FEBRUARY 1966 &1 HOSPITAL I COMMUNITY PSYCH (ForflCr1\ IATRJ \Iental J()tRN.I zlIfl()’i((I1/ 1s’,(It/afr/( 1-lospitak) oil III ;1,,so/af/()1/ A saboteur who deserves help Mental patients who fear or resent medication throw away thousands in drugs each year. of dollars Unhelped by drug therapy, they often pose a difficult management problem. And they sabotage the progress of other patients by spreading fears and multiplying conflicts on the hospital ward. You can virtually assure these patients the benefit of drug therapy with ‘Thorazine’ Concentrate. Easy to administer, ‘Thorazine’ Concentrate cannot be “cheeked” and disposed of later; it provides dependable control of agitation and hyperactivity. You can help him with Thorazine#{174} Concentrate brand of chiorpromazine Contraindications: Comatose states or the presence of large amounts of C.N.S. depressants. Principal Side Effects: The most frequently encountered side effect is transitory drowsiness. Other occasional side effects include: dry mouth, nasal congestion, constipation, mild fever, miosis, dermatological reactions, extrapyramidal symptoms, weight gain, hypotension and, less frequently, jaundice. Side effects which occur rarely include: mydriasis, pigmentation, ocular changes and agranulocytosis. Before mation, Smith prescribing, Kline see 8 French SK&F product Laboratories, Prescribing Philadelphia Infor- it takes 5 mg. of the most widely sold agent to control drug-induced extrapyram idal reactions it takes only 2 mg. of AKINETON (biperiden) A recent study equal in action experience, Akineton available produced agents.” the cost the reasons “The of therapy why being used. Side effects: vision). shows “...2 mg. of Akineton to 5 mg. of [trihexyphenidyl With less doses is therefore more Minimal parenteral and side is approximately HC1].” “In effects than are smaller. lower.”1 These are Akineton (primarily administration, dry euphoria Transient and able previously required more our . . should some (biperiden) mouth short and of is of disorientation mild postural be observed as tablets - pitalsl5:212 G., may be noticed in some hypotension may occur. in patients 2 mg., and ampules 1 cc. lactate in an aqueous for dosage. 1. Misevic, blurred periods or manifest Akineton V., and 1964. AKINETON#{174} (biperiden) KNOLL PHARMACEUTICAL COMPANY glaucoma. (biperiden) Avail. HC1, containing 5 mg. Akineton (biperiden) 1.4% sodium lactate solution. See P-DR Janevicius, (Apr.) with bisected, patients. Caution #{149} ORANCE,NEW JERSEY Csalany, L.: Mental Hos. 1 / / , / / #{149} #{149} I // I / // #{149}/ / / - - #{149} L -; / II / I - / / ;I -- li -- ;/ #{149} 1 I .now the prognosis is favorable.... NARDIL#{174} pheneizine KII W*NN*NCNSOOTT L*SOS*TOSis ov. 505515 PLAINS. N.J. sulfate N.QP.544C \OLUME HOSPITAL Anierican Psychiatric Donald APA Hospital P SYCHIATRY IlOSl’ITI. & C()\l Established 1950 in lditorzal Board Norman Q. Brill, Bloombeig, C. Kolb, Wilfred Lawrence Donald Lucy D. tramis A MI)., PSVCHIATRY Daniel Blain, M.D. An H. M.D., Cliairii,an M.D. M.D. M.D. MI). Ml). American THE I. The P. Countervaili.ig Rome, the L. l-1O$l’1lLS MENT.L Psychiatric Association Tendency (12) iI.i). Most of Our Manpower 29 - Ml). 1f(P/l(’el(rS, State Hospital to Comprehensive Preparing the \f. Area Health Mental #{149} Community Litin, Center 33 . ?t-I.D. Staff Pat Vosburgh, Editor Betty Keenan, Senior Assistant Editor Judy Ceniceros, Assistant Editor Mary Jane Dunlap, Assistant Editor Helene 1). Mastrovieh, Lolitorial Assistant Marion H. Hildebrand, Va/un leer Department II. Preparing Francis III. A. the .1. The IV. Ty-e. Hospital .)l.l)., IllSi(le #{149} - Robert aiul B. Bircha t#{149}(I , Canadian Nezi’s Glenna L. Boistad, Volunteer Material Henry A. Davidson, M.D., I)r. lVhatsisna,,,e Melvin Herman , Private Hospitals I ack Neher, Film J?evieu’s Lucy D. Ozarin, M.D., Book Reviews Hairy Schu il)l)e, Legislation But Doctor, Dr. JI’/ialsisnainc I.oizis a/locus Therapy Advertising, Production, Circulation Ed Pace, Chief. APA Publi Service Division Elke Holtz, Jeanne Schostek, !sing B e/ reseii I)on’t Know Techniques Paul, 34 lID. 41 iiii You Treatment #{149} Ryncarson, Story l)alilbcrg Contributors Carl A dverl foriiic’olv OF Editorial: Howard Edward Editorial 2 1966 Making F. Moore, Ozariii, #{149}. lc. NUMBER Chief NIUNIT\ by JOURNAL February Service W. Haminersley, Professional Services . COMMUNITY Association Howard P. Rome, M.D., President Harvey J. Tompkins, M.D., PresideutEleci Marion E. Kenworthy, M.D., and Frank H. Luton, M.D., Vice Presidents Dale C. Cameron, M.D., Treasurer Robert S. Garbcr, M.D., Secretaoy Walter E. Barton, M.D., Med#{252}al Director Bartholomew W. Hogan. MI)., Deputy Medical Director Mental 17 & in It’s Like \Vliat a Valk.in 48 (Iinic . #{248}n Parade Turner 49 M.D. I.. 51 Batt’c’ii an(l lfa;gar(’I II Prv(’r . atians Adnoin. Ass/s. A State Hospital Ray Brazs’n 1). Vocational an(1 Ito/lace Rehabilitation C. Celitel- 52 Petty to I ives Fred C. Michalove, East 44 N. Dean St., P.O. Box 533 Englewood, N. J. (LOwell 7-2120) Harley L. Ward, Inc., Midwest 360 N. Michigan Ave. Chicago. Ill. 60601 (CEntral 6-6269) Reviews Conferela-e Science News PubI iSlIC(1 onotot lily hr I lie Anicrican Porch atric Assodatioll. I 701) 1 8th St., N.%V., \ashIlgoon, I).C. 20009, for staff members of menlal hospitals, so liosols. and related institutions that sul)scrif)e to tfoe AI’A Mental Hospital Service. Subscription price: at the rate of $6.50 a scar each, Lip to -14 copies of each issue are included in the dues, which range from $30 to $350 a year for institutional subscribers, based on the number of beds in an institution. In(lividual subscriptions (for APA members and for staff of subscribing institutions) $6.50 a year. limited Service subscriptions of $25 a year for nonbed psychiatric facilities, related professional organizations, and mental hygiene societies include 5 copies of each issue. Foreign individual subscriptions $10 a scar. Printed at 3110 Elm Avenue, Baltimore, Md. Second Class postage paid at Baltimore, Md. Copyright © 1966 by the American Psychiatric Association. Report: (:oiu-e1ns & Notes Symposium iii - - - Psychotherapy on Iii tegration - of Social (33) - (37) - Photography Credits-36-l3, Rochester (M inn.) State Hospital; 51, Central Louisiana State Hospital. Pineville: 53-55, Milledge. ville (Ga.) State Hospital. Art Credits-Cover, Sharon Farr, R. Joseph Harrill Associates, Washington, D.C.; inside layout and design, Eugene \outz, Washington. D.C.; 48, Ralph Rot) inson, Washington, D.C. (3) I IIII W1EO- 133-ED2Z IUIIIIlUIIU when the I .4 .. A nan e#{174}TRIHEXYPHENIDYL HYDROCHLORIDE 2 MG. TABLETS Phenothazine-induced extrapyramidal symptoms may be brought under prompt control by adding hydrochloride while the primary therapy is continued without interruption) 2 Often, the patient little as half a 2 mg. tablet daily; in other cases, 5 to 15 mg. daily may be needed. . Effective choice . . in all forms of Parkinsonism, including phenothiazine/reserpine-induced of three forms: Tablets, 2 mg. and 5 mg.; SEQUELS5Sustained Release Side Effects: dryness of mouth, blurring as treatment continues. Patients with agitation, nausea, or vomiting. Contraindications: regularly. Incipient none, but patients with hypertension, glaucoma may be aggravated. LEDERLE LABORATORIES, central Capsules, of vision, dizziness, mild nausea, or nervousness, arteriosclerosis or a history of drug idiosyncrasies as well 1. Brooks. G. W.: Experience with the Use of chlorpromazine and Reserpine in ment of Extrapyramidal Dysfunction. New Engi. J. Med. 254:1119 (June 14) 1956. 2. Sarwer-Foner, G. J.: Recognition and Management of Drug-Induced Extrapyramidal atry. canad. Med. Ass. J. 83:3 12 (Aug. 13) 1960. - ARTANE trihexyphenidyl may be maintained on as - A Division as cardiac, Psychiatry; of AMERICAN liver with Reactions and disorders, Reference ‘Paradoxical” CYANAMID system disorders. Your Elixir, 2 mg./5 cc. tsp. which tend to lessen or disappear may exhibit mental confusion, or kidney Especial nervous 5 mg.; to the Behavioural COMPANY, should Significance Reactions Pearl be observed and Managein Psychi- River, N.’i #{149} .very often these anxiety two and depression] coexist in the same treating disorders patient and... the anxiety can aggravate alone the depression-and treating the depression can aggravate New...from alone the anxiety.h1* Merck Sharp & Dohme TRANQUILIZER -ANTIDEPRESSANT Provides a more comprehensive therapy than either a tranquilizer or an antidepressant alone A widely useful A for patients severe in everyday with moderate practice to anxiety/depression A containing perphenazine two established agents, and amitriptyline TRIAVIL has a wider span of activity than any single psychotherapeutic agent. Three complementing dosage strengths provide you with flexibility in treating patients with moderate to severe CoIIins. See emotional 1 H.: following problems. Piychosomotscs pages for 4:290. additional Sept.00., information 1963. 