http://exhibits.library.stonybrook.edu/mfp/files/original/07a3d1b2eec1cf62891da3ff4c4049c8.pdf f5bf70eb575371f639319602e2837d97 PDF Text Text EXPERIMENTAL PSYCHIATRIC RESEARCH AT HILLSIDE Review and Prospect MAX FINK, M.D. Reprinted from JOURNAL OF THE HILLSIDE HOSPITAL Volume X ° Nos. 3-4 ° July-Oct. 1961 �EXPERIMENTAL PSYCHIATRIC RESEARCH AT HILLSIDE Review and Prospect MAX FINK, MD. The dedication of Hillside Hospital as a Research Institute has been a dream of many of its students—a dream that may achieve realization in this decade. Dr. Tarachow was an early proponent of this view; and both in his sponsorship of the Journal, and in his encouragement of research studies, he presaged this development. He was also the inadvertent sire of the research studies in experimental psychiatry. While I was a resident in psychiatry in 1952, we collaborated in a study of the relation of the early separation of child from a parent to the adult choice of neurosis. Reviewing the hospital records of five previous years we concluded that there was, indeed, a relation—— neurotic patients with obsessional neuroses had a significantly, greater incidence of separation than patients with hysterical neuroses (2). This report was the beginning of the patient population studies described here. Since 1954 the various programs in experimental psychiatry have been devoted to an understanding of the mode of action of the psy- chiatric therapies of the hospital. The techniques have been adapted from descriptive and dynamic psychiatry, neuropsychology, electroencephalography, linguistics, pharmacology, and sociology. This report reviews these studies and presents support for the creation of a Research Institute at Hillside. PAST STUDIES In our early studies of convulsive therapy, instituted with the 1 From the Department of Experimental Psychiatry, Hillside Hospital, Glen Oaks, N. Y. The studies reported here have been aided by the Board of Directors Research Fund; the National Institute of Mental Health (Grants M-927; MY-2092,-27l5, -4798; MF-12,033); Foundations Fund for Research in Psychiatry (FFRP 56-151); Kaufmann, and Dazian Foundations; and numerous pharmaceutical concerns including Geigy, Bristol, Wyeth and Smith, Kline 8c French Laboratories. 159 �160 MAX FINK aid of a grant award of the National Institute of Mental Health, evaluations of patient improvement were shown to be dependent both on changes in brain function and on psychological factors. As our understanding of convulsive therapy developed, a general neurophysiologic-adaptive view of somatic therapies emerged (6). A change in brain function was seen as a necessary condition for behavioral change, with the type of change varying, depending upon psychological and sociological characteristics of the subject (22, 25). Thus, the mode of action was not seen as either “organic” or “psychological” but rather as the interaction of neurophysiological changes and individual patterns of response and behavior. This hypothesis was sustained in studies of convulsive and in sulin coma therapies (21, 22); and the mode of action of the new psychotropic agents was expressed within this hypothesis. It was suggested that psychotropic drugs would be effective to the extent that persistent changes in brain function were induced; and that the type of behavioral response would be related to the type of brain change, and to individual premorbid psychologic (personality) patterns (6, 28, 40). Convulsive Therapy Process: Seeking a measure of altered neurophysiological change that was sensitive and suitable for repeated retests, various measures were studied including changes in the face-hand test (1, 10, 13, 35), memory tests (17, 35), amount of slow-wave activity in the EEG (16, 23) and confabulatory and denial language patterns after amobarbital (3, 15). The latter two, EEG and amobarbital tests, were the most sensitive indices of change in convulsive therapy subjects. In one experiment, clinical ratings of improvement were correlated with high degrees of change in these indices (15, 16). These observations were tested in a double-blind study in which patients referred for electroshock were randomly assigned to either convulsive or subconvulsive therapy. High degrees of electrographic slow-wave activity and positive amobarbital tests were observed only in the convulsive group; improvement rates were significantly higher in this group, and when subconvulsive subjects were retreated by convulsive applications, the improvement rate was similar to the convulsive group (22). In subconvulsive applications, considerable electric current passes between the electrodes. It was postulated that the therapeutic agent was not the total electrical current per se, but the “all or none” quality manifested by the grand-ma] seizure (9, 23, 42). The signifi1. �EXPERIMENTAL PSYCHIATRIC RESEARCH 16] cance of the grand-mal seizure was examined in a comparative study of the inhalant convulsant, hexafluorodiethylether (Indoklon), and electrically induced seizures. Similar degrees of electrographic change, improvement rates, types of behavioral adaptations, and changes in neuropsychological task behavior were observed in both the inhalant and in the electrically treated groups (49). However, not all subjects manifesting high degrees of physiological change were evaluated as “improved.” In a descriptive typologic study, five adaptive modes were described, empirically termed “eu— phoric,” “hypomanic,” “somatization,” “paranoid-withdrawal," and “panic.” While the first two patterns were rated as “much improved,” the latter two were seen as “unimproved" or “worse” (50). In studies of psychological variables, it was reported that patients rated “much improved” and “recovered” frequently manifested personality patterns akin to the explicit verbal denial personality type (37). These patients expressed the “language of denial” more frequently than unimproved subjects, exhibiting such aspects as explicit. denial, minimization, displacement and clichés (27). Other psychological indices also related to favorable outcome included high F Scale score (42), Rorschach determinants of color, absent movement and absent form-color (30, 45), and low educational achievement and foreign birth (31). 2. Anticholinergz'c Compounds and Convulsive Therapy: Seek-ing a way to augment the degree of postconvulsive EEG slow-waveactivity, an anticholinergic compound diethazine, was given intravenously at various stages of the convulsive therapy process (20, 24).. Unexpectedly, diethazine caused an immediate and sustained de-crease in EEG slowing, which was associated with marked changes. in language and mood. In patients with denial language patterns. (27), these could no longer be elicited. Instead of euphoria and wellbeing, the subjects became irritable, anxious, and complaining. In‘ subjects prior to convulsive or drug therapy, diethazine induced, ex-citement, tension, anxiety, and illusory sensations. Subsequent studies with other central anticholinergic compounds" and sympathomimetic hallucinogens showed behavior and electrographic patterns similar to diethazine. These observations led to the suggestion that an increase in the cholinergic activity of the central nervous system was the biochemical basis for the convulsive therapy process (38). Psychotropic Drugs and EEG: Following these studies, the: neurophysiological changes induced by drugs were testedwithinan. 3. �162 MAX FINK acute experimental-EEG setting. It was observed that phenothiazines induced EEG synchronization and a shifting of the frequency spectrum to the slow frequencies; meprobamate and barbiturates, an increased synchronization and a shift of the spectrum to fast frequencies; reserpine, an increased slowing with synchronization at low dosages, and desynchronization at higher levels (18, 26, 28, 40). Imipramine induced desynchronization with a shift of frequencies to the slow bands (33, 34). Each active psychotropic compound was thus shown to have a characteristic frequency pattern. Various other experimental compounds were also tested, and for these no consistent electrographic pattern was recorded. These compounds have since been shown to have either no or very limited clinical psychotropic activity. The absence of behavioral change with these compounds lent further support to the assumption that brain change is a necessary condition for the action of psychotropic drugs. These observations suggested that psychopharmacological agents provide a means for eliciting various types of altered brain function in contrast to the single pattern following convulsive therapy. Furthermore, the type of neurophysiological alteration, as reflected in EEG synchrony and frequency patterns, was found to be related to specified types of behavioral adaptation. The advantage of EEG techniques for the assay of new psychotropic agents and the technical merits of electronic frequency analysis were assayed and described (47, 52). 4. Insulin Coma Therapy: In our insulin coma studies we con- firmed earlier observations that persistent alterations of brain function were related to prolonged coma and spontaneous seizures; and saw in this relationship support for a neurophysiologic-adaptive hypothesis. With the availability of the new psychotropic agent chlorpromazine, a controlled chlorpromazine-insulin coma study was undertaken in September, 1955. As patients were referred for insulin coma they were randomly assigned to courses of either oral chlorpromazine for at least three months in doses adjusted to fall short of toxicity; or insulin coma, induced by a standard technique at least fifty times in each patient. While a number of minor differences were noted in comparing the two therapies, the results at time of discharge showed no statistical difference in the effectiveness of both treatments. Neither treatment seemed to affect the basic schizophrenic process, but chlorpromazine had the advantage of being safer, easier to administer, and better suited to long-term management (21). Concurrently, following the suggestion by the Creedmoor workers that �EXPERIMENTAL PSYCHIATRIC RESEARCH 163 divided insulin doses were superior to single insulin doses, Blumberg and Laderman (39) essayed this problem and demonstrated no significant merit to the multiple-dose technique. (In 1958, following the general confirmation of these observations, insulin coma therapy was discontinued at Hillside). 