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THALE, THOMAS; GABRIO, BEVERLY WESCOTT; SALOMON, KURT
doi: 10.1176/appi.ajp.106.9.686pmid: 15405299
THOMAS THALE M. D. 1 , BEVERLY WESCOTT GABRIO B. A. 1 , , and KURT SALOMON M. D., PH. D. 1 1 The Biochemical Research Laboratory of the Departments of Neuropsychiatry and Radiology, Washington University, St. Louis, Missouri. Mescaline produces altered visual experiences of several types, whose vividness and degree of distortion is proportionate to the size of the dose. There are no sharp boundaries dividing abnormal sensibility, illusions, and hallucinations. Subjects who gave fewer responses of the type "I see it" when asked to imagine situations were more likely to hallucinate than other patients. Visual responses declined still further after administration of mescaline in a degree more closely related to the amount of drug given than to the vividness of hallucinatory alterations, even in those experimental subjects who reported virtually no alteration in actual vision. The fall in reported visual imagery was not found in control subjects.
ROSS, GEORGE L.; BROWN, THELMA E.
doi: 10.1176/appi.ajp.106.9.680pmid: 15405298
GEORGE L. ROSS M. D. 1 , and THELMA E. BROWN PH. D. 1 1 Veterans Administration Hospital. The term "rehabilitation" is a working definition of the psychosomatic concept. In order to carry out this Gestalt type of thinking, the emphasis of therapy must be changed from aggregation to integration of diagnostic, planning, and treatment services, The Fort Thomas staff is coordinating and integrating its functions as quickly and efficiently as possible to effect this change. Its interpretation of the psychosomatic concept in working clothes is presented in this paper through its three-step process: 1. The integrated diagnostic study; 2. Controlled planning; 3. Therapy and follow-through.
SANDS, SIDNEY L.; RODNICK, ELIOT H.
doi: 10.1176/appi.ajp.106.9.673pmid: 15405297
SIDNEY L. SANDS M. D., and ELIOT H. RODNICK PH. D. We have attempted, albeit in a somewhat circuitous fashion, to point up the kinds of experiences in the conduct of research that have led us to a critical reexamination of our concepts and experimental design in the field of psychosomatic relationships. In closing we wish to comment on the rôle of the clinician in this area of investigation and to make several recommendations derived from our own struggles for those who would participate in such work. In the hospital and in the clinic it is the clinician who must estimate the order and severity of the patient's illness, select and administer therapy, and attempt to predict his future adjustment capacity. No matter how much or what kind of information is afforded him from other sources he must work directly with the patient in a rather specialized relationship. His powers of observation plus his shared experiences with the patient enable him to make those judgments that determine the ultimate evaluation of the case. It is the synthesizing quality of his observations, related as they are to the empathic bond between physician and patient, that is the singular advantage he possesses over all other techniques available for the study of the patient. It is also the basis for certain disadvantages and for the particular prejudices of psychiatry in the field of research. A major disadvantage lies in the subjective quality of much that enters into the formulation of these "synthetic judgments" and the difficulty one has in abstracting them to such a point that they may be treated as logical inferences from classifiable data. The clinician attaches value, meaning, and predictive significance to phenomena expressed behaviorally. It is necessary and proper that we do so even as we recognize that in so doing we may for the time being make it more difficult if not impossible to arrive at those epistemic correlations with the data of physiology that might lead to the global concepts we desire. We cannot fall back upon the constructs of physics and chemistry and do justice to the kinds of judgments it is ours to render. In our introduction we stated that for us a concept of stress has relevance in terms of a concept of personality organization. Essential to any concept of personality dynamics, whether it be expressed in terms of psychoanalytic, topological, or Hullian mechanisms, is the viewpoint that behavior is motivated and occurs when a need, drive, or tension state exists in the organism. Without belaboring instinct theory we are reasonably secure in positing the existence of certain conditions in the organism that we may call tension states. These originate in disturbances of homeostasis, but with learning and maturation they come to operate effectively in the absence of immediate tissue requirements and ever more in a qualified relationship with environmental conditions. In response to these tensions we develop techniques of adjustment the aim of which is to reduce them to subthreshold levels. For the clinician, behavior, whatever its qualities may be, is a manifestation of change in tension states. The attributes of these tension states are dependent variables not only of the given stimulus, but of the pre-potent characteristics of the total organism as the emergent, on-going product of his experiences operating in and through the physiological matrix by means of which he occupies a position in a space-time field. This being true, then collaborative research is by definition necessary for an ultimate understanding of human behavior at any or all levels. In our experimental design each of us shall, despite our differences in viewpoint, critically define three phases of the study as elements within a structured whole: 1. The stimulus—its form, magnitude, and meanings. 2. The mediating mechanisms within the organism—not the organism as a whole. 3. The response—its quality and quantity as a function of the stimulus and the mediating mechanisms. Because of our differences any experiment will yield discrete sets of data which have significance primarily in an equally discrete frame of reference. In our zeal for holistic concepts we must guard against two tendencies: 1. The premature attempt to "explain" psychiatric phenomena in terms of physiologic data (and vice versa) on the basis of statistical correlations alone. 2. The tendency to ignore the data of our colleagues because we cannot translate them conveniently to our special needs. As each discipline develops its own conceptual framework more adequately the kind of interpenetration we desire will occur and then we shall see emerge those unifying concepts necessary for a true science of human behavior.
