Faculty Bibliography

Of 60 cocaine misusers seeking outpatient treatment, 33 (55%) dropped out by 4 weeks. Dropouts were more likely to be male, Black or Hispanic, or with no history of primary depression. Completers were more likely to be White, female, or depressed. The implications of these findings and possible strategies for reducing the dropout rate are discussed.

Of 17 consecutive patients receiving methadone maintenance treatment who had primary or chronic depression, nine (53%) improved in both mood and drug abuse after imipramine treatment. This finding suggests a potential for helping such dual-diagnosis patients reduce drug abuse and associated risk for HIV. Further controlled trials are warranted.

An open trial of lithium carbonate showed little efficacy for 10 cocaine abusers with bipolar spectrum disorders. It may be that the bipolar subgroup of cocaine abusers is heterogeneous and that only a fraction are lithium responsive.

The arecoline REM induction test, a measurement of central cholinergic sensitivity, was performed in 10 patients with atypical depression. Arecoline induced REM sleep significantly more rapidly than placebo. Atypical depressives without evidence of anxiety, in particular those without panic attacks, had a more rapid REM induction response to arecoline than atypicals with anxiety symptoms. We compared our atypical depressives with normal controls and affectively ill patients studied in other laboratories. The rapid REM induction response observed in atypical depressives without anxiety was comparable to that seen in endogenous depressives and euthymic bipolars. Previous studies have demonstrated the presence of cholinergic supersensitivity in the latter two groups of patients. Our results suggest that atypical depressives may be distinguished in their response to arecoline based on their anxiety history, and that cholinergic supersensitivity is present in atypical depressives without anxiety. Additional studies with larger samples and simultaneously studied control groups are necessary to test these preliminary findings.

In planning psychopharmacologic treatment of patients with borderline personality disorder (BPD), three partially validated subtypes should be considered. The validity of the schizotypal subtype is supported by their favorable response to neuroleptics as well as by familial and genetic studies. The validity of emotionally unstable character disorder (EUCD) is supported by the presence of neurological soft signs, their negative response to antidepressants, and their positive response to chlorpromazine and lithium. The data presented in this paper suggest that some patients who meet borderline criteria and have atypical depression (patients meeting DSM-III-R criteria for major depression or dysthymia who have reactive mood and any atypical symptoms) clearly benefit from treatment with antidepressant medication. Although some patients with atypical depression who meet borderline criteria will improve with tricyclic therapy, a significantly greater proportion will improve with the monoamine oxidase inhibitor (MAOI), phenelzine.

Eight (32%) of 25 alcoholic women on an inpatient detoxification unit met modified DSM-III criteria for panic disorder, 2 (8%) of 25 met criteria for depressive illness, and 7 (28%) of 25 met criteria for both disorders. These findings replicate the findings of other recent studies and lend preliminary support to the self-medication model of alcoholism.

The Type A behavior pattern (TABP) is a recognized risk factor for coronary heart disease (CHD), and yet treatments aimed at its modification are not in widespread use. We reviewed the literature of controlled studies (N = 18) of the psychologic treatment of the TABP and of CHD with the statistical method of "meta-analysis." The results of each study were converted to a standardized "Effect Size" (ES). The mean ES for TABP measures was 0.61 +/- 0.20 (95% confidence interval) (p less than 0.001), indicating that after treatment subjects across all studies reduced their TABP scores by half a standard deviation. The combined significance probability (pc) across studies for reduction in 3-year combined mortality and myocardial infarction was pc less than 0.0001, corresponding to a reduction in coronary events of roughly 50% after psychologic treatment. This finding must be approached with caution because it is based on only two studies. The analysis suggested that a combination of treatment techniques is most effective in reducing TABP and CHD recurrences. The literature was critiqued, and limitations of the findings are discussed. We conclude that psychologic intervention to reduce TABP may improve clinical outcome of CHD and that this deserves further study and preliminary clinical application.