Faculty Bibliography

The relative loss of interest in individual psychotherapy of schizophrenia is being replaced with a more careful reassessment of its value. This article presents some of the author's views on process and personal characteristics which are important in this treatment approach.

Based on the observation that Hispanic depressed patients appear to receive lower dosages of antidepressants, the clinical records of 41 Hispanic and 21 Anglo, female outpatients receiving antidepressants were compared. All the patients had been diagnosed by two psychiatrists as suffering from a major depressive episode according to the DSM III criteria. The records showed that the Anglo patients received about double the dosage of antidepressants given to the Hispanic patients. The Hispanic patients complained more about side effects, but the treatment outcome was comparable in both groups. Apart from pharmacokinetic factors, the authors suggest that these clinical observations may be due to the fact that Hispanic depressed patients express depression in terms of somatic symptoms which are often similar to the side effects produced by antidepressants. Clinicians ought to familiarize themselves with the psychological, sociocultural, and biologic characteristics of the patient, and should approach the chemotherapy in a differential manner. Controlled prospective studies should be designed to test the hypotheses generated by this study.

From their beginnings, county or municipal psychiatric services have reflected the political and social attitudes of the times. Traditionally they were public facilities that delivered acute inpatient care and a variable range of outpatient services, and, within their mandate, they functioned well. During the past two decades institutional psychiatry has evolved in such a way that there is little difference in the range of services delivered by county, state, and voluntary facilities. The logical role of the county hospital continues to be the provision of acute care for the poor. But for county systems to survive and flourish, they must be prepared to regionalize some services, and to differentiate their role in relation to voluntary and state facilities, yet integrate services with them where needed. They must strengthen ties with academic institutions and effectively address problems of third-party payment and other financial issues.

The side effects that may occur during treatment of schizophrenia with neuroleptic drugs are fully examined. Included are autonomic, extrapyramidal, other CNS, endocrine and metabolic, allergic, and skin and eye side effects. The differences between the side effect profiles of various antipsychotic drugs are noted. The restrictions imposed by laws designed to protect the patients's rights are evaluated with regard to the side effects of neuroleptic drugs. The meaning of informed consent is delineated.