---Clinical Abstracts---

Future relationship ofneuroscience and psychiatryPardes H: Neuroscience and psychiatry: Marriage orcoexistence? Am J Psychiatry 1431205-1212, 1986.

• This article discusses one of the corequestions confronting psychiatrists ofour time. Neuroscience is advancingrapidly and is having an ever increas­ing impact on our understanding ofpsychiatric conditions. Will psy­chiatry incorporate this knowledgeand put it to use? The answer will af­fect the credibility of psychiatry and

Alexithymia and chronic painPostone N: Alexithymia in chronic pain patients. GenHosp Psychiatry 8:163-167,1986

• Although research results have beenconflicting, alexithymia, with its in­ability to describe feelings, dimin­ished capacity to fantasize, and opera­tional cognitive style, has beenthought to playa role in the develop­ment of physical illness. This investi­gator compared chronic pain patients,

Undetected PTSD inchronic pain patientsBenedikt RA, Kolb LC Preliminary findings on chronicpain and posttraumatic stress disorder. Am J Psy­chiatry 143906-910,1986

• This study stresses the importanceof adequately screening patients with

may determine whether the specialtysurvives at all. The author explainshow current scientific research per­mits more precise understanding offunctioning of the brain, its responseto external factors, and the biology un­derlying mental functioning, as wellas how this new information may beutilized to improve the treatm.ent ofpsychiatric patients. In addition, hedescribes the evolution ofclinical psy­chiatry and the role ofeducators in en­suring that advances in neuroscienceare integrated into the curricula or

their spouses, and a group of psy­chotherapy patients without pain com­plaints, utilizing two measures ofalexithymia (the Beth Israel Question­naire and the alexithymia subscale ofthe Minnesota Multiphasic Personal­ity Inventory). Alexithymia proved tobe related to age, but not to other dem­ographic variables. On controlling forthe effects ofage, the pain patients hadsignificantly higher scores for alexi­thymia on both measures than did the

chronic pain complaints forpost-trau­matic stress disorder (PTSD). The lat­ter has been found to coexist with awide variety of psychiatric disorders,including substance abuse, anxiety,and depression, but it has been lesswell noted in chronic pain. Among225 patients in a VA pain clinic, 10%

skills of medical students, residents,academicians, and practitioners. Thearticle concludes that neuroscienceand psychologically based psychiatryare not irreconcilable and that, in­creasingly, they are becoming corner­stones of the specialty. Educators andacademic psychiatrists should take in­creasing responsibility for assisting alarge number of psychiatrists in notfeeling overwhelmed by the rapidpace of scientific developments.

John L. Black, M.D.MayoC/inic

psychotherapy group. Other groupcomparisons were not significant.Surprisingly, there was a poorcorrela­tion between the two measures ofalexithymia. Postone concluded thatchronic pain patients are a heteroge­neous group and that the presence orabsence of alexithymia might be animportant factor in selecting treatmentfor the pain.

Ronald K. McCraw, Ph.D.Fort Worth, Tex.

proved to meet DSM-III criteria forchronic PTSD, though all were pre­viously undiagnosed. In these pa­tients, the pain was localized at the siteof a former injury, predominantly inthe extremities and back. The pain hadbegun at the time of injury and persist­ed in most cases, but the PTSD was

(continued)

Alcohol: Clio up ResAmJ Mel!Am J PsychlalrYAm J PsycholherAon Intern el!MoNeurolArch Gen Psychlalry

FEBRUARY 19117-VOL211-N02

Arch Inlern MedArch eurolBr J PsychialryGao J Ps chlalryCampr PsychiatryGeo Hosp PsychiatryHeadache

Joumals Reviewed and Abatracted

Hosp Commumty Psychialrylot J Psychialry MedJAMAJ Behav MedJ Clln PharmacolJ Clio PsychiatryJ Clio Psychopharmacol

J MedEducJ Psydlosom ResJ StucI AlcohollancetMayo Clio ?rocNEnolJ MedNeurology

PoslgradMeclPsytlllatr AI1lIPsychopharmacol BullPsyc!lOsom MedSlapSlrokeand other JOUrnals

lOS

SlNEQUAN~(doxepin He!)

FEBRUARY 1987

t---- Abstracts ------i

Gary S. Nye. M.D.Orinda. Calif.

.. 59

.77-78

. . 90-92.106-108

. ..81-84

. .61-62,98-100

. . . . . . . . . _third cover­fourth cover

Pamelor. . . _ . . . . . second cover-58

The Upjohn CompanyHalcionXanax .

