Incentives for teaching psychiatry.

A questionnaire was sent to chairs and faculty in 137 academic departments of psychiatry regarding the methods used to promote teaching and their perceived value. The incentives most often used included promotion and retention, nomination to committees, and peer recognition. Least often used were bonuses and a designated teachers' career track. Chairs and their faculty often disagreed as to whether some incentives were being used at all Recognition of teaching excellence was generally most highly valued as a useful incentive. Clarification of the nature and purpose of teaching incentives would likely improve their effectiveness.

Medical student abuse: perceptions and experience.

A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10-item attitude assessment about abusive behaviour were administered to the first- and fourth-year medical students at a mid-west US university medical school. The first- and fourth-year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth-year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.

Nicotine potentiation of haloperidol in reducing tic frequency in Tourette's disorder.

In an open, nonblind study, 10 patients with Tourette's disorder who were being treated with haloperidol were videotaped before, while, and after chewing nicotine gum. The frequency of tics was reduced significantly during the 30-minute gum-chewing period and during the 1 hour after gum chewing. Nicotine appears to potentiate haloperidol effects in patients with Tourette's disorder.

Nicotine potentiates the effects of haloperidol in animals and in patients with Tourette syndrome.

Nicotine was found to markedly potentiate haloperidol-induced hypokinesia in rats. Nicotine alone was without effect. Subsequently, concurrent administration of 2 mg nicotine gum to 10 Tourette syndrome patients being treated with haloperidol produced a substantial decrease in tics and improvement of concentration and attention span. Nicotine gum alone was without effect. While 80% of children showed improvement with nicotine gum, 70% completely discontinued the gum because of side-effects, primarily involving nausea and bitter taste. Nicotine may prove useful for treating other neuroleptic responsive disorders, such as schizophrenia and Huntington's disease.

Cerebrospinal fluid indoleacetic acid in autistic subjects.

Cerebrospinal fluid (CSF) levels of the tryptamine metabolite, indoleacetic acid (IAA), have been measured in groups of autistic and control subjects. No significant difference was seen in group mean (+/- SEM) levels of CSF IAA (autistics 5.53 +/- 0.47 ng/ml, N = 10). The finding indicates that central metabolism of the behaviorally active trace amine tryptamine is probably normal in autism.

Reduction of elevated CSF beta-endorphin by fenfluramine in infantile autism.

Fenfluramine therapy has been reported to improve behavior in infantile autism and has been associated with a decrease in abnormally increased blood serotonin content. The primary central effect has not been proved to be serotonergic. Beta-endorphin is involved in the anorexic effect of fenfluramine and may play a role in autism. Nine children with infantile autism were treated with fenfluramine in double-blind, placebo-crossover design. Transient anorexia was the only adverse effect. Autistic behavior was reported to improve in three patients, but objective psychometric tests were unchanged. Beta-endorphin-like immunoreactivity was determined in lumbar cerebrospinal fluid of patients during and before or after treatment with fenfluramine and then was compared to normal controls. Beta-endorphin was elevated significantly in the baseline autistic group (p less than .005) and was reduced toward control values during fenfluramine treatment. The results are consistent with a role for beta-endorphin in infantile autism and in the mechanism of fenfluramine treatment.

Untoward effects of fenfluramine in autistic children.

Several recent studies have described the benefits of fenfluramine for the symptomatic treatment of infantile autism. No large surveys of side effects of this drug have been reported in autistic children. To evaluate the untoward effects of fenfluramine in children with autism, 12 subjects were systematically studied. Medication was administered in a double-blind, placebo-controlled cross-over study. Parents were trained in monitoring untoward effects. These observations were compiled in detailed daily notes. In addition, four cases describing unusual effects found in a sample of 170 patients treated with fenfluramine are also reported. In the initial 2 weeks of active drug listlessness, food refusal, and stomach upset were frequently seen. A different pattern of untoward effects was seen in the final 14 weeks of treatment. Irritability, agitation, and crying along with continued food refusal were noted. The subjects lost 2.1% of body weight during active drug phase, but there was a rebound weight gain during the subsequent placebo phase. A thorough understanding of fenfluramine's side effects and adverse reactions is necessary so as to differentiate them from the multiple symptoms inherent in the syndrome of autism.

Timing of elective hypospadias repair in children.

Psychological concerns for the timing of medical procedures on children result from the longstanding realization that events and behavioral patterns of childhood have wide-ranging effects on the later behavior of the adult. A review of the literature regarding the effects of surgery on psychological development is presented. Particular reference is made to the impact of genitourinary surgery with specific emphasis on the repair of hypospadias, a congenital anomaly affecting 1:250 to 1:400 live male births. Studies of adults who underwent hypospadias repair as children suggest that they are psychologically different from their peers who did not have this surgery. Specifically, as adults they frequently have sexual difficulty despite erectile competence and they generally occupy less responsible, less competitive, and less independent professions than similarly intelligent cohorts. These findings imply that the experience of hypospadias or its surgical repair may in some way affect psychological development. By examining these experiences in light of emotional and cognitive development and the emergence of body image and sexual identity, predictions for psychologically optimal timing of surgery are made. Importance of the role of the family in the psychological outcome and a discussion of surgical considerations are also provided.