Amitriptyline versus haloperidol in borderlines: final outcomes and predictors of response

The authors report the final results of a 4-year study of amitriptyline and haloperidol in 90 symptomatic borderline inpatients. Medication trials were double-blind and placebo controlled and lasted 5 weeks. Haloperidol (4-16 mg/day) produced significant improvement over placebo in global functioning, depression, hostility, schizotypal symptoms, and impulsive behavior. Significant effects of amitriptyline (100-175 mg/day) were generally limited to measures of depression. Factor analysis identified three symptom change patterns: a global depression, hostile depression, and schizotypal symptom pattern. Medication effects favoring haloperidol were most prominent for hostile depression. Variables predicting favorable response to haloperidol included severity of schizotypal symptoms, hostility, and suspiciousness. Schizotypal symptoms and paranoia predicted poor outcome on both depression patterns with amitriptyline. Placebo effects were most prominent on acute state symptoms, with severe character traits predicting poor response.

The self-reported effects of PCP on human aggression

The elicitation of violent of psychotic behavior by phencyclidine (PCP) administration is well documented. There are indications, however, that behavioral responses to PCP may differ among PCP users as a function of background or personality characteristics. The present study examined 35 male jail inmates with histories of PCP use. Estimates of the nature and extent of drug use and self-reports of previous psychiatric hospitalizations were obtained in these subjects. The Buss-Durkee Hostility Inventory was modified to reflect behaviors under the two simulated conditions of "No PCP" and "PCP" use. Results showed that PCP use was related to increased levels of hostility in our subjects when present age, age of first use, the frequency of use and suspicion and assaultive behavior when not using PCP was considered. Also, subjects with a history of psychiatric hospitalizations reported higher levels of assault when using PCP than those without psychiatric histories. These data suggest that the self-reported behavioral results of PCP use are associated with certain personality traits and background features.

An efficacy study of isocarboxazid and placebo in depression, and its relationship to depressive nosology

Isocarboxazid and placebo were evaluated in 130 anxious depressives. Drug was superior to placebo on depression, anxiety, interpersonal sensitivity, and global measures, and on symptoms of hostility, anxiety, obsessiveness, and psychological-cognitive components of depression. There were no significant differences between treatment effects on psychomotor and typical vegetative symptoms. Isocarboxazid was more effective than placebo in major, but not in minor, depression. It was significantly more effective in depression classified as endogenous depression or melancholia by various diagnostic criteria. Drug was more effective than placebo in atypical depression with vegetative reversal and in Brief Psychiatric Rating Scale (BPRS)-derived profiles of anxious and hostile depression; there were no drug-placebo differences in atypical depression without vegetative reversal, or in BPRS retarded and agitated/excited depression. Interpersonal sensitivity emerged as an important drug-responsive dimension.

Effects of beta-adrenergic stimulation and blockade on cardiovascular reactivity, affect, and type A behavior

The present study examined the acute effects of drugs that stimulate or block sympathetic nervous system activity on components of Type A behavior, affect, and cardiovascular responses to mental stressors. Either propranolol (a beta-adrenergic blocker), isoproterenol (a beta-agonist), or placebo was infused intravenously at different times in 12 healthy males. In two sessions, placebo (saline) was administered first, followed by a structured interview, challenging mental arithmetic test, and completion of affect scales. The procedure was then repeated with one of the active drugs, presented in counterbalanced order. Results indicated reliable drug effects on both heart rate (HR) and systolic blood pressure (SBP) reactivity to the tasks, with change scores to the tasks markedly increased by isoproterenol. Anxiety and hostility ratings paralleled results for HR and BP, with much of this effect being due to higher affect ratings for isoproterenol. The effect of the drugs on Type A behavior was unexpected, with global Type A and several components lowered by isoproterenol and unaffected by propranolol. These data are discussed in terms of the interfering effects of anxiety on Type A speech components. The influence of isoproterenol on affect and reactivity might reflect the physiologic action of a beta 2-adrenergic positive feedback loop which increases release of endogenous norepinephrine, and/or potentiating effects of emotion on reactivity to stress.