0 C TRIAVIL NEW FROM Tranquilizer-Antidepressant MERCK “...I’ve been been sleeping SHARP getting very manage the moderate sion seen in the patient lems such as the emotional balance, often disappear. torn & DOHME these well....” headaches. TRIAVIL to severe struggling marriage. presenting . . I haven’t may help you anxiety and depreswith personal probWith somatic the return complaints of .1 don’t I feel fine. know why she made this appointment. TRIAVIL may help the geriatric patient who denies anxiety and depression, but whose wife reports malor symptoms of them-particu’arly agitation, patients readily .. insomnia, .“ or poor appetite. With can often renew interests and to the reco!ities of growing old. TRIAVIL,such cidlust more I .1 . For the anxiety/depression “...I keep having this bloated feeling...l lot....” TRIAVIL may help your patient whose belch complex a somatic complaints are a mask for the anxieties, depressed mood, and frustrations he either fails to recognize or is reluctant to discuss. With TRIAVIL, the patient’s emotional balance is often restored and the physical symptoms relieved. I guess I’m just getting old. like I used to. I feel miserable....” relieve moderate associated menopausal loss” into to severe emotional patient-help years and of productivity Sec IcIH.-.ng anxiety, I don’t enjoy TRIAVIL may help depression, and somatic symptoms in you change the “years and cojos challenge. for addonol nformaton life the of NEW FROM MERCK SHARP & DOHME TRIAVIL#{174} has been used successfully in a variety of patient populations In a controlled study in moderately ill general practice patients“After breaking the code, the evaluation showed that patients on the TRIAVIL compounds showed an average of 82% good or excellent response, whereas the placebo response was only 20%. A large variety of somatic and emotional target symptoms were encountered in this series of patients. In psychosomatic illnesses or chronic somatic illnesses aggravated by emotional involvement, improvement was seen shortly after instituting therapy. Wherever a patient does not respond to therapy, TRIAVIL seemed to accelerate the curative upswing. Some target symptoms yielded promptly to the cornpound, especially insomnia, which is probably the most important single symptom in depressions.” . . . in patients who had been refractory to tranquil’ izers, antidepressants, or both-. “TRIAVIL appears to be an effective .well-tolerated combination of an antidepressant and a tranquilizer. attended by a low incidence of side effects. Combined therapy is worthy of trial in the chronically psychotic patient. . . . . . . . -Feldman, P.E.1 Psychosomotics 6,312. . . Sept.’Oct., 1965. ... - -Splitter. SR.1 Psychosomaiics 6322, Sept..Oct., 1965. in psychoneurotic office patients-. .the use of combined therapy (arnitriptyline and perphenazin#{233})improved patient accessibility so that in 5 of 7 with psychoneurosis, effectiveness was noted. It should be noted that in these patients after 4 to 8 weekly visits, the interval between visits could be prolonged while the dosage was steadily decreased.” -Dorfman. : W.: Psychosomotics 6,318, Sept.’Oct.. St. #{149} inclined to perform routine tasks.. .and experienced less difficultiesin verbally communicating omitriptyline and perphenazine placebo patients, patients. . compared . . than Amitriptyline- to all those other medications [perphenazine alone, alone, or placebo], showed increased social contact with other patients... being more re treated with amitriptyline active...more receptive to others.” -Hanlon, T.E.. et a!.: L New Drugs 4:52, ior’.’Feb.. 1964. 1965. BLOGRAPHY 1. Ayd, Fi, ir, GPs and drugs are potent weapons agonst suicide, J.A.M.A. 183,33, ian. 19, 1963 (in Medicol News). 2. Ayd, F.J., Jr.: Recognizing the Deptessed Patient, New York, Grune & Stratton. Inc., 1961, pp, 129, 133-134. 3. Sowes, HA.1 Same Experiences with a Combination l#{248}fAntftrlptyline (ELAVIL) and Perphenozine (TRItAFON) in Severe Psychi#{149} attic Syndromes, paper presented at meeting of Acod. Psychosomatic Med., Montic City, June 16, 1963. 4. Dorfmon, W,1 Current concepts of depression-Part Vil, Psychosomotics 5.J, ian.-Feb., 1964. 5. Dorfman, Combined drug treatment, Am. i. Psychiat. 120275, Sept., 1963 (in Clinical Notes). 6. Ernst, : Anxiety and depression. Treatment in g.n.ral practice. Pennsylvania M. J. 6643, Oct., 1963. 7. Greenfleld, Al. t Control of alcoholic agitation and depression, Curr. Therap. Res. 5:s_97,Nov., 1963 (Research Note). 8. Hanlon, T.E., et ci. : The comparotl%’e effectiveness of amitriptyline, perphenazine, and their combination In the treatment of chronIc psychotic female patients, J. New Drugs 452, .fon.-Feb., 1964. 9. Hollister, i.E., Overall,J.E., Meyer, F., and Shelton, J., Perphenazine combined with amitriptyline in newly admitted schizophrenIcs, Am. J. Psychiot. 121h591, Dec., 1963 (In Clinical Notes). 10. Karacan, L, ions, F., and Ersevim, : Evaluation of combined antidepressant and tranquilizing drug (amitriptyline-perphenazine) in the treatment of hospitolized chronic schizophrenic patients, Am. i. Psychiat. 120:500, Nov., w63 (in Clinical Notes). 1 1. Kennedy, RE., and Miller, ii. : Amitripty llne-perphenozine In the treatment of schizophrenia, Am. J. Psychiat. 119:1092, May, 1963 (in Clinical Notes). 12. Kris, E.B., and Gent, D. Combined perphenozine-amilriptytine as adjuvant therapy in psychiatric oftercare, Am. J. Psychiot. 121:498, Nov., 1964 (in Clinical Notes). 13. w.: and in a controlled study in chronically ill schizo. phrenic hospitalized patients.at the end of a 12-week treatment period, amitriptyline-perphenazine-treated patients were more Kennedy, RE. : Anfldepressive drugs in chronic schizophrenia, Lancet 2J82, Oct. 13, 1962 (in Letters to the Editor). 1 4. Kennedy, R.E., and Arnett, DL. : An effective drug combination, Am. J. Psychiat. 118.347, Dec., 1961 (in Clinical Notes). 1 5. Motley, W.S. : Combination therapy for relief of anxiety and depression, Curr. Therap. Res. 5,310, June. 1963 (Clinical Report). 1 6. McLaughlin, 8.E., Ryan, F., and Drucker, T.: Clini. cal trials with amitriptyline and perphenazine among psychiatric outpatients, Dis. Nerv. System 25:169, March, 1964. 17. Pennington, V.M.: The phrenotropic action of perphenazine’amitriptyline, Am. J. Psychiot. 120:1115, May, 1964 (in Clinical Notes). 18. Perphenozine, omitriptyline combination seems effective as antidepressant agent, J.A.M.A. 19037, Dec. 21, 1964 (in Medical News). 19. Smith, ME. : Perphenazine and amitriptyline as adjuncts to psychotherapy, Am. J. Psychiot. 12076, July, 1963 (in Clinical Notes). 20. New and Nonofficial Drugs, Philadelphia, Pa., J.B. Lippincott Company, 1964, pp. 445-6. 21. Ayd, F.J., Jr.: Phenothiozine tranquilizers. eight years of development, Med. Clin. North America 45:1027, July. 1961. 22. Ayd, F.J., : Clinical indications and toxicity of prolonged perphenazine therapy, N. England J. Med. 261:172, July 23, 1959. 23. Weiss, 1.1., Rubinger, J.H., Sorin, M , and Ryzen, N.: Trilafon treatment in psychotics, Am. J. Psychiat. 1 14:1118. June, 1958 (in Clinical Notes). 24. Vernier, V.G., Hanson, H.M., and Stone, C.A.: The Phormacodynamics of Amitriptyline, in Nodine, J.H., and Moyer, J.H., editors: Psychosomatic Medicine, Philadelphia, Pa.-, tea 8, Febiger, 1962, pp. 683#{149}690.25. Weiss, 1.8. : Clinical Use of Amitriptyline, in Nocline, J.H., and Moyer, J.H., editors: Psychosomatic Medicine, op. cit., pp. 691-694. 26. Symposium on Depression with Special Studies of a New Antidepressant, Amitriptyline, Dis. Nerv. System 22: supp., May. TRIAVIL is indicated in patients to severe anxiety and depression sent such symptoms as- with moderate who may pre.. TRIAVIL offers economy/convenience/flexibility/3 complementary dosage strengths. agitation C insomnia . TRIAVIL for most patients Each tablet cOntains 2 mg. and 25 mg. of perphenozine omitriptyline of hydrochloride. . restlessness C psychomotor retardation for adolescent geriatric C functional . feeling somatic TRIAVIL I1I#{174} or Each tablet perphenazine patients complaints amitriptyline loss of interest . anorexia for more severely ill patients TRIAVIL contains two cally proved agents: Perphenazine-an highly effective established which may effectively alleviate symptoms of anxiety, tension, psychomotor excitement, and other manifestations of emotional stress. Amitriptyline-the most-prescribed sant, useful in a full range tions, and for anxiety and with depression. Each tablet contains perphenazine amitriptyline 4 mg. of and 25 mg. hydrochloride. of II ;I!el’AI and clini. tranquilizer hydrochloride. TRIAVIL of tiredness . contains 4 mg. of and 10 mg. of I I I I I I I I TRANQUIUZERi antidepres- of depressive condiagitation associated Suggested starting four times a day. dosage for all tablet strengths-One tablet Maintenance-As soon as the desired response is obtained, should be reduced to the lowest level necessary to maintain (See product circular for full dosage recommendations.) 1961 (Section tancet 2,44. 2). 27. Gault. J.E. : Agranulocytosis July 6. 