Beta-adrenergic blockers for the control of aggressive behaviors in patients with chronic schizophrenia.

The authors conducted a chart review to determine the effect of beta blockers on chronic assaultiveness in seven patients with chronic schizophrenia. Six of the patients showed improvement. Four of the seven showed a greater than 70% decrease in actual assaults.

Nadolol as a treatment for akathisia.

The authors present three cases of patients with neuroleptic-induced akathisia who were successfully treated with nadolol, a peripherally acting beta blocker. They discuss the potential implications of this finding.

Use of propranolol for provoked and unprovoked episodes of rage.

The use of propranolol to treat unprovoked rage episodes in brain-damaged patients has recently been reported. The authors report three cases that indicate a role for its use in the treatment of overall aggressiveness in brain-damaged or mentally retarded patients.

Heart rate and blood pressure in black newborns and in white newborns.

Sixty-one full-term, appropriate-weight black newborns had higher heart rates, replicating a racial heart rate difference, but did not differ significantly in systolic blood pressure from 71 white newborns. Systolic blood pressure in the newborn is related both to the total number of feedings from birth and to the total fluid intake.

The effects of clozapine on severely aggressive psychiatric inpatients in a state hospital.

BACKGROUND: After noting a dramatic reduction in aggression and agitation in five psychotic inpatients residing on a specialized unit for the severely aggressive, the authors conducted a retrospective chart review to assess the possible role of clozapine treatment in this change. METHOD: The authors culled 12 months of nursing data, including progress notes, orders for seclusion, and mechanical and chemical restraint, to tabulate the frequency of aggression before and after the initiation of clozapine treatment, and looked at ratings on the Brief Psychiatric Rating Scale and periodic review reports to assess overall clinical change. RESULTS: The results of the review indicate that although psychotic symptoms were not greatly affected by the drug, the overall frequency of assaults, self-abuse, and the use of seclusion, mechanical restraint, and chemical restraint was reduced in the subjects. CONCLUSION: The authors conclude that because the reduction of aggression and agitation coincided with clozapine treatment, it is likely that clozapine was responsible for the change. The authors propose possible reasons for this effect and suggest that controlled studies are needed to substantiate these preliminary results.

Buspirone therapy for maladaptive behavior and anxiety in developmentally disabled persons.

The authors used buspirone, a new anxiolytic agent that has a low side effect profile, to treat 14 developmentally disabled individuals who demonstrated anxiety as well as aggressive and self-injurious behaviors. Nine of the 14 individuals responded favorably to the drug. The authors present case reports for 3 of the responders and discuss the clinical implications of buspirone therapy.

Nadolol to treat aggression and psychiatric symptomatology in chronic psychiatric inpatients: a double-blind, placebo-controlled study.

BACKGROUND: Considerable evidence indicates that the lipophilic beta-blocker propranolol is useful in treating organically based aggression. This study looked at the efficacy of a more hydrophilic beta-blocker, nadolol, to treat aggression in chronic psychiatric inpatients. METHOD: Forty-one chronic psychiatric inpatients with an average of one aggressive outburst per week (defined by the Overt Aggression Scale [OAS]) were entered into a double-blind, placebo-controlled study lasting 17 weeks. The OAS was used to track aggression on a per-incident basis, while the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impressions scale (CGI) were used to track clinical status. RESULTS: Nadolol subjects showed a significant decline in frequency of aggression compared with controls (p = .026) and a significant decline in the BPRS total score (p = .007) and in the subfactors "hostility and suspicion," "negative symptoms," and "signs of hyperarousal/tension." There was no significant change in CGI "severity of illness" ratings between groups, although the nadolol group was significantly improved from baseline at every subsequent time period while the placebo group was unchanged throughout the study. CONCLUSION: Nadolol is of significant benefit in the treatment of aggression in chronic psychiatric inpatients. This drug does penetrate the brain over time, but the success of a drug whose primary locus of action is peripheral may implicate a bimodal mechanism of action, i.e., a role for the CNS and the soma in the maintenance of aggression.

Open trial effects of beta-blockers on speech and social behaviors in 8 autistic adults.

We began open trials of beta-blockers, as adjunctive medication, in eight consecutive autistic adults. The immediate result across all patients was a rapid diminution in aggressivity (Ratey et al., 1987). As time on the drug increased, subtler changes in speech and socialization emerged. While results of open trials must be interpreted with caution, these changes were significant and lasting. We speculate that these effects may be the result of a lessening of the autistic individual's state of hyperarousal. As the individual becomes less anxious, defensive and dearousing behaviors are relinquished and more social and adaptive behaviors appear. There is a concomitant improvement in language, though it is unclear whether lost skills are recouped or new ones developed. Further research is indicated.

Unrecognized attention-deficit hyperactivity disorder in adults presenting for outpatient psychotherapy.

ABSTRACT Adult patients with significant childhood and current symptoms of attention-deficit hyperactivity disorder (ADHD), but whose ADHD had not been previously recognized, were evaluated by three clinical consultants working with diverse referral populations. These 60 adults shared common characteristics of physical and mental restlessness, impulsivity, disabling distractibility, low self-esteem, self-loathing, and a gnawing sense of underachievement. Specific learning or behavior problems were often present. These patients were chronically disaffected. The diagnosis of ADHD appeared to be missed because these individuals presented with atypical symptoms or had found ways to compensate for their deficits. Descriptive generalizations are offered concerning their coping strategies. These adults had sought previous psychiatric care for non-ADHD symptoms but had numerous unsuccessful treatment attempts. Most patients had been treated for mood or anxiety disorders. Traditional defense analysis had little beneficial effect and aggravated problems of self-esteem; modifications of the psychotherapeutic process are recommended. In open clinical trials without formal measures, the majority of such patients appeared to respond to low doses of antidepressants (i.e., desipramine 10-30 mg daily) and seemed to lose the therapeutic effect at higher antidepressant doses.