Clinical and biochemical effects of verapamil administration to schizophrenic patients

We administered verapamil hydrochloride, a calcium channel antagonist, to seven chronically ill schizophrenic patients for five weeks under double-blind, placebo-controlled conditions. No therapeutic effect was noted. Worsening in hostile and uncooperative behaviors and a syndrome of heightened emotional tone was observed during verapamil treatment and during the postverapamil placebo period. Verapamil produced significant increases in cerebrospinal fluid (CSF) and plasma levels of homovanillic acid and in plasma levels of prolactin, as well as significant decreases in plasma levels of 3-methoxy-4-hydroxyphenethyleneglycol. Verapamil and its active metabolite, norverapamil, were partitioned into CSF with CSF/plasma ratios of 0.06 and 0.04, respectively. The lack of therapeutic effects of verapamil in schizophrenic patients differs from earlier reports of its usefulness in treating manic patients. The biochemical and clinical data from our study suggest the possibility that verapamil exerts behaviorally relevant central nervous system activity in schizophrenic patients.

Combination of psychotherapy and drugs in the treatment of neurosis. A controlled comparison of bromazepam and thioridazine

Eighty out-patients with neurotic disorders were studied in an integrated treatment model combining psychotherapy and psychotropics in a "conjoint marital therapy" setting. The spouses, who seemed a healthy group, were used as reporters, as controls and as participants in the psychotherapy. The pharmacological trial was a double-blind, cross-over study, comparing bromazepam and thioridazine after a placebo period. Bromazepam was more effective in controlling different anxiety symptoms and demonstrated more potent activating properties than thioridazine. Hostility symptoms, however, responded better to thioridazine. These findings were confirmed by ratings performed by patients, spouses and the investigator. Differences in drug preference and drop-out rate showed the same tendency. Nine weeks' continuous treatment did not change the differences found in the cross-over study. No pharmacological rebound symptoms were observed after drug withdrawal. The personality of the spouses was related to the outcome in the patients. Moreover, there was an obvious positive interaction between the psychotherapy given and the drug treatment.

A comparison of parenteral loxapine and haloperidol in hostile and aggressive acutely schizophrenic patients

In a parallel groups, double-blind study, 54 acutely psychotic schizophrenics were given loxapine or haloperidol parenterally for 24 to 72 hours, then orally for a total study period of up to 10 days. Dosage ratios of loxapine to haloperidol ranged from a minimum of 2.7:1 to a maximum of 4.4:1. Both groups showed significant and rapid improvement from baseline. Forty-eight percent of the loxapine patients and 33% of the haloperidol patients achieved and maintained a global severity of illness rating of mild or better. By the end of the study, 84% of the loxapine patients and 63% of the haloperidol patients had achieved an improvement rating of moderate or marked. This difference approached significance (p less than .10). The most frequently reported adverse experiences were dystonic reactions and akathisia. The number and severity of adverse experiences did not differ significantly between drug groups. Intramuscular loxapine was at least as effective as haloperidol in the initial management of hostile and aggressive schizophrenic patients. The maintenance of therapeutic response after conversion to oral concentrate was comparable with the two drugs.

Behavioral indications for phenothiazine and benzodiazepine tranquilizers in dogs

In a controlled study on 18 caged dogs, the effects of 2 psychoactive drugs on friendliness, excitability, and fearfulness were systematically and quantitatively evaluated. Diazepam was selected to represent the benzodiazepine group, and chlorpromazine represented the phenothiazine group. Diazepam was more effective in suppressing signs of fear than was chlorpromazine. Diazepam increased measures of excitability, whereas chlorpromazine had opposite effects.

Reduction of distress in hyperprolactinemia with bromocriptine

In a double-blind placebo-controlled crossover study of bromocriptine in eight hyperprolactinemic patients, self-rated distress decreased and well-being increased parallel with the fall in prolactin levels; for the majority of measures the differences were significant.