1963 (in Letters to the PRECAUTIONS: due to amitriptyline, 28. lsaacs. AD. , and Editor). ponent toxicity to the Editor). J. Kentucky 34. Med. Storrow, HA. A. 62292, : April, Depression 1964. bined antidepressant-tranquilizer Psychosomatics 6:312, Sept.-Oct., therapy therapy with a new drug. Elavil zine) in a medical office setting, (amitriptyline) Psychosomatics 37. Dorfman, tional illness, INDICATIONS: W. The comprehensive Psychosomatics 6318. Moderate through agitation. and depression, presenting ciation with, chronic physical disease; CONTRAINDICATIONS: pression; pregnancy; Glaucoma; drug-induced of mixed 1965. , 35. 36. masquerading Feldman, psychiatric Splitter, and Trilafon coexisting bone and convulsions, triptylin. tremities, emo- and/or combined therapies. use with MAOI Patients who drugs. become a car or operate machinery for use in children. of convulsive Similar to those reported damage, cerebral endocrine edema, following athy, all possibly of drug origin, have allow should alert allergic atten- ol effects extrablood reactions, effect, grand mal processes. For amiand tingling of cx’ activation of latent may prevent reactions are and peripheral reported two be the use of either epinephrine been or of alone. side These include hypotension). disturbances, reversed Generally drowsy requiring polyphagia, reactivation of psychotic alone, drowsiness, hypotension, numbness transient confusion (on high dosagesl. in patients this reacpossible. neuropreceiv’ ing amitriptyline. Before de’ prescribing or available 0 histories the dosage the patient. of brain tumor. intestinal obstruction, other drugs. Consider the possibility schizophrenia (although perphenazine in TRIAVIL tion in some cases). Dose-related anticholinergic Rare appearances of agranulocytosis, jaundice, of, or in asso’ depression. marrow liver peripheral 1965. with EFFECTS: dyscrasias, (perphena’ anxiety, either independently schizophrenia with urinary retention; CNS depression. Com’ Sept.’Oct.. with the constituents when used alone. For p.rph.nazine caused by any of the phenothiazines may occur. pyramidal symptoms, autonomic reactions (including Combined , management of patients SeptOct.. 1965. severe SIDE syndromes. SR. o,322, , in patients conceal existence to overdosage of warned not to drive tion. Not recommended as P.E. may due potentiation in weeks between in Nodine, J.H., and Moyer. J.H., editors: Psychosomatic Medicine, op. cit., pp. 695-699. 31. Ayd, F.J.. Jr., Toxic somatic and psychopathologic reactions to antidepressant drugs, J. Neuropsychiat. 2119. supp. 1, Feb.. 1961. 32. Blair. D.: Drugs for depression, Brit. M.J. 1:945, April 6, 1963 (in Correspondence). 33. Hollister, I.E.. and Bennett. J.t. , Thyroid func’ lion and psychotherapeutic drugs. J.A.M.A. 185890. Sept. 14. 1963 (in Letters carefully to disorders or adverse reactions to phenothiazines. TRIAVIL potentates effects of antidepressants. CNS depressants, atropine, phosphorous insecticides, and heat. The antiemetic effect of the perphenazine com- Carlish, S.: Peripheral neuropathy after omitriptyline, Brit. M.J. 1,1739, June 29. 1963 (in Correspondence). 29. Smith, R.C.N. , and Grieve, R.C., Peripheral neuropathy after amitriptyline, Brit. M.J. 2,254, July 27, 1963 (in Correspondence). 30. Ayd. F.J. . Jr. : Toxicology of Antidepressants. apathy, Use three on or administering, MERCK SHARP & DOHME wl Division of M#{149}rctiA co..tNc..w..i read product circular with packag, request. pe:.t, pa today’stheoiy Is tomorrow’s therapy SUBSCRIBE NOW Meprosoan400 (meroIlamale 41mm. suslaloeO release) I COMMUNITY TO t PSYCHIATRY APA Members, $6.50 a year Foreign -FILL AMERICAN 1700 18TH WASHINGTON, Dear OUT $8.00 S10.0() AND PSYCHIATRiC ST. NW. MAIL Contraindications: Previous allergic or idiosyncratic reactions to meprabamate or meprobamatecontaining drugs. Precautions: Meprobamate Careful supervision of dose and amounts prescribed is advised. Consider possibility of dependence, particularly in patients with history of drug or alcohol addiction; it should be noted, however, that dependence on ‘Meprospan’ has not been reported to date. Withdraw gradually after use for weeks or months at excessive dosage. Abrupt withdrawal may precipitate recurrence of pre-existlng symptoms, or withdrawal reactions including, rarely, epileptiform seizures. Should meprobamate cause drowsiness or visual disturbances, the dose should be reduced and operation of motor vehicles or machinery or other activity requiring alertness should be avoided if these symptoms are present. Effects of excessive alcohol may possibly be increased by meprobamate. Grand mal seizures may be precipitated in persons suffering from both grand and petit mal. Prescribe cautiously and in small quantities to patients with suicidal tendencies. Side effects: Infrequent side effects of ‘Meprospan’ have included drowsiness and dizziness. Rare side effects have included urticaria, headache, nausea, erythema multiforme, vertigo and euphoria. The following side effects were associated with administration of meprobamate in conventional tablet form. Meprobamate-Drowsiness may occur and, rarely, ataxia, usually controlled by decreasing the dose. Allergic or idiosyncratic reactions are rare, gen erally developing after one to four doses. Mild reactions are characterized by an urticarial or erythematous, maculopapular rash. Acute nonthrombocytopenic purpura with peripheral edema and fever, transient leukopenia, and a single case of fatal bullous dermatitis after administratian of meprobamate and prednisolone have been reported. More severe and very rare cases - ASSOCIATION D. C. 20009 Sir: Enclosed herewith tion HOSPITAL immediately. to j Non-Members, Subscribrs, Indications: ‘Meprospan’ (meprabamate, sus tamed release), a convenient dosage form, may be used whenever meprabamate is indicated and a sustained-release form is desired. Meprobamate is effective in relief of anxiety and tension states. Also as adjunctive therapy when anxiety may be a causative or otherwise disturbing factor. Although not a hypnotic, it fosters normal sleep through both its anti-anxiety and muscle. relaxant properties. to begin is $ for & one COMMUNITY years subscrip- PSYCHIATRY NAME ADDRESS IN.f:.,T rbOk4 J .1 F3fI GRANULES .RIN a#dta4te4 Z4JU1a of -I Jfl1III - - :, Il . 3.1: I II . , U I Ui. y fI jra,/; iie 4555 e,,d spasms, hypotensive I.,(:(ilO.S crises recommended. Supplied: ‘Meprospan’- A:::, release capsule contains ‘Meprospan’200 - Each sule contains fever, edema, (1 fatal chills, bronchial case), anuria, WALLACE ALLEN FOODS, r,,d, a, N,zs/s s.d I,uit,ti,.. (10) 400 - Each sustainedmeprobamate 400 mg. sustained-rel.ase cap- meprobamatc- Before prescribing. r,,,r produce angioneurotic dosage may be increased depending on clinical response. Doses above 2400 mg. daily are not ALLEN FOODS, INC. Ro, H,te/, may spells, anaphylaxis, stomatitis and proctitis. Treatment should be symptomatic in such cases, and the drug should not be reinstituted. Isolated cases of agranulocytosis, thrombocytopenic purpura, and a single fatal instance of aplastic anemia. have been reported, but only when other drugs known to elicit these conditions were given concomitantly. Fast EEG activity has been reported, usually after excessive meprobamate dosage. Suicidal attempts may produce lethargy, stupor, ataxia, coma, shock, vasomotor and respiratory collapse. Dosage: Usual adult starting dosage is one 400 mg. capsule in the morning and at bedtime. This JUST ADD WATER!... I hypersensitivity fainting 200 mg. consult package circular. LABORATORIES / Cranbury, N. J. -,-. --cr /ji TG ?rTTc7i .- 1I ft fi IICWIt it (t 4 iit .O WLFLflL liii 1i1F(1 11i ‘i 1[ftLLLJ. i i (t ( fl I U .iJi1r) .‘ i 1 I L I a. JL I ‘I -_ I / / ,, EDITORIAL laid bare. and outrage, l’1ie ))ul)lic which reacts are with further indignation inflamed by NEW mount- ing evidence of deficiencies. By the familiar process of social contagion, the searing criticism spieads be)Ofl(l the inuriediate criminately stitutions that I unction, ter affilia to outraged that appears less related by o in- to be brand THE AMERICAN PSYCHIATRIC ASSOCIATION mus- thoroughly now FROM proximity, denigration sensibilities can PUBLICATIONS indisand process now cycle or interests, public the The something be The to discard symbol. more people, tion. when action and the appear or is complete old target blackens devalued start afresh, with new. PSYCHIATRIC I allows F ONE for simplified what the defects the this a the public perpetrators, institution ration. The this new sor, the l)lack-white Yet and resources are ences have cial not task bridged took offers required to within groups. While are are remarkably the problems atric and that the similar. of leads the the mental climate, hospitals American P. MEMBERSHIP OF THE PSYCHIATRIC or ASSOCIATION ION Contains on over pages. current 14,000 information members. 