Intranasal sumatriptan for the acute treatment of migraine

Two double-blind, placebo-controlled, randomised, multicenter, multinational, parallel-group studies were carried out to identify the optimum dose of intranasal sumatriptan for the acute treatment of migraine. Study medication was taken as a single dose through one nostril in the first study, and as a divided dose through two nostrils in the second study. Totals of 245 and 210 patients with a history of migraine were recruited into the one-and two-nostril studies, respectively. In both studies, headache severity had significantly improved at 120 min after doses of 10–40 mg sumatriptan compared to placebo (P < 0.05) and the greatest efficacy rates were obtained with 20 mg sumatriptan. With 20 mg sumatriptan 78% and 74% of patients experienced headache relief in one- and two-nostril studies respectively. Sumatriptan was generally well tolerated, the most frequently reported event being taste disturbance. The results of the two studies are similar and indicate that administering sumatriptan as a divided dose via two nostrils confers no significant advantage over single-nostril administration. The publication committee members were as follows: Prof. C. Dahlöf Gothenburg; Prof. N. E. Gilhus, Bergen; Dr. V. Lüben, Giessen; Dr. R. Salonen, Tampere; Prof. J. M. Warier, Strasbourg; Ms E. Ashford, Glaxo Group Research Limited, Greenford; Mr. R. Dawson, Glaxo Group Research Limited, Greenford; Mrs D. Noronha Glaxo Group Research Limited, Greenford.Principal investigators were as follows: One nostril study France: Dr. N. Brion, Le Chesnay; Prof. G. Chazot, Lyon; Dr. P. Dano, Marseille; Prof. A. Destee, Lille; Dr. M. Schwob, Paris; Prof. J.M. Warter, Strasbourg. Germany: Dr. J. Brand, Konigstein; Dr. R. Enkelmann, St. Goar; Prof H. D. Langohr, Fulda; Dr. V. Lüben, Giesssen; Dr. M. Mockesch, Weinheim; Dr. H Pistauer, Preetz; Dr. Schimek, Giegen; Dr. E. Siegel, Munich. Norway: Dr. J. S. Aasen, Fredrikstad; Prof. N. E. Gilhus, Bergen; Dr. I. Monstad, Elverum; Dr. T. Mörland, Skien; Dr. K. Nestvold, Nordbyhagen; Dr. O. Roald, Oslo; Dr. R. Salvesen, Bodö; Prof. O. Sjaastad, Trondheim; Dr. B. Stadnes, Drammen; Dr. K. A. Tjörstad, Stavager.Two Nostril study Eire: Dr. A. Rynne, Dublin. Finland: Dr. M. Farkkila, Helsinki; Dr. H. Havanka, Kemi; Dr. T. Jolma, Pori; Dr. H. Kilpelainen, Savonlinna; Dr. E. Koivunen-Tapio, Jyvaskyla; Reunanen, Oulu; Dr. E. Sako, Turku; Dr. R. Salonen, Tampere. Sweden: Dr. B. Andersson, Gävle; Dr. C. Behring, Vasteras; Prof. C. Dahldf, Gothenburg; Dr. S. E. Eriksson, Falun; Dr. Hindfelt, Malmö; Dr. H. Hultberg, Osmo; Dr. F. Johansson, Umea; Dr. C. Muhr, Uppsala     

The acquisition of grammatical morphemes in autistic children: A critique and replication of the findings of Bartolucci,Pierce, and Streiner, 1980

The correct use of 13 morpheme rules by a group of 16 autistic children was investigated. The percentages of different morphemes used correctly correlated significantly with the results reported in an earlier study of Bartolucci, Pierce, and Streiner (1980), and internal consistency among the autistic children suggested some evidence of rule learning. As in the Bartolucci study, there were no significant correlations with the data presented by DeVilliers and DeVilliers (1973) for younger children. However, the conclusions drawn by Bartolucci et al. regarding the deviant nature of syntax acquisition by autistic children are questioned on various methodological grounds. More satisfactory ways of comparing language development in different groups of children are discussed. The work reported in this study was funded by a generous grant from the Department of Health and Social Security. The home-based treatment program discussed was a collaborative project undertaken with Dr. M. Berger, Mrs. R. Hemsley, Mrs. D. Holbrook, Dr. L. Hersov, Prof. M. Rutter, and Dr. W. Yule of the Institute of Psychiatry and Maudsley Hospital, London.     