Sex steroids and affect in the surgical menopause: a double-blind, cross-over study

The effect of estrogen and/or androgen on mood in surgically menopausal women was investigated with a prospective, double-blind, cross-over design. Oophorectomized women who received either estrogen (E), androgen (A), or a combined estrogen-androgen preparation (E-A) parenterally attained lower depression scores during both treatment phases compared to a placebo group (PL), coincident with their higher plasma estrogen and testosterone levels. When steroids were withdrawn, depression scores of all oophorectomized women were significantly higher than those of a hysterectomized control group with intact ovaries (CON). The A group also had higher hostility scores than the E, PL, and CON groups. These data provide evidence of a covariation between circulating levels of estrogen and testosterone and certain affects in healthy women.

[Pharmaco-ethological analysis of agonistic behavior between resident and intruder mice: effects of psychotropic drugs]

The present study was conducted to investigate the effects of psychotropic drugs on agonistic behavior between resident and intruder mice. The effects of four doses of the following drugs were assessed in either resident or group-housed intruder mice: chlordiazepoxide (0, 5, 10 and 20 mg/kg, i.p.), haloperidol (0, 0.25, 0.50 and 0.75 mg/kg, i.p.) and imipramine (0, 5, 10 and 20 mg/kg, i.p.). Residents and intruders were drugged on alternate test days, and all animals received different sequences of each of the drug conditions according to a random schedule. The injection-test interval was 30 min. When resident mice were treated with chlordiazepoxide the resident's aggressive episodes (sideways posture, attack bite, tail rattle) were significantly suppressed. Both haloperidol and imipramine also showed a similar suppressive effect on the resident's aggressive episodes, but haloperidol significantly suppressed locomotor activity at all doses. When intruder mice were treated with chlordiazepoxide, attack bites by untreated residents were significantly increased in a dose-dependent manner, and the frequency of defensive upright posture displayed by intruder animals were significantly decreased. Haloperidol and imipramine did not alter resident's behavior and intruder's upright posture when intruders were drugged. The results suggest that chlordiazepoxide has specific effects on both the hostility of the resident and the anxiety of the intruder, differing from haloperidol and imipramine.

Differential effects of diazepam and pentobarbital on mood and behavior

The effects of administering moderately high doses of diazepam and pentobarbital sodium for five consecutive days to subjects with histories of sedative drug abuse were examined. The two drugs produced similar dose-related effects on psychomotor performance, daytime sleeping, and ratings of magnitude of drug effects. Diazepam, but not pentobarbital, produced dose-related decreases in staff ratings of subjects' mood and social interactions and increases in staff ratings of subjects' hostility, complaining, and unusual behavior. During the placebo washout periods that followed drug administration. diazepam, but not pentobarbital, was associated with carry-over effects. The diazepam-produced deterioration in mood and social behavior was a subtle effect observed in a population for which usual therapeutic indications were lacking and at higher than usual therapeutic doses. The syndrome may, however, occur with long-term diazepam use or misuse in therapeutic settings and, hence, warrants clinical awareness in monitoring the course of treatment.

Alcohol, affect, and the disinhibition of verbal behavior

A study was conducted to investigate the effects of acute alcohol administration on affective states and verbal behavior during the ascending and descending limbs of the blood alcohol curve. Sixteen male social drinkers were given alcohol (1.0 g/kg) or placebo in a double-blind crossover research design. Subjects tested while blood alcohol levels (BAL) were ascending close to peak concentration (0.11 g%) described themselves as more elated, friendly, and vigorous than when tested under placebo conditions. As BAL declined, subjects described themselves as more angry, depressed, and fatigued. Cognitive confusion, hostile verbal interaction, and aggressive thematic content were also greater during alcohol intoxication, but these measures were unrelated to direction of change in the BAL curve. It was concluded that (1) the effects of alcohol on affect are biphasic and are closely related to direction of change in the BAL curve, (2) the disinhibition of certain types of verbal behavior is related neither to affective state or to direction of the BAL curve, and (3) the perception of cognitive disorientation may mediate the effects of alcohol on those behaviors normally suppressed by various controlling influences.