140 $2.00 per copy for members $3.00 per copy for non-mem- cen- hospital the bers. central experi- chasms of so- empathy and and patience and problems of conflict public processes we can the Psychiatric of the the today’s much APA the and in ROME, in light do us to overshoot HOWARD a year AMERICAN a simple homologue this can 1966 by principles we $3.00 DIRECTORY The health dimensions If in ac- published barriers. a social manage greater, social time 1100 Publications Services Division 18th St., N.W., Washington, 0. C. 20009 Dear Sirs: Please send me the publications checked below. [] Psychiatric News fl 1966 Membership Directory I enclose payment fl Please bill me for a total of view psychi- NAME: to correct mark. M.D., the as 1966. Subscriptions, is un- Rochester’s great issue of gray. of of illogical efforts zeal as organizational First January, predeces- mental one as APA center for Office. cas- past. shades state But circumvention problem a as be the APA developments within mental health field tivities. social far its mental of to This adroit in well pub-. the Information Covers overall melio- so make come hospital Psychotherapy the of either/or new health it institution impossible, had education. mental with demonstrated. distance the the connection does the natural instant because grounds involving tine a of a comprehensive very Public - I)rol)os1l of attribute of if reality the or:O. by not mental Their favor of any creating on tel- the polarities even boroO cud. newspaper monthly that All paradoxical in “warehouse” choice, Nu,sc of victims, and the charisma by the disparagenent. concept gratuitous contaminated -- tabloid-size lished effect. fact behavior. by with a side the were abandoned gifted - To Iscusos P,uosu For APASOrpIOcu obvious discharge overlooked and climaxed be but the scapegoats of contumely they - years A -:--. N.n*sn C change recent The was shameful become was o over- social in for hospitals of have tigation has hospital we mental hospitals of health. scapegoats affects, the that mental of the for deep-running kind this mental hospitals were exposed. of care jerry-built by public system search objects hy)erbole, witnessed for size our have large was neglect-the In -e crusa(le of Yet t(lmitted r#{233}sum#{233} of one illustrates duiing an NEWS ADDRESS: President Association (13) -- _______________ I 4 When the patient first tries to face himself... you can ease his entry into psychotherapy with (HYDROXYZI Since Science for the NE) 1849 world’s weIl-beingA ON ON No other tranquilizer is as precise, as uncomplicated. Once started on Vistaril, your patient’s anxiety is quickly relieved without distortion of reality.WithVistaril he will feel calm. His insight will neither be impaired as by depressant tranquilizers nor by the false optimism of the euphoriant tranquilizers. Vistaril avoids these problems and their effects on the verbal content of therapy. For the referred patient who already has the problem of withdrawal symptoms on meprobamate, chlordiazepoxide, or diazepam, Vistaril can provide a fresh start, for it is entirely unrelated to these compounds. At your option Vistaril is easily discontinued, either gradually or even abruptly. Over eight years’ use has revealed that addiction, psychic dependence or general systemic toxicity are not characteristic of Vistaril. Turn page for brief summary... ContraindicaUons yzine. muscular The : Hypersensitivity parenteral or intravenous jected subcutaneously Precautions: Hydroxyzine action In of central the tranquilization calmer, are are better tional stress of cesses paired. and motor Because somatic spillover,’6 quilizer for your Proof: yzine benefits Over have of precise low-risk patients become striking; able to cope therapy. with Yet the driving a car or operating usual should have site, been been injection gangrene have Therefore, served veins; pro- activity are virtually of its minimal psychic Vistaril is the particular unimand ideal 1,000,000,000 given doses and the related depression do not of to be to hydroxyzine. Results: thousand able responses. single reports, psychiatric patients 77% of over had intra- extravasation. should be not no faster to exceed than 100 mg. days Drowsiness transitory of continued reduction. may and occur; may therapy Dryness of the with higher doses. has been reported or upon mouth may Involuntary motor in some hospitalized patients on higher than recommended dosage. Supply: Vistaril (hydroxyzine pamoate) Capsules: 25 mg., 50 mg.. 100 mg.Vistaril (hydroxyzine pamoate) 5 cc. Vistaril More Oral Suspension: (hydroxyzine 25 mg./cc.-10 cc. and detailed mg. 25 HCI) cc. vials, per Parenteral and 50 mg./ 10 cc. vials. professional available information Nicola, C. C., in Carattini. S. and Chetti. V.: Psychotropic Drugs. Elsevier Pubhshing Co.. Amsterdam. L. C. and Hamelberg, W.:Ohio Med. J. 58:915, Aug.. 962. 3. Savona. B. and Perrcone. C.: Minerva Pract. 8:1584, Oct.. 957. 5. Steinberg. N. and HoIz. W. C.: New York J. Med. 60:691. Mar. Med. 37:51, Dec. 22, 957. 1957. Ginec. I, 1960. 0:317, Apr.30. 1958. 4.Settel. E.: Amer. 6. Weyne. F. and Roussei. J. L.: Bruxelles Science for the tranquilizer world’s is as precise, as uncomplicated, (HYDROXYZI wel!-being PFIZER Since 1849 if disappear on request. Ref erence: 1. Bozza. M. L. and p.569. 2. Payne. A. B.. Claassen. No other ob- into intact injection or administration slowly, and injection dose. it is usually cc.-2 favor- to the digital to inadvertent caution minute, intraof injection only intra-arterial Reactions: Solution: In published three any be seen activity or or appear in dosage of hydrox- blood dyscrasias, euphoria, habituation addiction, pharmacologic incompatibilities per in a few tran- problems mg. proper instances Intravenous 25 so, ven reported distal be accomplished Adverse patients. been drug-induced should machin- intramuscular soft-tissue reac- or periarterial to insure avoid either may dangerous On to be due drugs against reported occurred injection these cautioned for used. a few considered arterial be precautions be followed; rarely has venous emo- thinking drowsiness should extravasation. Vistaril, for patients technique With dosage occur, the depressants. Because be decreased. tions The Vistaril site of action is the seat of anxiety use, system should ery. The injection for intranot be in- or intra-arterially. may potentiate nervous conjunctive to hydrox- solution, use, must DIVISION, CHAS. PFIZER & CO., INC. NEW as NE) LABORATORIES YORK, N.Y. 10017 .#{149}#{149}#{149 . . paticnts who wcll on thcn !platcau rcsistirnt start a singtc out tranquiliztr, with sgmptoms ... Principal side effects are similar to those which may be seen when the components are administered individually, though some (e.g d rowsiness, extrapyram idal symptoms) appear to occur less frequently and to be less severe. Principal side effects of the components include: occasional drowsiness, fatigue, dry mouth, nasal congestion, constipation, dizziness, insomnia, muscular weakness, extrapyramidal symptoms, dermatological reactions, anorexia, weight gain, mild fever, lactation, miosis, blurred vision; and, rarely, jaundice, mydriasi and agranulocytosis. No unexpected side effects have been reported with combined therapy. ., A Because dosage levels of both drugs should be individualized to each patient’s needs, use of combined therapy should be limited to patients who are hospitalized or under adequate supervision. And, because two potent drugs are used concomitantly, special caution should be exercised with “poor risk” patients. Before prescribing, Prescribing see SK&F product Information. .#{149} ‘p. . . . oftcn combina tion Thorazi,w brand bciu4it from tlwrapg and of Sk4azint brand Smith of trifluoptraziiw chIorpromazin Klinc & Frcnch Laboratoriis, Philadelphia -4--.‘a p ,‘ I 4’,-- “We reduced I Consider Metrazol (pentylenetetrazol) as a means of reducing tranquilizer dosage in your geriatric patients. A recent study of geriatric patients showed that after being placed on Metrazol (pentylenetetrazol) therapy they had a decreased need for tranquilizers. “Over the previous year, when using considerable amounts of Metrazol on an empirical basis, we had gradually noted that for the geriatric gentle patient cerebral for patients who needs added stimulation our quota of tranquilizers had become increasingly adequate. During the study we found ourselves with an excess!” This reduced dosage of tranquilizers can be of significant value in the older group where complications of tranquilizer therapy are likely to present more of a problem than in younger patients. 1. Gericke, 0. L., Lobb, Lois G.: Psychiatric Studies & Projects 2:2 (April) 1964. who require peripheral vasodilation for patients who need supplementary vitamins METRAZOL#{174} NICO-METRAZOL#{174} VITA-METRAZOL#{174} (pentylenetetrazol) ELIXIR-Each 5 cc. contains Metrazol (pentylenetetrazol) nicotinic acid. TABLETS-Each contains Metrazol (pentylenetetrazol) nicotinic acid. LIQUIDUM Each 5cc. contains 100 mg. Metrazol (pttylenetetrazol) and 1 mg. thiamine HCI, in wine flavored 15% alcohol elixir. TABLETS100 mg. (gr. 1/2) CAUTION: treating There patients are no known with a low contraindications convulsive threshold. KNOLl. l’I1.HMACEtTICAI. to Metrazol Occasional and 100 mg. 50 mg. 100 mg. and 50 mg. (pentylenetetrazol) pruritus associated :OM ELIXIR-Each 5 cc. contains 100 mg. Metrazol (pentylenetetrazol), 10 mg. niacinamide, 1 mg. each of thiamine, riboflavin, pyridoxine, and 2 mg. d-panthenol. TABLETS-Each contains in addition to the above, 25 mg. ascorbic acid. PAN’ although with nicotinic #{149} onA;I:.Naw caution acid .JF:RSEY should be exercised administration may when occur. convention 1. First of all, notes... gentlemen, the ing about are not hospitalized. depend on theni to remember patients you’re talk- So you have their medication. 