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Skin conductance level (SCL) and skin conductance responses (SCR) to a random series of tones were measured in 25 drug-free schizophrenic patients, 15 males and 10 female, before and after standard chlorpromazine treatment. The DSM-III diagnostic criteria were used for selecting subjects. Psychopathology was measured with the Brief Psychiatric Rating Scale. After treatment, patients showed an improved psychopathology and decreased SCL. There was a transition of patients to lower response categories: the number of responders decreased twice and the number of non-responders increased three times. Responders exhibited significantly higher SCL than non-responders and fast habituators were between the two groups. [ABSTRACT FROM AUTHOR]

The prolactin response after ECT in ten female melancholic patients correlated significantly to their prolactin response to i.v. TRH. These findings may suggest an underlying common mechanism between TRH and ECT regarding their PRL releasing properties. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the predictive value of trainees' previous experience and performance at an introductory course in Cognitive Therapy for their subsequent success in an advanced course. From 203 completers of an introductory course during seven consecutive years 32 participated in an advanced course. In a linear regression analysis previous clinical and psychotherapeutic experience as well as performance at the introductory course were studied as predictors for trainees' success in the advanced course. Performance at the introductory course was the only significant predictor of trainees' successful completion of the advanced course. An introductory course might help to select those trainees who have the desired qualities to succeed in a formal psychotherapeutic training program.

In medicine, along with the other domains of our life, the myth of Sisyphus is frequently evoked upon confronting a task conceived as laborious, endless and for some futile or even purposeless and meaningless. In this paper, we explore the origin of the myth of Sisyphus so that its connotations and symbolizations will hopefully emerge clearer. It is suggested that the natural background of the myth might be related to the seismologic history of Greece, and Corinth in particular, a city ruined and rebuilt several times. The natural component might symbolically echo in the personified myth of Sisyphus, Corinth's founder and might explain the peculiar labor he was condemned to execute eternally, as well as the meanings the myth carries. Like his own city, Sisyphus also suffered the same "ups and downs" of fate, either as a public figure -patron of several big achievements- or as a punished hero condemned to role a stone in the underworld. His persistent efforts led to temporary successes, even though he could not find permanent solutions to the labors he undertook alive or dead. Thus, the myth of Sisyphus is related to human efforts and its limitations, the feasible and infeasible the two main poles between which the myth functions. Conceptualizing with Sisyphean terms their function, physicians can celebrate their transient victories, and by realizing their limitations, reconstruct their aspirations without decreasing their efforts.

In view of the continuous theoretical and clinical expansion of cognitive therapy, the traditional, information processing-based description of cognitions into products, processes and schemata displays certain, mainly clinical, limitations. The authors try to refine and expand this "tripartite" conceptualization by employing a new, clinically relevant metaphor to describe cognitions and offer new ideas of potential theoretical and practical utility. Indeed, the dispositional (structural) and functional (state-dependent) aspects of cognitions may be seen as reflecting an underlying theme that could be labeled "the mind as a parliament". Conceptualized as such, the various types of cognitions may then be metaphorically described as members of a parliament, who when confronted by environmental constrains, confer, discourse and decide to give meaning to one's experience and direction to one's behavior. This paper provides a general overview of this metaphor-driven model and a detailed description of its various components. The potential applications of this model as a clinical and educational tool and its limitations are also discussed.

Twenty-two patients with major depressive disorder, 11 of them with melancholic features, and 11 controls were investigated with CANTAB subtests focusing in visual memory/learning and executive functions. Melancholic patients performed worse than the other groups in all tasks and manifested a significant impairment in set shifting. The results are discussed in association with prefrontal dysfunction.

In spite of its impressive progress, medicine has been strongly criticized for relying on its modern biomedical tradition to the neglect of the psychosocial aspects of health. This neglect may account for patients' dissatisfaction and eventual use of alternative health approaches. The concept of placebo has sustained dramatic "protean" metamorphoses through the ages. For centuries, placebos have been regarded as powerful deceptive therapies. From the middle of the twentieth century, however, conventional medicine has used placebos as methodologic tools to distinguish the specific from the nonspecific ingredients in treatments. In modern medical research, the double-blind, placebo-controlled, randomized clinical trial has been established as the gold standard for the assessment of any new treatment. Recently a new trend regarding placebos seems to have emerged. The placebo and other nonspecific effects elicited by the "healing situation" have been independently subjected to scientific study. Progress in this area may promote useful clinical applications, enabling physicians to broaden their perspectives on the healing process. We present the historical changes of the concept of placebo and the ethical issues raised by their use.

We investigated the effect of thyrotropin-releasing hormone (TRH) on orientation time and recall, in nine depressed female inpatients undergoing electroconvulsive therapy (ECT). In a balanced order crossover design, an intravenous bolus of 0.4 mg TRH or placebo was administered 20 min before ECT in the first two sessions. Orientation time and retrograde and anterograde components of the memory dysfunction, immediately and 24 h later, were assessed. Administration of TRH did not influence orientation time, word recall, or immediate short story recall compared with placebo. We did find, however, an improvement in the number of short story items recalled after 24 h when patients were given TRH compared with placebo. This indicates that TRH may have a protective role against the specific negative effect of ECT on delayed recall.

The effects of thyrotropin-releasing hormone (TRH) administration on electroconvulsive therapy (ECT)-induced prolactin (PRL) secretion and the duration of the seizure were studied in 14 depressed women. In a balanced order crossover design the patients were given 0.4 mg TRH or placebo intravenously 20 min before ECT during the first two sessions. In the third ECT session TRH was given just prior to ECT. ECT elicited the expected PRL response when given alone and when given 20 min after TRH when PRL plasma levels were high. During the coadministration design (third ECT session) PRL levels were raised not as a sum of the two stimuli but even significantly more. TRH failed to modify the duration of the seizure induced by ECT. Therefore, if TRH is involved in seizure modulation during ECT, our findings suggest a postictal rather than ictal role for TRH.

