Effects of medication on parotid salivary flow rates in an individual with dementia of the Alzheimer type.

Data available on the relationship between salivary function and specific drug therapy are sparse. We measured unstimulated and stimulated parotid salivary flow rates associated with the drug therapies. Our ancillary study design is an N = 1 double-blind randomized controlled trial in which the patient undergoes a series of treatment blocks of either placebo or active treatment. The purpose of the parent N of 1 study was to find the "best single drug" treatment for a resistive patient diagnosed with dementia of the Alzheimer type. This study demonstrates that thiothixene was associated with inconsistent effects on parotid flow. Oxazepam had no effect on his parotid function, and diphenhydramine hydrochloride had inconsistent but generally negative effects. The data also show that this individual with dementia of the Alzheimer type had lower baseline unstimulated and stimulated parotid salivary flow rates when compared with mean "normal" values; however, flow rates were above the lowest 10th percentile of "normal" volunteers.

Psychophysiological assessment of posttraumatic stress disorder imagery in World War II and Korean combat veterans.

We assessed the heart rate, skin conductance, and left lateral frontalis electromyographic responses of World War II (WWII) and Korean War male veterans to recollection of their combat experiences by using a script-driven imagery technique previously validated in Vietnam veterans (Pitman et al., 1990; Pitman, Orr, Forgue, de Jong, & Claiborn, 1987). Medication-free subjects were classified on the basis of criteria from the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders into posttraumatic stress disorder (PTSD; n = 8) and non-PTSD (n = 12) groups, which did not differ in overall combat exposure or severity of personal combat events. PTSD subjects' physiological responses during personal combat imagery were markedly larger than those of non-PTSD subjects', even though the self-reported emotional responses of the two groups were comparable. A physiological discriminant function derived from Vietnam veterans (Orr et al., 1990) correctly classified 7 of the 8 PTSD subjects (sensitivity was 88%) and 12 of the 12 non-PTSD subjects (specificity was 100%; p < .001).

A single-case-study method for treating resistiveness in patients with Alzheimer's disease.

A single-case-study approach was used to identify the best medication for treating resistiveness to care in patients with moderately advanced dementia. The double-blind research design incorporated three medications, placebo washout periods, multiple baselines, frequent ratings by nurses of patients' resistiveness, and visual and statistical analysis of results to find the optimal drug, one that provided a stable response at a low dose. Six patients completed the trials. Thiothixene was more effective than oxazepam and diphenhydramine. Important features of the design were its avoidance of polypharmacy and high doses and its use of frequent ratings (each nursing shift) of patients' resistiveness. Although the single-case-study method is labor intensive, it can be beneficial when adapted for clinical use.

Psychometric profile of posttraumatic stress disorder, anxious, and healthy Vietnam veterans: correlations with psychophysiologic responses.

Three groups of Vietnam combat veterans, posttraumatic stress disorder (PTSD, n = 25), anxious (n = 7), and healthy (n = 18), completed a battery of psychometric tests. Measurement of psychophysiologic responses to imagery of individualized combat experiences followed the psychometrics. The PTSD Ss differed significantly from the healthy Ss on almost all measures but showed fewer differences from the anxious Ss. The typical PTSD S was characterized as anxious, depressed, prone to dissociation, and external in locus of control. Correlations with the physiologic responses supported the validity of psychometric scales specifically designed to measure PTSD but cast doubt on the interpretation of traditional measures of overreporting or dissimulation in this disorder.

Psychophysiologic responses to combat imagery of Vietnam veterans with posttraumatic stress disorder versus other anxiety disorders.

We used psychophysiologic techniques to assess responses to imagery of psychologically stressful past experiences in medication-free Vietnam combat veterans classified, on the basis of DSM-III-R criteria into posttraumatic stress disorder (PTSD; n = 7) or non-PTSD anxiety disorder (anxious; n = 7) groups. Scripts describing each individual's combat experiences were recorded and played back in the laboratory. Ss were instructed to imagine the events the scripts portrayed while heart rate, skin conductance, and frontalis electromyogram were recorded. PTSD Ss' physiologic responses were higher than those of anxious Ss. A discriminant function derived from a previous study of PTSD and mentally healthy combat veterans identified 5 of the 7 current PTSD Ss as physiologic responders and all 7 of the anxious Ss as nonresponders. Results of this study replicate and extend results of the previous study and support the validity of PTSD as a separate diagnostic entity.

Additional psychiatric illness by Diagnostic Interview Schedule in male alcoholics.

Seventy-four male veterans entering an alcohol abuse treatment program were screened for additional psychiatric diagnoses using the Diagnostic Interview Schedule (DIS). Fifty-four of these also completed a questionnaire on personal and family drinking history. Over half (54.1%) had another diagnosis. The most common syndromes other than substance abuse were antisocial personality disorder, phobic disorder, and depression. In each of these cases, the presence of the additional disorder accelerated the course of the alcohol problem significantly. The difference in course between syndromes was dwarfed by the time of presentation by the difference between "pure" alcoholism and alcoholism with another diagnosis. The primary versus secondary distinction appeared to account for only a part of this effect.

Response to neuroleptic drugs as a device for classifying schizophrenia.

Although schizophrenic patients are routinely treated with neuroleptic medication, the diversity in response to such treatment is noteworthy; some patients are exquisitely responsive to neuroleptic treatment, while others are clearly resistant. The authors examine the hypothesis that neuroleptic-responsive and neuroleptic-resistant patients have different illnesses by considering the following issues: the reliability of the distinction between neuroleptic responsiveness and resistance; the consistency in neuroleptic responsiveness over time; the association between neuroleptic responsiveness and other clinical features; and the neuroleptics' therapeutic action. On the basis of the data available and on theoretical and historical grounds, the distinction between neuroleptic-responsive and neuroleptic-resistant patients warrants application in both clinical and research settings.

Pharmacologic management of Alzheimer-type dementia.

Diagnosis of Alzheimer-type dementia is made by excluding other causes of dementia. This type of dementia is not well understood, but affects one million persons in the United States. Ergoloid mesylates are sometimes useful. A promising approach may be increasing brain cholinergic activity through combinations of drugs, such as lecithin and physostigmine. Sleep disturbances and impulsivity may both respond to benzodiazepines. Other drugs are being studied, but nonpharmacologic strategies may accomplish more.

Aspects of teaching psychotherapy to medical students.

Much concern has centered on medical students' failure to choose psychiatry as a career. Little of this discussion focuses on the challenges of treating psychiatric patients. Although all students of psychotherapy face difficult training, the medical students' preparation is unique, especially in experiencing, tolerating, and using countertransference. Understanding and caring for psychiatric patients (whether pharmacologically, psychodynamically, or otherwise) involves exposure to extremes of emotion. A therapeutic response demands skills quite different from those culled by the medical admission process and the preclinical years. Appropriate handling of consequent problems is hampered when some of the psychotherapeutic aspects of clerk-patient relations go unrecognized and when supervisors avoid discussion of the student's reactions as an integral part of the work. Without specific attention to these areas, many students feel inadequate or frightened in the clerkship. With supervisory aid, such unwelcome situations can be converted to diagnostic and therapeutic tools of great value.