Insights into physician retirement.

Most physicians in this study retired because they thought the time was right, and they did not feel forced to do so. This situation may not be the case in the future with changes occurring in the practice of medicine. Most of the physicians were pleased with their retirement after they had completed an adjustment period, often lasting about a year. The most important factor involved in successful retirement was the health of the physician and his or her spouse. A good relationship with the spouse was important. Typically, relationships with spouses improved. If a physician has no spouse or poor spousal support, some other method of replacing the support network previously provided by staff, patients, and practicing colleagues is necessary. After retirement, the physicians in our study became comfortable with living on their savings. Strategies employed after retirement were diverse. Many of the retired physicians took advantage of increased time to exercise for enjoyment and for health. Although some of the retired physicians continued to pursue medical interests, many others discovered rewarding activities away from medicine, but rarely for financial compensation.

Double-blind placebo-controlled multicenter evaluation of the efficacy and safety of nomifensine in depressed outpatients.

Outpatients with primary affective disorder-depression who scored at least 20 on the Hamilton Depression Rating Scale (HDRS) were randomly assigned to treatment for 1 month with nomifensine (100-200 mg/day) or placebo. Clinical laboratory and physical evaluations, including ECGs when feasible, revealed no clinically significant changes over the course of treatment. Nomifensine patients showed improvement compared to placebo on the HDRS total score endpoint analysis (p = .06) and the Cognitive Disturbance and Retardation factors (p less than or equal to .05). A better rate of improvement was seen with nomifensine on the Clinical Global Impressions severity of illness (p less than or equal to .05) and therapeutic index (p less than or equal to .05) components. No differences were seen between groups in the incidence of overall or specific side effects. Nomifensine thus appeared safe and superior to placebo on several key measures of depressive symptomatology in this multicenter study of depressed outpatients.

Major side effects of antipsychotic drugs.

Since the introduction of phenothiazines into clinical practice in 1952, over 250 million people have received these drugs for the treatment of psychotic states. In addition to the phenothiazines, five other classes of neuroleptic medications are now in use: butyrophenones, thioxanthenes, dihydroindolones, diphenylbutylpiperidines, and dibenzoxazepines. Besides their use in the treatment of psychosis, these drugs have been used in the treatment of anxiety, depression, nausea, alcoholic withdrawal, and pain, and are often administered in combination with other medications. Through the use of these drugs, many psychotic patients have been able to move back into the community, and the family physician is coming into contact with more patients on maintenance dosages of neuroleptics. He/she may wish to prescribe these drugs or may, in the treatment of a medical problem, need to prescribe other medication to an individual already receiving neuroleptics. It is important, therefore, for the family physician to be aware of the side effects of these drugs and of complications which can arise when neuroleptics are given in combination with other families of drugs.

Cerebellar cAMP levels following acute and chronic morphine administration.

Acute administration of morphine sulfate at 20 mg/kg decreased mouse cerebellar adenosine 3',5'-cyclic phosphate (cAMP) levels while not affecting cAMP phosphodiesterase (EC 3.1.4.17). The cAMP levels and cAMP phosphodiesterase activies were not affected by chronic treatment. However, cAMP levels increased during abrupt withdrawal both with and without naloxone precipitation, with cAMP phosphodiesterase activities being correspondingly decreased. Propanolol prevented the cAMP increase during abrupt withdrawal.

Alcoholism and the courts: experience with a traffic safety project.

The authors describe a federally funded Alcohol Safety Action Project in Texas that attempted to change the drinking behavior of individuals arrested for driving while intoxicated. The project was one of more than 35 around the nation designed to deal with the problem of the drinking driver; unlike many others, its primary emphasis was on rehabilitation. The project functioned as a self-supported ancillary agency to the probation department; however, because of problems in coordination with the legal system, it had access to only about a fourth of the DWI offenders. Despite that drawback, and the inability to prove the value of the projects by the federal evaluation criteria initially set, the authors believe that the experience in Texas has demonstrated the advantages of combining the efforts of the judicial and the health-care systems to deal with alcohol abuse.

Effects of morphine administration on cerebellar guanosine 3',5'-monophosphate.

An increase in mouse cerebellar C-GMP levels during acute morphine treatment was observed, which was possibly related to the decrease in C-GMP phosphodiesterase levels also observed in acute treatment. Chronic treatment lowered C-GMP levels as did abrupt withdrawal without naloxone.

Self-esteem in alcoholics and nonalcoholics.

Alcoholics scored lower on a test of self-esteem than did nonalcoholics, Alcoholics with lower self-esteem were found to be more willing to seek treatment than those with higher self-esteem.

Item analysis of the Michigan Alcoholism Screening Test.

The Michigan Alcoholism Screening Test was administered to 200 persons arrested for driving while intoxicated. Most items adequately discriminated between problem and nonproblem drinkers, but several questions assessing severe alcoholism symptoms did not consistenly differentiate between the 2 groups.

Absorption and excretion of thioridazine and mesoridazine in man.

Tritium labeled thioridazine and mesoridazine were given to four schizophrenic subjects to determine if differences in reported clinical potency of these two drugs could be explained by different rates of absorption and excretion. Mesoridazine was found to have earlier peak blood levels and lower fecal excretion. However, the blood and fecal differences were too small to be an adequate explanation for the differences in clinical potency suggesting that the rate of metabolic degradation is a more likely explanation for the potency difference. Thioridazine differs from other phenothiazines by containing two sulfur atoms. Thioridazine is metabolized by oxidative demethylation, oxidation at both sulfur atoms to sulfoxides and sulfones and by hydroxylation in the ring followed by glucuronide formation. Monosufoxides, disulfoxide and disufone have been found in the urine and bile of rats after thioridazine administration by inverse isotope dilution analysis. Neither the ring sulfoxide nor the disulfone show significant pharmacological activity, but activity is shown by the side chain monosulfoxide, mesoridazine. In fact it has been postulated that mesoridazine is the active form of thioridazine. Mesoridazine when compared on an equal dose basis to thioridazine is more potent in anti-emotional and hypotensive effects and produces more extrapyramidal symptoms. Since oxidation of the ring sulfur would be expected to decrease potency, it has been theorized that a portion of thioridazine is oxidized within the ring prior to the oxidation of the side chain sulfur atom thus effectively decreasing the potential activity of thioridazine. Thioridazine studies in rats have shown greater excretion in the urine and bile of the side chain sulfoxide than of the ring sulfoxide or of unchanged thioridazine. The difference in potency of these two compounds could alternatively be a result of differences in absorption, reabsorption after biliary excretion or the rate of urinary excretion. The metabolic pathways of mesoridazine in the human are essentially unknown. Because of this, we thought it worthwhile to determine if the difference in potency between thioridazine and mesoridazine is also related to differences in the rate of excretion and absorption. Because phenothiazines are found in extremely low plasma concentrations, we used radioactive compounds to perform this study.