5. Neuropsychology: Various psychophysical tests were adapted from neuropsychology, where their significance in brain-damaged subjects had been demonstrated. The early studies assessed these tasks as indices of altered brain function (35), and measured the range of performances of psychiatric patients, who are generally assumed not to be brain-damaged. Thus, memory function was assessed on immediate recall, after various interpolated learning tasks (17, 35), as well as during convulsive therapy (17). Tactile perceptual tasks were first examined in the clinical population (1). Later, with more sensitive electrical tactile stimuli, Korin (10) observed the range of thresholds in different body parts, the changes with altered brain function (10), and the influence of set (instruction) on performance (36). We also studied the perception of embedded geometric figures (43), tachistoscopic presentation of embedded color figures (55), perception of the visual upright (55), critical flicker frequency (49), and interference in reading time by delayed auditory feedback (55). For each task, the degree of decrement in task performance was found to be positively correlated with the amount of EEG slowing. Following treatment completion, with the return of physiological indices to pretreatment levels, performance in these psychological tasks also returned to pretreatment levels, or higher—a betterment of performance ascribed to practice effect. Concurrently, assessment of various psychological measures as indices predictive of behavioral change during convulsive and drug therapies led to studies of the Rorschach determinants (30, 45), California F Scale scores (30, 42), language patterns after amobarbital (27), denial scores on interview (37), and the perception of the visual upright and auditory feedback (55). 6. Psycholinguistics: Concurrent with the syntactic language studies (27), analyses of other language patterns were undertaken, both in a search for more objective indices of behavioral change and to gain experience in the technical problems of tape analysis for psychotherapy research. An index of variability in the vocabulary of speech, the type-token ratio (TTR) of consecutive samples of dyadic speech, was extensively studied (7,41, 44, 46, 56, 57). In convulsive therapy patients, significant changes in TTR mean �164 MAX FINK and standard deviations were related both to the degree of induced EEG slow-wave activity and to syntactic language patterns obtained in independent structured interviews. It was noted that speech became more repetitive (lowered mean TTR) and more variable in consecutive samples (41). In interviews before and after the intravenous administration of centrally active agents, similar changes were observed. Agents which produced predominant synchronization patterns on the EEG were related to a decrease in mean TTR and an increase in the standard deviation of scores, while desynchronizing compounds elicited greater variability in speech patterns and decrease in variability of consecutive scores (44). Other language measures studied included distress-relief quotients, self-reference, and alterations in tense and person. It was suggested that these psycholinguistic measures are useful techniques for the operational analyses of physiological and psychological effects of psychopharmacological agents (44, 46). 7. Brain Damage and Schizophrenia: Following his studies at Ittleson Center, Pollack reviewed the relationship between age of hospitalization, intellectual functioning and prognosis in schizophrenic children and adults. He noted that initial hospitalization in childhood and adolescence was related to I. Q. scores in the subnor— mal range, deviant performance on psychomotor tasks, and more frequent ratings of “unimproved” at hospital discharge than was initial hospitalization as an adult. The early and insidious onset of the behavioral syndrome “schizophrenia” was thus related to brain dysfunction (54). Findings suggest that different subgroups of schizophrenia may be classified on the basis of neuropsychological deviancy. 8. Sociological Studies: Considerable interest in the family organization to which discharged patients were returning, the relation of social factors to choice and results of psychiatric treatment, and the specific problem of the relation of these factors to treatment referral patterns led to a series of population studies. In one study (8), education, age, place of birth, and score on the California F Scale were significantly related to the type of therapy received and the utilization of adjunctive hospital services. In a second study (3]), duration of hospitalization, discharge evaluation, and diagnosis were related to the same social factors, while in a study of patient refusal of ECT, similar relationships were observed (51). These observations suggested a comparative interinstitution study, and among three hospitals the relationships between social class and other demographic variables (age, sex, education) to the clinical �EXPERIMENTAL PSYCHIATRIC RESEARCH 165 variables of patient classification (diagnosis), duration of hospitalization, selection of therapy, and discharge evaluation have been assessed. Three teaching institutions were selected in which all therapies are equally available