SENSORY, AUDITORY AND SPEECH DEFECTS IN CEREBRAL PALSY

This discussion was held at the Hospital for Sick Children, Great Ormond Street, London, on May 9, 1959, with Dr. J. H. Crosland in the Chair. The main speakers were Dr. J. P. M. Tizard, Dr. L. Fisch, and Mrs. D. E. Back.     

Organization development in mental health services

The term organization development encompasses a number of techniques developed largely in private industry to facilitate communication and collaborative problem solving in work groups. OD approaches now are being introduced into mental health organizations, so administrators need information related to making good decisions about whether an OD program might be beneficial in their settings. This discussion focuses on defining OD, describing its current use in mental health and other human service organizations, and assessing the potential payoffs and disadvantages of implementing an OD program in a mental health setting.Edward M. Glaser, Ph.D., is the president of the Human Interaction Research Institute, Los Angeles, and the managing associate of Edward Glaser & Associates, consulting psychologists to management, Los Angeles.Thomas E. Backer, Ph.D., is a senior staff associate of the Human Interaction Research Institute, Los Angeles, and consulting psychologist of Edward Glaser & Associates, Los Angeles.This article was prepared under the support of the National Institute of Mental Health, Mental Health Services Development Branch, Grant No. R12 MH27566-01.The authors are indebted to the following persons for their perceptive critiques of several draft versions of this article: Dr. John Bell, V. A. Hospital, Palo Alto; Dr. Leonard Goodstein, University of Arizona; Mr. Jim Kouzes, San Jose State University; and Mr. Marvin Weisbord, Organization Research & Development. Inputs from our editorial consultant, Ms. Molly Lewin, also were most helpful.     

Precursors of symbol formation and childhood autism

The salience of various precursory requirements for the formation of symbols is discussed. The conclusion is drawn that several necessary precursors could be assumed, and two experiments are described that were designed to test for the presence of these precursors in autistic children compared to matched retarded children. First, there was a study of the children's ability to imitate and form internal images, and then there was a study of their development of a concept of object permanence and ability to anticipate. These studies led to the conclusion that the autistic children could form internal images but seemed to lack the ability to manipulate them in a purposeful and meaningful manner, as reflected in their inability to show symbolic imitations and their lack of tendency to use elements of their perceptions that might allow prediction of future events. The findings are discussed in terms of cognitive and social development.This research was supported by a grant from the Hogeschool Pool of Tilburg University, Holland. The authors wish to express their gratitude to Dr. N. O'Connor, Dr. B. Hermelin, and Prof. Dr. J. M. van Meel for their helpful advice, and to the staff of the Pedologisch Institute in Oisterwijk, Holland.     

Future issues in mental health administration: A report

This article describes highlights and findings of the 1977 National Conference in Mental Health Administration sponsored by The Staff College, National Institute of Mental Health. Over 100 invited experts from the mental health field were assembled to identify changes, trends and developments most likely to influence the administration of mental health services in the future. Conferees also itemized the skills administrators should possess to anticipate and successfully cope with these emerging issues.Noel Mazade, Ph.D. is Director, Advanced Training Program in Community Mental Health Administration, The Staff College, National Institute of Mental Health. The author wishes to thank the following Conference group leaders and recorders whose work forms the basis of this article: Dr. Joseph Aponte; Ms. Carolyn Cherington; Dr. Laurel Files; Ms. Lynn Gunn; Mr. Ronald Metzger; Dr. Joseph Morrissey; Mr. Larry Nikkel; Ms. Joan Offutt; Mr. John Sheets; Dr. Richard Surles; and Ms. Ann Thompson.     