2. to Frankly, my experience patients have difficulty tion three or four times breakthrough medication... 3,. . . well, you may sarily-not to patient’s friends always prescribe lose a lot of ground unneces- mention the distress that the or family may experience. So I ‘Thorazine’ Spansule capsules. 4. My has been remembering a day. And occurs patients tell because me ‘Thorazine’ sules are convenient-only ber all day. And believe I understand costs less, equivalent that many medicaif symptom they forget Spansule their cap- one dose to rememit or not, gentlemen, as it, a ‘Thorazine’ Spansule milligram for milligram, multiple-tablet dosage. capsule than the Thorazine#{174}Spansule#{174}Capsules brand of chiorpromazine Comatose Contraindications: amounts of C.N.S. brand states of sustained or the presence release of capsules excessive Principal Side Effects: The most frequently encountered side effect is transitory drowsiness. Other occasional side effects include: dry mouth, nasal congestion, constipation, mild fever, SMITH KLINE miosis, weight depressants. & FRENCH dermatological gain, hypotension effects which ocular changes Before prescribing, LABORATORIES, reactions, extrapyramidal and, less frequently, rarely include: and agranulocytosis. occur see SK&F product PHILADELPHIA mydriasis, Prescribing symptoms, jaundice. Side pigmentation, Information. a rapid lift from the hell of depression \ -: .. ‘ ‘- -. ---.- fr’-’- “. often relieves mental pain in 2-5 days ‘. ‘c , NORPRAMINe Dor#{233} Illustration Norpramin is a rapid-acting specific drug for the treatment of depression. Depressive signs and symptoms-sometimes described as “mental pain”-typically begin to improve in 2-5 days. Patients are more hopeful, less empty and less weighed down by their troubles. Norpramin has only slight sedative qualities, nevertheless anxiety secondary to depression is frequently relieved as depression is lifted. If anxiety or tension persists it LAKESIDE IN LABORATORIES, INC. or by reducing dosage. effects are usually mild. Milwaukee, -. . . H-:-.1 ) : ; (desipramine hydrochloride) can be controlled by adding a tranquilizer Norpramin is not a MAO inhibitor. Side . Wisconsin DOSAGE from AND Dante’s Inferno ADMINISTRATION Optimal results are obtained at a dosage -two of about 150 mg./day 25 mg. tablets t.i.d.After achieving optimal maintenance mg./day) dose results, a (50-100 should be sought. 53201 BRIEF: Indications: In psychotic volutional depressive psychotic Contraindications depression of any reactions; reactions. and Precautions established. of treatment in human and or in- Adverse Effects: Side dry mouth, constipation, urination, tion and or ureteral spasm, recent myocardial coronary heart disease and epilepsy. within two weeks inhibitor. Safety kind-neurotic manic-depressive : Glaucoma, urethral infarction, severe Should not be given with a monoamine pregnancy has oxidase not been effects, usually mild, may dizziness, palpitation, include: delayed “bad taste,” sensory stimulation, sweating, illusion, tinnitus, agitadrowsiness, headache, orthostatic hypotension, flushing, ness, blurred vision and mydriasis, nausea, cramps, weakrash, allergy, transient eosinophilia, granulopenia, and extrapyramidal signs. Supplied : Norpramin of 25 mg., in bottles altered (desipramine of 50, 500 and liver function, hydrochloride) 1000. ataxia tablets F Thickened or slurred speech in the patient maintained on phenothiazines may herald serious extrapyramidal side effects. Other early signs and symptoms may be slight drooling, a fine tremor, slowed motor function, or apathy. These early effects, of course, can be transient and, if so, may be of no consequence to the patient. If, however, they become serious or extremely bother- some to the patient, add COGENTiN Mesylate (benztropine mesylate) to the regimen. COGENTIN usually relieves parkinsonian effects (muscular rigidity, gait disturbances, tremorat rest, drooling) as well as other extra pyramidal effects such as dystonia, akathisia, and akinesia. For most patients there is no need to discontinue the tranquilizer or even to reduce dosage. 0 M&l INDICATIONS: Parkinson’s disease; or reserpine. estrapyramidal reaction to phenothiazines CONTRAINDICATIONS: None reported. PRECAUTIONS: Supervision of patients is required. In severe reactions, discontinue drug or reduce dosage. Use with caution in hot weather to minimize risk of anhidrosis. SIDE EFFECTS: These may be both anticholinergic and antihistaminic. Possible untoward reactions, usually doserelated, include: dryness of mouth, blurred vision, nausea, nervousness, glaucoma, vomiting, anhidrosis, muscular weakness, numbness of fingers, rash, dysuria, urinary retention, constipation, sedation, listlessness, depression, mental confusion, encitement, visual hallucinations, intensiticalion of symptoms in patients with mental disorders who are receiving phenothiazine or reserpine medication. BEFORE PRESCRIBING OR ADMINISTERING, READ PRODUCT CIRCULAR WITH PACKAGE OR AVAILABLE ON REQUEST. Coge nti benztropine fl Mesylate mesylate where today’s theory is tomorrow’s therapy When oppressive despondency is an obstacle to psychotherapeutic success I q can troI’ I, bring the 1 A #{149} S rapidly The apathetic, withdrawn. depressed patient is often inaccessible except after much time and effort On the part of the therapist. ‘Deprol’ . helps put the patient within reach by rapidly reducing his oppressive ncy. Often, the patient . more hopeful, better able to } himself, more willing and of working with you toward . ii and social readlustments. . . . . ‘ . . . . I . . . . .- vious - . . AGITATION si BY ANXIETY TENSION, OR RUMINATION allergic or idiosyncratic reactions to meprobamate contra- indicate subsequent use. Precautions: Meprobamate - Careful supervision of dose and amounts prescribed is advised. Consider possibility of dependence, particularly in patients with history of drug or alcohol addiction; withdraw gradually after use for weeks or months at excessive dosage. Abrupt withdrawal may precipitate recurrence of pre-existing symptoms, or withdrawal reactions including, rarely, epileptiform seizures. Should meprobamate cause drowsiness or visual disturbances, the dose should be reduced and operation of motor vehicles or machinery or other activity requiring alertness should be avoided if these symptoms are present. Effects of excessive alcohol may possibly be increased by meprobamate. Grand mal seizures may be precipitated in persons suffering from both grand and petit mal. Prescribe cautiously and in small quantities to patients with suicidal tendencies. Side effects: Side effects associated with recommended doses of ‘Deprol’ have been infrequent and usually easily controlled. These have included drowsiness and occasional dizziness, headache, infrequent skin rash, dryness of mouth, gastrointestinal symptoms, paresthesias, rare instances of syncope, and one case each of severe nervousness, loss of power of concentration, and withdrawal reaction (status epilepticus) after sudden discontinuation of excessive dosage. Benactyzine hydrochloride Benactyzine hydrochloride, particularly in high dosage, may produce dizziness, thought-blocking, a sense of depersonalization, aggravation of anxiety or disturbance of sleep patterns, and a subjective feeling of muscle relaxation, as well as anticholinergic effects such as blurred vision, dryness of mouth, or failure of visual accommodation. Other reported side effects have included gastric distress, allergic response, ataxia, and euphoria. Meprobamate-Drowsiness may occur and, rarely, ataxia, usually controlled by decreasing the dose. Allergic or idiosyncratic reactions are rare, generally developing after one to four doses. Mild reactions are characterized by an urticarial or erythematous, maculopapular rash. Acute nonthrombocytopenic purpura with peripheral edema and fever, transient leukopenia, and a single case of fatal bullous dermatitis after administration of meprobamate and prednisolone have been reported. More severe and -..-. very rare jr cases of hy,persensitivity - .. . . COMPUCATED indications: ‘Deprol’ is useful in the management of depression, both acute (reactive) and chronic. It is particularly useful in the less severe depressions and where the depression is accompanied by anxiety, insomnia, agitation, or rumination. It is also useful for management of depression and associated anxiety accompanying or related to organic illnesses. Contraindications: Benactyzine hydrochloride is contraindicated in glaucoma. Pre- - . FIRST CHOICE aep INSOMNIA, . . . EVEN WHEN ., . . . . TOF . LOGICAL . ;,. . . I.