Clba PharmaceuticalsLithobid. . . . . . . . . . . . . .69-70

McNeil PharmaceuticalHaldol .....

Mead JohnsonPharmaceutical Division

Desyrel 64

MemllDowPharmaceuticals

Norpramin _ .. _ .

Monarch Health CorporationSymposium. . . . . . . . . . . . _103

RoerlgNavane.Sinequan

SandozMellaril.

INDEX TOADVERTISERS

not diagnosed for a mean of 16 years.Coexistence of the pain complaints orpsychiatric disorders such as sub­stance abuse and depression probablymasked the diagnosis. Here thedepression appeared to be secondaryto the PTSD or the pain. Prior to treat­ment in the pain clinic, inadequate re­lief had been obtained from customarymedical and surgical services. Nu­merous treatment modalities had beenused, but without identification of thepsychological aspects of the paincomplaints. This deficiency may havecontributed to development of thedepression.

BRIEF SUMMARYSINEOUAN' (dolepln HCI) Cepsules/Oral ConcentrateContralndlcatlons. SINEOUAN is contraindicated in Individuals who haw shown hyper­sensitivrty to the drug PosSibility of cross sensItivity wIth other dibenzoxepines should be keptin mind.

SINEOUAN IS contralndicaled in patients with glaucoma or a tendency to urinary retention.These disorders should be ruled out. particularly In older patients.Warnings. The once-a-day dosage regimen of SINEOUAN in patients with intercurrentillness or patients taking ofher medications should be carefully adjusted. This is especiallyimportant in patIents receIVIng other medications wrth anticholinergic e"ects.

Usage In G«latrlcs: The use of SINEOUAN on a once-a-day dosage regimen in geriatncpatients should be adjusted carefully based on the patient's condrtion.

Usage In Pregnancy: Reproduction studies have been pertormed In rats. rabbits.monkeys and dogs and there was no evidence of harm to the animal fetus. The relevance tohumans IS not known. Since there IS no expenence In pregnant women who haw receIved thisdrug. safety In pregnancy has not been esfabloshed. There are no data Nlth resPect to thesecretIon of the drug in human mIlk and its e"ect on the nursing infant.

Usage In Children: The use of SINEOUAN In children under 12 years of age is notrecommended because safe condItIOns for ItS use haw not been established.

MAO Inhibitors: Serious side e"ects and ewn death haw been reported following theconcomitant use ot certaIn drugs with MAO Inhibitors. Therefore. MAO inhibitors should bediscontinued at least two weeks prior to the cautIous inrtiatron of therapy with SINEOUAN.The exact length of tIme may vary and IS dependent upon the particular MAO inhiMor beingused. the length of time it has been administered. and the dosage involved.

Usage ",Ith Alcohol: II should be borne In mInd that alCOhol ingestion may increase thedanger inherent in any IntentIOnal or unrntentional SINEOUAN owrdosage. This is especiallyimportant In patients who may use alCOhol excessiwly.Precautions. Since drOWSIness may occur WIth the use of this drug. patients should bewarned of the posslbiloty and cautIOned against driving a car or operating dangerous machin­ery while taking the drug. Patients should also be cautioned that their response to alcohol maybe polentiated.

Since suicide is an inherent risk in any depressed patient and may remain so untilSIgnificant improvement has occurred. patients should be closely supervised during the earlycourse ot therapy. PrescriptIOns should be written tor the smallest feasible amount.