Mental health and the quiet campus

Summary An investigation of the social correlates of mild emotional disturbance, specifically anxiety and depressed mood, was conducted among a sample of full-time undergraduates (N=214) at a liberal arts college which had been free of social disorder for some time. Results of the study indicated the presence of strikingly high levels of both mood disturbances among the outwardly calm student body. These mood disorders were strongly correlated with negative attitudes toward the college. And contrary to alienation theory, negative attitudes were not decreased in those who participated in college activities. Students who were more closely integrated into college life, particularly residentially, were those with the most negative attitudes and the highest reported stress reactions to college. Consideration of the college as a total institution may help to explain these findings.This research was partially supported by National Institute of Mental Health Grant MH 20681 — 02. The authors gratefully acknowledge help and guidance from Dr. J. R. Newbrough and Mrs. Geri Simpkins of the Community Mental Health Epidemiology program, and encouragement from Dr. Howard Cohen and Dr. Yoosuf Haveliwala.     

The effectiveness of operant language training with autistic children

Studies of operant language therapy with autistic children have indicated that behavioral techniques may be of value in increasing the language skills of such children. A review of recent studies, however, suggests that in the absence of adequate experimental controls, misleading conclusions may be drawn about the effectiveness of treatment. It is also apparent that the effects of therapy vary according to the linguistic competence of the children involved, and to the different aspects of language ability being taught. The implications of recent findings for our understanding of the basic deficit underlying early childhood autism are discussed.The work reported in this study was funded by a generous grant from the Department of Health and Social Security. The home-based treatment program discussed was a collaborative project undertaken with Dr. M. Berger, Mrs. R. Hemsley, Mrs. D. Holbrook, Dr. L. Hersov, Professor M. Rutter, and Dr. W. Yule of the Institute of Psychiatry and Maudsley Hospital, London.     

BOOK REVIEWS

Book reviewed in this article:
A Textbook of Clinical Neurology, 3rd Ed. by J. M. Nielsen
Die beginnende Schizophrenia — Versuch einer Gestaltanalyse des Wahns von Prof. Dr. K. Conrad
Integrating the Approach to Mental Disease edited by H. D. Kruse
Neurochemistry of Epilepsy — Seizure Mechanisms and their Managements by D. B. Tower     

Psychiatry of the Elderly

J. Wertheimer, Professor for psychogeriatrics at the University of Lausanne and Chairman, Geriatric Psychiatry Section, World Psychiatric Association (WPA) and Dr. J. A. Costa e Silva, Director, Division of Mental Health and Prevention of Substance Abuse (WHO) organized a Consensus Meeting which took place in Lausanne from 05.–07.02. 1996. The meeting aimed at the elaboration of recommendations on psychogeriatrics. The meeting was attended by the above mentioned WHO and WPA representatives and also by representatives from the following organisations: International Psychogeriatric Association, International Association of Gerontology, International Union of Psychological Science, Alzheimer's Disease International, International Council of Nurses, International Federation of Social Workers, International Federation of Ageing, World Federation of Occupational Therapists. Further attendants were various experts who participated at the meeting on invitation of Prof. Wertheimer and Dr. Costa e Silva. The discussion was chaired by Prof. H. Häfner (Mannheim). Dr. N. Graham (London) and Prof. C. Katona (Harlow/Essex) acted as co-rapporteurs. The Consensus Statement was unamnimously accepted by all participants. It contains recommendations for the development within a field of great future importance with regard to the current and expected global demographic structure and the increasing knowledge about agespecific diseases and general health, social and personal problems of the elderly.This document is a consensus statement on Psychiatry of the Elderly jointly produced by WHO and the Geriatric Psychiatry Section of the World Psychiatric Association, with the collaboration of several pertinent NGOs and the participation of experts from countries in several WHO regionsThis document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commerical purposesWorld Psychiatric Association Geriatric Psychiatry Section     

Experimental neurinoma in tissue culture

Summary Malignant peripheral nerve tumors of the trigeminal and other peripheral nerves have been produced in the rat by means of nitrosourea compounds. These tumors have been culturedin vitro and the behavior of the grown cells has been studied with phase contrast optics including time-lapse cinematography. It was concluded that these experimental tumors are Schwann cell tumors. They differ from the common human Schwannoma in that they are malignant and produce no microglia-like cells. The malignant character of the cultured cells was apparent because of a) rapid growth, b) maintenancein vitro through continuous subculture for over 18 months, c) loss of contact inhibition and d) capacity to induce' malignant tumors when transplanted subcutaneously to isologous hosts.This work was supported in part by USPHS Research Grant NS08376-04 from the National Institute of Neurological Diseases and Stroke.We thank Dr. Seung Kim for technical assistance and Mrs. Carmen D. Carrodeguas for secretarial help.     

