The effect of a single low dose of trihexyphenidyl on memory functioning in the healthy elderly.

Medications with anticholinergic properties, when taken at therapeutic doses, are known to adversely affect memory functioning in young adults and the elderly. However, their impact at lower doses in geriatric persons has been less thoroughly studied. We investigated the impact of a single 2-mg dose of trihexyphenidyl on memory functioning in 20 healthy elderly subjects using a within-subjects, double-blind comparison with a placebo. Memory functioning was evaluated using subtests of the Wechsler Memory Scale. Subjects also rated the perceived impact of medication on their performance following memory testing. Results indicated that the single 2-mg dose of trihexyphenidyl produced impaired performance on measures of immediate and half-hour delayed recall of complex verbal and visual material when compared to the placebo condition. However, differences were not found on several other memory measures, including general orientation, attention-concentration, and learning of word associations. The significance of these selective memory deficits and suggestions regarding future research are discussed.

Inhibited female orgasm resulting from psychotropic drugs. A five-year, updated, clinical review.

As of 1989, the psychotropic drugs that have been reported to inhibit female orgasm include antipsychotic agents (thioridazine, trifluoperazine and fluphenazine), the combination drug perphenazine/amitriptyline, antidepressants (phenelzine, isocarboxazid, tranylcypromine, amoxapine, clomipramine, imipramine, nortriptyline and desipramine) and anxiolytic agents (diazepam, flurazepam and alprazolam). The management of psychotropic-drug-induced female anorgasmia includes discontinuation of the offending drug, reduction of the dosage level, a wait for spontaneous remission while the patient remains on the agent and substitution of another medication. The use of bethanechol chloride and cyproheptadine has been successful in resolving anorgasmia while patients continue to receive antidepressants.

Status of behavioral medicine in American and Canadian medical training.

This article reports a survey of attitudes and current practices regarding behavioral medicine in American and Canadian medical school departments of psychiatry. Participants were eighty-two chairpersons of departments of psychiatry. Five major areas were addressed concerning the existence, location, and composition of behavioral medicine faculty and their contribution to training and research programs. Results indicate that behavioral medicine is represented in the majority of medical schools and teaching hospitals. Faculty tended to be located in psychiatry. A majority of the respondents did not think that behavioral medicine should be considered a separate clinical specialty area, but in actual practice behavioral medicine was distinct from consultation/liaison psychiatry as often as integrated with it. The analysis of subjects and methods taught in residency training programs suggested a meaningful trend in the data. The implications of these results for models underpinning traditional medical education and psychosomatic medicine are discussed.

Influence of factors before and during medical school on choice of psychiatry as a specialty.

Prompted by the recruitment problem facing psychiatry, the authors investigated the influence of factors before and during medical school on choice of psychiatry. A questionnaire was completed by 392 of the 1982 graduates from 114 United States medical schools who entered a psychiatric training program in 1982. College courses, work experience, and experience with someone having a psychiatric disorder were the most positive "before" factors; the clinical psychiatric elective, the psychiatrist-patient relationship, inpatient experiences during the psychiatric clerkship, and control over practice hours were the most positive "during" factors.

Inhibited female orgasm resulting from psychotropic drugs. A clinical review.

Female orgasm inhibition associated with psychotropic agents was reported ten years after the first report of ejaculatory disturbance in the male resulting from psychotropic drugs. To date, the psychotropic agents that have been reported to inhibit female orgasm include antipsychotic agents (thioridazine and trifluoperazine), monoamine oxidase inhibitors (phenelzine, isocarboxazid and tranylcypromine) and tricyclic antidepressants (amoxapine, clomipramine and amitriptyline). As awareness of this sexual side effect of psychotropic drugs grows, more drugs undoubtedly will be added to the list. Physicians should be alert to the underreporting of sexual side effects by female patients and should solicit such information from them.

How psychiatrists use vocational rehabilitation resources.

Little information is available in the literature on the extent to which psychiatrists use vocational rehabilitation resources for their patients and the kind of services they use. A survey of 174 members of a regional psychiatric society on their use of vocational rehabilitation services showed that psychiatrists referred few patients, that younger patients were referred more often than older ones, and that men were more often referred than women. Seriously disturbed patients were more often referred than less seriously ill patients. The state vocational rehabilitation agency was the one most often used by the referring psychiatrists. The authors suggest improvements in psychiatric residency training and the establishment of information programs to increase the use of vocational rehabilitation referrals by psychiatrists.

A comparative study of Asian FMG and USMG psychiatrists.

Of 367 East Asian and South Asian psychiatrists responding to a 1976 survey, 295 were identified as foreign medical graduates (FMGs) and 72 as U.S. medical graduates. Comparison of the two groups showed that the FMG'S WERE MORE LIKEly to be trained and employed in state mental hospitals and other nonacademic settings and to treat patients of other minorities. The Asian FMGs were less likely to have specialty board certification, a finding that seems to reflect their incomplete professional development and American acculturation. The authors conclude that Asian FMG psychiatrists shoulder much of the responsibility for treating minority patients in the United States, a job for which they may be ill equipped. Their need for special training in both cultural and professional areas is emphasized.

A profile of Asian-American psychiatrists.

Of 367 respondents to a survey of Asian-American members of the American Psychiatric Association, fewer than 16% were American-born U.S. medical graduates, and 41% of the patients treated by this sample were minority group members. These findings have important implications for training. Asian psychiatrists have recently emerged as the largest visible multiethnic minority group within American psychiatry, and increased attention to this group may lead to its more appropriate utilization in this country.

A study of involuntary patients in Seattle.

The authors describe a study of 224 involuntary patients admitted to, Harborview Medical Center in Seattle in 1974, the first year of the implementation of Washington States Involuntary Treatment Act. The patients, 115 men and 109 women, had a total of 297 episodes of hospitalization, with an average length of stay of 12.7 days. Fifty-one per cent were discharged in less than ten days. The authors compare the findings with studies of similar patient groups in Sacramento, California, and New York City. They concur with others who believe involuntary treatment statues provide a means of dealing with the small group of psychiatric patients whose needs would otherwise go unattended.

The first year of a child advocacy project.

In a child advocacy project funded through a community mental health center, five area residents were trained as advocates and assigned to two elementary schools. The advocates spent much of their first year in training, and in trying to establish themselves as resource persons for children and families, in setting up parent-school councils, and in developing recreational programs. They found it easier to be activists and caregivers than corrdinators of services, and they met some resistance from the schools and the community. But by the end of the first year the advocates had made significant progress in helping children and families obtain community services and in increasing contact between parents and the schools.

A behavior analysis report for assessing clients' needs.

The entry and assessment service of Harborview Community Mental Health Center, attepting to find the most suitable approach to diagnosis and assessment for its facility, developed the Behavior Analysis Report (BAR). The BAR is a five-part report written through the collaboration of both interviewer and client. It contains problem behaviors, adaptive behaviors and resources, treatment goals, disposition, and suggestions for treatment. The authors give sample descriptions from each part, together with a complete BAR.