Medical treatment of psychiatric patients: possible polypharmacy problems.
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Biomedical subjects
Publications and source records attributed to A M Ludwig.
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This report attempts to delineate the nature of "Nerves" using data collected from 101 Social Security Disability petitioners from Eastern Kentucky. Statistical analysis of Cornell Medical Index items reveals a relatively unique constellation of symptoms for individuals claiming disability primarily due to "Nerves" rather than somatic or mental causes. The report concludes that "Nerves" serves as a useful clinical label for a fairly consistent pattern of somatic and emotional complaints incorporating the distinctive Appalachian world view and life style.
Benefit payments and numbers of clients on the disability payrolls have substantially increased, while the numbers and proportions of those terminating because of recovery or rehabilitation have steadily decreased. The powerful effects of compensation on the disability process, psychological factors, bureaucratic interests, the weakening work ethic, and changing social values contribute to this problem. The responsibility of medicine with respect to the problem of disability is discussed.
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The place of psychotherapeutics in psychiatry is again in question. In many ways the situation recapitulates that of the late 19th century when psychotherapeutics first came upon the medical scene. The psychiatric hegemony over psychotherapeutics was the outcome of three fierce internecine "battles", (1) the "medicalization" of psychotherapeutics (1870-1910); (2) securing the psychiatric monopoly of psychotherapeutics (1890-1930); and (3) the "medicalization" of psychoanalysis (1920-1940). Three "revolutions" in psychiatry have occurred, since the stable halcyon 1950s, that have loosened the knot which binds psychotherapeutics to psychiatry. The emergence of specific psychopharmacologic therapies, the resurgence of the laboratory tradition (behaviorism) and the community-mental-health movement have diluted the importance of psychotherapeutics in treatment and widened the therapeutic franchise. In addition, there is evidence that the function of psychotherapeutics in society is itself changing. The future of psychotherapeutics in psychiatry is discussed in light of these developments.
Systematic, standardized evaluations for neurological soft signs were conducted on five psychiatric populations and a control group of medical inpatients. Soft signs were grouped according to their probable clinical association with cortical lobe dysfunction. Preliminary results indicated that schizophrenics, compared to other groups, showed significant increased presence of soft signs presumably related to frontal and parietal lobe dysfunction.
Derived from the hypothesis that many alcoholics would experience autonomic "arousal" and craving for alcohol under conditions of high sensory stimulation, this study does not support prior findings.
In earlier studies the authors have reported impairments of cortical function in the parietal and frontal lobes of schizophrenic patients. In this study these results are pursued. The performance of different groups of psychiatric patients with respect to individual neurological soft signs rather than combined cortical function scores, was studied. The potential influence of psychotropic drugs on the significant findings was also analyzed. The results show that specific individual neurologic soft signs are significantly more frequently present in schizophrenics than in either controls or in other psychiatric groups. Additionally, there was no statistical evidence of psychotropic drug effects on the findings.
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This study evaluates the ability of alcoholics to regulate their blood alcohol levels (BAL) within a designated range by relying primarily on interoceptive cues. Forty male alcoholics and 20 control subjects were exposed to an initial training session in which they received sufficient ethanol to maintain them within a designated BAL range over a 2 1/2-hour period. They were then exposed to two experimental sessions, one providing "overfeedback" and one "underfeedback." During each session, subjects had ten drinking decisions to make with respect to regulation of their BAL. The results indicated that alcoholics displayed greater "loss-of-control" than control subjects. This finding supported the hypothesis that alcoholics may possess a neurophysiologic feedback dysfunction that contributes to their relative inability to regulate ethanol intake.
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The authors state that the medical model represents the most useful and appropriate model available for the practice of psychiatry. They discuss the implications for psychiatry of the three essential features of the medical model: the concept of disease and diagnosis, the concept of etiology and treatment, and the nature of the doctor-patient relationship. They conclude that the adoption of the medical model for psychiatry would have profound implications for residency training, continuing education, delivery of care, standards of ethical and professional practice, dealings with third-party payers, and conflicts with other professions.
A case of multiple personality is presented and described. Psychological and neurophysiological parameters obtained on the personalities are evaluated. Major differences between the personalities in the processing of sensory information (augmenting-reducing parameter) are discussed.
Analysis of the scores of alcoholics on five tests of withdrawal, alcohol craving and cognitive function failed to support the hypothesis that the severity and frequency of alcohol withdrawal are related to impaired cognitive function.
In a study of men alcoholics, cortical average evoked response proved to be a good indicator of subsequent alcohol acquisition and consumption behavior in the laboratory.
In an appropriate experimental paradigm, loss-of-control drinking can be demonstrated when an individual consumes sufficient ethanol over time to cause his blood alcohol level (BAL) to rise progressively above a previously established, designated range. For this study, 10 alcoholics were exposed to a training session and provided accurate feedback of their blood alcohol level at ten 15-minute intervals. On following days, they were then exposed to three exposed to three experimental sessions during which they were instructed to maintain their BAL within the established training session range by relying primarily on interoceptive cues. The experimental sessions were characterized by distorted or no feedback concerning blood alcohol levels as the basis for drinking-decision behavior. The results indicated that 60% of alcoholics displayed loss-of-control (LOC) (by our criterion) in a least one session, the greatest percentage in the "No Feedback" session. The results were interpreted to support our theory of a neurophysiologic feedback dysfunction associated with LOC drinking.
It is hypothesized that alcoholics possess a perceptual-neurophysiological sensitivity which renders them vulnerable to the effects of information or stimulus overload: the resort to alcohol, therefore, may represent an adaptive attempt to restore physiologic homeostasis through the pharmacologic "dampening" properties of this drug. Twelve alcoholic subjects were assigned to three different levels of audio-visual sensory stimulation (no, medium, high) and three different doses of alcohol (placebo, low, high) according to a balanced incomplete block design. The results indicated trend level and significant interactions between alcohol and sensory level effects on craving intensity and systolic blood pressure, respectively, as well as a number of other intriguing findings. Should the findings of this pilot study be replicated, they will have important implications for the understanding of alcoholism.