Type A and ectopy in patients with coronary artery disease and controls

The purpose of the current study was to determine if the Type A (coronary-prone) behavior pattern is associated with task-related ectopy either in patients with coronary artery disease or in controls. Two 10-min interviews related to heart disease and three performance tasks inducing different sympathetic and vagal responses were administered. The prevalence of ectopy was significantly higher in Type A volunteers, and was no different in coronary patients vs controls. Analyses of cardiovascular responses and patient characteristics failed to identify any other variable that separated Type As from Type Bs or those with ectopy from those without ectopy.     

Self-administration of orally-delivered phencyclidine and ethanol under concurrent fixed-ratio schedules in rhesus monkeys

In 1946 von Euler identified the major transmitter of sympathetic nerve fibers, norepinephrine (NE), and about a decade later Vogt (1954) provided the first evidence that NE may also serve as a neurotransmitter in the central nervous system (CNS). Since that time, a literal explosion in CNS neurotransmitter research has taken place involving histological, biochemical, physiological, pharmacological and clinical investigations, Yet, it is only now that we are beginning to understand the biological function of NE in brain, in particular because of recent advances regarding the physiology and regulation of NE neurons in locus coeruleus (LC), a bilateral pontine structure with a uniquely wide-spread terminal network reaching throughout the neuroaxis and in primates accounting for about 70% of all brain NE. Recently, the neurobiology of the LC noradrenergic network was extensively reviewed by Foote et al. (1983), and its implication in vigilance as well as global orientation of behavior towards imperative, environmental sensory stimuli was outlined. Yet, more recent information regarding the peripheral, autonomic regulation of LC neurons in brain provides fundamentally new biological aspects on behavior and mental function which seem to allow a more integrated view of the rôle of brain NE in the overall function of the individual than previously understood. The purpose of this review is to summarize these findings and, furthermore, to outline some putative implications for psychiatry and neuropsychopharmacology. In particular, the new data seem to allow a better understanding of how autonomic vulnerability or visceral dysfunction may precipitate or aggravate mental symptoms and disorder.     

The effect of peripheral beta-blockade on psychophysiologic responses in obsessional neurotics

Ithas been postulated that anxiety symptoms are mediated through peripheral mechanisms and that subjective feelings of anxiety are learned associations to bodily symptoms.¹ This hypothesis has been supported by findings indicating the beneficial effects of beta-adrenergic receptor blocking agents in psychiatric patients.^2,3 In anxiety states, particularly, mood changes have been reported even with beta-blockers that penetrate very slowly into the brain.^4–6 Therefore, the improvement in subjective anxiety would appear to be related to peripheral beta-blockade rather than central action.There is also evidence that obsessive-compulsive patients experience increased subjective discomfort, associated with increased autonomic reactivity, while they hold in fantasy ruminative thoughts, or when they touch “contaminating” objects, compared to neutral thoughts or objects.^7,8 The present work is an attempt to measure the psychophysiologic arousal during internal stimulation of such patients before and after beta-blockade with practolol¹ an agent lacking central effects. A decrease in autonomic reactivity accompanied by similar amelioration in subjective anxiety would support Breggin's hypothsis.¹ On the other hand, failure of the latter to accompany the physiologic modifications brought about by practolol would support the theoretical position that assigns fundamental importance to cognitive and situational factors in the genesis and maintenance of anxiety.⁹ This would be of interest with patients in which a specific type of cognitive activity and avoidance behavior dominate the clinical symptomatology.     

The dexamethasone suppression test in depressive illness: Clinical correlates

Clinical correlates of endogenous depression which may be associated with dexamethasone resistance have been evaluated by many investigators and found to be inconclusive. The authors investigated in 40 endogenously depressed patients the relationship of the dexamethasone suppression test (DST) and various clinical correlates - SADS scales, Research Diagnostic Criteria (RDC) depressive subtypes, family history from the FHRDC, responsivity to antidepressant treatment, etc. Dexamethasone resistance was found to be significantly associated with psychotic and bipolar depression but unrelated to the other clinical correlates examined. These findings are limited to the 2 mg DST; clinical correlates associated with non-suppression to dexamethasone may be related to the dose of dexamethasone.     

The treatment of involuntary patients in the general hospital psychiatric unit

In response to pressure to assume more responsibility for chronic patients, many general hospitals have asserted that they should limit care to those suitable for voluntary treatment on an open ward. This assertion appears to be based primarily on political and symbolic arguments. The limitation of admission to voluntary patients would serve to exclude many acutely psychotic patients with excellent prognosis best treated in a general hospital. The locked ward appears to offer the maximum flexibility in dealing with illnesses which in varying degrees affect the individual's judgement and impulsivity. The limitation of psychiatric units to voluntary patients in open wards would preclude psychiatry from joining in the mission of the general hospital—the best possible care for the community it serves.     

Prediction of treatment response in pain patients: the illness self-concept repertory grid and EMG feedback

Eighteen patients with chronic musculoskeletal pain completed a trial of EMG feedback where each subject was exposed to biofeedback, a control condition and a waiting list. Pain scores were determined pre- and posttrial, and the percentage change calculated for each subject. EMG activity and present pain measured during the trial gave an EMG/pain correlation for each patient. A repertory grid was completed by each patient at the pretrial evaluation. Repertory grid technique is a highly flexible way of measuring subjective data such as attitudes. The specific test used involved the patient in rating a series of 6 self-concepts across 8 'constructs' or concepts concerning illness and emotional distress. The resulting matrix of 48 ratings was analysed to produce a measurement of 'distance' between the self and ideal-self concepts. The major finding was that the self-ideal-self distance was significantly positively correlated with pain score changes by rank correlation. The self-ideal-self distance is essentially a measure of self-satisfaction or dissatisfaction and the results imply that patients who show a relatively greater degree of self-dissatisfaction are more likely to respond well to EMG feedback. In addition, patients with high EMG/pain correlations had a better outcome and this measure also correlated with pain scores. The relationship between self-concepts and EMG/pain correlations is discussed. The Illness Self-Concept Repertory Grid appears capable of predicting treatment outcome and shows promise as a prognostic tool.     

Psychological effects of habitual aerobic exercise: A critical review

Controlled experiments of the effects of habitual aerobic exercise on mood, personality, and cognition are reviewed. The results indicate that exercise improves self-concept. They provide little evidence for claims that exercise improves anxiety, depression, body image, personality, or cognition. Several processes have been hypothesized to mediate the psychological benefits of exercise but none has been adequately tested. Future research should examine the individuals and the disorders that are most likely to experience psychological benefits from exercise, the types of exercise that are most beneficial, and the proposed mechanisms for the psychological benefits.     

Coordination of services for outpatients under concurrent medical and psychiatric care

The proportion of outpatients with concurrent medical and psychiatric problems is high and is expected to increase, but coordination of services has not been satisfactory. The medical and psychiatric records of 28 patients under regular psychiatric and medical care were abstracted, for a total of 323 visits, to ascertain issues related to assessment and coordination of care. Results indicate that psychiatric therapists and primary-care providers do not perform satisfactorily in assessing medical and psychiatric problems, respectively, and in initiating coordination of their patients' health care. The implications of these findings for the training, education, and supervision of staff are discussed.