During an ongoing study on potential neurochemical and neuroendocrine predictors of recovery after ECT, it was observed that depressed patients with unfavorable response to ECT, improved consequently with antidepressants alone or in combination and in some cases with the addition of neuroleptics or lithium salts. 13 female depressed patients with melancholia (DSM-III criteria), who had proven resistant to electroconvulsive therapy (ECT) and showed marked improvement with subsequent psychopharmacologic regimens, are described. In not less than 2 months after the last ECT, remission was achieved with a heterocyclic antidepressant (HCA) alone (3 patients) combined infusion of chlorimipramine and maprotiline (3 patients) combined HCAs-antipsychotics (4 patients) and HCAs in combination with lithium (3 patients). It is worth noting that certain depressed patients improved markedly with drugs which had poor results at the same doses before ECT. Confirmation of these observations by prospective studies would provide novel therapeutic capabilities and clues about the mode of action of this controversial treatment.

Thyroid stimulating hormone (TSH) and prolactin (PRL) plasma levels were studied during electroconvulsive therapy (ECT) in five schizophrenic patients in a simulated ECT (SECT) controlled experimental design. The data were compared to those obtained from a group of 10 depressed patients treated with ECT. In the schizophrenic group, both PRL and TSH increased significantly during ECT compared to SECT, as they did in the depressive group during ECT. Thus, the hormonal TSH and PRL profile during ECT is similar in schizophrenia and depression. It is concluded that the changes in TSH and PRL induced by ECT are specifically linked to the current or the seizure, and are not related to the type of psychopathology.

The effect of electroconvulsive therapy (ECT) on serum thyrotropin (TSH) and prolactin (PRL) was systematically investigated in two studies: a simulated ECT (SECT) versus real ECT controlled design, and one in which a more sensitive TSH assay was used. In addition to the expected PRL response, a small but consistent TSH increase was demonstrated, especially when the new TSH assay was used. The implications of these findings concerning the underlying ECT mechanisms mediating these effects are discussed and the involvement of thyrotropin-releasing hormone (TRH) and serotonin is stressed.

Plasma prolactin levels were studied after bilateral and unilateral ECT in eight female melancholic patients. Although prolactin levels were higher after both treatments, patients who received bilateral ECT had significantly higher prolactin levels than did those who received unilateral ECT.

The electroencephalographic (EEG) and behavioral effects of oral doses of phenytoin from 100 mg to 1 g in normal male volunteers were measured. The electroencephalogram exhibited decreases in power in the slow frequencies and increases in the fast frequencies, accompanied by an increase in mean frequency. These changes are similar to those seen with psychostimulants. They occurred at average plasma levels of 8 micrograms/ml and above. The time course and the intensity of EEG effects parallel plasma levels. Drug-related EEG changes were bilaterally symmetric. EEG changes at plasma levels of 8--12 micrograms/ml were not associated with behavioral toxic signs. These findings suggest that future psychiatric studies of phenytoin as a psychostimulant should include monitoring for plasma levels, with a minimum of 8 micrograms/ml as a guide to clinical efficacy.

Measures of neuroendocrine function--plasma cortisol and its response to dexamethasone, and plasma thyroid-stimulating hormone (TSH) and its response to thyrotropin-releasing hormone (TRH)--were employed in 50 hospitalized male veteran psychiatric patients with diagnoses of unipolar or bipolar melancholia, secondary depression, or schizophrenia. Of 20 cases of unipolar melancholia, 17 (85%) exhibited hypercortisolism; 14 (70%) failed to suppress plasma cortisol after dexamethasone; and 4 (31%) of 13 tested had an abnormal TSH response to intravenous TRH. Two patients with secondary depression also exhibited hypercortisolism; no other patients evinced abnormal neuroendocrine test results. These measures were repeated in 14 unipolar depressed patients after a course of electroconvulsive therapy (ECT). Improvement in psychopathology was directly related to normalization of measures of hypothalamic-pituitary-adrenal (HPA) function. The TSH response to TRH was not systematically altered. After a followup period of 1 to 9 months, there was a good correlation between the measures of HPA function and the clinical outcome. These findings encourage further study of HPA function measures as outcome criteria for depressed patients receiving ECT.

Study of serum prolactin during electroconvulsive therapy (ECT) in depressive patients revealed a greater prolactin increase after bilateral than after unilateral ECT. A linear correlation between the two types of prolactin response was found for a group of 10 patients, a finding that suggests a quantitative rather than a qualitative difference between bilateral and unilateral ECT with regard to their prolactin-releasing properties. The magnitude of prolactin response did not differ between right and left unilateral ECT, nor in a systematically studied case of postictal dysphoric excitement that occurred after right, but not after left, unilateral ECT. In this case, maximal prolactin response occurred earlier with right than with left unilateral ECT. Prolactin increase after ECT was not correlated with such factors as severity of depression nor seizure duration.

The patterns of prolactin release after bilateral ECT and after 0.4 mg TRH i.v. were studied in 11 female melancholic patients in a 5-min sampling protocol. Mean prolactin peaking times were 10.2 min after ECT and 20.5 min after TRH. The elimination rate coefficients were significantly lower--and the corresponding half-lives longer--for prolactin released by TRH than by ECT. A significant positive correlation of the maximal prolactin responses by the two stimuli was also found.