Fluoxetine treatment of obsessive-compulsive disorder.

Two patients suffering from severe obsessive-compulsive disorder which had proven refractory to clomipramine and/or phenelzine treatment were successfully treated with fluoxetine, a new drug with a strong serotonin uptake inhibiting action. Outcome of treatment was measured on psychometric tests including the Leyton Obsessive Inventory, Hopkins Symptom Checklist-90, Beck Depression Inventory, and daily self-reports of the duration and degree of discomfort of their most severe obsessions. The delay in responding to fluoxetine, the continuing improvement even after one year on the drug, and the prompt relapse with abrupt withdrawal of treatment were noted.

Fluoxetine in panic disorder.

This paper presents the cases of two patients who suffered from panic disorder with agoraphobia and depression. One had been refractory to alprazolam and tricyclics and to behaviour therapy; she had responded to phenelzine, but due to a weight gain of 50 lbs, had discontinued treatment and she relapsed. The second patient, who also suffered from post-traumatic stress disorder, did not respond to alprazolam, imipramine or to phenelzine, but gained weight (33 lbs) on phenelzine.

The fluoxetine treatment of low-weight, chronic bulimia nervosa.

Ten low-weight (mean, 87.8% of ideal), chronic bulimic patients, seven of whom were previously unsuccessfully treated with antidepressant drugs, received fluoxetine 80 mg/day for 3 months. Endpoint analysis showed a significant decrease in bulimic episodes (p = 0.

Psychiatric ethics and ethical psychiatry.

This paper critically examines the code of ethics that applies to practising psychiatrists. The code performs the functions for which it was designed admirably well. It does not, however, resolve moral dilemmas (i.

The validity of commitment certificates in British Columbia.

This study surveyed the content of committal forms completed at two B.C. hospitals.

Trazodone treatment of bulimia nervosa.

Thirteen consecutive referrals of bulimic patients who met DSM-III criteria for bulimia were treated in an open-label, flexible-dose study with trazodone. Three of the 13 dropped out before the fourth week of treatment, the minimum duration of treatment for evaluable subjects, and hence were not included in the analyses. For the 10 evaluable patients, the mean duration of treatment was 6.

Effects of caffeine on behavior of schizophrenic inpatients.

The present study replicates that of De Freitas and Schwartz (1979), using more typical chronic patients (on open wards rather than locked wards), and monitoring coffee intake with serum caffeine levels. The serum caffeine levels observed indicate that caffeine can be effectively manipulated on an open ward by switching the type of coffee served. Contrary to our predictions, no significant improvements in patients' behavior occurred when decaffeinated coffee was first introduced, nor was there any deterioration when regular coffee was reinstated.

The relationship between neuroleptic dosage and cognitive functioning in chronic schizophrenic patients.

A review of the effects of phenothiazines on cognitive function suggests that phenothiazine derivatives facilitate performance on tests of cognitive function, at least in subjects who are thought disordered. Drug effects frequently depend on the dose administered, however, and the response to various doses of some drugs (e.g.

Controlled follow-up of patients released by a review panel at one and two years after separation.

Fifty patients released by the Review Panel are compared with a matched group of 50 patients discharged by the attending physician at one and at two years after separation from hospital. The two groups did not differ with respect to readmission rate or time spent in the community. At two years the physician-discharged patients were functioning better than the Panel-discharged patients in two of the seven areas of functioning; in the other five areas of functioning the adjustment of the two groups did not differ.

The review panel process: interpretation of the findings and recommendations.

In a series of three studies, the present authors and others in this research group have examined the Review Panel process: (a) before the hearing (which patients apply for a hearing?); (b) at the hearing (how do the patients released by the Panel differ from those retained by the Panel and; (c) after the hearing, how are the Panel-released patients faring one and two years after being released by the Panel, compared to patients released by the attending psychiatrist?) In the present paper, the findings of these three studies are summarized and an attempt is made to explain the findings, some of which are surprising (for example, the 35% disagreement between Panel and attending physician with respect to suitability for discharge and the finding that Panel-released patients survive as long in the community as do physician-discharged patients). Based on the findings and the interpretation placed on them, the authors make a series of recommendations with respect to the operation of Panels, the management of defiant involuntary patients and future research in this area.

Delineating social phobia.

The natural history--including psychiatric symptoms, precipitating factors, onset and course of illness, and personality characteristics--of 47 social phobics, 80 agoraphobics, and 72 simple phobics was examined. The social phobia group differed from the agoraphobia group by having a lower mean age, fewer females and married members, and a higher educational and occupational status. They were less fearful generally, less obsessive, and less likely to follow a fluctuating or phasic course.

Variables affecting the decision making of a review panel.

This study was designed to identify the variables that influence a review panel's decision to discharge or detain an involuntary patient. A group of fifty patients consecutively discharged by the review panel of a provincial mental hospital were compared according to thirty-five variables, with a group of forty-five patients consecutively detained by the panel. The variable set included information on the patient's psychiatric history, current hospitalization and treatment as well as ratings of dangerousness, insight and psychopathology, as reflected in the attending physician's case summary prepared for the review panel.

Review panels for involuntary psychiatric patients: which patients apply?

This study attempted to identify which involuntary patients apply to Review Panels for discharge. Four hundred and eighty-seven (487) patients who applied for review at a provincial mental hospital during a five-year period were compared, on 27 variables, with 2,966 patients who, although eligible to apply, chose not to do so. The groups differed on nineteen of the twenty-seven variables.