- I “-1 - .,-i . may produce fever, chills, faint.1 ing spells, angioneu., rotic edema, bronchial /#_ spasms, hypotensive crises .7 (1 fatal case), anuria, anaphylaxis, stomatitis and proc. titis. Treatment should be symptomatic in such cases, and the drug .d, .d ,, .,#_ , [$- .7v, ., s#{149}._Ji . . ,i : . ,. . - . . . penic cases should purpura of agranulocytosis, not and be aknown reinstituted. single fatal thrombocytoinstance Isolated only aplastic when other anemia drugs have been vasomotor to reported, elicit these butto meprobamate activity conditions has dosage. been were reported given Suicidal concomitantly. usually attempts after may Fast excessive produce EEG respiratory lethargy, collapse. stupor, ataxia, Dosage: coma, Usual shock, starting dose, one taband six lettablets three daily or four andoftimes gradually daily. reduced May be increased to maintenance gradually levels upon establishment of relief. Doses above six tablets daily are not recommended even though higher doses have been used by some clinicians to control depression and in chronic psychotic patients. Supplied: Light-pink, scored tablets, each containing meprobamate 400 mg. and benactyzine hydrochloride 1 mg. Before prescribing, consult 2’ vj . .. . . . . . . . ; \ . package . . . . 4!k WALLACE . ‘‘%i\:; circular. _ LABORATORIES/Cranbury, N. J. cn.e4ol Clear or cloudy for your psychotic patient? ____ I You have but a choice, also on the produce other senses. calms the disturbed more Prolixin, is most agitated With usually and be (logginess, without where similarly relief Prolixin, clouding better able the to corn- commonly the used treatment symptoms of such phenothiazines, schizophrenic and as hallucinations, delu- are manifest. maintained Prolixin manageable. stupor). becomes of all for institutionalized non-hypnotic, more sedation provide to therapy. potent hyperactivity Prolixin, phenothiazines patient indicated psychotics - Certain effectively accessible the specifically sions excessive hand, Thus municate, doctor. patients on long-term therapy on just one dose a day. Non-soporific alleviates symptoms and makes markedly low And Prolixin is also the can and patient in non-CNS toxicity. SIDE EFFECTS, PRECAUTIONS, CONTRAINDICATIONS: As used for anxiety and tension, side effects are unlikely. Reversible extrapyramidal reactions may develop occasionally. In higher doses for psychotic dis. orders, patients may experience excessive drowsiness, visual blurring, dizziness, insomnia (rare), allergic skin reactions, nausea, anorexia, salivation, edema, perspiration, dry mouth, polyuria, hypotension. Jaundice has been exceedingly rare. Photo-sensitivity has not been reported. Blood dyscrasias occur with phenothiazines; routine blood counts are recommended. If symptoms of upper respiratory infection occur, discontinue the drug and institute appropriate treatment. Do not use epinephrine for hypotension which may appear in patients on large doses undergoing surgery. Effects of atropine may be potentiated. Do not use with high doses of hypnotics or in patients with subcortical brain damage. Use cautiously in convulsive disorders. AVAILABLE: mg. Tablets-i of fluphenazine , 2.5 mg. , ‘:‘ per cc. and 5 mg. Elixir-supplying 0.5 mg. contains 14#{176}/i alcohol by volume. lnjection-multiple dose vials of 10 cc. , providing 2.5 mg. of fluphenazine hydrochloride per cc. For full information, see your Squibb Product Reference or Product Brief. S c?.UIBB hydrochloride Squibb , Quality - the Priceless Ingredient ‘ ‘ tt’ -‘5- ‘: SI’ tl ‘, I 1S depressed ;oxne patients need still EST. $‘rv S some ELAVIL Vith S Lr)d For many mentally depressed patients, therapy with ELAVIL has these important -and measurable-advantages: discharge with reduced or no EST’3 fewer relapses under maintenance therapy ELAVIL provides a foundation for overall therapy that can lead to lasting remission. ELAVIL, because of its antianxiety properties, often controls anxiety in anxious or agitated depressed patients without the need for other manY patients ‘Sneed ‘t need EST drugs. In those patients in whom an alternate route of therapy is desired, injection ELAVIL, given I.M., usually provides rapid, marked relaxation, reducing anxiety and agitation prior to elevation in mood. As initial therapy, the injection form allows prompt, optimal control particularly in patients who refuse oral medication. With the onset of drug effect, patients can be switched to a tablet regimen. less at EST all. so THAT PATIENTS MORE MENTALLY DEPRESSED CAN RETURN HOME TO STAY ELAVIL AMITRIPTYLINE . a highly effective, HCI well-tolerated antidepressant . relieves insomnia as it acts to control and concomitant anxiety underlying depression N . 5-SS I SPAN OF ACTIViTY ‘ OF PSYCHOACTIVE DRUGS recommended for use in pregnant patients. Hypotension, numbness and tingling of extremities, including possible peripheral neuropathy, activation of latent schizophrenia, and epileptiform seizures in chronic schizophrenics may occur. Temporary confusion and disturbed concentration may be seen with high doses. Other reactions include tachycardia, dry mouth, blurred vision, constipation, urinary retention, drowsiness, dizziness, weakness, incoordination, nausea, excitement, tremor, jitteriness, headache, SIDE INDICATIONS: accompanying CONTRAIND1CATIONS: depression depression. Glaucoma Mental and anxiety or un nary retention. Supervise patients closely. Consider possibility of potentiation in cornbined use of antidepressants, and of mania or hypomania in manic-depressive patients. Not PRECAUTIONS: ‘! ‘ EFFECTS: heartburn, anorexia, sweating, and possibly jaundice, and Before prescribing product circular on request. or administering, read with package or available 1 Ayd, F. i,, Jr.: Amitriptyline depressive Nov-Dec., states: Hordern, a controlled 1962. A.: Amitriptyline trial, 3. Davis, amitriptyline, Psychiat. (ELAVIL) reactions, Psychosomatics 1960. 2. Burt, C. G., Gordon, N. F., and 5ept., skin rash, agranulocytosis. a new 5:87, i. Ment. antidepressant, theory 108:711, with Indian I. 1963. #{216}MERCI( SHARP& IJDHME where today’s for in depressive 5ci. R. B.: Experience April, therapy 1:320, W. F., Holt, 5-CO is tomorrow’s . S therapy TofrniI#{174} brand of imipramine hydrochloride APAMHS Appoints Remotivation Director Robert J ersey, S. Garber, will M.D., continue to be of New the chair- man of the APA Remotivation AdCommittee. Other members are William S. Hall, M.D., South Carolina; visory On January Si, Francis V. Dugan became project director of the APA/ SK&F Remotivation Project, which will now be administered by the Mental Hospital Service of the American Psychiatric Association under Donald W. Hammersley, M.D., chief of professional services, at the APA central office, Washington, D. C. Since 1956 the Remotivation Project has been sponsored by the APA and administered and financed by Smith Kline & French Laboratories. The project will continue to be financially supported by SK&F. After 22 years in the U. S. Navy, Mr. Dugan retired as a lieutenant cornmander, commissioned as a specialist in administration. He will Granville Francis Mary Lee N.W., Washington, D.C. 20009. He will also make visits to regional training centers and to other mental hospitals. M. J. The O’Neill, R.N., M.D., basic the M.D., M.D., M.D., Litin, Liston, G. Sewall, and New Jersey; Minnesota; New York; New York; Arkansas. remotivation remotivator and literature pins and accom- panying citations are available in quantity, at no cost, from Mr. Dugan in the Washington office. He will also supply the basic remotivation literature: . Remotivation Technique (training manual) Remotivation-Basic . About gram . a Useful Mental Motivation for Facts Hospital the Pro- Mentally Re- tarded coordinate the Rernotivation Project in Washington. Questions and requests for literature should be addressed to him at the APA central office, 1700 18th Street, L. Jones, Edward ing . Outline Course. Copies of for Remotivation Train- Brief Summary: imipramine remission of 4 patients with endogenous and reactive depressions. The following “target Two new Western Higher mental grants Interstate Education health grams were in data mental The to the to Commission collect and for use and to develop pro- retardation National research. Institute of Mental grant for a Health awarded the first three-year period. The second was awarded by the National Institute of Child Health and Human Develop- ment which on will a one-year contract be open to negotiation subsequent Under Levy, Ph.D., years. the direction the two new of basis, for Jerome programs intended to work very closely each other. According to Robert Kroepsch, Ed.D., WICHE director, “One will to train data help mental health field foster research retardation based data collected.” Dr. Levy executive institute programs collectors and programs on the explained are with H. the in other the will in mental utilization of that a major aspect of time new research program will be a regional advisory committee composed of consultants who will meet at frequent intervals to share their specific