Effect of psychotropic medications on seizure control in patients with epilepsy.

Psychiatric problems are frequently encountered in patients with epilepsy. In an adult clinic population of 2,000 patients, 219 were identified as having been treated with psychotropic medication (PTM). Of these, 59 patients had adequate documentation of seizure frequency 2 months prior to and 2 months during treatment with PTMs. Contrary to many reports, most patients experienced better seizure control on PTM therapy. This demonstrates that most patients will not have an increased frequency of seizures when psychotropic medication is used in low to moderate doses and is introduced slowly.

Psychiatric aspects of patients with chronic obstructive pulmonary disease.

This chapter reviewed many of the psychiatric aspects of patients with COPD. It is hoped that this chapter will facilitate an understanding of some of the more common psychological and sociocultural settings in which COPD patients operate and some of the variables that can be utilized to increase these patients' and their families' abilities to adapt by increasing the fit of their environments with the severity of the patients' COPD.

Effect of doxepin on seizure frequency in depressed epileptic patients.

We performed a retrospective study of the effect of antidepressant treatment with doxepin on seizure frequency. From 47 patients treated with doxepin in 3 years, a confirmed seizure disorder and adequate follow-up (mean, 6.8 months) were available for 19 patients. Comparison of mean monthly seizure frequency during equal blocks of time before and during treatment with doxepin in doses of 5 to 400 mg/day demonstrated improved seizure control in 15, no change in 2, and increased seizures in 2 patients. The reduction in seizure frequency may have been a result of a direct antiepileptic effect of doxepin, an indirect effect because of improved affective state, drug interactions, or some combination of these mechanisms.

Intravenous chlorimipramine and refractory depression.

A total of 252 infusions of chlorimipramine were performed on 12 patients with refractory depression. It is suggested that the intravenous route of administration is safe and effective. It may, in fact, be the preferred route when the oral route of administration is not available.

Psychophysiologic aspects of respiratory control.

By fashion we have been taught that causes of medical and surgical diseases are known; yet in reality very little was understood about disease until recently, and we still operate in a scientific twilight. We have worked with myths inventing scientific explanations to cover our lack of knowledge about the causative factors in illness, and we have traditionally examined physiologic organ systems from a fragmented perspective. The psychological variables of behavior and emotion have not been considered as directly related to physiological functioning. Consequently, by convention, certain disease entities have been defined and categorized by behavior and feelings. Persons function as a psychobiologic unit. A complex interplay between persons and their environment determines their state of health. Identification and appropriate application of the physiologic and psychological components have been disassociated to such an extent that the systematic relationship of behavioral and physical patterns of functioning are not recognized. Nevertheless, with increasing awareness of respiratory psychobiologic adaptive influences, the chemical and mechanical control system is better understood. The existence of secondary breathing disorders, in pulmonary disease, are not isolated to a physiologic genesis. With the advent of new instruments (i.e., Coping Scale and Schedule of Recent Experience) to measure and quantify adaptive factors, wide swings of activation can be more readily stabilized.

Emergency use of intravenous haloperidol.

Experience is reviewed with intravenous haloperidol in 20 cases in which the mental state was gravely impaired, prohibiting necessary investigation and treatment of physical disabilities. This use of haloperidol was efficacious and uncomplicated, although not specifically FDA approved.

Life change, its perception and alcohol addiction.

Alcohol addiction was associated with high life change and an attenuated perception of life change. The possible association of these factors with the perpetuation of the addiction is discussed.

Psychiatric and biochemical correlates of respiratory decompensation in a terminal and non-terminal chronic pulmonary disease patient.

A psychiatric and biochemical study was undertaken at the request of two patients who were thought to be terminally ill by the medical staff. One patient accepted dying and expired from her disease. The other patient wished to continue living and did not die. The dying patient exhibited abnormally high levels of catecholamine excretion which were not associated with verbal reports of anxiety or discomfort and did not seem upset or uncomfortable to the physician and nurses caring for her. The patient who lived had relatively low levels of catecholamine excretion and was anxious, irritable and uncomfortable. The behavior of these two patients differed during the period of acute respiratory failure. The dying patient had given up and felt that she was engaging in goal-directed activity which she would or could not shut off. The patient who lived was frightened of dying and felt that she would overcome her current difficulties and that she was not ready or willing to die. The major cardiovascular differences were those of a significantly lower blood pressure and higher heart rate in the patient who died.

Post-detoxification drug treatment of anxiety and depression in alcohol addicts.

A study was undertaken to assess the effectiveness of treating alcoholics after detoxification for the very commonly observed syndrome of anxiety, depression, and somatic complaints. Previous studies had indicated that these patients generally respond quite well to drug treatment with the phenothiazine class of drugs. However, a double blind placebo-controlled study of adequate size had not been undertaken. Forty-five comparably addicted male alcoholics with anxiety or mixed anxiety-depression from an inpatient alcohol treatment ward comprised the treatment group. Twenty-three patients received thioridazine treatment and 22 received placebo treatment in a double blind fashion after acute withdrawal from alcohol. Progress over a 4-week period was measured with standard rating instruments--the Hamilton Rating Scale for Depression (by physician) and the Zung and Lipman Self-Rating Scales. Both placebo and active medication groups improved symptomatically during the 4-week program. The thioridazine group had significantly better improvement in sleep disturbance (early, middle, and late insomnia) than the placebo group. There was also significantly better improvement in anxiety with thioridazine as compared with placebo. Interestingly, the placebo group had significantly better work and activity (as appraised by the ward physician) than the thioridazine group. The authors note that active drug effect might actually hamper some patients in their rehabilitative effort, especially if phenothiazines of the more sedating variety are used. Since alcohol rehabilitation generally utilizes a wide range of activities (such as didactic sessions, occupation therapy, group therapy), alertness and performance ability appear to be important factors in the rehabilitation program. Although thioridazine treatment for some patients with anxiety and insomnia would appear to be quite helpful, its blanket use for the post-detoxification anxiety-depression of the alcoholic might be detrimental for others and cannot be recommended as a routine treatment strategy in an alcohol rehabilitation program.

Frequency and magnitude distribution of life change in heroin and alcohol addicts.

A study of the frequency and magnitude of life change in two Veterans Administration Hospital addiction groups was made. Both heroin and alcohol addicts were characterized by a high frequency and magnitude of life change. The life change was highly correlated between the two addictions and there were no significant differences. This kind of evaluation is seen as important in identifying areas in which social disruption is concentrated and as an aid to organizing treatment in a way that is acceptable and nonthreatening to the patient.

The Cornell Medical Index as an adjunct to paraprofessional evaluation of alcohol addiction.

The Cornell Medical Index may prove a significant aid to paraprofessional personnel in recognizing alcoholics in need of medical attention.

Life change, disease, perception and heroin addiction.

This is a pilot study of heroin addicts using recently developed tests which measure life change, perception of life change and perception of disease. The data indicate that heroin addicts maintain very high levels of life change while having normal or augmented perception of the impact of life change and of the seriousness of their disease. It is postulated that treatment techniques aimed at increasing understanding and insight may be countertherapeutic for these patients in that it gives them additional methods of manipulating others and tends to perpetuate the addiction life reducing life change in a setting of tight behavioral control where behavioral substitutes to heroin use are offered.