Loxapine succinate as initial treatment of hostile and aggressive schizophrenic criminal offenders

The efficacy and safety of loxapine were evaluated in 18 acutely ill schizophrenic criminal offenders in the Essex County Jail. The offender patients were treated for three days with intramuscular loxapine (25 mg three or four times a day), followed by seven days of oral concentrate (up to 150 mg/day in three or four divided doses). Psychiatric status was determined with the Brief Psychiatric Rating and the Clinical Global impression scales at the time of admission, after 8, 24, 48, and 72 hours, amd on days 7 and 10 of medication. Three patients did not complete treatment: one was released on bail after 24 hours of therapy, and the other two had adverse reactions (tongue swelling and muscle spasms, each in one patient) which required cessation of treatment. Statistically significant improvement in both rating scale results was evident as early as 8 hours after treatment began. By day 10, all Brief Psychiatric Rating Scale items and factors and the Clinical Global impression results were statistically improved over baseline measurements. At the end of the study, 87 per cent (13/15) of the patients were well enough to cooperate with their attorneys and understand the procedures of the court. Adverse effects (generally extrapyramidal) appeared in four of 18 patients during parenteral administration and in two of 15 patients during oral therapy.

The effects of a provocation on aggression for three types of alcohol users

Investigated the effects of a provocation on aggression for three types of alcohol users. The Alcohol Use Inventory was used to select 30 light-moderate and 30 moderate drinkers. Thirty abstainers were selected as a control group. Half of each group was assigned randomly to one of two treatments, a provocation or a no-provocation. After treatment, each S completed the Adjective Rating Form (ARF) verbal aggression scales and the Multiple Affect Adjective Checklist (MAACL). The results of this study indicated that, for both instruments, the provocation elicited significantly more feelings of hostility and verbal aggression than the no-provocation. However, there were no significant level effects, nor was there a significant interaction between level of drinking and presence of a provocation. The failure to find significant level effects was attributed to the abstainers' scores. With the abstainer category excluded from the analysis, additional findings resulted in significant level effects for the MAACL hostility scales, but not for the ARF verbal aggression scales. It was recommended that future studies investigate risk factors of abstinence and eliminate the abstainer category as a control.

Benzodiazepine derivatives--side effects and dangers

The benzodiazepines are generally safe and effective drugs with usually only minor side effects, dose-related sedation being the most common. A range of paradoxical effects can occur of which release of aggressive and hostile feelings has excited most attention. These responses are idiosyncratic however, as most patients report decrease of such feelings while taking benzodiazepines. Dependence on benzodiazepines with escalation of dosage and/or social abuse is uncommon set against their widespread use. Recently though, evidence has accumulated that patients on normal doses for prolonged periods can commonly experience withdrawal symptoms, often unpleasant and even severe. These drugs should be reserved for patients suffering from defined clinical anxiety syndromes and not used indiscriminately in patients with normal stress responses.

Anxiety, anger, and neurogenic tone at rest and in stress in patients with primary hypertension

To determine whether basal blood pressure or pressor responses to stress are related to sympathetic nerve tone or to psychological factors in hypertensives, 15 hypertensives and 13 normotensives were studied by mean of a self-administered questionnaire, isometric handgrip exercise (IHE), and the mental stress of serial subtraction. Plasma norepinephrine (NE), epinephrine (E), blood pressure (BP) and heart rate (HR) were measured before and at the end of IHE and mental stress. A greater number of hypertensives had suppressed anger (p less than 0.01) and scored higher on anxiety trait (p less than 0.01) and depression (p less than 0.05). Prestress (IHE and mental) BP and NE values were significantly greater in hypertensives (all p less than 0.01). During IHE, both groups had a significant increase of BP, HR, and NE (all p less than 0.01) but E rose in hypertensives only (p less than 0.05). The percentage change of BP, HR, NE, and E during IHE was similar in both groups. The changes of BP and HR were not related to NE or E. During mental stress, HR (p less than 0.01) and E (p less than 0.05) increased in both groups. However, BP (systolic and diastolic) increased in normotensives only (p less than 0.01). Plasma NE contents were unchanged in both groups. There were significant positive correlations of anxiety trait with systolic BP (p less than 0.05), diastolic BP (p less than 0.05), and NE (p less than 0.05) and E (p less than 0.05). Although hypertensives had increased neurogenic tone related perhaps to inward anger and anxiety, the percentage responses of neurogenic tone and BP to IHE were equivalent to those of normotensives. The challenge of serial subtraction did not elicit further noradrenergic or pressor responses in hypertensives. Suppressed anger and anxiety, via increased basal neurogenic tone, may be pathogenic factors in some patients with primary hypertension.