Early childhood autism and the question of egocentrism

An individual's social competence is often considered in terms of his role-taking abilities. In the light of studies by Piaget, it has been supposed that a child's developing capacity to appreciate the viewpoints of others in a social context is reflected in his ability to recognize points of view in a visuospatial setting. If this is valid, then visuospatial role-taking tasks may afford a measure of some relatively “cognitive” component of the capacity to engage in social behavior. Tasks in which subjects were required to make judgments about different and yet related views of a three-dimensional scene or object, together with tests of operational thinking, were presented to normal children and to subjects with the diagnosis of infantile autism. The results indicate that autistic children are no more impaired in their recognition of visuospatial perspectives than are normal children of comparable intellectual level in tests of operational thinking. A further, more limited study yielded suggestive evidence that over this series of tasks, autistic children perform as well as subjects with Down's syndrome who have a similar verbal mental age. These findings render it improbable that autistic children are especially “egocentric” in their appreciation of visuospatial perspectives. The present research was undertaken in partial fulfillment of a Ph.D. degree at the Institute of Psychiatry, University of London. Some of the tasks were originally devised in collaboration with David Mant in the course of undergraduate work at Cambridge University. I am indebted to the subjects who took part in the study and to the teaching staff who helped me, particularly Mrs. Wendy Brown, Mrs. Elizabeth Kelleher, and the staff at the Helen Alisson School for Autistic Children, Gravesend. I am grateful to Dr. Beate Hermelin, Professor Michael Rutter, and Dr. Peter Clark for their encouragement and advice, and to Ms. Maria Callias and Dr. Richard Cromer for their helpful criticisms.     

Zur „Buscaino-Reaktion“

Ohne ZusammenfassungDer psychiatrischen und Nervenklinik, insbesondere ihrem Direktor Herrn Prof. Dr.J. Lange, sowie HerrnG. Szyszka aus dem chemischen Institute der Universität Breslau, sagen wir unseren aufrichtigsten Dank für die weitgehende Unterstützung unserer Arbeiten.     

PROCEEDINGS OF THE SIXTY-THIRD MEETING OF THE BRITISH NEUROPATHOLOGICAL SOCIETY HELD AT CHURCHILL COLLEGE, CAMBRIDGE 15–16 JULY 1982