knowledge and their experi- on actual duplication. needs and without This assist based undue Conferences, workshops, institutes, seminars, and individual and specific consultation will be used by both proj. ects to achieve their goals. Eight Awards Made For Community Centers By the Department Welfare for the of depression may to the drug: psychomotor retardation and inhibition; despond ency, sadness; fatigue; lack of interest and emotional response; helpless ness, hopelessness, pessimism and despair; feelings of incapacity and inferiority; suicidal drive; delusions guilt and unworthiness; hypochondria and psychosomatic complaints; insomnia; weight anorexia, Contraindications: gether with of loss. Do not give to or less than a week after M.A.O. inhibitors. Warning: Consider possible unconfirmed teratogenicity first trimester of pregnancy. risks of during Use low dosage and care in patients with film Remotivation: A New Technique for the Psychiatric Aide will continue to be available directly from the SK&F Medical Film Center, I 500 Spring Garden Street, Philadelphia, Pennsylvania 19101. the ence with individual programs. total regional perspective will in starting new research projects awarded symptoms” respond cardiovascular end of November 1965, the of Health, Education, and had approved 15 state plans construction of community disease. Precautions: Suicide is possible in seriously depressed patients. Administer cautiously to patients with increas ed intraocular thyroid WICHE Receives Two Program Grants Tofr#{227}nil,brand of hydrochloride, produces of symptoms in about 3 out pressure, and to hyper- or thyroid-treated patients. Adverse Reactions: Dryness of the mouth, tachycardia, constipation, dis turbances of accommodation, sweat ing, dizziness, weight gain, urinary frequency or retention, nausea and vomiting, peripheral neuritis, mild parkinson-like syndrome, tremors, rare cases offalling in elderly pa- tients, agitation (including hypomanic or manic episodes), confusional states (with such symptoms as hallucinations and disorientation), activation of psychosis in schizophrenics, epileptiform seizures, orthostatatic hypotension and substantial blood pressure fall in hypertensive patients, purpura, transient jaundice, bone marrow depression including agranulocy- mental health centers. The states were: California, Colorado, Florida, Kansas, Louisiana, Maryland, Minnesota, Missouri, New Jersey, New York, tosis, sensitization and skin rash including photosensitization, eosinophilia, and mild withdrawal symptoms. Ohio, Average Adult Dosage: Initially, one 25 mg. tablet t.i.d., increased to two 25 mg. tablets t.i.d. or q.i.d., if necessary. Oregon, Carolina, A and total Pennsylvania, Sou tim Washington. of $3,836,039 had been awarded for the construction of eight community centers, six in California and one each in Missouri and Florida. Three of the California grants were made to centers connected with county hospitals, two with general hospitals, and one with a private hospital. (60) Maintenance therapy and dosage adolescent and geriatric patients should be lower. See Prescribing formation for full details. Geigy for In- Pharmaceuticals Division of Geigy Chemical Ardsley, New York Corporation I #{174} brand of imipramine T ofr#{228}n ii hydrochloride In Depression The Standard Comparison of Usually Relieves Symptoms in 3 out of 4 Patients Round tablets of 25 mg.,triangular 0 Geigy U tablets of 10 mg. for geriatric use, and ampuls of 2 cc., each for containing 25 mg., Mental Hospital Service ii‘-“ PSYCHIATRIC 111 ,.. I J.. ‘11PSYCHIATRIC ill P PSYCHIATRIC 111 & ProJJjj [fttudIes & ProjectjJj ti’ _!i!!JJi #{149}5 Pnhlications x.. s Il ‘.L .,.,.,7 I. EMERGING TION retarded, for psychiatric patient clinics. 32 pp. gels- out- i ‘“ FOR PRolEssIoNAL IN HOSPITALS FOR THE ‘ NPkh sssa #1 AND MENTALLY Th. ‘“ 1mI INSTITU- PATIENTS: Prepared Ph.D., G. by Charles Sewall, kau, M.D. tion of hospital BY ft1PSYCllIATRI?11 RL:!b & ProjectsJ OF STATE ‘ S ,‘.iiaais or . ii 1MI hI*C ,, ,.,1 aWt. N*NTM. P1TCRATIIC V NOIPIT4L tendent Island. 221 $UUCI ing Lem- EMPLOYED H. . Jones, Prepared Superin- . M.D., Hospital, Rhode of a 1962 to survey determine during years, A HOSPITALS: SURVEY. liabilities of V. PIIY5Ic1ANS Report tent I’.L*N..a F.*vwI1f N. . G. Berger, P/iD., Lee Paul MENTAL of Butler five METHOD. and hospitals cian Psv- SOCIAL A study of social restorapatients as a measure of performance. 32 pp. ,i #4 by Charles [1futhes & Proj OF David E. Rice, M.D., PRELIMINARY I S TIlE INVENTORY ADJUSTMENT RETARDED, ‘‘‘.‘ M.id EVALUATION CHIATRIC LIABILITY HI PSYCHiATRIC II gg U POSTHOSPITAL STATE SEPTEMBER 1963. . . Prepared by Dorothy M. Richardson, Statistician, American Psychiatric Associalion. A survey of salary ranges among all professional groups from trainee to supervisory levels. 40 pp. i #3 the in ‘‘ EMPLOYED MENTAL for psychiatric RANGES TIONS psychi- services and t’p4eb.-‘ PERSONNEL . Committee institutions hospitals, SALARY . Policies for HosA new look at procedures hospitals, eral A.P.A. and Clinics. operational ADMINISTRA- FACILITIES by the on Standards pitals and atric OF PSYCHIATRIC Prepared ‘““‘ , * r.,...,,i M..i. F.i4lhks PATTERNS IN p,.i,..,...i t., Adm1.L*eadl. P.fl.rwi,.t Prh.*ri.. Ee’-i&.* s...,.. case the results, insurance preccdand protection. Tb. ,p..1 #{149}i.MIk7 .1 1’.,,*..I. ..d l:.$....., .. LpI..4 Me..I Il-IL .4#{149}. by Si,,,.y #{149}, I. .I,,,..., order IS3 c_._ - #5 H...I.: A PreIIl..ry P$ei S.,, Pky.Ie1a .5 St.., .,,.,,,I,,. ‘5--., t THE DEVELOPMENT TRAINING . . . SERVICES Report of the Held August, in 1963. National Health, Association, sociation ordinators. FOR COORDINATORS Planning Confer- Washington, D.C., Co-sponsored Institute American and the of Volunteer 40 pp. by of the $1 $4? only STANDARDS CURRICULUM VOLUNTEER ence OF five *J5 for AND all M3 N_ the Psychiatric Service Dear Sirs: #1 0 Mental American APA Publications Services Division 1100 18th St., N.W., Washington, D.C. 20009 Please send me the publications #2 I enclose payment NAMF As- Co#2 ADDRESS: (62) checked below. #3 #4 D Please bill me for a total of ex12 pp-si I., of physi- At the rate of #5 $1.00 each, NEWS & NOTES California Center Gets PHS Facilities Grant The Association dren, Inc., in received Stockton, established ice program tion of the mentally in and continuous and and of the total the The state Mental Construction 88-164). or the be Act of aid must to for the 35 of approved by the Medical Service, which January of State Directors and thori Mental and SLIPPER are not community have ceive building buildings granted health or centers Those not been construction improving or states general state hospital STRENGTH C for SAFETY D for FIT STRAP -+ contour nylon - elastic reinforced Light as a cloud! Wear like women, phone boys, ANdover soft Nylon inner Made stretch fold and taped outwear any and can be washed They’ll and to fit either White, 3-0600 stitchsd with special composi- sole. girls. :<j:iEliDIJ3 1IL plans states double double They fit snugly in a few minutes. men, tape, anklet, heel, iron! toe bias SUppers are 100% slipper. Write,. whose the - sole and soft cushion dried for Au- able to funds B for other H ill-Burton to COMFORT tion State Health t approved. therefore federal of A for Nyl-Nif health Program Conference mental been Hill-Burton be made unanimously in National Associa- presen HEEL pro- the Mental A t SUCCESS Health Health the Territorial ties. funds have PROVEN Hospital mental was passed by both the facilities specified. their of certain be- essen- been Public that again or the enacted have Division all also conipleted funds for area provide STYLES! State Officials Request Hill-Burton Policy Review available services be- that are administers construction catchment cannot as centers 1N3 serv- which asking their health con- qualify 1YAllABLE 1YL-MT SLIPPERS graIn. resolution they health to mentally was Facilities, of cause tial mental fail mental ineligi- train- the legislation have needed projects cause is 88-164.” explained provide retarded of certain and under P.L. statement They to workshops 26 con- to Health re- education, states plans, tion funds states Health Mental ters comprehensive the 1963, state A Hill-Harris the Mental State Authority community hospital permit ELASTIC Since and Hill-Burton] ANOTHER eligible. in [ State for a grant A supporting that for the by pub- designed mentally struction “That application the Law agencies. provide asks: ble facili- project and facilities care Construction regulations program an(l Federal 10, folofficials will decision. Service by Authority psychiatric that the Cell i)e sponsored custodial Hill-Burton policy nsodcrnize is approved deliber- the March 1)rovided es- of (Public eligible, especially of on be or ties pro- was 1963 Sheltered help utilize to struct association. Health nonprofit retarded. being the treatment, or to is isof to ed- Facilities tal be diagnosis, ing, H ill-Harris one enactment Men To other must tue community cost, is and a recommendation Health com- provides Retardation ni ty a ‘Tue