Changes in the hostility of schizophrenic patients during treatment

Hostility towards self and others often precipitates admission to hospital of the schizophrenic patient. A follow-up study of 24 newly admitted schizophrenic patients during eight weeks of treatment indicated high intropunitiveness and extra-punitiveness at admission which decreased concurrently with psychopathology. The larger change was in intro-punitiveness, resulting in an increase in the original predominance of extra-punitiveness. The various measures of hostility were not predictive of response to treatment at eight weeks. Comparisons between the schizophrenic group and a group of depressed patients indicated significant differences in the expression of hostility. At admission the schizophrenic patients are less intro-punitive and more extra-punitive than the depressed patients, these differences disappearing after eight weeks of treatment. This finding tends to support the psychodynamic view of projective and introjective mechanisms in these two illness groups.

Paradoxical reactions to benzodiazepines

1 The overall incidence of paradoxical responses to the benzodiazepines is extremely small, but a few controlled studies have been carried out which define the population at risk.

2 Such reactions tend to be idiosyncratic except possibly in patients with pre-rage personality, and do not seem to be associated with any predictable clinical indications.

Morphine, experimental pain, and psychological reactions

This study examines the effects of morphine (10 mg/70 kg body weight) versus placebo (isotonic saline) on experimentally induced cold pressor pain threshold and tolerance, on self-reports of psychological states and drug effects, observer ratings of psychological states, and performance on timed cognitive-motor tasks in 20 non-drug using, normal male volunteers (21-28 years of age). Morphine increased both threshold and tolerance for cold pressor pain, and also increased "euphoric" and decreased "clear thinking" responses on the respective scales. Morphine, in contrast to placebo, increased scores on depression, fatigue, and cognitive loss-dysfunction scales and decreased scores on carefree and "friendliness" scales. Three sets of psychological variables were observed to covary significantly: Measures of anxiety and hostility; reports of fatigue and cognitive dysfunction; and reports of carefree feelings and perceptions of clear thinking. While measures of hostility, fatigue, and cognitive dysfunction covaried positively, reports of carefree feelings and perception of clear thinking covaried negatively with increased pain threshold and tolerance. Anxiety, contrary to reports in the literature, also covaried positively with the pain measures. The results were interpreted as supporting a relationship between increased arousal of the nervous system and decreased pain sensitivity in conjunction with the known analgesic effects of morphine.

Effects of althesin in psychotherapy of schizophrenics. Preliminary report

Althesin infusions in subhypnotic dosage were given as a possible supportive agent during psychotherapy sessions in 6 chronic schizophrenics nonresponsive to neuroleptics and hardly amenable to psychotherapy. Speech content analysis (Gottschalk-Gleser method) of the therapy sessions of 2 patients gave the impression that there was lower hostility during Althesin sessions whereas anxiety was less influenced. The scoring from 2 patients in a self-rating scale on the state of wellbeing supported in impression of a beneficial effect of Althesin. Negative feelings were decreased and patients appeared to be more assertive.