FREEMAN, HARRY; ELMADJIAN, FRED
doi: 10.1176/appi.ajp.106.9.660pmid: 15405296
HARRY FREEMAN M. D. 1 , and FRED ELMADJIAN PH. D. 1 1 The Worcester Foundation for Experimental Biology, Shrewsbury, Mass., and the Worcester State Hospital, Worcester, Mass. A series of studies have been carried out in schizophrenic patients and normal controls that indicate that (1) there is a reduction of tolerance to glucose in this psychosis; (2) the response of the adrenal cortex to stimulation by the ingestion of glucose is generally deficient as exemplified by measurements of various blood and urinary variables known to be pertinent to adreno-cortical activation.
GARNETT, RICHARD W.; KLINGMAN, WALTER O.
doi: 10.1176/appi.ajp.106.9.697pmid: 15410225
RICHARD W. GARNETT M. D., and WALTER O. KLINGMAN M. D. Theoretically and experimentally the vital role played in cellular metabolism by the cytochromes as respiratory tissue enzymes is recognized and appreciated(14). This apparently also applies to tissue activity in the nervous system, particularly during growth, differentiation, and regeneration following injury. Cytochrome C, a commercially available preparation, was selected for clinical trial in cases of presenile and senile states with or without evidence for nervous system arteriosclerosis. We fully recognize that there are other equally important enzyme systems involved in cellular metabolism, notably riboflavin or flavoproteins and pyridine nucleotides. The latter has the important nicotinic acid amide component serving as a reversible hydrogen acceptor and is indispensable for the action of a great many dehydrogenases. However, catalytic action of Cytochrome C is still a link in part of the oxidation going on through these systems. The relation of cellular oxidations to lipid phosphorylation is also thought to be through oxidations by the cytochrome system(11). Cytochrome C, therefore, seemed to be a good choice for trial(15, 16). Clinical improvement was noted in a majority of cases observed in regard to memory, orientation, irritability, interest, confusion, and behavior. Only slight changes were observed in the electroencephalographic recordings and these changes may be insignificant. Psychometric examination showed qualitative improvement in keeping with clinical improvement and a trend toward higher scores. The changes noted in these patients during the trial period are quite in contrast to the results obtained in the problem of treatment of the senile states for the previous 3 years on the psychiatric service. During that period 27 cases were diagnosed as senile reactions. Of these, 6 were improved and, of these 6 cases, 4 were treated with electroshock. The remaining 21 cases were referred to state institutions, domiciliaries, nursing homes, or sent home as unimproved. These cases were given the routine supplementary vitamine therapy, symptomatic care, special diets, and routine activity programs which were also part of the program for the cases reported in this series. Total duration of mental illness, as judged by reviewing the literature, in the senile psychotic state tends to be from 1 to 3 years, generally less than 2 years, and when improvement takes place it most generally does so within 2 or 3 months time. Because of the heavier and increasing burden to mental hospitals, any aid to hasten possible improvement and the care of the aged seems justifiable when psychological and physical factors combine to incapacitate the individual. We wish merely to report these studies as observations, making no claims beyond the theoretical about specific action or changes produced by this enzyme. We feel encouraged, though, by the clinical changes noted during the short observation period. The biochemists can give us little help in interpreting these observations beyond theoretical speculation but neither can they tell us what happens to cellular metabolic processes in nervous tissue as a result of electroshock or insulin therapy. We, nevertheless, use such therapy because it works. The pharmacologists express themselves freely that the rôle of cytochrome in cellular respiration is well established but they are very skeptical that injected cytochrome can be utilized as such by the body tissues. However, practically no work has been supplied by either the pharmacologists, the experimental biologists, or pathologists that would indicate Cytochrome C to be of any utility in the therapy of pathological tissue states such as those in which we are interested. More promising and encouraging are apparent results from Cytochrome C noted by us in our trial of it in acute toxic inflammatory reactions of the nervous system, about which we hope to report separately at a later date.
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