to all patients—Menninger Foundation Hospital (upper-class, Protestant), Massachusetts Mental Health Center (lowerclass, Catholic), and Hillside Hospital (middle-class, Jewish). In such a comparison we have found the differences in designations of treatment, diagnosis, and discharge evaluation so marked as to make comparisons difficult. While many relationships between social variables and clinical variables were observed in each hospital, no social variable was found related to the clinical variables in every hospital (53). In an outpatient department study, sex, age, and marital status were found to be related to the acceptance and rejection of patients and failure to complete the application process (55). These observations in population samples led to concurrent studies of staff attitudes in the selection of therapy (ll, 12). In a series of ward observation studies, Kaplan and Lefkowits indicated the significant role of staff attitudes (especially nursing personnel) in the referral for subjects for somatic therapies, and in the transfer of patients from one ward to another. (To study the influence of stafi attitude on patient selection for drug therapy, we requested one ward be designated as a “no-movement” unit. This was adopted in September, 1959 and shortly thereafter by the whole hospital.) PRESENT STUDIES During the period of the convulsive therapy studies, many new psychotropic compounds were assessed clinically (5, 21), electrographically (34, 40, 48), and psychophysically (48). The present psychopharmacology evaluation program, based on these studies, was designed to answer the following questions: 1. Is there a relation between measurable alteration in brain function and behavioral change with psychotropic drugs on chronic administration? 2. Are there pretreatment clusters of psychiatric, physiological, and psychological variables which are related to the type of behavioral adaptation? 3. Are such clusters related to the type and degree of physiologi- cal change? As an initial approximation, a double-blind, fixed dosage, ran- �166 MAX FINK dom assignment drug study was undertaken. Based on our clinical experiences three types of compounds were selected on the basis of their EEG patterns. In this study, 203 subjects were referred, and 149 have completed the testing program, from October, 1959 to July, 1961. l. Behavioral Change: In a survey of the behavioral adaptations of patients receiving various psychotropic compounds during 195859, a behavioral typology based on the treatment response and on pretreatment psychiatric profiles was developed (55). In the present study, the typologies are being tested, and various measures of behavioral change studied, including therapist ratings, self-ratings, and various ward observation scales. 2. Neuropsychology: Psychological tasks have been viewed both as indices of behavioral change and as predictive guides in convulsive therapy. Each of these tasks and a selected group of motor tasks are now being assessed for both their capacity to reveal change with various drugs and their capacity to predict change with the drugs in. this program (48). 3. Electroencephalography: In the convulsive therapy studies, the degree of EEG slowing was measured by counting the consecutive waves in selected samples (16). When the more subtle changes of drug effects are studied, it is necessary to apply less tedious techniques (48), and electronic frequency analysis was introduced in August, 1959. By measurement of the pen deflection for various frequencies from 3 to 33 cps in ten-second epochs, rapid measurement of apparently small changes in total activity and frequency spectra are obtained (52). Other physiological variables studied in this program include the response of EEG to intravenous chlorpromazine, blood pressure response to mecholyl, the EKG, radioactive iodine uptake, and analyses of various blood and urine elements. 4. Data Analysis: To analyze the data generated in this study, we have sought the aid of complex statistical methods and computational facilities. Analyses of covariance, correlation matrices, factor analyses, and discriminant function analyses are computations now in progress with these data at the NIMH Psychopharmacology Service Center’s Biometric Laboratory in Washington. THE NEXT STEPS Favored by a national research climate and a cooperative hospital staff, these studies have proceeded vigorously. The assets for research in this setting have been great—a selected, intelligent patient popula- �EXPERIMENTAL PSYCHIATRIC RESEARCH 167 tion resident from six to twelve months, without individual economic limitation of hospital stay; a sophisticated administration tolerant of controlled studies; and approval of a Board of Directors who desire “research” as an institutional function. As Dr. Lewis Robbins noted in his first hospital report in 1959, a specialty hospital can make little impact on the mental illness problems of the community by treatment alone. The successful treatment of 350 patients a year is but little comfort to the 40,000 resident patients in the state hospitals of Long Island. Nor will the annual training of twenty or thirty physicians in the arts of psychotherapy do much to help these unfortunates