Psychiatric therapy research

The next few years were not the happiest in Pauling s life. Not only did he sever his connection with Caltech, he resigned from the American Chemical Society as well. The move to Santa Barbara was not a success. He turned to theoretical physics, but his close-packed spheron theory of the atomic nucleus met with little acceptance. He became engaged in actual and threatened libel suits. He moved briefly to the University of California at San Diego (1967-69) and then on to Stanford University (1969-72), where he was closer to his ranch at Big Sur, but he had no stable position in which to continue his planned research into orthomolecular psychiatric therapy. Meanwhile, he was deeply unhappy about the American involvement in Vietnam and about American politics in general. 

Sociocultural, illness, and biological factors affect individual attitudes towards psychotropic medications. Health beliefs or explanatory models, particularly causal attributions regarding the illness and the treatment options afforded within such models, exert a profound influence on patients attitudes and behavior regarding medications (Smith, Lin Mendoza, 1993). Such effects can be subtle and can occur during the course of treatment even if there has been initial successful negotiation about the nature of the illness and treatment. In psychiatric illness little research has been leveled at the personal meaning that patients bring to treatment practices such as electro-convulsive therapy (ECT), oral medications, and depot injections, or to the transition between different administrative routes and types of medications. 

The most direct way to help people manage the symptoms of nicotine dependence and withdrawal is therapeutic use of nicotine replacement therapy (NRT) (Fiore et al. 2000 Henningfleld 1995 American Psychiatric Association 1996). Nicotine has been shown to be the main active ingredient in tobacco that causes and sustains addiction to tobacco (US Department of Health and Human Services 1988). Laboratory research has demonstrated that animals (Goldberg et al. 1983) and humans (Henningfleld et al. 1983) who have been chronically exposed to nicotine or tobacco smoke will self-administer nicotine infusions. It should be noted that other constituents in tobacco, such as MAO inhibitors (Fowler et al. 1996a, b), may also play a role in tobacco dependence. The potential role of alkaloids other than nicotine has not been ruled out. This is consistent with the observations that what has been termed tobacco delivered nicotine is more addictive and toxic than formulations provided by nicotine replacement medications (Royal College of Physicians 2000). 

An emerging literature suggests that treatment of psychiatric illness may reduce the risk of developing SUD later in life. The findings are most dramatic for stimulant therapy of ADHD, as several studies have observed decreased SUD rates in children whose ADHD was treated with stimulants, compared to ADHD children who received no such treatment (Biederman et ah, 1999 Toney et ah, 1999 Molina et ah, 1999). There is also preliminary evidence that treatment of bipolar disorder can reduce future substance use (Wilens et ah, 2000). While these findings are encouraging, further research is needed to support the initial data and to... 

Electroconvulsive therapy [ECT] is one of the oldest somatic treatments in psychiatry. The emergence of the field of psychopharmacology in the 1960s eclipsed advancement in ECT practice and research. To some extent, the pendulum has swung back in the past 15 years, as there has been intensive rediscovery of the basic science of ECT and an increase in its clinical use. Contemporary research has reexamined clinical issues, such as indications for treatment, response prediction, and relapse prevention, given the changing nature of psychiatric treatment and referral patterns. At the same time, more sophisticated approaches to treatment... 

DPT has not been very widely used to date, but those who have tried it seem to agree that it does produce psychedelic or "peak experiences. Much of its application in psychotherapy has taken place in Europe, under the supervision of such specialists as Dr. Hanscarl Leuner, who has just published a book in German on psycholytic therapy. Initial reports in the U.S. have come from the Maryland Psychiatric Research Center, which used this drug in conjunction with therapy at Spring Grove Hospital near Baltimore. 

The discovery of the mood-elevating effect of MAO inhibitors was a classic example of serendipity in drug research. In 1951, isoniazid and its isopropyl derivative, iproniazid, were successfully introduced for the treatment of tuberculosis. In contrast to isoniazid, iproniazid was found to produce undesirable stimulation in some patients. In 1952, Zeller and his co-workers demonstrated that iproniazid was capable of inhibiting MAO, whereas isoniazid was ineffective (Zeller and Barsky 1952 Zeller et al. 1952). In 1956, Crane analyzed the psychiatric side-effects of iproniazid and came to the conclusion that it might be beneficial in the treatment of depression (Crane 1956). In 1957 Kline introduced it as a psychic energizer (Kline 1958). At the same time Kuhn discovered the antidepressant effect of imipramine (Kuhn 1957). This opened the way to the most powerful antidepressant therapy to date. 

Measurement of the catecholamines and a variety of the intermediate metabolites in blood or tissue is common in psychiatric and neurochemical research. In clinical chemistry the major interest in catecholamine metabolism surrounds the detection and location of the tumors of neural crest origin -phaeochromocytoma and neuroblastoma. These tumors are fortunately rare but their identification is important because if treated promptly they may be curable. Phaeochromocytoma is associated with secretion of adrenaline and/or noradrenaline into the bloodstream and can either be detected by the increase in the parent compounds or by increased VMA excretion. The most common presentation by the patient is hypertension unresponsive to conventional therapy. Neuroblastoma is the commonest malignant soft tissue tumor of childhood, arising from ectodermal neuroblasts. These tumors secrete abnormally high concentrations of dopamine which is largely metabolized to HVA. 

Currently, the American Academy of Pediatrics and the American Psychiatric Association feel that megavitamin therapy is unproved in terms of safety and efficacy. Nevertheless, hope should not be abandoned. There are certain genetic disorders for which megavitamin therapy can be justified and future research may find its justification in other disorders. For example, nine studies reported in the world literature show that megadoses of vitamin B-6 are helpful in treating autism, though more experimental work is needed. ... 

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