Faculty Bibliography

Although the scope of basic studies in psychopharmacology and psychobiology has been expanding steadily for about 30 years, relatively few clinical psychiatrists, psychologists, and psychopharmacologists now choose to become researchers or teachers in these disciplines. Such training is crucial to the future vitality of both academic and private-practice psychiatry, and in view of increasing constraints on training funds, student researchers may well be an endangered species. With these concerns in mind, at its 1984 meeting, the American College of Neuropsychopharmacology's Education and Training Committee organized a symposium of investigators, administrators, and former trainees to explore aspects of effective clinical research training in psychobiology and psychopharmacology. Aspects discussed included mentoring, settings and content of training, depth versus breadth of curriculum, and the effect of a critical mass of colleagues at various stages of professional development. Following a brief overview, selected panelists addressed the issues from their individual perspectives.

The inpatient treatment of the chronically mentally ill as it has been practiced in the past, is practiced at the present, and may be practiced in the future is discussed. The reasons for admitting the chronically ill to inpatient services; the steps of such treatment and treatment modalities employed; and considerations for discharge are presented. In addition, the indications as well as pros and cons for long-term inpatient hospitalization are included.

A method for the quantitative determination of chlorpromazine and five of its major metabolites in a single sample of biological fluid in the ng/ml range has been developed utilizing gas chromatography/mass spectrometry with selected ion recording. The assay is highly specific and quantification is accomplished by an inverse stable isotope dilution technique, using deuterium-labeled variants of the compounds as internal standards. In this way the concentrations of chlorpromazine and five of its major metabolites (the sulfoxide, the N-oxide, the monodemethylated, the didemethylated, and the 7-hydroxylated compounds) can be determined in biological fluids. Levels in humans have been measured both in plasma and in red blood cells and are compared to those found in related in vitro studies.

Although family intervention is practiced in most psychiatric hospitals, there are no adequately controlled studies of its efficacy. This study was designed to answer, in part, the following question: What is the relative efficacy of hospitalization with family intervention as compared with hospitalization without family intervention for patients with major psychiatric disorders who are in need of hospital treatment and for whom both treatments are judged clinically feasible? This is our first report, presenting preliminary data on six-month follow-up for the first three quarters of the total sample of 144 patients (80 with schizophrenic disorder and 64 with major affective disorder).

It is unclear why delusional depressives respond poorly to usual doses of tricyclic antidepressants alone. Seventeen elderly, delusional depressives were treated with high doses of imipramine or desmethylimipramine while monitoring plasma levels in an open study. Four of seven patients who received an adequate trial responded, but over half of the total sample had to be dropped due to intolerable side effects or worsening clinical condition. Antidepressants in high doses may be effective for part of the delusional depression sample, but this potentially effective pharmacologic therapy is not feasible in a large percentage of elderly or agitated patients.

Because individual therapy for troubled physicians has been notoriously difficult and often ineffective, we report our experience using a treatment--marital therapy--newly applied to such problems in the medical community. The sample involved 13 male physicians and their spouses with emotional difficulties in themselves and/or their relationships. After marital treatment, there was substantial improvement in more than 92% (12/13) of the physicians, their spouses, and/or their marital relationships.

The coexistence of medical and psychiatric problems in psychiatric inpatients often causes compliance difficulties, based on either irrational and distorted fears of medical treatment or more rational concerns that proposed psychiatric treatment could adversely affect a preexisting medical condition. The authors propose the use of joint consultations, in which both the psychiatrist and the other medical specialist meet together with the patient, as a way of ameliorating such distortions and conflicts and thereby improving compliance with both medical and psychiatric treatment.