Craggs R. (introduced) & King R. H. M. (Royal Free Hospital School of Medicine, London NW3 2PF) King R. H. M. & Thomas P. K. (Royal Free Hospital School of Medicine, London NW3 2PF) Love S. (Institute of Neurology, Queen Square, WCIN 3BG) Jones H. B. (introduced) & Cavanagh J. B. (Institute of Neurology, London WCIN 3BG) Kemplay Sheila (introduced) & Cavanagh J. B. (Institute of Neurology, London WClN 3BG) Reske-Nielsen E. & Daa Schroder H. (introduced) (Aarhus Kommunehospital, DK-8000 Aarhus C, Denmark) Goebel H. H., Fidzianska A. (introduced) & Osborn M. (introduced) (University of Gottingen and Max Planck Institute for Biophysical Chemistry, D-3400 Gottingen, FRG) Koppel H., Clarke S. (introduced) & Innocenti G. M. (introduced) (Institute of Anatomy, Lausanne, Switzerland)Anderson J. R. & Treip C. S. (Addenbrooke's Hospital Cambridge CB2 2QQ) Sapsford I. (introduced) & Weller R. O. (Southampton General Hospital, Reid H. (Department of Pathology, University of Manchester M13 9PT) Deane B. R., Greenwood J., (introduced) Lantos P. L. & Pratt O. E. (Institute of Psychiatry, London SE5 8AF) Ilgren E. B. (introduced) & Kaye A. (introduced) (Radcliffe Infirmary, Oxford OX2 6HE) Garson J. A., Coakham H. B., Harper E. I., Kemshead J. (all introduced) & Brownell Betty. (Brain Tumour Research Laboratory, Frenchay Hospital, Bristol. Imperial Cancer Research Fund, London) McLellan D. R., Adams J. H., Doyle D., Graham D. I, Kerr A. (introduced) & Murray L. S. (introduced) (Institute of Neurological Sciences, Glasgow G51 4TF) Harper C. G. (introduced) & Blumbergs P. C. (introduced) (Royal Perth Hospital, Western Australia and Institute of Medical and Veterinary Science, Adelaide, South Australia) Allsop D. (introduced), Landon M. (introduced) & Kidd M. (The Medical School, Nottingham NG7 2UH) Wilcock G. K. (introduced), Esiri M. M. & Bowen D. M. (introduced) (Radcliffe Infirmary Oxford OX2 6HE & Institute of Neurology, London WCIN 3BG) Mann D. M. A. & Yates P. O. (University of Manchester, Manchester M13 9PT) Esiri M. M. & Tomlinson A. H. (introduced) (Radcliffe Infirmary, Oxford OX2 6HE) Anderson J. R & Field H. J. (introduced) (Addenbrooke's Hospital, Cambridge CB2 2QQ and University of Cambridge, Cambridge) Kristensson K. Leestma J. (introduced), Norrby E. (introduced) & Orvell C. (introduced) (Karolinska Institute, Griffiths T. (introduced), Evans M. C. (introduced) & Meldrum B. S. (Institute of Psychiatry, London SE5 8AF) McConnell P. (introduced) & Berry M. (Medical School, Birmingham, B15 2TJ) Allen Y.S., RobertsG.W., Crow T.J. M. (Histochemistry Unit, Royal Postgraduate Medical School, London, W12 and Clinical Research Centre, Harrow, Middlesex)     

Condon's multiple-response phenomenon in severely dysfunctional children: An attempt at replication

The present study was conducted in an attempt to replicate the findings of William Condon on multiple entrainment and dyssynchronous behavioral organization in autistic children. Three autistic and two normal children were filmed while being presented with five discrete auditory stimuli. Microkinesic analyses of the children's motor responses were performed in relation to three hypotheses designed to support the double-response and dyssynchrony effects. No firm evidence of multiple-responding to single sound was found for the autistic or normal children. There was some indication of dyssynchronous, or awkward, response organization for the autistic children, in comparison to the smooth-flowing body movements of the normal children.This project was carried out through the support of Research Grant No. 606-1240-44 from the Department of National Health and Welfare (M. M. K.) and by funding from both the University of Victoria Research and Travel Fund and the British Columbia Medical Association (C. D. W.). A more detailed report of this research is available from the senior author.We acknowledge with thanks the excellent technical film work of Mr. R. Rivers of the Audio-Visual Department of the Clarke Institute of Psychiatry. His willingness not only to make moving film but to spend time with our subjects is much appreciated by us as well as by the children themselves. We also thank the children and their parents for participating so willingly in our work. We are also grateful to Mrs. Linda Hill Brand of the University of Victoria for her painstaking and intelligent analysis of the film. Finally, we thank Dr. Leo Lazar, chief psychologist, Child and Adolescent Service, for providing us with funds for film.     