Should Increased symptoms of psychoSIS or shift to manic symptomatology occur. It may

~~~:~Za~I~~~~~i~~~~~d~f~,:a~~~~~~~I~~~[o~st~:satt'1ow.,=nriot beenspecifically reported with SINEOUAN use. Howewr. due 10 the close pharmacologicalsimilarities among the tncyclics. the reactions should be considered when prescribingSINEOUAN.

Anticholinergic Ellects: Drf mouth. blurred viSIon. constIpation. and urinary retentIon hawbeen reported. If they do not subsIde WIth continued therapy. or become sewre. it may benecessary to reduce the dosage.

Central Nervous System Effects: Drowsiness is the most commonly noticed side e"ect.This tends to disappear as therapy is contInued. Other infrequently reported CNS side e"ectsare confusion. disorientation, hallucinations. numbness. paresthesias. ataxia. and extra­pyramidal symptoms and seIzures.

Cardiovascular: Cardiovascular e"ects includIng hypolenslon and tachycardia haw beenreported occaSIOnally.

Allergic: Skin rash. edema. pholosensitozation. and pruritus haw occasionally occurred.Hematologic: Eoslnophiloa has been reported In a few patients. There haw been occa­

sional reports of bone marrow depreSSIOn manIfestIng as agranulocytosis. leukopenia.thrombocytopenIa. and purpura

Gastrointestinal' Nausea. vomIting. Indigestion. taste dIsturbances. diarrhea. anorexia.and aphthous stomatrhs haw been reported. (See anticholinergic e"eets.)

Endocrine: Raised or lowered libido. testicular swelling. gynecomastia In males. enlarge­ment ot breasts and galactorrhea In the female. raISIng or lowerong of blood sugar lewis. andsyndrome of Inapproprlale antidiuretic hormone have been repor1ed with tricyclicadministration

Other: Diz.ziness. tinnitus. weight gain. sweahng, chills. fatigue. weakness. flUshing. jaun­dice. alopecIa. and headache haw been occasionally observed as adverse e"ects.

Withdrawal Symptoms.' The possibility of development of withdrawal symptoms uponabrupt cessation of treatment af1er prolonged SINEOUAN administration should be borne InmInd. These are not IndIcative of addIctIOn and gradual withdrawal of medIcation should notcause these symptomsOosage and Administration. For most patIents with illness of mild to moderate sewrity. astarting daily dose of 75 mg IS recommended. Dosage may subsequently be increased ordecreased at appropriate Intervals and according to indIvidual response. The usual optimumdose range is 75 mg/day to 150 mg/day

In more sewrely ,II patients hIgher doses may be required with subsequent \lradualIncrease to 300 mg/day If necessary. Additional therapeutic e"ect IS rarely to be obtaIned byexceeding a dose of 300 mg/day.

In patients with wry mIld symptomatology or emotional symptoms accompanying organICdisease. lower doses may su"ice. Some 01 these patIents haw been controlled on doses aslow as 25-50 mg/day.

The total daily dosage of SINEOUAN may be glwn on a dIVIded or once-a-day dosageschedule. If the once-a-day schedule IS employed the maximum recommended dose is150 mg/day. This dose may be glwn at bedtime. The 150 mg capsule strength IsIntended for maintenance therapy only and Is not recommended for Initiation oftreatment.

Anti-anXIety e"ect is apparent before the antidepressant e"ecl. OptImal antidepressante"ect may not be eVIdent for two to three weeksOverdosage.A. Signs and Symptoms

1. Mild: Drowsiness. stupor. blurred vision. excessIve dryness of mouth.2. Severe: Respiratory depression. hypotenSIon. coma. convulsions. cardIac arrhythmias

and tachycardias.Also: urinary retentIon (bladder atony). decreased gastrointestinal molility (paralytic ileus).

hyperthermIa (or hypolhermia). hypertenSIon. dilated pupIls. hyperactIve reflexes.B. Management and Treatment

1. Mild: Observation and SUpportlW therapy is all that is usually necessary.2. Severe: Medrcal management 01 _ SINEOUAN 0Vllfd0sage consosts 01 aggressive

supportiw therapy. If the patIent IS conscIOUs. gastroc lavage. with appropriate precautions toprewnt pulmonary aspiration. should be performed ewn though SINEOUAN is rapidlyabsorbed. The use of activated charcoal has been recommended. as has been continuousgastroc lavage with saline for 24 hours or more. An adequate airway should be established incomatose patients and assisted ventilation used it necessary. EKG monitoring may berequired for sewral days. sInce relapse alter apparent recowry has been reported. Ar·rhythmias should be treated with the appropriate antiarrhythmic agent. It has been reportedthat many of the cardiovascular and CNS symptoms of tricyclic antidepressant poisoning inadults may be rewrsed by the slow Intravenous admInIstration of 1 mg to 3 mg of physostig·mine salicylate. Because physostigmine IS rapidly metabolized. the dosage should berepeated as requored. ConvulSIons may respond to standard anticonvulsant therapy. howewr.barbiturates may polentlate any respiratory depression. Dialysis and forced diuresis ~ner­

ally are not of value in the management of overdosage due to hogh tissue and protein bIndingof SINEOUAN

More detailed professional Information available on request.

ROeRIG G'lD 108 PSYCHOSOMATICS

A division of Pfizer PharmaceuticalsNew York. New York 10017