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Posttraumatic Stress Disorder (PTSD) is a complex and challenging psychiatric disorder. Its more severe manifestations will require psychopharmacologic intervention. This paper offers guidance in the psychopharmacologic management of PTSD.

The Physician Rehabilitation Program of Maryland has been developed by Med Chi's Committee on Physician Rehabilitation over the last twelve years. Its primary purpose is to assist physicians who are experiencing problems because of substance abuse, physical disability, or psychiatric illness. Rapid changes in the field have challenged the Committee in recent years. New funding which started in July of 1990 will assist Med Chi in meeting these new challenges.

MROs need to be knowledgeable and experienced in the area of substance abuse. This relatively new field raises many clinical issues, complicated by legal and ethical issues. It is advisable that MROs be independent from the companies, laboratories, and collection sites with which they contract or to which they relate in the process of performing their evaluations.

Recently more and more families have assumed the role of primary caregiver for their schizophrenic relatives. The author enumerates the needs of caregiving families and reviews the work of researchers involved in family therapy approaches to the treatment of schizophrenia. After discussing theories based on the concept of expressed emotion--that is, the amount of hostility, intrusiveness, or criticism expressed by family members toward the schizophrenic relative--the author examines the effects of contact with families exhibiting high expressed emotion on patient relapse. He suggests that high expressed emotion is not a characteristic unique to families of schizophrenic patients and calls for further standardized research among families who care for individuals with other mental disorders.

This paper discussed the changing role of state psychiatric hospitals within the mental health system. Important factors included state demographics, the education and training of psychiatric residents, and the revolutionary changes taking place within the medical care system in America. The author emphasized the importance of viewing specific approaches to system problems from a total mental health system perspective.

Of the 270 patients who had been hospitalized at least 1 year in Maryland public psychiatric facilities in 1976, 15% remained 7 years later. The authors' data provide evidence that a new long-term population is not accumulating in Maryland.

The major concern of this study was to identify the personality traits connotated by a number of diagnostic labels such as paranoid, schizoid, hysterical, and cyclothymic. Twenty psychiatrists were given a list of nonpsychotic personality disorders and were asked to indicate what personality traits were typically associated with them. Results showed good agreement among psychiatrists on the personality traits they believed to be implied by the diagnostic terms. A factor analysis of the ratings showed a circular configuration of relative similarity among the different diagnoses. The results are interpreted as indicating that diagnostic labels are types of codes for various sectors of an implicit space of traits, signs, and symptoms.

The authors examine the development and characteristics of a "new" long-term population in the public mental health system in Maryland. The findings do not substantiate concern over a large increase in the number of chronic patients in state hospitals in the next several years.

After biosynthesis of norepinephrine was inhibited, treatment of rats for 10 days with rubidium chloride (0.6 milliequivalent per kilogram of body weight) caused an increase in the rate of disappearance of norepinephrine in the brainstem but not in the telencephalon. Also the utilization of intracisternally injected tritiated norepinephrine was increased and was accompanied by a shift in the pattern of norepinephrine metabolism to normetanephrine. These data suggest that greater amounts of neuronally stored norepinephrine were released to central adrenergic receptors.