Peter Hesbacher

Assessment of psychiatric illness severity by family physicians

Abstract Independent psychiatric illness assessments of family practice patients are compared. Of the three ratings-self-ratings, evaluation by the treating physician, and a clinical interview by a research psychiatrist-patient and research psychiatrist ratings achieved the highest level of agreement (50% of the variance). Of the three kinds of raters, treating physicians showed the greatest variability. Least agreement appeared for Practice Two, upper middle class college town people who were relatively high in interpersonal sensitivity complaints. Most agreement appeared for Practice Three, ghetto inner city people who were relatively high in somatic complaints. The rating performance of treating physicians is attributed to both rating instrument and rating context.

Fenfluramine in the treatment of obesity.

Abstract 90 obese women taking fenfluramine for seven weeks were studied. This double-blind, between-patient study, the first to compare fenfluramine with an amphetamine, was carried out by six general physicians. Fenfluramine and dexamphetamine treatment produced similar weight-losses and had similar drop-out rates. Each drug produced a greater weight-loss and had a lower drop-out rate than did a placebo. Both drugs resulted in modest decreases in emotional symptoms, but fenfluramine produced more side-effects.

Setting, patient, and doctor effects on drug response in neurotic patients

Diazepam was compared to placebo and phenobarbital sodium in a double-blind study with 472 anxious psychoneurotic patients. Patients were treated in 3 settings — medical clinic, general practice, and private psychiatric practice. The treatment setting was found to be at least as important as the medication in producing a treatment response. Drug effects were pronounced. Compared to phenobarbital patients, diazepam patients more often completed the study, followed prescribed dosage, and reported fewer side reactions. Diazepam patients did not differ from placebo patients in dosage intake or side effects, only in higher completion rate. Population effects indicated clinic patients to drop out and deviate from dosage more than private patients. General practice patients reported the most and private psychiatric patients reported the least side effects. These differences are explained in terms of patient background and behavioral patterns and of a medical as opposed to a psychiatric orientation toward treatment.

Differential effects of chlordiazepoxide and fluphenazine in two anxious patient populations

SummaryFluphenazine and chlordiazepoxide were evaluated for therapeutic effectiveness in a double-blind study carried out with anxious neurotic patients attending either a hospital clinic or a general practitioners office.All patients had significantly lower psychopathology scores after treatment than before, the general practice sample improving significantly more than the hospital clinic sample. While there was no significant difference in the degree of improvement produced by each drug in the general practice sample, in the hospital clinic sample, chlordiazepoxide was significantly more effective than fluphenazine, but only when using the somatic symptom cluster of the Physician Questionnaire as improvement criterion.Differences in population characteristics, primarily in social class and its related variables, but also in treatment set were suggested as important non-specific factors, which, by interactions with specific drug effects, influenced significantly the results observed in the present study. This study thus confirms the 2 hypotheses stated earlier in the introduction.

Pills and improvement: A study of placebo response in psychoneurotic outpatients

SummaryThe hypothesis that clinical improvement would be significantly correlated with number of daily placebo pills prescribed was supported for clinic and general practice patients but not for private psychiatric practice patients. Patients in the 3 treatment settings differed in other ways, particularly in treatment orientation, i.e., their awareness of having emotional problems and the most suitable treatment recommended for them by their physicians, as well as in social class. Treatment orientation was found not to account for the demonstrated “pill effect”, and social class differences, seen only in general practice, also did not appear to modify the relationship between pills and improvement within the entire patient sample.Our findings in this study have methodological as well as clinical implications. The fact that higher placebo intake levels resulted in reduced drug-placebo differences in improvement poses a practical problem for the clinical researcher, while the lack of placebo improvement observed at lower placebo intake levels indicates that 1 placebo pill per day is not a very effective agent in the symptomatic treatment of neurotic outpatients. Further research is needed to determine the optimal dosage for placebo therapy. Perhaps dosage intake norms, which probably vary within different treatment settings and social classes, represent a major factor influencing the “pill effect” on placebo response.

Emotional symptomatology in obese patients treated with fenfluramine and dextroamphetamine

Emotional sympomatology data on 78 obese females treated for 3 weeks with fenfluramine, dextroamphetamine, or placebo were evaluated. These obese females were shown to be considerably less emotionally disturbed than neurotic females, and similar in emotional symptomatology to other females seeing physicians for nonpsychiatric complaints. Even within these marginally sympatomatic patients, fenfluramine and dextroamphetamine were significantly more effective than placebo in reducing anxious, depressive, and anxious-depressive symptomatology. Fenfluramine was particularly effective in alleviating anxiety in patients who were initially higher in anxiety. Most important, fenfluramine produced significantly greater weight loss than dextroamphetamine in patients with higher levels of anxiety and depression, while dextroamphetamine was an especially effective anorexic in low anxious patients. Differences in initial anxiety and depression, even within relatively normal patients, may well affect results obtained with fenfluramine and dextroamphetamine in the short-term treatment of obesity.

Psychiatric illness detection: A comparison of osteopaths and M.D.s in private family practice

Abstract The detection of psychiatric illness is increasingly becoming the responsibility of non-psychiatric physicians. As part of a large scale epidemiological survey of psychiatric illness in a metropolitan area, primary care M.D.s and osteopaths were compared for their ability to detect psychiatric illness. Although neither group of physicians detected as much illness as patient self-assessments revealed, osteopaths detected significantly more psychiatric illness than M.D.s. When, however, physician and patient reports of illness were juxtaposed, to determine concordance, M.D.s and osteopaths showed similar degrees of overall accuracy. Osteopaths tended to detect more true positives, while M.D.s detected more true negatives. Different practice and social characteristics were not found to account for practice differences in physician rates of psychiatric illness detection. Osteopaths appeared to be performing at least as effectively as M.D.s in a first line of defence against mental illness.

“Substream” recordings: Some shifts in stature and alterations in song

Abstract “Substream” recordings (performances at variance with current commercial “mainstream” song types) disseminate essentially regional material to a mass audience. This paper details the fluctuations in popularity of substream musics relative to mainstream (traditional pop and rock) musics and examines artist type and lyric content for number one records to indicate that substream material is usually performed by solo male vocalists and includes primarily narrative ballad and novelty songs, not the love songs typically reported by prior studies of popular music. Sub‐stream hits appear independent of general trends in sound recording and achieve popularity in times of industry stability as well as industry change. This evidence suggests that substream music success is generally unpredictable in nature.

Are neurotic patients in psychotropic drug trials representative?: A comparison of study and non-study patients in four family practices☆☆☆

Abstract Drug treated emotionally ill patients on clinical trials were compared with similar patients not on clinical trials in each of four family practices. The results show an absence of selection bias in demographic characteristics and for those few treatment and illness characteristics which do differ between both patient samples, one finds that physicians are more likely to place sicker patients who have not responded well to other prior drugs on controlled clinical trials. These findings are interpreted to indicate that the response of clinical trial patients represents a justifiable test of clinical efficacy and safety.

Tybamate in treatment resistant headaches.

IN 2 STUDIES INVOLVING quite different patient populations tybamate appeared to be effective for a specific range of somatic complaints. Our assessment of anxious neurotic medical clinic outpatients showed that chronically ill, low socio-economic class patients reported the greatest drug-placebo differences in improvement when rated high by the physician on somatic complaints.1 Since the natural tendency of such low socio-economic patients is to somatize we conducted a similar study among less somatizing middle class, general practice psychoneurotic patients. Again we found that those patients reporting somatic complaints, particularly headaches and sleep disturbances, responded more to tybamate than to placebo, and that patients who were initially sicker improved more on tybamate than less sick patients.2