The Canadian Journal of Psychiatry

This paper is Part I of a three-part presentation attempting to assess, with the use of clinical material, those conditions which seem most to bring about favourable change in patients undergoing psychotherapy.

This includes an attempt to differentiate between two kinds of change. The first is that which occurs under the suggestive influence of the therapist and in which the change comes about as a result of the patient's incorporation of the therapist as a friendly and powerful transference figure.

A comparative double-blind trial of butaperazine and prochlorperazine was carried out in 40 chronic schizophrenic patients. Subjects were matched in 20 pairs according to sex, age, duration of hospitalization, staff, ward and score on the B.P.R.S. Drugs were randomly allocated within each pair of patients and their effects evaluated according to the B.P.R.S. Posology was progressively increased up to 200 mg. daily but remained always equal for all patients. Results were analysed by non-parametric statistics for the B.P.R.S. and by an χ² test for the global evaluation.

Butaperazine and prochlorperazine showed a significant therapeutic efficacy throughout the twelve-week period. At the fourth and tenth week, prochlorperazine was significantly superior to butaperazine. However, at the twelfth week there was no significant difference in the efficacy of both drugs, as measured by the B.P.R.S. and the global evaluation. Beyond 100 mg. daily of both drugs a plateau was reached which higher doses did not influence.

Side effects made their appearance sooner with butaperazine but at the end of the trial the frequency of side effects was comparable with both drugs.

A highly significant positive correlation between raters adds weight to our results^*.

Three groups of Ss, normal controls, severely depressed and mildly depressed, were compared on several objective tasks. Only the speed of perception of three dimensional objects differentiated satisfactorily between the groups. It was concluded that severely depressed Ss differed from both normals and mildly depressed Ss on the complex speed tasks.

Five cases of peptic ulcer in children are reported and the coexistence of reluctance or refusal to attend school is noted. The psychopathology observed is felt to result from the failure of the parent to set limits for the child and to permit the child to develop capacity for functioning in other than dependent ways. The direct management of the syndrome to achieve mother-child separation is recommended.

A simple physiological battery, consisting of autonomic and behavioural measures, was investigated in a clinical psychiatric setting with respect to its discriminatory powers between various groups of subjects and to its suitability for the detection of effects of psychiatric treatment. It was found that the behavioural tests discriminate well between diagnostic groups, and that the autonomic tests, particularly the finger sweat index, are suited for the detection of strong emotional changes and of changes due to physical treatment. The results were interpreted in terms of the complexity of the control mechanisms of the tested physiological functions.

Twenty-five patients with depression seen in private psychiatric practice in Manhattan were given nortriptyline to determine

1) Whether the drug was active.

2) What the approximate dosage should be.

3) How long a course of treatment was required.

4) When dosage should be changed.

5) What type of patient was most likely to respond.

6) What side effects were likely to occur.

Sixty per cent of the patients showed initial improvement but twelve per cent relapsed and in one case the improvement was slight. Thirty-two per cent however gave a favourable and apparently lasting response which is significant since most of these patients had previously been treated with other medications unsuccessfully. Of the total group about a quarter of the patients complained of intolerable side effects so that medication was discontinued, although with two exceptions this was at the option of the patient rather than the therapist. All of the patients who responded favourably had manifested moderate to mild anxiety in addition to depression. Side effects were relatively mild and particularly so in respect to hypotension, which is the most common difficult side effect in the use of antidepressants. In two cases reversible psychotic reactions developed which led to discontinuance of the drug in one case and the addition of phenothiazines in the other.

Seven of the patients were referred for psychological testing which included Wechsler-Bellevue Digit Span and Digit Symbol Sub-Test; Rotter Sentence Completion; MMPI; Rorschach; TAT; Figure Drawings and Stories; and Bender-Gestalt Figures A, 4 and 8. Six of the patients returned for retesting after one to three months of drug therapy. Based on psychological test data alone, four of the six showed signs of improvement although no single quantitative or qualitative change in test pattern was found.