or the many thousands of ambulatory mentally ill resident in the nation. No, a therapeutic goal alone is salutary but inadequate to our needs. As he proposed, the answer may lie in the dedication of a “research hospital,” as it is here that a specialty hospital can truly excel. The charter has been written in the Board’s assertion of research as a hospital goal. With the assets of an exemplary therapeutic facility, such rededication can provide the stimulus for the continuous study of the cause of mental illness and of methods of therapy. Such dedication would provide the stimulus for comparative and controlled assessments of different therapeutic techniques. Continued study is urgently required of the selection of patients for various therapies; the application and mode of action of the therapies; and the role of social and milieu factors in supporting the effects of our ther- apies. Assessments require a meaningful classification of subjects. The behavioral variables alone, which are the basis of our present diagnostic schemata, are unsatisfactory. Study is urgently required of the applicability of social and demographic variables; psychological task performance profiles; typologies based on behavioral response to defined stresses or drugs; and physiological reactivity measures. Such classifications are also essential for any biochemical, physiological, or evaluative study to provide homogeneous samples and comparable controls. Assessments also require meaningful indices of evaluating change. Present global “improvement” ratings and socialization measures are inadequate. Whether the intervening variable be milieu therapy, psychotherapy, drug therapy, or time, the criteria of behavioral change require definition. The applicability of rating scales, language tasks, self-ratings, psychophysical change scores, family assessments, etc., require study and evaluation. Recent studies of psychotic subjects have provided the suggestion �MAX FINK 168 that there is a neurologic factor in a group of the schizophrenias. The high incidence of electrographic and neurologic dysfunction, the lack of behavioral response to all therapies, and the relentless course of the illness suggest an “organic” involvement in this cluster. Such a substrate must be clearly sought by the application of biochemical, neurophysiological, and epidemiological techniques to various clus- ters of young psychotic subjects. These are broader views of some of the questions studied in the programs in experimental psychiatry of the past seven years. These programs, and the contemporary projects in biochemistry and in medicine, provide models of bootstrap studies undertaken with limited support. A dedication of Hillside Hospital as a Research Institute will provide the needed focus and impetus for the scientific and humanitarian forces of the community to join in a common endeavor to resolve the problems of the mentally ill. Acknowledgment: Participants in these programs include the present members of the Department of Experimental Psychiatry: Ira Belmont, Martin A. Green, Abraham Kaplan, Eric Karp, Donald F. Klein, John C. Kramer, Max Pollack, and Arthur Willner. Former associates included Karl Andermann, Joseph Jaffe, Robert L. Kahn, Hyman Korin, George Krauthamer, Nathaniel Siegel; and Research Fellows Barre Alan, Fred Coleman, Harold Esecover, Stanley Friedman, Henry J. Lefkowits, and Robert Shaw. The cooperation of Arnold G. Blumberg of the Department of Medicine in the present program is gratefully acknowledged. The reports listed here are the result of the collaboration of these workers and the professional staffs of the hospital who gave unstintingly of their time and their good-will. REFERENCES' (1) This Journal, 1:21, 1952; (2) ibid., 2:67, 1953; (3) ibid., 4:3, 1955; (4) ibid., 4:134, 1955; (5) ibid., 5:67, 1956; (6) ibid., 6:197, 1957; (7) ibid., 6:207, 1957; (8) ibid., 6:216, 1957; (9) ibid., 6:229, 1957; (10) ibid., 6:241, 1957. This Journal, 10:84, 1961; (12) ibid., 10:97, 1961; (13) Neurology, 4:211, 1954; (14) Arch. Neurol., Psychiat., 72:233, 1954; (15) ibid., 76:23, 1956; (16) ibid.‘, 78:516, 1957; (17) Conf. Neurol., 16:88, 1956; (18) EEG Clin. Neurophysiol.,9:180, 1957; (19) ibid., 10:162. 1958; (20) ibid., 10:207, 1958. (21) J. Am. Med. Assn., 166:1846, 1958; (22) Dis. Nero. Sys., 19:113, 1958; (23) ibid., 19:227, 1958; (24) Arch. Neurol., Psychiat., 80:380, 1958; (25) ibid., 80:73, 1958; (26) Neurology, 8:682, 1958; (27) Psychopathology of Commum'cation, New York: Grune 8c Stratton, 126, 1958; (28) Psychopharmacology Frontiers, New York: Little, Brown, 325, 1959; (29) Proc. XV Int. Cong. Psychol., North Holland Publ., 238, 1959; (30) J. Nerv. Ment. Dis., 1281243, (11) 1959. (31) Arch. Gen. Psychiat., 1:565, 1959; (32) EEG Clin. Neurophysiol., 11:398, �EXPERIMENTAL PSYCHIATRIC RESEARCH (41) (51) 169 1959; (33) ibid., 12:243, 1960; (34) Canad. Psychiat. Assn. 1., 4:166S, 1959; (35) Proc. Int. Cong. Neurol. Sci., Pergamon, 613, 1959; (36) Am. J. Psychol., 72:384. 