A sensitive semi-micro column HPLC method with peroxyoxalate chemiluminescence detection and column switching for determination of MDMA-related compounds in hair.

A sensitive semi-micro column HPLC method with peroxyoxalate chemiluminescence (POCL) detection and column switching has been developed for simultaneous determination of 3,4-methylenedioxymethamphetamine (MDMA) and related compounds, for example 3,4-methylenedioxyamphetamine, methamphetamine, and amphetamine, in hair. After digestion of the hair with 1 mol L-1 sodium hydroxide the compounds were extracted with n-heptane and derivatized with 4-(N,N-dimethylaminosulfonyl)-7-fluoro-2,1,3-benzoxadiazole. A mixture of hydrogen peroxide and bis(2,4,5-trichloro-6-carbopentoxyphenyl)oxalate in acetonitrile was used as post-column CL reagent. Calibration plots showed linearity was good (r=0.999); detection limits were 0.02-0.16 ng mg-1 hair at a signal-to-noise ratio of 3. The precision of the method, as RSD (n=5), in intra-day and inter-day assays was better than 5.0 and 6.9%, respectively. The proposed method was sufficiently sensitive to detect low ng mg-1 levels of MDMA and related compounds in hair, and could be used for quantification of the compounds in hair samples from patients treated in a chemical dependency unit.

The use of electroconvulsive therapy in atypical psychotic presentations: a case review.

Convulsive therapy and its progeny, electroconvulsive therapy (ECT), were originally used for the treatment of catatonic schizophrenia, and there is little doubt that ECT remains an effective intervention for the treatment of schizophrenia. However, current practice tends to favor the use of ECT in severe or treatment refractory affective disorders, and its use in schizophrenia and other nonaffective (atypical) psychotic disorders has become controversial.CASE REPORTS HAVE SUGGESTED A ROLE FOR ECT IN TWO SPECIFIC ATYPICAL PSYCHOTIC DISORDERS: Cotard's syndrome and cycloid psychosis. In this article, we review the atypical psychotic disorders and report a series of five case examples that signify the role of ECT in atypical psychotic presentations, particularly when the symptoms resemble those found in Cotard's syndrome and cycloid psychosis.

Expert testimony in capital sentencing: juror responses.

The U.S. Supreme Court, in Furman v. Georgia (1972), held that the death penalty is constitutional only when applied on an individualized basis. The resultant changes in the laws in death penalty states fostered the involvement of psychiatric and psychologic expert witnesses at the sentencing phase of the trial, to testify on two major issues: (1) the mitigating factor of a defendant's abnormal mental state and (2) the aggravating factor of a defendant's potential for future violence. This study was an exploration of the responses of capital jurors to psychiatric/psychologic expert testimony during capital sentencing. The Capital Jury Project is a multi-state research effort designed to improve the understanding of the dynamics of juror decision-making in capital cases. South Carolina data (n = 214) were used to investigate the impact of expert testimony on the mitigating factor of mental illness and the aggravating factor of future dangerousness. Ordered logit regression analyses revealed significant correlations (p < .005) between the presence of a defense psychiatrist or psychologist expert witness during the sentencing phase and jurors' having the impression that the defendant was mentally disturbed. Similar analyses revealed no significant relationship between the presence of state-introduced psychiatric testimony and jurors' having the impression that the defendant, if not executed, would be violent in the future. These findings seem to contradict the view that psychiatric testimony on future dangerousness in death penalty cases has a powerful impact on jurors. The jurors in this study were significantly influenced, however, by psychiatric/psychologic testimony in the area of a defendant's mitigating mental abnormality.

An analysis of the effect of funding source in randomized clinical trials of second generation antipsychotics for the treatment of schizophrenia.

OBJECTIVE: The effect of funding source on the outcome of randomized controlled trials has been investigated in several medical disciplines; however, psychiatry has been largely excluded from such analyses. In this article, randomized controlled trials of second generation antipsychotics in schizophrenia are reviewed and analyzed with respect to funding source (industry vs. non-industry funding). METHOD: A literature search was conducted for randomized, double-blind trials in which at least one of the tested treatments was a second generation antipsychotic. In each study, design quality and study outcome were assessed quantitatively according to rating scales. Mean quality and outcome scores were compared in the industry-funded studies and non-industry-funded studies. An analysis of the primary author's affiliation with industry was similarly performed. RESULTS: Results of industry-funded studies significantly favored second generation over first generation antipsychotics when compared to non-industry-funded studies. Non-industry-funded studies showed a trend toward higher quality than industry-funded studies; however, the difference between the two was not significant. Also, within the industry-funded studies, outcomes of trials involving first authors employed by industry sponsors demonstrated a trend toward second generation over first generation antipsychotics to a greater degree than did trials involving first authors employed outside the industry (p=0.05). CONCLUSIONS: While the retrospective design of the study limits the strength of the findings, the data suggest that industry bias may occur in randomized controlled trials in schizophrenia. There appears to be several sources by which bias may enter clinical research, including trial design, control of data analysis and multiplicity/redundancy of trials.

Persistent, unwanted erections in an 8-year-old boy.

Although unusual somatic preoccupations can be seen in somatoform disorders and obsessive-compulsive disorder (OCD), unwanted penile erections have been described only in two cases of OCD, both adults. In the present case an 8-year-old boy developed unwanted erections, other obsessive-compulsive symptoms, as well as symptoms of posttraumatic stress disorder, such that he met criteria for both disorders. Treatment consisted of sertraline combined with individual play therapy and family therapy, following which the patient reported modest improvement in symptoms of both disorders.