[Drug-response differences of high and standard dosage of fluphenazine-decanoate in relation to schizophrenic symptoms (author's transl)]

The treatment of schizophrenic patients with high-dosed neuroleptics is discussed. The drug-response difference between a low dose and a high dose of Fluphenazine-Decanoate was investigated in 40 chronic schizophrenic patients. All patients were resistant to standard doses of neuroleptics and were therefore treated with higher doses. All patients entering the study were treated for at least three months with high doses of Fluphenazine-Decanoate, i.e. 100 mg or more within three weeks. From this pool of 40 patients two groups were created at random for the doubleblind study: In one group the high dose was continued (average dose 225 mg/in 14 days), in the other group Fluphenazine-Decanoate was reduced to a standard-dose of 25 mg in 14 days. During the 24 weeks of investigation the somatic and psychopathological state of the patient was evaluated by means of the AMP-System. Furthermore the self-rating scale EWL-K was used. After 24 weeks the patients of the high-dosed group were more often rated as unchanged, while the patients in the standard-dosed group were evaluated significantly more often as better or worse. Average condition-differences between the both groups could not be found in a covariance-analysis. A factorial covariance-analysis showed that differences in the initial hostility-syndrome and catatonic-syndrome scores are predictors for a syndrom-relevant differential dosage per group. Patients with low hostility- and low catatonic-syndrome-scores improved after reduction of the doses in the apathic, the halluzinatoric-desintegrative and the neurological syndrome, whereas patients with high initial hostility- and catatonic-syndrome-scores became psychopathologically worse after dosage reduction. Finally the possibilities of generalizing from the results obtained to the relevance of high and standard neuropletic therapy are discussed.

Effects of estrogens on sleep and psychological state of hypogonadal women

A double-lind crossover study involving 16 hypogonadal women compared the effects of placebo and conjugated estrogens, 0.625 mg daily, on gonadotropin levels, symptoms, sleep patterns, and psychological state. After one month, serum concentrations of follicle-stimulating hormone fell 31%, and levels of luteinizing hormone, 19%; the number of vasomotor flushes also decreased. The administration of estrogens was also associated with a shorter mean sleep latency, a longer period of rapid eye movement sleep, and a positive correlation between psychological intactness (as clinically ranked) and latency to sleep onset. Psychological testing, including the Clyde Mood Scale, and the Gottschalk-Gleser Test indicated that estrogens caused this group to be less outwardly aggressive but more inwardly hostile.

Benzodiazepines in the treatment of aggressive patients

A double-blind, controlled clinical trial of chlordiazepoxide, oxazepam and placebo was conducted in 65 outpatients with past histories of temper outbursts, assaultive behaviour and impulsiveness associated with anxiety, irritability and hostility. Of those tests showing statistically significant results, there was a tendency for oxazepam to be somewhat more effective in the reduction of anxiety than chlordiazepoxide. Oxazepam was also superior to the latter on 1 subscale of tests used to measure hostility. No paradoxical rage responses were noted.

Doxepin versus imipramine in psychoneurotic depressed patients with sleep disturbance: a double-blind study

This double-blind randomized study compared the effects of imipramine (48 patients) and doxepin (49 patients) in psychoneurotic depressed patients with sleep disturbance symptoms. Mean doses of 112.7 mg/day for doxepin and 116.7 mg/day for imipramine were administered for a mean period of 26 days. While both drugs proved effective, 24 of 27 analyses of covariance showed imipramine to be superior to doxepin. This superiority was statistically significant for the anxiety/depression factor measured on the Hamilton Depression Scale and for the total score, general neurotic feelings factor, cognitive performance difficulty factor and anger-hostility cluster on the Lepman-Rickels Scale. Mild-to-moderate side effects were prevalent to a comparable degree in both treatment groups.

Prazepam in the treatment of anxiety: a placebo-controlled multicenter evaluation

A double-blind randomized multicenter parallel group comparison of prazepam in divided doses vs. placebo was conducted by 15 investigators among 847 patients presenting with anxiety alone or concurrent with other medical illnesses. Study groups were well matched for age, sex and level of pre-treatment symptomatology. Efficacy evaluation by a physician questionnaire included serial assessment of global improvement plus 10 target signs/symptoms during the 2 to 4 weeks of treatment. Prazepam was statistically significantly superior to placebo as shown on final on-treatment scores for global improvement ratio and for the target symptoms of anxiety, tension, irritability/hostility, depressive mood, insomnia and somatization.

