Sumatriptan responsiveness and clinical, psychiatric and psychologic features in migraine patients.

OBJECTIVE: To compare sumatriptan responders and nonresponders in a migraine population with regard to a number of clinical, psychiatric and psychologic features. METHODS: Patients were drawn from a referral headache clinic population, and classified as responders or nonresponders. Clinical features were assessed by a written questionnaire. The lifetime prevalence of several psychiatric disorders was determined by the National Institute of Mental Health diagnostic interview schedule and personality factors were measured by the 16 Personality Factors (16PF) Questionnaire. RESULTS: Nonresponders indicated less influence on their migraine by menstrual factors, had a higher lifetime prevalence of generalized anxiety, and showed 16PF scores indicating greater shyness, self-sufficiency and perfectionism. Nonresponders were also more imaginative and less socially outgoing. CONCLUSION: Although they must be interpreted with caution due to small sample size and the multiple comparisons made, our results indicate that there may be differences between sumatriptan responders and nonresponders with regard to a number of clinical, psychiatric and psychologic factors. These results suggest that biological differences exist between the two patient groups which likely account for both the differences in their responses to sumatriptan and in the clinical features noted above.

Hospital days in risperidone-treated patients.

OBJECTIVE: To compare inpatient hospital days of a group of "real world" schizophrenia-spectrum patients for 3 years prior to and 3 years after risperidone initiation. METHOD: This is a retrospective cohort study using a mirror-image design of hospital days in 120 patients over a 6-year period. Hospital admission and discharge information was obtained from chart review and database extraction at 3 outpatient treatment sites. The sample comprised all patients attending these clinics who were prescribed risperidone during the first year of the drug's release. RESULTS: Patients separated into 3 treatment groups: those who were prescribed risperidone for 3 uninterrupted years (N = 35), those who interrupted but resumed risperidone use and were prescribed the drug at 3 years (N = 8), and those who discontinued risperidone during the 3-year follow-up period (N = 77). The group continuing risperidone to 3 years demonstrated a significant decrease in hospital days after risperidone treatment, in contrast to the other 2 groups. The reduction in inpatient days for the total sample was not statistically significant. CONCLUSION: In this outpatient clinic sample, the 29% of patients who continued on risperidone showed a significant reduction in inpatient hospital days, from an average of 17.2 days per year in the 3 years before risperidone treatment to an average of 2.1 days per year for the 3 years of risperidone treatment.

Hospital days in clozapine-treated patients.

OBJECTIVE: To examine inpatient hospital days used by a group of patients with treatment-resistant schizophrenia for 3 years before and 3 years after clozapine initiation. METHOD: A retrospective chart review of 26 consecutive admissions to an outpatient clozapine clinic was conducted for a 6-year period. The total number of hospital days was recorded. RESULTS: Patients separated into 3 groups: those who used clozapine for 3 uninterrupted years (N = 11, 42.3%), those who interrupted but resumed clozapine and continued on to 3 years (N = 4, 15.4%), and those who abandoned clozapine treatment (N = 11, 42.3%). Only the group that was continuously on clozapine showed a decline in percentage of inpatient days during the 3-year follow-up period. Three of the 11 patients who discontinued clozapine died during the posttreatment period: 2 suicides and 1 "death by misadventure." CONCLUSIONS: Continuous clozapine treatment significantly reduces days in hospital; this reduction was sustained throughout 3 years' follow-up. While the sample size is small, all patients were tracked over a 6-year period, and both drug continuers and dropouts were followed. The reduction in inpatient days may be lost if patients stop and then restart clozapine. For patients who do not respond to or abandon trials of clozapine, there is an urgent need to develop more effective treatment strategies.

Cognitive failures and stress.

138 healthy volunteers in four age groups completed the Cognitive Failures Questionnaire (Self and Other) as well as measures of attention, freedom from distractibility, daily stress, and trait-state anxiety. Self-reported and observed cognitive failures were strongly associated with stress and anxiety. Higher self-reported cognitive failure in one age group appeared tied to this finding. We discuss the usefulness of self-report of cognitive failures for neuropsychological practice.

Elizabethan madness: on London's stage.