1959; (37) J. Neuropsychiat., 1:45, 1959; (38) EEG Clin. Neurophysiol., 12:359, 1960; (39) Am. J. Psychiat., 116:839, 1960; (40) Neuro-Psychopharmacol., 1:441, Elsevier, 1960. J. Nerv. Ment. Dis, 130:235, 1960; (42) ibid., 130:187, 1960; (43) Arch. Neurol., 2:547, 1960; (44) Dynamics of Psychiatric Drug Therapy, Springfield: Thomas, 29, 1960; (45) ]. Neuropsychiat., 1:242, 1960; (46) Am. J. Psychother., 15:46, 1961; (47) Neuro-Psychopharmacol., 2:30, Elsevier, 1961 ; (48) ibid., 2:381, 1961; (49) Arch. Gen. Psychiat., 4:259, 1961; (50) ibid., 5:30, 1961. J. New. Ment. Dis., 132:153, 1961 ; (52) Medicina Experimentalis (in press); (54) Arch. Gen. Psychiat., (53) VA Conf. Psychopharmacology (in press); 2:652, 1960; (55) Unpublished manuscript; (56) Psychiatry, 21:249, 1958; (57) Comparative Psycholinguistic Analysis of Two Psychotherapeutic Interviews. New York: Int. Univ. Press, 1961. ' Due to the length of this Bibliography, it is presented in an abbreviated form. ��IIPRIIIBIIAL PBIGIIATEIO 13831303 A! IILLBIBI noiiow and Proapoct HI: Pink, 3.9. Iron tho Dopsriuont of Export-cutnl Psychin$ry, 31113160 Hospittl, clan Oaks, L.I., 1.!. 2h. Itud1fil roportod hart hi1. baa: ntdud hr tho Board Dir-ctoro Research Fund; thc lttiannl Instituto or I: Honttl nutlth (Grants l-927; I!-2092,-2715,-h7983 nr~12,033); POIndationl Fund for honoureh 1: Psychiatry (373? 56-151); xuutnan§, tad Dalian fantastical; and lustrou- pharnao ooutionl cost-rap tncIudinx 60131, Briatbl, Wrath and Snith, K1130 a Iroach Lnboratorioa. 1': 10/1/61 �Exporinontol Poyohtotrio Rooooroh ot Htlloido lovtov ood Proopoot tho dodtoottou of 3111-14. Boopttol oo o Rooooreh Inotttoto boo boon o drooo o! nony or 1to otudooto - o drool that nay oohiovo rooliootion in thin dooodo.< Dr. 3. toroohov woo on oorly propoooot of thio vtow, ood both in hto oponoorohip of tho Joorool, ond to his onooorozonont or rooooreh otldtoo, ho prooosod thio dovolopuoot. no woo oloo tho toodvortoot oiro at tho rooooroh otodtoo 1n oxporioontol poyohtotry. “halo 1 woo o rootdoot 1n poyohtotry to 1952, no oolloborotod in o otudy or tho ro~ lotion of tho oorlr ooporotsoo of child tron o ohotoo tho poroot to odolt of uoorooto. notion13¢ tho hoopttol rooordo o: ttvo proviomoyyooro no oonolodod thot thoro woo, todood, o rolotioo nourotto pottooto with otooooionol oouroooo hod oigoitxoootly xrootor tooxdoooo o: ooporotioo thou potiooto with hyotoriool oonroooo (a). rhto roport woo tho boctooinc of tho potioot popolottoo otodxoo dooorabod horo. stnoo 19Sh tho vortooo progrooo 1o exportoontol poyohiotry hooo boon dovotod to on ondorotoodtog of tho undo o: o U �.2.- antioo of tho poyehiatric thoropioo of tho hoopitol. rho tochniquoo hovo boon odoptod tron doooriptivo ood dylooio payohiotry, oouropoyoholou, olootroonoopholonophy, linguiotiuo, phoroooology, ood sociology. Ihio roport roviowo thooo otudioo ond prooooto support for tho erootion or o nooooroh lootitoto ot lilloido. PIS! SIFDIBS In our early ttudioo or oonvoloivo thoropy, inotitotod with tho oid o: o grout oword of tho Iotionol Institoto o: nontoi Roolth, ovoluotioal o: potioot iaprovonont woro ohown to to dopoodont both on choocoo in broio function ond on poyoholociool tootoro. AI our Indorotondioz of oonvoloivo thoropy dovolopod, o gonorol nooropnyoioloxio~ odoptivo viow'o: ooIotio thoropioo ooorgod (6). i cholgo in brain function woo oooo oo o noooooory condition for hohoviorol ohonuo, with tho typo or chooco, houovor, voryiu; dogoadin; upon poyoholocicol oud oooio— logiool chorooto'iotioo ox tho outjoot (22,25). thou, tho oodo o: ootioo woo not too: oo oithor “orgooie' or ”prlyoholouinl' but rotbor oo tho iotoroction or non-ophyoiologiool chooaoo nod individual pottoroo o: rooponoo oud bohovior. fhio hynothooio ' woo oootoiood in otodioo or convulsivo old insulin oono thoropioo (21,22); and tho oodo or action of tho now psychotropic oconto woo ozprooood within thin �.3. payohoiropic'drugn that It would bu urinativo to tho uxtnn‘ thu‘ pcrllutcnt ehgugon k.— fiypo or tho tad induncd; that brain Inuation ugro in hnvtoral reopens. would bu rolntcd to tn. iypo o: br¢1a hypothosta. wan unggun‘od chnnga, and to individual pro-norb1d psychologie (par-caulitr) vtttnrns (6,28,ho). consu1;1v3 thcrngz Draco-s: Soaking a noncaro of gltorcd nourOphgstoleglogl «hangs that w:- annuitivo 1. tnitnblo for rcpol#od rutolta, various nan-urns wort studigd inpludinx chanson in tho ts¢o~hand tout (1,10,13,35), nanory tout; (17,35), anoant .1 slow utvn activity 1» tit :30 (16,23) tld contnbulatory and duaial languago pfit‘Orll attur nuebarbitul (3,15). an. llttor two, EBB und unubnrbittl touts, Hit. tbs nest oonlttlvo indie.- o: chaulc 1a convulnivo thgrtpy subjects. In on. uxpcrincnt, clinical rating: a: taprcvcfiont var. carrolatod wi‘h high 6.320.! of chungo in than. indicol (15,16). 2)... oblcrvutlon: wore touted 1n n doublo-bltnd study in which p;titntl tutorrod tor oloctroahock worn rindauly ‘3313306 to oithor convulsivo cr anhconvnlsivu and . therapy. nigh dour-on o£_oltetrogrnphic Ilcw wave :otivity and pastfiivg nnfibarbttnl tout: warn obsorvod only 13 the convulaivc group3~1nprovcutnt titan were algntticuntly highQr in this group, and whnn subconvn1I1Vt aubjccto var. retransod by convulnsvo applications, (he tnprovogout rat. way 31:31.: to tho ooarulstvo ureup (22). �.3. In sibeonvuluivo applications, nousidornblo oloatric current pgaau: botwugn the cleatrudou. It wan pontulntod that tho ihcrapoustc tguut was nut tin $Otl1 olootrt¢:1 current, r so, but_thu ":11 or nonn' quali$7 llhiftl‘td by tho crana 331 Ittluro (9,23,h2). 