Faculty Bibliography

Fluoxetine (20 mg/day) was added for 7-10 days to stable doses of haloperidol given to eight psychotic patients. Mean plasma concentrations of haloperidol were elevated by 20% (p less than 0.05), but extrapyramidal side effects did not increase appreciably, indicating a relatively minor interaction between these agents

A heterogeneous sample of 61 chronically psychotic patients were subgrouped according to the presence or absence of a self-reported history of childhood abuse. Patients reporting childhood abuse (n = 27) had an earlier age of onset, scored higher on the Dissociative Experiences Scale, reported more amnesia, and relapsed more frequently than patients not reporting abuse histories. Histories of childhood abuse and of past stimulant abuse predicted the score on the Dissociative Experiences Scale. A history of childhood abuse may thus contribute to the symptomatology and course of illness in some chronically psychotic patients

The authors report two cases of ejaculatory dysfunction induced by fluoxetine. Cyproheptadine, an antihistaminic and antiserotonergic drug, restored sexual function in each case. Possible mechanisms of fluoxetine-induced anorgasmia are presented and treatment options are reviewed

In a double-blind, random-assignment, parallel-group trial, outpatients with major depression received either the new antidepressant clovoxamine, the tricyclic amitriptyline, or placebo for 6 weeks. By an 'improvement' criterion of 50% or greater improvement in the Hamilton Depression Scale (HAM-D) total score, 88% of clovoxamine completers improved versus 75% with amitriptyline and 43% with placebo; however, due to small numbers, the differences failed to reach statistical significance. Diminished salivary flow was significantly greater with amitriptyline, as were complaints of dry mouth, somnolence, dizziness, and headache. Nausea and vomiting were more common in the clovoxamine-treated group. With amitriptyline, but not with clovoxamine, memory performance declined over a month. However, psychomotor performance was not affected

The authors enrolled 21 patients in a random-order, crossover, double-blind trial of phosphatidylcholine (lecithin) 20 g/day and placebo. Fourteen patients completed at least 6 weeks of the second 8-week trial and were used for efficacy analyses. Side effects were minimal. The lecithin treatment effect--about one half of an Abnormal Involuntary Movement Scale point--was seen as a statistical effect of treatment order, based on differences between patients who took the active compound before or after they took the placebo. Clinically, however, the lecithin effect was negligible

The authors present a series of cases demonstrating that some chronically psychotic patients require higher doses of antipsychotic medication (greater than 15 mg/day of haloperidol equivalents) than are currently in vogue as a result of research on low-dose treatment. In a random sample of 100 patients treated with psychotropic medication, 64 were treated with antipsychotics. Of these, 8 (12.5%) appeared to require high doses. The literature on low-dose treatment is reviewed, and the role of higher-dose therapy is placed in perspective

Mean ratings of positive and negative symptoms and depression significantly improved in nine treatment-resistant schizophrenic patients who completed a 6-week open trial of fluoxetine added to their neuroleptics. The authors identify differences between responders and nonresponders and recommend controlled trials

The effects of the therapist's assuming control of the patient's finances through representative payeeship is discussed. The authors use case examples from an urban outpatient community mental health center to illustrate administrative issues, ethical conflicts, and transference and countertransference manifestations of payeeship. They favor an approach whereby the institution is formally the payee and a clinician is designated to manage a patient's account. For most patients for whom a clinician assumed payeeship, compliance with treatment increased, the number and length of hospitalizations decreased, and housing arrangements improved. Although designating the therapist as payee has a significant impact on the therapeutic relationship, in most cases the patient is so impaired that the benefits outweight the liabilities

Of the first 60 patients treated at our clinic with the antidepressant fluoxetine, 5 (8.3%) developed treatment-emergent sexual dysfunction (anorgasmia and/or delayed orgasm). Three of those 5 patients had a history of treatment-emergent sexual dysfunction while receiving other antidepressant agents. Clinicians should be aware of this side effect of fluoxetine