Lack of clinically significant improvement of patients with tardive dyskinesia following phosphatidylcholine therapy.

A double-blind controlled study was undertaken to examine the value of phosphatidylcholine as a treatment for tardive dyskinesia (TD) in 19 psychiatric patients. All patients were maintained on their usual psychotropic medication throughout the entire study. In addition, they were given either phosphatidylcholine (30 g/day) or placebo for 6 weeks. Thirteen of the patients received the crossover treatment for 6 weeks, after which 10 of the 13 were continued on the crossover medication for an additional 6 weeks. At the end of the study, 5 patients had received phosphatidylcholine for 12 weeks and another 12 patients had received the drug for only 6 weeks. Plasma and red blood cell choline levels were monitored every 3 weeks as a measure of compliance. Although some patients showed clinical improvement of their TD, the results did not differ significantly between active drug and placebo. This was in spite of a marked elevation of plasma and red blood cell choline (up to 300% for the Lafayette Clinic patients and up to 400% for the patients from the Ypsilanti Regional Psychiatric Hospital) during treatment with phosphatidylcholine. Side effects of the drug included occasional gastrointestinal upsets and diarrhea but, in general, the medication was tolerated very well. The results indicate that large doses of phosphatidylcholine of soya origin are of no clinical value in treating symptoms of TD in spite of very large increases in blood choline.

A field application of the ASAM placement criteria in a 12-step model of treatment for chemical dependency.

Procedures followed in the development of a standardized method of rating patient behavior relevant to engaging in a 12 step model of recovery are presented in the context of deriving an empirical cross-walk for the ASAM PPC. This instrument permits addictions counselors to rate the severity of operationally defined behaviors on each of the six criteria dimensions identified in the adaptation of the PPC by the WV Division on Alcoholism and Drug Abuse for use in the 14 member community mental health centers funded by the state. Substance dependent adults (N = 78), who self-selected either residential or partial day treatment at EastRidge's Addictions Treatment Center were evaluated with this procedure over a nine month period. Intercorrelations of ratings on six criteria dimensions at intake ranged from .053 to .576 and after an average length of stay of 18 days, behavioral severity on all dimensions was significantly reduced (p < .0001) on the discharge evaluation with this tool. An empirically based, treatment matching matrix, was constructed from confidence intervals calculated obtained from intake data to form norm referenced ranges for four levels of care (which equate to PPC-2 Levels: III.5, II.5, II.2, I). The utility of this methodology in facilitating the application of the WVPC and PPC-2, and the potential of the DRS as a multiple baseline measure in treatment outcome research is discussed.

Volunteers at risk.

An experiment is described in which three male volunteers, who fully understood the nature of the project, were given doses of heroin which could have led to addiction if the subjects had proved to be physiologically or psychologically vulnerable to developing a state of addiction. The experiment was discussed most carefully by the Ethics Committee of the unit where it was conducted, and the subjects were themselves the investigators. The objective was to learn about the initial stages of the adaptation to heroin, of which nothing was known as heroin addicts usually come to the doctor when the habit is firmly established. A physician, who has studied the subject of drug addiction in a special clinic, is the first commentator, the second a lawyer and the third an associate professor of social ethics. These three experts are not discussing the results or the methodology of the experiment but whether the decision of the Ethics Committe was the right one.