Faculty Bibliography

These clinical data may offer some support for the hypothesis that opiates have antidepressant, antimanic, and antipanic effects. This hypothesis should be studied directly by double-blind studies of the effects of exogenous and synthetic endogenous opioid peptides in patients with major depressive illness, panic and anxiety states, schizophrenia, and schizo-affective illness. These clinical data support our studies in nonhuman primates and man which suggest a common LC or NE hyperactivity may underly both drug withdrawal and spontaneous panic states. Whether endorphin deficiency or derangements account for the postulated NE hyperactivity needs additional study and we will discuss our preliminary work later. Failure of endorphins to terminate bursts in LC firing rate and NE release may be responsible for both of these types of panic states. In addicts, this mechanism could exist prior to opiate use, or abuse of potent exogenous endorphinomentic compound may cause an endorphin-abnormality. Both of these possibilities would be compensated by continuous opiate maintenance. Methadone maintenance is a complicated psychiatric, psychological, and social phenomenon. Further studies are necessary to evaluate the role of opiate maintenance in treating or suppressing the emergence of underlying psychopathology. Previous psychiatric hospitalization or treatment for a schizophrenic or affective illness may contraindicate absolutely the use of clonidine or other rapid detoxification methods. These data suggest the possibility of substituting a nonaddicting psychotropic medication for opiates in some patients who are self-medicators. The clinical data support other data suggesting the potential antipsychotic, antidepressant, and antianxiety/antipanic effects of the endogenous opioids, endorphins, and exogenous opioids, endorphins, and exogenous opiates. These and other data suggest potential utility for opioid agonists and endorphin testing in psychiatric treatment and diagnosis

Psychiatric complications of antihypertensive medications have been identified in the literature primarily in case reports. Most other studies to date have suffered from major design flaws. Side effects seriously complicate the treatment of hypertensive patients and no doubt decrease compliance. There are significant interactions between psychotropic medications and antihypertensive drugs. The literature is reviewed, and the implications for clinical practice of psychiatric side effects of antihypertensive treatment and of psychotropic-antihypertensive interactions are discussed

Recognition of depression as a psychobiologic disorder, its division into categories more descriptive than 'endogenous' and 'reactive,' and use of certain laboratory tests in suspected major (primary) depression have led to increased accuracy of diagnosis. An episode of major depression now can be readily identified by conformance to descriptive criteria, can be confirmed by results of neurophysiologic testing, and can be treated with a tricyclic antidepressant and psychotherapy

Studies of patterns of lutenizing hormone (LH) secretion in anorexia nervosa are reviewed. Restoration of ideal weight is not always associated with return to adult circadian LH secretion patterns. Abnormalities in LH secretion (immature patterns) may represent a biological 'marker' of active anorexia nervosa