During the reign of Elizabeth I (1558-1603) a renaissance of both literary and political history occurred. The stage was transformed from primitive echoes of the morality plays to a vibrant and diverse exploration of human endeavor and man's place in the universe. The titanic literary figure of Shakespeare today veils a group of friends and challengers whose pens strove for the same goal. The depiction of madness was ubiquitous during plays of this time and reflection on the views of this group of men gives us a more reliable insight into mental illness then and today.

The clozapine experience from a family perspective.

OBJECTIVE: To examine how the lives of family members of clozapine-treated patients with schizophrenia have been affected by this treatment. METHODS: Through the use of a questionnaire and an interview of family members, this qualitative study focused on the families' perceptions of change in their family member and the impact on the family unit. RESULTS: Fourteen patients and their family members participated. The family interview was conducted an average of 1.78 years after clozapine initiation (range 0.58 years to 3.73 years). Global ratings of behavioural change were positively and significantly correlated between all raters: patients, family members, and clinicians. Family members were positive about clozapine's effect on their relatives and the impact on the family. CONCLUSION: A positive response to clozapine decreases the burden on the family. This is in part the result of a decreased need for rehospitalization.

Clomipramine treatment and behaviour therapy with agoraphobic women.

The separate and combined effects of clomipramine hydrochlorzide and behaviour therapy on agoraphobic symptoms were investigated in a 28-week placebo-controlled double-blind clinical trial. One hundred and eight women diagnosed as agoraphobic were randomly assigned to one of four treatment conditions: clomipramine alone, behaviour therapy alone, clomipramine and behaviour therapy or placebo. Sixty women completed the assigned treatment. Clomipramine was prescribed in weekly increments to a maximum of 300 mg per day, with a mean dosage at week 8 of 94.6 mg per day. Behaviour therapy focused on graded in vivo exposure therapy. Assessments of patients were performed at six points prior to and during the trial and included standardized questionnaires, daily diaries and a Behavioral Approach Test. Significant main effects for both clomipramine and behaviour therapy on 15 and 12 of the dependent measures respectively were found but no interaction of treatments emerged.

The use of chloral hydrate and sodium amytal during clozapine initiation.

Sedative hypnotics are frequently a necessary adjunctive to neuroleptic treatment. The recently released antipsychotic agent clozapine poses a challenge in this regard since the manufacturer advises caution when using clozapine with patients receiving benzodiazepines. The effectiveness of alternate agents sodium amytal and chloral hydrate when initiating clozapine was evaluated in a group of 15 patients suffering from schizophrenia. These medications were observed to be both safe and effective.

Terms of madness: historical linguistics.

The etymological origins of commonly used descriptors of mental conditions are explored. In reviewing history for signs of mental disorders, we need to understand the terms used previously to indicate abnormalities. A wealth of terms is evident indicating that, contrary to the conclusions of some historians, mental illnesses have an extended and broad history.

A case of pseudologia fantastica with antisocial personality disorder.

A case of pseudologia fantastica with antisocial personality disorder is described. It is important to obtain previous admission records as early as possible so patients can be confronted with the discrepancies in their history. The concept of pathological lying is discussed.

Long term use of neuroleptics by schizophrenic patients.

1. Use of antipsychotic medications by schizophrenic patients. 2. Side effects of typical neuroleptics. 3. Dosage strategies for treating schizophrenia. Evidence that high dosage treatment and rapid neuroleptization concepts should be abandoned. 4. Minimal effective dosage in maintenance treatment. Studies attempting to define this regimen. 5. Blood levels of antipsychotics and their clinical relevance. 6. New research strategies, focusing on a) case definition, b) target symptoms, c) clinically stable patients, d) dosage reduction studies.

Self-paced learning in children with attention deficit disorder with hyperactivity.

Attention deficit (ADDH) children self-paced the delivery of response pairs for paired-associate learning at about the rate previously shown to be conducive to relatively good learning in attention deficit. The self-pacing opportunity did not seem either to impair or to enhance the learning performance. On methylphenidate they paced themselves at about the same rate but learned much more. Stimulant therapy does not help by "slowing the child down" but permits more effective memorizing at the same presentation rate.