Absence of hostility in outpatients after administration of halazepam--a new benzodiazepine

A number of benzodiazepine have been shown to increase hostility and aggression. This study examines whether halazepam, a new benzodiazepine structurally very similar to diazepam, is associated with increases in hostility. Fifty-one adult outpatients in a double blind, 6 week study were randomly assigned either halazepam or placebo. Hostility was measured by changes in response on four different scales, the anger-hostility factor of the Patient Symptom Checklist and three MMPI hostility scales. The results of our study indicated that halazepam does not induce significant changes in hositility.

The use of benzodiazepines in prison populations

Experience with the use of tranquilizing drugs in the control of anxiety and in attempts at behavior modification, prompted a controlled study in the use of the benzodiazepines at the Utah state prison. It appeared that the benefits derived from the administration of these drugs in prisoner control were nearly outweighed by the frequent appearance of paradoxical rage reactions and increase in hostility and aggressive tendencies in these individuals. A double blind, cohort, prospective, randomized study was set up comparing Valium and Serax in their antianxiety qualities and their tendency to produce increased aggression and paradoxical rage reactions. Guidelines are proposed for the use of benzodiazepines and Serax is suggested as a superior drug to Valium for this purpose if indeed a tranquilizer of this type is indicated.

Effects of chlordiazepoxide and oxazepam administration on verbal hostility

We compare the effects of chlordiazepoxide, oxazepam, and placebo on hostility, as both an inner motivational or potential state and verbal interpersonal behavior. This article reports the findings relevant to the latter dimension of hostility and integrates them with those findings, presented in an initial report, relevant to hostility as an inner motivational state. The verbal data again support the hypothesis that chlordiazepoxide-induced increases in verbal interpersonal hostility, following frustration, are greater than those associated with placebo. With regard to oxazepam, the verbal hostility data were consonant with the motivational data that suggested that oxazepam does not substantially disinhibit hostility but did not as consistently differentiate oxazepam and chlordiazepoxide at the level of overt hostile behavior.

The effect of alcohol and smoking on testosterone function and aggression in chronic alcoholics

Forty alcoholics without other significant medical or psychiatric problems were studied on a research ward for two weeks. All subjects abstained from alcohol and cigarettes during the first week; 30 randomly selected subjects were permitted unlimited alcohol and/or cigarettes during the second week. Plasma testosterone levels were normal during the first week but decreased rapidly and significantly in those subjects allowed alcohol. A variety of measures of affect failed to show a significant correlation between hostility/aggression and plasma testosterone levels or alcohol ingestion.

Effect of marijuana and placebo-marijuana smoking on psychological state and on psychophysiological cardiovascular functioning in anginal patients

Ten male anginal patients with angiographically documented coronary artery disease, in a randomized double-blind crossover study, smoked one marijuana cigarette (containing 18 mg of delta-9-THC) on one morning and one placebo marijuana cigarette (containing 0.05 mg of delta-9-THC) on a successive morning. Significant increases occurred in average cognitive and intellectual impairment scores, derived from the objective content analysis of 5 min of speech, 30 mins after smoking the marijuana cigarette as compared to the placebo marijuana cigarette, and these scores decreased to near presmoking levels 60 min after smoking. No significant average changes occurred in anxiety or three hostility scale scores following smoking marijuana. Sizable individual differences were noted in the psychological responses to marijuana smoking due, presumably, to personality differences and/or differences in THC pharmacokinetics. Significant psychocardiovascular hemodynamic correlations, as measured by echocardiography, were observed during placebo-marijuana smoking between hostility inward scores and systolic blood pressure and ejection fraction, overt hostility outward scores and diastolic blood pressure, as well as between anxiety scores and stroke volume and left ventricular end-diastolic dimension and left ventricular diastolic volume. These significant psychophysiologic correlations were all eliminated during marijuana smoking. In view of associated findings that marijuana smoking decreased myocardial oxygen delivery, decreased exercise time until the onset of anginal pain, and increased myocardial oxygen demand in anginal patients, the use of marijuana by such patients is clearly inadvisable.

