Seymour Fisher

Drug, doctor's verbal attitude and clinic setting in the symptomatic response to pharmacotherapy

Summary138 psychoneurotic outpatients manifesting anxiety were treated for 6 weeks with medication and brief, supportive interviews every 2 weeks with a psychiatric resident. The patients were divided among 12 different treatment conditions composed of 1. meprobamate 1,600 mg q.i.d. versus an identical placebo in a double-blind arrangement, 2. a doctor expressing an enthusiastic attitude toward the medication versus a doctor expressing a skeptical attitude toward the medication and 3. three different psychiatric outpatient clinics.The patients symptomatic condition was assessed at each visit by means of five ratings made by the patient before each interview and three ratings made by his doctor afterward. These ratings included an overall judgment of change, a checklist of 64 common symptoms, a score based on the patients presenting complaints and adjective checklists for registering anxiety and depression.The results at one clinic showed the expected interaction between medication and doctors expressed attitude: with the enthusiastic doctors, patients taking meprobamate improved more than patients taking placebo; whereas with the skeptical doctors, patients taking placebo tended to improve more than patients taking meprobamate. At the other two clinics, however, this interaction was absent or possibly reversed, with meprobamate tending to be superior to placebo with skeptical doctors.Some striking clinic differences among the characteristics of patients were found, particularly in social class status and the commonly associated styles of complaint and goals and expectations regarding treatment. The clinic showing the anticipated interaction between medication and doctors verbal attitude had patients with the lowest social class standing. The doctors at this clinic also came from backgrounds of lower social class than the doctors at the other two clinics. These differences suggest that the participants at this clinic may have assigned meanings to the enthusiastic and the skeptical attitudes contrasting with the meanings assigned at the other two clinics. The possible relevenace of these differences to the results is discussed.

Drug effects and initial severity of symptomatology

SummaryA recurring question appearing in clinical psychopharmacological research concerns the nature of the relationship between initial severity of symptomatology and the magnitude of a drug effect. Data are presented to show that, with meprobamate and placebo in neurotic outpatients, the magnitude of the pharmacological effect remains constant across all levels of initial severity.

Is a double-blind clinical trial really double-blind? - A report of doctors' medication guesses

SummaryIn a double-blind trial of meprobamate and placebo, carried out with 138 anxious neurotic outpatients, psychiatrists performed medication guesses after 2, 4, and 6 weeks of therapy. At the same time, physician and patient independently completed several improvement measures and the physician recorded the presence or absence of side reactions as spontaneously reported by the patient.The results may be summarized as follows: a) Clinical improvement and side effects often enable the physician to make reliable medication guesses and thus break the double-blind design in drug trials. b) Clinical improvement seems to exert the most important influence in determining physician medication guesses, at least with anti-anxiety drugs in studies of only 4 to 6 weeks duration. c) The correlation between side effects and medication guesses increases with the duration of therapy.

Persistence of a drug-personality interaction in psychiatric outpatients

CLINICAL drug trials with psychiatric outpatients usually span brief time periods. Investigators rarely follow up such trials. Apparently only one previous study reported an objective and comprehensive follow-up of a clinical trial of mild tranquilizers.1 Unfortunately it used different measures during the clinical trial and at follow-up, and psychiatric status for the two periods could not be compared. This paper reports a follow-up four months after the end of a double-blind trial of diazepam (Valium).a-4-t The 2-week trial indicated that a personality characteristic (Acquiescence) and medication had significant joint, or interactive, effects upon outcome. Patients had been classified as High or Low Acquiescers by their frequency of agreement with 35 glib generalizations from the Bass Social Acquiescence Scale.5

Effects of chlordiazepoxide and secobarbital on film-induced anxiety

After twa weeks of treatment Low Acquiescers had improved more on drug than on placebo, while High Acquiescers had improved more on placebo than on drug. Figure 1 depicts the interaction pattern on a typical criterion. The research questions in the follow-up phase concerned: (1) the persistence of the medication-personality interaction; (2) the effects of the clinical trial upon subsequent treatment and clinical progress.

The Effect of Different Preparations on Film-Induced Anxiety

SummaryNormal college students were given a single dose of chlordiazepoxide, secobarbital or placebo 85 min before being shown an anxiety-inducing film. Measures of sedation and of subjective anxiety were taken before and after the film. Results indicate that chlordiazepoxide and secobarbital had a measurable sedative action compared with placebo. Neither medication showed a significant anti-anxiety effect.

Effects of cannabis intoxication on primary suggestibility

To test the hypothesis that emotional responses can be affected by prior experience, three groups of subjects were prepared in three different ways. One group saw an anxiety-evoking autopsy film, one group saw a relaxing travel film, and the third group saw no film. Then all groups saw the stress film, Subincision. Subjects who saw the travel film showed the greatest anxiety response to Subincision, subjects who saw the autopsy film showed the least response, and no-treatment subjects fell between. This “contrast effect” is discussed in terms of Helson’s adaptation level theory.

The effect of a good and a poor model on hypnotic susceptibility in a low demand situation

Thirty-five subjects of known hypnotizability were tested for primary suggestibility in the waking state with and without marijuana intoxication. The drug caused an increase in suggestibility similar to that produced by the induction of hypnosis. The effect did not persist when subjects were retested one week later in their normal waking state.

Effects of Protriptyline and Perphenazine in Neurotic Depressed Outpatients

Abstract A review of recent studies reveals that there has yet to be a clear demonstration of a behavioral model affecting hypnotic levels. Two studies were conducted to test whether a peer model who portrayed deep or light hypnosis could affect S hypnotizability under minimal demand conditions. Using a low demand version of the Harvard Group Scale of Hypnotic Susceptibility, Form A (Shor & E. Orne, 19621, the first study showed a difference (Good Model scoring higher than Poor Model) that only approached significance. A replication on a larger Sample, however, showed significantly higher scores for those Ss observing a good model rather than a poor model. Although base scores were not obtained on these Ss, norms from comparable populations suggest that the poor model seems more effective than the good modek but this difference does not appear attributable to differential attitudes created by the models.

A Controlled Outpatient Trial of Perphenazine—Amitriptyline and Chlorpromazine

A four-week comparison of protriptyline 10 mg three times a day and perphenazine 2 mg three times a day, alone and in combination, and a placebo in a group of nonpsychotic depressed outpatients showed no significant differences among any of the treatment groups after both two and four weeks, and a slight trend in favor of the placebo group. A significant positive correlation was observed between changes in hostility and changes in depression, contrary to many commonly held assumptions regarding the relationship between hostility and depression.