accommo- progranm with Commu serves construction grant tablished which construction services, evaluation, remainder of center. The entire the recommendation Joaquin provide grant The by lowing training. federal $92,631. the present San will and The vided of addition diagnosis aid its l)Lrt Council announce for which children prellelssive third to Center, The 80 ucation, will retarded County. llOSl)ital Public adding mentally include Servconstruc- facilities grant Activity ices the retarded. association date a Health stimulate $30,877 Youth has under community-based The the California, Public to Hot health including the tvo organizations, ated at the meeting Chil- grant are SUC, Retarded lroiect a newly lic for that mental now foot Blue for - and further in sizes Maroon. details INciNsTiT:Tl:NALoiv1sioN:I refor hospital units Canadian L ‘ (63) Dlitrlbutors: SIMPSON’S, 45 Richmond $tt#{149}.t, Was?, Toronto 1; Canada .1 Reactions to Tension in Mailer ... I A I I Color stress patterns in a piece of plastic. . Plastic cantilever beam subjected to stress and viewed through a polariscope (as shown above) uncovers areas of dangerously high tension,. helps engineers strengthen flaws in designs. -and Patients Man in therapy environmental often forces at times a this useful tension, occurs, Valium Valium (diazepam) helps and significant when are or in patients achieves the desired As numerous helps activities the they to benefit from frequently can attest, office and his therapist. complicate results. psychiatrists (diazepam) fail (diazepam) pa- symptoms which who Valium a in most depressive tension be psychic produce response there to psychic agents, occur, can patient cooperate If drowsiness will usually Valium his maintain more and disappear states induced somatic Psychoneuroses, capac. (diazepam) By reducing therapy, with a reduced to therapy. Even normal have Tension or imagined pressures, adlunct secondary other situational they by engendered them. noticeable tients. stresses and when ity to handle When face effectively ataxia with dosage adjustment. by environmental moderate fatigue and restlessness; systems. fear; aggression psychophysiologic Depressive symptoms fears Somatic complaints emotional factors. and and severe: Tension, hostility; agitation and disturbances of organ associated restlessness. and or real disease. mild, tension, stress; resulting with from psychoneurotic or concomitants of Alcoholism: agitation, hallucinosis; drawal. As an aid to symptomatic relief of acute tremor, impending or acute delirium tremens, useful in agitation due to alcohol with- Geriatrics: require responinitially, Tension symptoms in elderly patients lowest dosages. Since these patients are highly sive, limit dosage to smallest effective amount increase gradually if and as needed. Muscle tosis. spasm associated with cerebral palsy In prescribing: Dosage-Adults: Mild to choneurotic reactions, 2 to 5 mg b.i.d. psychoneurotic reactions, 5 to 10 mg t.i.d. holism, 10 mg t.i.d. or q.i.d. in first 24 t.i.d. or q.i.d. as needed; muscle spasm palsy or athetosis, 2 to 10 mg t.i.d. or patients: 1 or 2 mg/day initially, increase and athe- moderate psyor t.i.d.; severe or q.i.d.; alcohrs, then 5 mg with cerebral q.i.d. Geriatric gradually as needed. Contraindications: convulsive disorders Infants, patients or glaucoma. Warning: Not of value tients, and should not ate treatment. Va ium with a history of in the treatment of psychotic pabe employed in lieu of appropri- Precautions: -psychic tension due to situational stress Limit dosage to smallest effective amount patients (not more than 1 mg, one or two times daily) to preclude ataxia or oversedation. Advise patients against possibly hazardous procedures until correct maintenance dosage is established; driving during therapy not recommended. In general, concurrent use with other psychotropic agents is not recommended. Warn patients of possible combined effects with alcohol. Safe use in pregnancy not established. Observe usual precautions in impaired renal or hepatic function and in patients who may be suicidal; periodic blood counts and liver function tests advisable in long-term use. Cease therapy gradually. -psychic tension with concomitant somatic Side Effects in elderly (diazepam) 2-mg, 5-mg, useful in -psychic 1 0-mg tension tablets with assodated depressive sym ptomatology ness complaints E:jL:-j c11 --) (usually ataxia. dose-related) Also reported: are mild fatigue, nausea, drowsidizziness, blurred vision, headache, diplopia, incontinence, slurred speech, tremor and skin rash; paradoxical reactions (excitement, depression, stimulation, sleep disturbances, hallucinations); changes in EEG patterns. Abrupt cessation after prolonged drawal symptoms Roche Laboratories Division Lc and of Hoffmann-La Nutley,N.J.07110 rates, Roche Inc. meprobamate Supplied: overdosage similar to those and may seen chlordiazepoxide Tablets, 2 mg, 5 mg and 10 mg; for convenience and economy in prescribing. produce withwith barbitu- HCI. bottles of 50 i Jut %MEmtA-JOUI15I rs riD -. #{163}‘J#{216}R.’tL %%txIfl(J% M1)U . F ‘./ Diseases iu Nercus Ststern * ,, PSYGHOSOMATI( MED!CJ-L . .--......--- ....‘.‘ 1.. 3 4 6 S clinical 7 Published indicate comparisons there is no better antipsychotic agent than Mellaril and most show Mellaril causes notably less extrapyramidal reaction The known published no antipsychotic agent ability to produce greater In addition, significant -the When clinical comparisons have demonstrates a statistically markedly the logical drug on admission SANDOZ PHARMACEUTICALS, improvement the majority advantage all factors overall over therefore, of first choice N.J. phenothiazines #{149} ORIGINAL reactions. Mellaril becomes for the schizophrenic -both as maintenance HANOVER, other risk of extrapyramidal are considered, and Mellaril. of these studies emphasize of Mellaril reduced than shown that significant RESEARCH therapy after discharge. a 1H 101 CMAD1A JuuIt*L v- MflhII:’ JOt’RxAL .: -.. r,.I1K’N H11E5 . , r. - UL ‘1 P:Quuteriy 1tt ?SCHIA -.- -‘‘ =--E-t .2 #{149}1 1 12 The papers listed here While minor variations agent demonstrated a than Mellaril. Starred reactions on Mellaril. all compare Mellaril with other antipsychotic agents. in drug effect have been observed, in none of the studies has any statistically significant ability to produce greater overall improvement studies emphasize the lower incidence and severity of extrapyramidal Copies of any or all papers are available on request. * 1. Herman, E. and Pleasure, H.: Dis. Nerv. Syst. 24:54, Jan. 1965. *2 Dierks, M.: Amer. J. Psychiat. 119:775, Feb. 1963. *3 The National Institute of Mental Health Psychopharmacology Service Center Collaborative Study Group: Arch. Gen. Psychiat. 10:246, March 1964. *4 Azima, H., Durost, H. and Arthurs, D.: Canad. Med. Ass. J. 81 :549, 5. Lasky, J. J., Klett, C. J., Caffey, E. M., Jr., Bennett, J. L., Rosenblum, and Hollister, L. E. : Dis. Nerv. Syst. 23:698, Dec. 1962. *6 Waldrop, 7. Ulett, F. N., Robertson, G. A., Heusler, on Psychosomatic Philadelphia, *9 Medicine, 1962, *8 Freedman, R. H. and Vourlekis, A. F., Word, chap. V. I. and Nodine, 46, pp. Word, A.: Compr. J. H. and Moyer, J. H. (eds.), D. X. and De Jong, J.: Amer. J. Psychiat. 117:930, D. M., Cohen, P. H. and Graves, G. D.: J. Ment. Somerville, First April 1, 1959. M. P. Psychiat. T. J. : The 384-390. Oct. 2:96, April Hahnemann 1961. Symposium Lea & Febiger, 1961. Sci. 106: 1417, Oct. 1960. 10. Stabenau, J. R. and Grinols, D. R.: Psychiat. Quart. 38:42, Jan. 1964. 11. Hughes, W.: Canad. Med. Ass. J. 84:268, Feb. 4, 1961. 12. Schiele, B. C., Vestre, N. D. and Stein, K. E. : J. Clin. Exp. Psychopath. 22:151,July-Sept. 1961. 13. Svendsen, B. B., Faurbye, A. and Kristjansen, P.: Psychopharmacologia 2:446, 1961. 14. Daggett, D. R., Clark, R. S., Nelson, S. E. and Mandel, N. G.: Minnesota Med. 45:9, Jan. Indications: Anxiety, tension and agitation in pediatric, adult, and geriatric patients. Psychomotor hyperactivity in psychotic patients. Contraindications: Severely depressed or comatose states; major degree of hypertensive or hypotensive heart disease; with or following recent use of MAO inhibitors. Precautions and Side Effects: From a clinical experience of more than ten million patients, it is apparent dryness that of the Mellaril mouth, amenorrhea, orthostatic may occur. Pigmentary given over long periods and convulsive seizures phenothiazine nasal has a wide range stuffiness, skin of safety. disorders, Jaundice has not been nocturnal confusion, Drowsiness, galactorrhea, hypotension, inability to ejaculate in the male, or pseudoparkinsonism retinopathy has been reported in doses in excess of 1600 mg. daily of time. Leukopenia, agranulocytosis, photosensitization, are extremely rare, but are possible complications of all administration. S#{174} Mell arid when observed. all factors (thioridazine) are considered SA N DOZ 1962. - - ,;- Nvrozc’iy - 10 9 8 LHJd . -- - jrLlT1Y -,--=#{149}. - - PSYCHOPHARMACOLOGIA - QwrculyRtic E2.. . VOlW1)OktT . - ----- - tioumal ofc1ntctin#{244} - . #{149}::.:: . . 13 14