Mesoridazine (Serentil) in personality disorders--a controlled trial in adolescent patients

A double-blind study vs. placebo was carried out over a 6-week period in thirty adolescent patients to determine the efficacy and safety of mesoridazine, in the form of 10 mg tablets, in the treatment of symptoms associated with various personality disorders. The average daily dose for the 15 patients in the mesoridazine group was 27.3 mg in the first and 44.7 mg in the sixth week. Mesoridazine relieved anxiety to a highly significant degree when compared with placebo and proved significantly more effective than placebo also in terms of mean improvement scores for depression and hostility. Significant reductions were likewise achieved in the overall severity of the disorders and in the severity of nearly all the other symptoms. The incidence of adverse reactions did not differ significantly from that following placebo administration. No extrapyramidal symptoms were noted.

Marijuana and hostility in a small-group setting

The authors used several indices to assess the relationship between marijuana and hostility as both inner affect and verbal behavior in a small-group setting. Marijuana subjects reported a small but statistically significant decrease in hostile feelings after the introduction of a frustration stimulus. They also showed significantly less verbal hostility than placebo subjects both before and after introduction of a frustration stimulus. The authors note that research findings on marijuana and hostility are not consistent and suggest a multidetermined relationship based on dose, environment, nature of the frustration stimulus, and intraindividual factors.

The rational use of anxiolytics

The prescribing of anxiolytics is often a hit-and-miss process. Current knowledge is examined to encourage a more rational use of such drugs. Because the common symptoms occur in a great array of illnesses, diagnosis is of first importance. For the transient situational disturbance drugs may be unnecessary or may be used merely for a day or two. If the anxiety state persists for a month or so the illness might be termed an anxiety neurosis and if there is no accompanying depression, a short course of benzodiazepine may be of value. With depression present to more than a mild degree as part of the neurosis the tricyclic antidepressant doxepin usually achieves better results than a benzodiazepine. Imipramine can be helpful for the phobic anxiety syndrome and monoamine-oxidase inhibitors can be of separate utility. If the anxiety and depression occur in the context of alcoholism, thioridazine and amitriptyline have certain advantages. There is very little place for phenothiazines or other antipsychotic agents in low doses in the therapy of anxiety except for thioridazine in the above indication.

Interpersonal behavior in a small group setting during the heroin addiction cycle

In a study of social interaction during an experimental addiction cycle, male narcotic addicts expressed more hostility after higher doses of heroin. No consistent role variations were observed in dominance, friendliness, or therapeutic-orientation.

Psychopathology, craving, and mood during heroin acquisition: an experimental study

Six detoxified addict volunteers were allowed to self-administer intravenous heroin on an essentially self-determined schedule. Two periods of heroin acquisition were compared: an unmodified cycle in which patients could become intoxicated and a later cycle in which the effects of heroin were blocked with a narcotic antagonist. In the unblocked condition, patients initially experienced an increase in positive mood, but with chronic administration there was a significant rise in psychopathology and the development of a generalized dysphoric state. Similar changes did not occur when the same patients took heroin while blocked with a narcotic antagonist. Drug craving rose dramatically when "unblocked" heroin was available, but gradually fell during methadone detoxification. Following treatment with a narcotic antagonist, the presence of heroin failed to elicit any sustained rise in craving and drug taking was dramatically reduced.

Marihuana effects on TAT form and content

In a double-blind study, 72 normal male subjects were given either placebo or marihuana containing 20 mg. Delta-9-tetrahydrocannabinol. Stories written to cards selected from the Thematic Apperception Test did not differ on hostile or sexual content scales between drug and placebo conditions, but 6 out of 10 scales specifically constructed to detect marihuana effects were successful at differentiating the two conditions. Under marihuana the stories had a timeless, non-narrative quality, with greater discontinuity in thought sequence and more frequent inclusion of contradictory ideas. Novelty of content was somewhat increased by marihuana, while relation to the picture, imagery, repetition, and closure were not significantly affected.