Stanley P. Hoffman

Kinetic behavior in altered clinical states: approach to objective analysis of motor behavior during clinical interviews.

This paper presents a scheme, derived both rationally and empirically, for the analysis of body movements occurring spontaneously in psychotherapeutic interviews. Focussing on hand movements, a distinction is made between two broad, conceptually different, and independent classes of movements: those accompanying speech (object-focussed), and those involving some form of self-stimulation but not speech-related (body-focussed). Furthermore, different kinds of object-focussed movements are identified according to their integration with and primacy vis-a-vis speech. Observations on two paranoid patients, each at two different points in his treatment, suggest that the coding scheme can reflect the patients altered clinical states.

Neurological Consequences of Psychotropic Drug Withdrawal in Schizophrenic Children.

A preliminary study is presented, involving 34 schizophrenic children, 6 to 12 years of age, who were carefully observed following discontinuation of active neuroleptic treatment to ascertain the clinical effects of drug withdrawal. The children had been on maintenance therapy for periods of 6 to 15 months. Five neuroleptics were involved: fluphenazine, haloperidol, thioridazine, trifluoperazine, and thiothixene. All but two children suffered massive clinical relapse within 1 to 2 weeks after drug withdrawal. Fourteen of the children exhibited neurological withdrawal emergent symptoms (WES) characterized by involuntary movements and ataxia. In half the children the WES remitted spontaneously. In the remainder, symptoms disappeared within two weeks of resumption of active treatment with another neuroleptic. The findings are discussed in relation to the syndrome of tardive dyskinesia observed in adult schizophrenics.

A double-blind comparison of fluphenazine and haloperidol in outpatient schizophrenic children

A study is presented in which fluphenazine and haloperidol administered on a double-blind basis were evaluated in an outpatient group of 30 schizophrenic children, 6 to 12 years of age. The duration of treatment was 12 weeks. Mean dosage for both treatment groups was 10.4 mg/d, with a maximum dose of 16 mg/d. Both fluphenazine and haloperidol proved highly effective in our population of schizophrenic children, with the two drugs indistinguishable in overall efficacy. Both drugs were characterized by low incidence of side effects with a tendency for fluphenazine treatment to induce extrapyramidal symptoms with greater frequency than haloperidol. Side effects were easily managed by dose reduction or contramedication. No child had to be terminated due to an adverse reaction. It is suggested that these findings, as well as other reports in the literature, indicate that fluphenazine and haloperidol deserve consideration in the treatment of schizophrenic children.

Lead and Hyperactivity: Lead Levels Among Hyperactive Children.

Previous work has demonstrated an association between hyperactivity and increased body lead burdens in school-age children. In the present study it is shown that within a group of hyperactive children those for whom an organic etiology is present have lead burdens lower than in those for whom no apparent cause could be found. These data lead us to reject the notion that hyperactivity per se is responsible for the acquisition of elevated lead levels, and further strengthen the suspicion that for some children lower lead level absorption may be implicated in the development of the hyperkinetic disorder.

The relationship of hyperactivity to moderately elevated lead levels.

Controversy exists with respect to whether moderately elevated lead levels are toxic in certain children with various central nervous system dysfunctions. One way of addressing this controversy is to remove the lead; if the condition is ameliorated a presumption of toxicity becomes reasonable. Such a strategy is reported herein. Children with an operationally defined central nervous system dysfunction (hyperactivity) and moderately elevated lead levels were treated with a lead chelating agent in a random allocation double blind treatment regimen. The finding of statistically significant and obvious behavioral improvement reported by three separate evaluators (i.e., parent, teacher, and treating physician) of the child suggests that the presumption of a toxic relationship between moderately elevated lead levels and hyperactivity is supported.

Childhood lead poisoning: a re-evaluation.

Long recognized as an environmental toxin of fearsome lethality, lead effects are commonly described as extremely serious, particularly as regards the central nervous system. It is postulated here that this represents only part of the pathologic spectrum. Ohter lead-related conditions, as yet unrecognized, may include a wide range of central nervous system dysfunctions that although severe, are not so acutely dramatic or widely destructive as the classic encephalopathic or preencephalopathic states. These conditions remain etiologically unrecognized primarily because of (1) the variable nature of onset, (2) the variable nature of the manifestations, (3) the relative subtlety of the dysfunctions, and most importantly, (4) the absence of consistant, unequivocal evidence demonstrating the relationship of lower blood lead levels with pathologic effects. This last is seen as pivotal, and an extensive examination of the reasons for its absence is presented. It is postulated that biological variability, a concept widely used in medicine but rarely invoked in the researching of lead toxicity, is a crucial ingredient in lead research. It is further asserted that the grevious lack of etiologic recognition will continue until that factor is incorporated into research designs.

A Single-Blind Evaluation of Thiothixene with Outpatient Schizophrenic Children.

The results of a single-blind study assessing the effectiveness of thiothixene in a group of severely ill, outpatient schizophrenic children are presented with details pertaining to procedure and side effects. The subjects, 17 boys and one girl, ranged in age from 5 to 13 years. Thiothixene proved effective in all of the 18 schizophrenic children, as indicated by the psychiatrists global impressions. Further evaluation of behavioral change, using a 23-item psychiatric rating scale, indicated significant improvement in motor activity, stereotyped behavior, coordination, sleeping, affect, exploratory behavior, concentration, eating habits, and range of communication. Despite relatively high dosages (10 to 24 mg per day) few side effects were noted during the course of the treatment period. It is suggested that thiothixene is a safe and effective antipsychotic agent for the treatment of schizophrenic children on an outpatient basis.