Consistent stress profiles in mothers of children with autism

The present study extends the area of research on stress in parents of autistic children. In this study we used the Questionnaire on Resources and Stress (Holroyd, 1987) to compare the stress profiles across mothers (a) who lived in different cultural and geographic environments; (b) who had children of different ages; and (c) who had children with different functioning levels. Results showed a characteristic profile that was highly consistent across each of these subgroups. Major differences from the normative data occurred on scales measuring stress associated with dependency and management, cognitive impairment, limits on family opportunity, and life-span care. Results suggest the importance of developing treatment programs aimed at reducing stress in specific areas in families with autistic children.Orchard Mental Health CenterThis research was supported by U.S. Department of Education, NIDRR Cooperative Agreement No. G0087C0234 (Koegel and Dunlap), by U.S. Public Health Service Research Grants MH28210 (Koegel) and MH39434 (Schreibman) from the National Institute of Mental Health, by Grant No. G008530082 from the U.S. Department of Education, Handicapped Children's Early Education Program (Dunlap), and by Fogarty Senior International Fellowship 1 FOB TWO 1374-01 (Schreibman) from the Fogarty International Center of the National Institutes of Health. The authors acknowledge the contributions of Prof. Dr. med. Hedwig Amorosa, and Dorle Staniczek, Soz. Pad. of the Max Planck Institute for Psychiatry, Munich, West Germany, and express particular appreciation to Prof. Dr. med. D. Ploog, Director of the Institute.     

The psychopathology and measurement of environmental stress

Recent research on environmental stress is reviewed with emphasis on human subjects and on psychopathology. Theoretical and methodological issues are considered with reference to the need for increased attention to stress in clinical research. A new brief interview procedure for measuring recent and current environmental stress is described. It has been used with recently released mental hospital patients and qualified informants in a longitudinal follow-up study. Despite the provisional status of the stress inquiry, it yielded promising early results in discriminating between patients who were later rehospitalized and those who continued living in the community. Md. Mrs. Gansereit was formerly Research Associate with the same organization. This investigation was supported by PHS Research Grant MH-05529 from the National Institute of Mental Health, Public Health Service. The authors are grateful to Friends of Psychiatric Research, Inc., for administrative assistance and to the following persons for their help and advice in project planning and execution: David G. Crough, Dr. Gertrude J. Fleischmann, Henry L. Hammond, Dr. Martin M. Katz, Henri A. Lowery, Hubertine Marshall, Dr. Mary H. Michaux, and Dr. Bruno Radauskas.     

Psychiatric disorders of abused women at a shelter

Thirty physically abused women were randomly selected from the population of a local women's shelter and evaluated by psychiatric interview and psychiatric rating scales. High prevalences of major depression disorder (37%) and PTSD (47%) were determined. Furthermore, these disorders were found to be positively associated. These results suggest the need for immediate availability of psychiatric services at such shelters along with further study of their populations and possible intervention strategies.This paper was presented at the National Medical Assoc. Convention, July 1990, in Las Vegas, Nevada.Adelaida Fernandez, M.D., is in private practice in Chandler, Arizona. James Randolph Hillard, M.D., is Chairman, Dept. of Psychiatry, Univ. of Cincinnati Medical College. Mary Schoof, M.D., is in private practice in Farmington Hills, Michigan. Joseph Parks, M.D., is in private practice in Chicago, Illinois.     

The use of 5-hydroxytryptophan in a child with Lesch-Nyhan syndrome

The effects of 5-hydroxytryptophan (5-HTP), a serotonin precursor, were studied in a boy with the Lesch-Nyhan syndrome. During the course of drug treatment, self-mutilation, crying, sleep state architecture, serum dopamine B-hydroxylase (DBH), and cerebrospinal fluid levels of 5-hydroxyindolylacetic acid and homovanillic acid were studied. Treatment with 5-HTP failed to affect this child's biting behavior. However, the drug significantly reduced irritability as measured by crying time. Moreover, 5-HTP may have affected sleep state architecture, making it more normal in character. Serum DBH levels were normal throughout the study. Neither the patient's mother nor his maternal grandmother showed a hypertensive response on the cold pressor test.The authors wish to express their gratitude to Mrs. Pamela Angwin, Mrs. Martha Bowden, and Miss Donna Wong for performing the biochemical assays; to Ms. Debbie Zarin and Dr. Helena Kraemer for assistance in the statistical analyses; to the nursing staff of the Clinical Research Center for their outstanding clinical care of the patient; and to Dr. William Nyhan for performing the HGPRT assays required to establish the diagnosis of Lesch-Nyhan syndrome and for calling the authors' attention to the use of 5-HTP in this illness. This investigation was supported by Public Health Service Research Grant R.R. 70 from the General Clinical Research Center, Division of Research Resources, and in part by National Institute of Health Grants MH23861 and MH 25998.