Ibogaine: complex pharmacokinetics, concerns for safety, and preliminary efficacy measures.

Ibogaine is an indole alkaloid found in the roots of Tabernanthe Iboga (Apocynaceae family), a rain forest shrub that is native to western Africa. Ibogaine is used by indigenous peoples in low doses to combat fatigue, hunger and thirst, and in higher doses as a sacrament in religious rituals. Members of American and European addict self-help groups have claimed that ibogaine promotes long-term drug abstinence from addictive substances, including psychostimulants and opiates. Anecdotal reports attest that a single dose of ibogaine eliminates opiate withdrawal symptoms and reduces drug craving for extended periods of time. The purported efficacy of ibogaine for the treatment of drug dependence may be due in part to an active metabolite. The majority of ibogaine biotransformation proceeds via CYP2D6, including the O-demethylation of ibogaine to 12-hydroxyibogamine (noribogaine). Blood concentration-time effect profiles of ibogaine and noribogaine obtained for individual subjects after single oral dose administrations demonstrate complex pharmacokinetic profiles. Ibogaine has shown preliminary efficacy for opiate detoxification and for short-term stabilization of drug-dependent persons as they prepare to enter substance abuse treatment. We report here that ibogaine significantly decreased craving for cocaine and heroin during inpatient detoxification. Self-reports of depressive symptoms were also significantly lower after ibogaine treatment and at 30 days after program discharge. Because ibogaine is cleared rapidly from the blood, the beneficial aftereffects of the drug on craving and depressed mood may be related to the effects of noribogaine on the central nervous system.

Maintaining treatment boundaries in small communities and rural areas.

Psychiatrists and other mental health professionals practicing in small communities and rural areas encounter unique situations and customs that may complicate the task of maintaining treatment boundaries. Boundary adjustments are frequently required that do not disturb the psychiatrist-patient relationship. The authors discuss specific boundary problems that arise in maintaining the psychiatrist's neutrality; fostering the psychological separateness of the patient; protecting confidentiality; ensuring that the psychiatrist has no previous, current, or future personal relationship with the patient; preserving anonymity of the psychiatrist; and establishing a stable fee policy. Four vignettes illustrate boundary issues that may be encountered in psychiatric practice in small communities. The authors suggest that applying the rule of abstinence, which states that the therapist must abstain from obtaining personal gratification at the expense of the patient, can help therapists distinguish between boundary issues, crossings, and violations.

The value of the Mini-Mental State Examination in childhood: a preliminary study.

The Mini-Mental State Examination (MMSE), a screening test of higher mental function, has been modified slightly for use in a pediatric outpatient setting. The test, which takes 5 to 10 minutes to administer, covers a range of cognitive functions including orientation, attention-concentration, memory, language, and constructional ability. In a preliminary study, we have found that the test can be applied from the age of 4 years. Highly significant correlations were found between the MMSE score and chronologic age (r = .57; P < .001), reading age (r = .79; P < .001), and mental age (r = .83; P < .001). MMSE scores reach a plateau at a mental age of approximately 10 years. The MMSE is a suitable instrument for screening higher mental function in children at the age of 4 years and above and can be readily incorporated into the routine neurologic examination of children.

Are your students learning in a safe environment?

Whenever numerous people gather in a limited area the chances for unsafe conditions exisitng increase. A school building is no exception. Each year the results of unsafe conditions in school settings show up in national accident statistics. By law, school districts are required to provide a safe school environment. Specifically, each teacher is responsible for providing a safe learning environment. To help teachers become more aware of a safe environment the authors have developed a self-awareness checklist.