2h. Itcniriounao o: tut [rand 3:1 .oisuro was «an-$306 in n ounparuttv. study of sh. 13ha1:nt oonvulutut, lnxaflnnrodiothylathnr (Indckloa), :nd clnotrtotlly inducad soituroa. 81:11:: dour... ct olcatrtcrnphao chango, improvuuunt rat‘s, typo. or bohnviornl ndtptntionn, Ind ohnnxcn in Inuropcychnltgiotl talk hchavior war. ohocrvod 1n bush tho inhalant And in tho alcctraa;117 tronfiod crouy: (k9). Kuvonr, not ‘11 Iibaootl auntie-ting high dccroo: or phyttolbgiaal thugs. var. avnluttcd .3 “improved“. I: n doncrtp‘tvo typologia Ifindy,_£1vo .dnptivn aldol war. dusoribod, cupirxcslly torund “ouphorto', ”hypunnaic‘, "nmuuuon', 'mmnld-wtthdravnl', Vial. ‘h. strut tun pattcrnn ltttcr worn ratcd and ”pan“ . an 'uuoh inprovnd', var. loan as 'undnpruvod' or “war-0' (So). In utudloa at plynholoaicnl varinblou, it was ruportod that pationtn ratod “much inpravcd’ $36 'rocovorod' troquently nanitultnd parloatlttw pattern: :kin t. tho explicit vurbal dcntnl parnonnlity type (37). 2h... pattoutn cxproslod tho ”innauago a: 6.3151“ nor. troguontly than uninprov‘d aubjoctl, antibiting such asp-oil a: tho two �-5- explicit deeiel, einieieetiee, dieyleeeeeet eed oliehee (27). Other perchelexieel indieee else releted te fevereble eeteeee included high I fleele eeere (ha). nereeheeh deternieente ex eeler, ebeent eeveeeet eed ebeeet rereneier (30,h5), eed lee edueetieael eehieveeent eed rereice birth (31). 2. Aetiohelieer ie cenmeuede end Geeveleive There seeking e we: te enceeet the degree at peet-eeevuleive EEG e10? were eetivity, en eetiehelieergie deepened dietheeine, wee given intreveueeely e. verioue etegee or the ceavuleive therepy preeeee (20,2h)Q Unexpectedly, dietheeiee eeeeed en ieeediete end eeeteined deareeee in EEG elewiec, ehieh wee eeeeeieted with eerked cheagee in lengeeae end need. In petieete with deeiel leeteege petterne (21), theee oeuid no longer be elicited. Ineteed e! eupherie eed well 'heing, the subjects beoeee'irriteble, enxieus end coepleiuinn. In eebjeote prior to convulsive or drug therepy, dietheeine induced exeiteeent, teeeiee, eexidty end illeeery eeeeetieee. Subeeqeeet-etediee with ether centrel entiehelinergie cenpeeede end eyepethenieetie helleeieegeee ehewed behevier end electregrephic petteree eieiler to dietheeiee. the-e ebeervetieee led te the eeaxeetien thet ee ieereeee ie the ehelieergic eetivity at the eentrel eerveee eyetee wee the bieoheeieel beeie to: the eenveleive therepy preceee (38). �-6Iad‘filat Fallowing thtli Itudiou, tn. neurophyliolosic‘l august: induond by drugwar! touted within a. acito oxporiadnt.1 EEG Iotttng. It run obitrvod Butt phnuothinuianu induced BIG synchronxuuticn and a Ihittlnc at tun Iroqunncy spectrum to tbs slew Iroqunuotons taprobannfic and barbituratoa, tn agar-1:04 lynchruatagsgon ;nd a ahttt of thy spectrum to tact troquaauiau; rosorptnu, an iuaruatod slowing with uynohrcn3. ?a tutttoa at chair: is ,r law dontgua, gnd doqynohronitasion IIVOII (18,26,28,ho). at hiahur Iazprnliao induced douynchronination with a sun .1 trauma to the now bud: (33,310. Each ‘otivu psychotrnpia compound wgu #hu: about to ant. a charactnriatic trnqnoacy patturn. Vtriouo 9th.: axpcrtncafisl coipounda wort also tantad and tar than.. no noafiistcnt ulcotrogruphic pattart was rooordod. In... ounpuinds bl?! Gino. boon nhawa to have dittor no ¢r vary limitad clinical psychotropic :ctivity. rho .bIOflei of bahaviurul chins. with than. coupoundo loot turthor uupport Sc tho anlunptton that 32.1: chnnco is a accosstry condition far the nefiion of puyehntrOptc drugs. 2h... obncrvnfisons auccoattd thnt psychophgrnncou 10310.1 tannin provide a noun: icr niioitin; vnriou- typgs or altarod brain function in coltrnst to tho $13319 pattcrn following canvalniva tharupy. furthermora, tn. type a: luurophrliolocionl altorution, an rallcotod in EEG Iyuohrcay �.1and traqucncy patfiorns, val round rcln‘cd to 0’0011106 a: bohnvicrul adaptation. 2h: ndvnntazu 0: £80 toohnancs to: tho ‘Icay at new psychotrOpic taunt. sad types fihy toohntcnl tarts: or aloo‘rontu Iroquanoy tally-t- «or. unnarcd and dolcrihod (£7.52). h. Insulin can: fhnragz: In our inluliu can: studies we ocuttrnod anrlaor observations that porutntout alfiorntiona or brain tunottom were taint-d to prolonsud «one and upcntanaonu nuilnrou; and tau in this rolntioanhtp suppert for n nitroplyltologtc~ndapttvo hwpothontl. With thc grailnbtlitr 01 ‘h. ncv psychotropic asant chlnrprunasinn, a ountrollod?chlorprunaltao Insult: can; atudy was undartnkon in Sop‘anbgr 1955‘ AI patiaata war. rotorrod for insulin aim: tun: get: rundonly unsignod fin couraos or nithor oral chlorprcualino for at IQlIt 3 months in dosoa adJuIt-d #0 1111 short of toxicity; or'tnnultn cans, induoud by s uuhmd «chateau at last» so was 1: «ch pattont. Vh110 a uI-bur or ulnar distoroncou worn noted in comparing the two thgrnpigs, thn results at tile or dicohtrac chewed no stutilfitonl ditrorcnco in tho offsettVQBQnI at both traatncntl. loithnr troutunat £00.06 to affect tn. bantc nonsquhrcnto procons, but chlorpro-asino had tn. advantagot boing 3:202, tacit: to adniniator, lad hotter suited so long torn unnnzunont (21). concurrontly, following the 0“goutton by £ha Or-odnoqr worker. thtt dividod insulin �.3. doooa woro aofiorior to olaglo insulin doooo, Bloabor; and Ladoroao oooayod thin probloo and donorotratod no significant oorit to tho oulttplo dooo toohoiquo (19). (lo 1958. £91 ral courtroa too at hooo oboorvotiono tho a , 5. floor woro adaptod oho :' Various poychaphyoloal tooto tron oooropoyoholozy, whoro thoir signitioaooo to brain da-agod onbdocto had boon dononotratod. 