The concept of noise.

"Noise" is a term we are using to describe a complex and distressing aspect of the bodily and cognitive experience of many very ill psychiatric patients. By "noise," we mean an internally experienced state of crowding and confusion created by a variety of stimuli, the quantity, intensity and unpredictability of which make it difficult for individuals so afflicted to tolerate and organize their experience. Attempts to do so may only add to confusion and psychotic phenomena.

Defense behavior and coping in an autistic savant: the story of Temple Grandin, PhD.

The causal factors in the behaviorally defined syndrome of autism remain unclear, although the past decade has brought to bear two significant developments that shape our view of the disorder. The first of these developments is a growing body of biomedical research that indicates there are multiple etiologies associated with the disorder. This research has allowed for the formation of subgroups based upon neuroanatomical, neurobiological, and neurophysiological abnormalities (Damasio 1984; Piggot 1979; Ritvo et al. 1990). The second is neuropsychological research indicating that the socioemotional deficits are primary to the disorder and may underlie much of the behavioral symptomatology (Fein et al. 1986). These areas of concern undoubtedly have enhanced our understanding of the disorder, yet in their achievements they may too easily absorb what we know about autistics who experience a chronic state of physiological hyperarousal, evidence of which has been found in neurophysiological studies (Delius 1967; Hutt et al. 1965), neurochemical studies (Lake et al. 1977), psychopharmacologic studies (Ratey et al. 1987a), and behavioral studies (Kinsbourne 1980; Kootz et al. 1982; Tinbergen and Tinbergen 1972; Zentall and Zentall 1983). These individuals, perhaps constituting a subgroup of their own, experience an inner state of disorganization that markedly impairs their functioning (Sands and Ratey 1986).

Hysteria, anorexia and the culture of self-denial.

Anorexia and hysteria seem to be expressions of age-specific conflicts intensified by constrictive cultural ideas and certain kinds of familial constellations. The disorder that ensues appears to represent the individual's desperate attempt to escape the conflicts of adult life according to models offered by the prevailing cultural values.

Neurocognitive disorders in psychiatry: a case example of diagnostic and treatment dilemmas.

We present a case example that illustrates the diagnostic and treatment difficulties engendered by adult psychiatric patients with primary behavioral problems and neurocognitive disorders. In the case cited, the neuropsychological evaluation plays a significant role in reconceptualizing a patient who had accrued multiple psychiatric diagnoses including schizophrenia, borderline personality, and impulse control disorder. Formal examination revealed deficits in language, executive, and attentional functions that were far greater than had been expected and led to a major change in treatment strategy, including successful trial of imipramine and nadolol and more structured milieu therapy. The cognitive deficit and intrapsychic conflict models are used to demonstrate the critical aspects of our diagnostic reclassification of the patient to Neurodevelopmental Disorder of Unknown Etiology and Auditory Attention Deficit Disorder.

A psychoanalytic study of eating disorders: I. A developmental profile of 67 index cases.

Much has been written in both the professional literature and lay press regarding the sociocultural basis for the current increase in eating disorders. The typical victims of these afflictions appear to be intelligent adolescent girls from middle and upper class families (Garfinkel and Garner, 1982). Although the general pressure for thinness, mastery, and achievement among women in our culture undoubtedly help shape the course of illness, these social mores do not appear to be its root causes. The data presented here suggest strongly that the truly eating-disordered individual has a history of disturbances in early relationships, leading to a lack of security and pronounced difficulties in trusting others, and in simply being an authentic individual in the presence of others. As such these individuals share many characteristics of others with severe personality disorders such as inner emptiness, problems with identity, fear of abandonment, and peer relationships (Clarkin et al., in press), but differ in the expression of these basic defects or in solutions found to compensate pathologically for these core deficiencies. Therefore, although contemporary cultural ideals and values may supply the shape of the disorder, these individuals would have fared badly in any social climate although their presentation of illness may have differed (Bemporad et al., 1988). It is this profound underlying personality pathology that necessitates prolonged treatment for any hope of amelioration. Later reports will address this indication with a description of the results of therapy.

The psychopharmacology of aggression: toward a new day.

Psychiatrists should reconsider the use of neuroleptics and benzodiazepines as the primary treatment for aggressive behavior, as these drugs do not have a specific anti-aggressive effect. They reduce aggression often at the cost of grave side effects (e.g., tardive dyskinesia, akathisia, and cognitive dulling). Newer regimens such as beta-blockers, serotonin-agonists and serenics have fewer side effects, and do not negatively affect cognitive or attentive functions, allowing for more effective rehabilitation of the patient. These drugs are more specific, and positively influence the four axes of cognition, attention, arousal, and mood regulation, which, if unbalanced, can lead to a higher "noise" level, and thus increased agitation and aggression.

The relationship between extra- and intracellular lithium concentration in human red blood cells: an in vitro study.

Red blood cells (RBC's) from normal volunteers were incubated in vitro at four different extracellular lithium concentrations. Extracellular lithium concentration affected RBC lithium accumulation in several ways. As extracellular lithium concentration increased, the inter-individual variability of RBC lithium accumulation increased. Furthermore, the ratio of RBC lithium concentration to extracellular lithium concentration (lithium ratio) increased in relation to increasing extracellular lithium concentration. A lack of agreement among the authors of recent reports dealing with the significance of the lithium ratio as a psychobiological measure has been noted. It is suggested that this lack of agreement may be due, in part, to the study of patients with differing levels of extracellular lithium.