Rapid heroin detoxification using a single high dose of buprenorphine.

To test the effect of 32 mg of buprenorphine on the withdrawal process from heroin, 10 street-heroin using subjects were given 32 mg of sublingual buprenorphine, following heroin abstinence of 24 hours. Withdrawal symptoms were monitored during the first few hours, and followed for six days after buprenorphine administration, after which naltrexone (50 mg) was introduced to prevent future heroin use. Nine subjects completed detoxification with negligible withdrawal symptoms and a smooth transition to naltrexone. One subject was excluded from the study due to methadone ingestion prior to experiment. These results strongly suggest that painless detoxification from heroin can be obtained by a single high dose of buprenorphine.

Possible pitfalls in the diagnosis of acute myocardial infarction in acutely psychotic patients.

The disturbed communication of the acutely psychotic patient with Emergency Room (ER) personnel can occasionally lead to a missed or delayed diagnosis of acute myocardial infarction. Conversely, miscommunication may also lead to a false positive diagnosis of acute myocardial ischemia or infarction. We describe a patient who failed to report lithium ingestion because of his psychotic and toxic state. Moreover, the patient was agitated and was treated with intramuscular haloperidol. These factors produced electrocardiographic changes due to the lithium and a rise in serum creatine kinase due to the intramuscular haloperidol, two criteria which could mislead an inexperienced observer to make the false diagnosis of acute myocardial ischemia or infarction. Lithium related electrocardiographic abnormalities and the causes for elevated creatine kinase isoenzymes are reviewed.

Psychotherapeutic aspects of the martial arts.

Formerly understood by Western thought as only a set of fighting skills, the Martial Arts (MAs) have come to be seen, in the psychological literature about the MAs, as a comprehensive approach to both physical and mental health. The MAs enhance self-esteem through the provision of physical activity and group experience, and the teaching of relaxation, concentration, assertiveness, and directiveness and honesty in communication. Thus, they are understood to be a legitimate form of therapy, for both "neurotic" and some chronically mentally ill patients. It is proposed in this paper, that the MAs can also be a useful supplement to verbal psychotherapy, as they foster and expose feelings through a physical modality, which can then be observed and analyzed in the modality of verbal psychotherapy. A case report illustrates how the MAs produce feelings and reveal problems, which are brought into the psychotherapy arena and analyzed.

Post-traumatic stress disorder in myocardial infarction patients: prevalence study.

This study examined the prevalence of post-traumatic stress disorder (PTSD) in a sample of 100 Israeli myocardial infarction (MI) patients. Chronic PTSD was diagnosed in 16% of these patients and acute (PTSD) in 9%. The appearance of PTSD following MI was found to be related to the following variables: ethnic background; prior traumatic experiences, including prior MI; and anticipation of disability following MI. Objective measures of MI severity were not related to propensity to develop PTSD. The presence of PTSD correlated with self reports of dysfunction in these MI patients and may account for the majority of failures in rehabilitation.

Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians.

The Iraqi missile attack on Israel provided a unique opportunity to study the effects of fright due to a perceived threat of annihilation on the incidence of acute myocardial infarction (MI) and sudden death among the civilian population. During the first days of the Gulf war we noted a sharp rise in the incidence of acute MI and sudden death in our area compared with five control periods. Patient population in the various study periods did not differ significantly in age, sex ratio, hospital mortality, or proportion of patients in whom the acute event was the first presentation of coronary disease. However, during the first period of the war there were more cases of anterior wall MI and more patients received thrombolytic therapy than during control periods. Despite the continuing missile threat, the incidence of acute MI reverted to normal after the initial phase of the Gulf war.

Samson's complex: the compulsion to re-enact betrayal and rage.

A comparison of the life story of a psychotherapy patient to that of biblical Samson reveals that both men suffer from a behavioural disturbance, manifested in the compulsion to re-enact the experience of betrayal by women, followed by destructive attacks of rage against others, and ultimately against their own tormented selves. The author tracks the origin of repetition compulsion to its proposed psychobiological foundations of attachment-formation and its development. Samson's complex is viewed as a deep-seated, characterological defect, stemming from faulty object relations and leading to existential despair and suicidal longing. The existence of a detailed psychopathological phenomenology embedded in timeless biblical lore denotes once more the alliance between myth and psychology.

Post-traumatic stress disorder following myocardial infarction.

The evaluation of Post-Traumatic Stress Disorder (PTSD) following myocardial infarction in four patients is described. The authors outline principles of the therapeutic interventions performed to alter the disorder and alleviate patients' incapacitation. Also discussed are the reasons that may be at the root of the omission of the diagnosis of PTSD for this patient population.

Varieties of combat stress reaction. An immunological metaphor.

The use of an immunological metaphor allows the incorporation of established theoretical ideas about trauma and stress in an integrative way which enables delineation and illustration of several varieties of combat stress reaction, including subtle forms of that condition which do not often appear in post-traumatic stress disorder literature.

Assessment of autonomic function in humans by heart rate spectral analysis.

