed throughout active treatment. Zopiclone (7.5 mg) increased sleep efficiency by decreasing sleep latency, wakefulness after sleep onset and increasing total sleep time. Sleep architecture was minimally affected by zopiclone treatment; no significant changes in delta or REM sleep were observed. The commonest side effect was a bitter or metallic taste. No significant changes in biological functioning were noted throughout the study period. These findings indicate that zopiclone is a safe and effective hypnotic medication which maintains its effectiveness with protracted use.

Use of Antianxiety Drugs as Countermeasures in the Detection of Guilty Knowledge

To evaluate whether antianxiety drugs enable guilty subjects to appear innocent on polygraph tests, we compared the effects of diazepam, meprobamate, and propranolol on the outcome of a guilty knowledge test (GKT). Seventy-five undergraduate students were evenly divided among one innocent and four guilty groups. Subjects in each of the guilty groups received either one of the drugs or a placebo prior to the administration of the GKT and after viewing a videotape that depicted a burglary as seen from the perspective of the burglar. The results showed that drug status had no influence on the outcome of the GKT. Innocent subjects who coincidentally obtained high scores on a recognition memory test covering details of the mock crime tended to obtain higher guilt scores on the GKT.

A comparison of the efficacy and safety of alprazolam and desipramine in depressed outpatients

Fifty-two adult depressed outpatients fulfilling Research Diagnostic Criteria for Definite Major Depressive Disorder were enrolled in a double-blind study comparing the antidepressant effects of alprazolam versus desipramine. Twenty-nine patients completed the seven week (one week placebo followed by six weeks of active drug) study. The mean daily dose of alprazolam and desipramine at study termination was 3.34 mg and 192 mg respectively. Based on psychometric ratings of depression (Hamilton Scale) and severity of illness (Clinical Global Impressions) there was no significant difference between alprazolam and desipramine at the end of six weeks of active drug treatment. Both medications were well tolerated with drowsiness being the most common side effect of alprazolam, and insomnia, dry mouth, and constipation, the complaints most associated with desipramine.

A Case Report of Obstructive Sleep Apnea in a Patient with Bipolar Affective Disorder

A patient with a bipolar mood disorder developed obstructive sleep apnea which altered the clinical presentation of the mood disorder and affected compliance with prophylactic treatment. Significant improvements in the management of her mood disorder and in her life adjustment followed surgical relief of the upper airway obstruction.

A Comparison of the Safety and Efficacy of Alprazolam and Desipramine in Moderately Severe Depression

Fifty-four patients (34 outpatients, 20 inpatients)fulfilling Research Diagnostic Criteria for Definite Major Depressive Disorder were enrolled in a double-blind study comparing the antidepressant effects of alprazolam versus desipramine. The mean daily dose of alprazolam and desipramine at study termination was 3.78mg and 208mg respectively. As there were no significant demographic or clinical differences between outpatients and inpatients, both groups were combined in data analysis. Using the Hamilton Depression Rating Scale (HAM-D) both drug groups showed highly significant improvement beginning with the first week of active drug treatment. HAM-D scores continued to decrease through study termination (six weeks of active drug). There were no significant differences when comparing alprazolam and desipramine (outpatients, inpatients, or both groups combined) on any of the subjective or objective psycho-metrics used in this study. Clinically, only twelve of thirty-four outpatients (35.3%) were felt to be “markedly or moderately” improved, suggesting that neither the outpatient alprazolam nor desipramine patients did particularly well with drug treatment. In terms of drug safety there was no difference between the alprazolam and desipramine in the number of excessive or serious drug side effects. However, five of twenty-nine alprazolam patients had to discontinue therapy because of excessive drowsiness, and two of the alprazolam outpatients had motor vehicle accidents directly related to this adverse event. Alprazolam appeared as effective as desipramine in the pharmacotherapy of this group of depressed outpatient and inpatients. Alprazolam appeared well-tolerated by most subjects although drowsiness was a common — and at times serious — medication side effect.

Sleep architecture changes in depression: interesting finding or clinically useful.

1. Since the late 1970s, considerable progress in the description and quantification of EEG sleep changes in depression has been made. A consistent finding in the sleep of depressed patients is a shortening of the time from sleep onset to the appearance of the first REM period (short REM latency) suggesting that this finding might be used as a clinical test to differentiate depressed from nondepressed patients. 2. Sleep architecture changes in depression are described and factors influencing REM sleep are identified. The stability of REM sleep abnormalities and the specificity of these changes for depression are discussed. Methodological issues, which have been identified as possible contaminants affecting the reliability of research findings, are described before the author concludes with a summary of current obstacles to using polysomnography in the clinical assessment of depressed patients.

Evaluation of clinical competence in psychiatry by the Royal College Examination.

One hundred and seven psychiatric residents, postgraduate program directors and Royal College Examiners returned questionnaires which inquired into the areas of training programs, interim performance checks and the Certification Examination. There was relatively little dissatisfaction expressed with the written examination. However, most residents, program directors and examiners felt there were better ways to evaluate clinical competence than by means of the oral examination which was considered to lack validity and reliability. Respondents were very constructive in the suggestions they offered which focused on two main areas: the need to provide examiners with a larger work sample of a candidates performance (for example, through a sample of the candidates treatment audio-visual tapes), and the desirability of explicit performance criteria from the Royal College as to their expectations in the areas of knowledge, skill, judgment and ethics, so that the examination could be the final step in a shaping process rather than a high risk, single trial, pass/fail situation.

Memory effects of restricted environmental stimulation therapy (REST) and possible applications to ECT

Restricted environmental stimulation (REST) has been shown to facilitate learning and memory in both human and animal experimental subjects. This paper reports early data from a test of the usefulness of REST in reducing post-ECT amnesia in depressive patients. Two such patients were placed in a quiet, dimly illuminated room for 2-4 hrs. after recovering from each ECT administration in a series of treatments; three others, following standard practice, were returned to their normal hospital rooms. Measures of memory (verbal, numerical, nonverbal, life event, and self-rating) were given prior to the first ECT treatment; after the first post-recovery session; after the last post-recovery session; and one week after the last ECT administration. The major difference found was that the REST group showed an improvement in self-rated memory functioning from the first to the last ECT administration that was 15 times as great as that reported by the control group. This finding is interesting because of the major role played by self-reported memory disturbances in the scientific, clinical, and popular evaluation of ECT. The sample size is being increased, as it must be for any reliable conclusions to be drawn from this study.