Spectral analysis of spontaneous heart rate fluctuations were assessed by use of autonomic blocking agents and changes in posture. Low-frequency fluctuations (below 0.12 Hz) in the supine position are mediated entirely by the parasympathetic nervous system. On standing, the low-frequency fluctuations increase and are jointly mediated by the sympathetic and parasympathetic nervous systems. High-frequency fluctuations, at the respiratory frequency, are decreased by standing and are mediated solely by the parasympathetic system. Heart rate spectral analysis is a powerful noninvasive tool for quantifying autonomic nervous system activity.

Meditation and psychotherapy: a rationale for the integration of dynamic psychotherapy, the relaxation response, and mindfulness meditation.

A framework for the integration of meditation and psychotherapy is presented through a consideration of the psychobiological nature of meditation (the relaxation response) and discussion of a traditional meditation practice (mindfulness meditation) as an effective cognitive technique for the development of self-awareness. The mechanisms by which the emotional and cognitive changes of meditation can be of therapeutic value are explored and the synergistic advantages of the combination of psychotherapy and meditation are discussed.

Meditation as an adjunct to psychotherapy. An outcome study.

The effect of a 10-week meditation program on 20 patients who were undergoing long-term individual explorative psychotherapy was studied. Change in the psychological well-being of the patients and the impact of the program on the process of their psychotherapy was evaluated. Results obtained from the patients' self-ratings and the therapists' objective ratings demonstrated a significant and substantial improvement in most measures of psychological well-being.

Diagnosis of misdiagnosis: on some of the origins and functions of psychophysical misdiagnosis.

Four cases of Peripheral Neurological Disorders (PND) are reviewed as models of misdiagnosis. Weaknesses in the logical process of diagnosis formation, combined with the dismissive function of the diagnosis, may lead to psychiatric misdiagnoses such as hysteria. The same logical and emotional factors can prevent correction of misdiagnosis and thus the misery of the patient may continue. Comments are made about the dangers of misusing the diagnosis of hysteria.

Epinephrine-induced changes in the distribution of lymphocyte subsets in peripheral blood of humans.

We have previously demonstrated that mitogen responsiveness of mononuclear cells (MNC) from peripheral blood is reduced after a single injection of epinephrine to human subjects. The purpose of the present study was to characterize the relative distributions of MNC subsets after epinephrine administration using monoclonal antibodies and conventional cell markers. The absolute number of circulating MNC increased 64% within 30 min after injection of epinephrine, and returned to baseline by 2 hr. Analysis of MNC subsets revealed that there were no changes in the relative percentages of total T lymphocytes [T3+ cells, or neuraminidase-treated sheep red blood cell rosettes (EN-rosettes)], B lymphocytes (B1+, or cells with surface-bound immunoglobulin), or monocytes (by morphologic criteria) after epinephrine administration. The percentage of inducer T cells (T4+) declined at 30 and 60 min postinjection. Overall, the percentage of suppressor/cytotoxic T cells (T8+) did not change after injection of epinephrine; however, analysis of individual subjects revealed opposing responses of this subset. The T4:T8 ratio was 2.19 before injection, declined to 1.56 at 60 min, then increased to 3.10 2 hr postinjection. The percentage of natural killer/killer cells (HNK-1+) increased from a baseline of 15.5% before epinephrine injection to 29.6% at 30 min postinjection, then declined to 11.4% at 2 hr. Therefore, the administration of physiologic doses of epinephrine results in changes in the relative proportions of lymphocyte subsets in peripheral blood, in addition to reduced mitogen responsiveness as reported previously.

Decrease in mitogen responsiveness of mononuclear cells from peripheral blood after epinephrine administration in humans.

A single subcutaneous injection of 0.2 mg epinephrine into healthy human subjects caused a transient lymphocytosis in peripheral blood. Mononuclear cells (MNC), isolated at various times after epinephrine administration, were cultured in the presence of mitogens. The blastogenic responses to pokeweed mitogen (PWM) and phytohemagglutinin (PHA) were significantly reduced for up to 60 min post-epinephrine (p less than 0.05); the response to concanavalin A (Con A) was reduced in the 15-min samples only. All responses returned to pre-injection levels by 120 min post-injection. Removal of adherent monocytes from MNC isolates before culture did not restore normal mitogen responsiveness. When MNC were cultured in the absence of mitogens, there was no difference in survival between pre- and post-epinephrine samples. Incubation of untreated MNC for 2 hr or 18 hr in vitro with various concentrations of epinephrine (10(-5) to 10(-1) mg/ml) had no effect upon the subsequent blastogenic response to mitogens. Other workers have reported that epinephrine administration causes alterations in the composition of the circulating lymphocyte pool. Taken together, these data suggest that the reduction in mitogen responsiveness after epinephrine is the result of changes in the distribution of lymphocyte subclasses in peripheral blood.

Effect of electroconvulsive treatment on serum dopamine-beta-hydroxylase activity in man.

The activity of dopamine-beta-hydroxylase was measured in the serum before and immediately after electroconvulsive treatments. No significant difference was observed, suggesting that the seizures did not cause an increase in the peripheral sympathetic tone.