1h. oarly otodioo aooooood thooo took: on lodlcoo a: altorod brain rotation (35), aod ooaaurod tho ranzo of portornaocoo or poyohtotrlc patiooto, who oro conorally aooonad not to to brolo dana‘od. Into, looory function woo aooooood on inoodiato roooll, artor vorlouo tutorpolatod loorninc tooko (11,35), aa roll ao aorta: coorulolvo thorapy (1?). rootilo porooptoal tooko voro tirot oxaninod to tho clioioal population (1). Lator, with ooro oonoitivo eloctrioal tootilo otlaoli, Karin oboorvod tho raafio o1 throoholdo 1a dittoroot body parto (10), tho ohaogoo with altorod . brain function (10) and tho inflooooo or oot (inotrootloo) on porforaanoo (36). Ho also studied tho porooption o: ooboddod gooootrio figuroo (h3), toohiotoooopio prooootatloo o1 ooboddod color rigoroo (55), porooptloo of tho vzoual oprlsht (55). orltlool illokor froqaoocr (h?) and 1ntor~ toroooo 1n roadtag tioo by dolayod auditory toodbaok (55). For oooh took, tho dogroo of dooroaoat 1» took portoroaooo �-9- gastttvaly oarralatad with tha anoint at 386 aldwtas. Folluuina troatnoat couplattan, with an. rota»: at partialoatoal tadtaaa ta pre-traatlaat lavala, partaraauoa in thaaa paychalagioal tanks also rataraad to prautraataant lavala, or tight: -.a battaraanfi a: partoraaaoa aacribad to practiaa afract. waa found $0 be concurrautly, aaaaaanant or varioua payoholaxtcal aaaauraa an indicaa pradictiva or behavioral «hang. daring convulsive and drug tharaptaa lad to studiaa of the Rorschach datarninanta (30,h5). calitornia F Seala nonra(30;h2), languaco pattern. attar atobarbital (21), daatal acarae an antarviaw (3:) and tha paroapttan of tho visual upright and auditory taadback (55). 6. razehalég‘uiattoa: concurrant with an: syntactic studio: languaua (27), analyaaa of othar languaga pattaraa warn andartakan, boat 1: a aaarch tor aura objective xadiaaa a: bahavtaral chaaua and to gain oxparianca in the taehnioal pwablana of tapa aaalyaia tar payahatharapy research. La . influx of variability in the vocabulary of apaaoh, tha typo- tokaa-ratio (if!) of eonaacufiavo Iaaplaa of dyadic apaaoh, wu “unholy atudiod (1,h1,hh.h6,56). In convulsiv. aharapy patxanta, aigaiftoant chanson 1n TIE naan hué standard daviationa war. ralatnd bofih to the dagraa or iadaaad 280 slow wave activity and to ayniactic �~10- lcnlicsc puitarnl abicincd in indcpcndcnt tircotnrcd intnrvicvn. It was cocoa that uptick bola-o norrepetitive (lav-rod not: III) an! acre varinblo in colaocntiVb cunplc: (kl). In intnrviowl infur- nnd cttor tho intravenous administration or ccntrclly active agents. ainiIcr chanson war. ohlcrvcd. input: which produced prcdo-iaact synchronisation pattorun on tho EEO ware rclctod to a docrctso in «can 1!! cad an incronno in flu: smdcrd duration or ...m. while «synchronising ccapcuada clicitod groatcr variability in cpccch pcticruc and dccrocnc in variabilifir at consecutivu acorn: (hh). 0thcr 1:33:53. Iltlflrlfl atndicd included diatrclc~rclict quoticntc, colt-rotoroncc, and altar:ticnc in till. cad patina. It VIC snag-ntod that than. paychcliuguictic accsuro- arc usctnl techniqnoc for thc operational caclyscl c: phyniolcgical and psychological uttcctc or psychopharnncclcgiccl cgcnta (hh,h6). 7. ling; B‘llli gud Schinaghrcgil: rollcwiug his ' Itudicl at Ittlsccn Ccntnr, PoIlnck ruvicwod th. rclcticnu chip bctwcon can 9! hospitaliscfiicn, intollcctucl tunationils and prognosis in cchincphrcnic childron ind nttad that initiil bagpitalilltica cdclta. H: in childhood cad Idoloaccncc was rclatcd to I.Q. secret in tko cubncrncl tango, dcvicnt pcrxcrnancc on psychanctcr ttlkfl, and nor. �.11; troqasat ratings or 'uaiaprsvsd” ai hospital discharge than was initial haspihaliaaiioa as as adult. rho aarly sad insidious sasst st iha hahsvisral syndrsss “sohissphrsaia‘ was ihas rslatsd to brain dysfunction (5?). Findings saggsai that say ha olsssitiod on davianoy. diffsrsat suhrroaoo s: aohisophrsoia tho basis at asarspsyohslogioal in Considarahlo iotorssi Studios: aooiols‘ioal tho family organisation to vhioh disohargsd patisnhs ohoios‘ wars rotsraing, tho ralatioa a: social factors to sad rssults o: pevohiatrio irsaiaaat, and ihs spaoifio prohlaa of tho ralatioa at thasa factors to irsatasot rorsrral paiisras lad to a ssrisa of population studios. Ia oas study (8), soaoatiao, ago, plaoa at birth and soars on tho California I seals wars significantly rslaisd to tho hypo or thorapy rsasirsd ass tho utilisation of adaaaotivs hospiial ssrviosa. In a ascend study (31), darstioa or hospitalisation, dischargs avaluaiioo and diagnosis wars rslatsd to tho sans social factors, whila in a study of patisht rafuaal of BOT, sitilar relationships wars ohsarvad (51). Thass ohssrvations suggastad a_conparativs and tho three among hospitals study, min-institution batwssn othsr demographic social class and rslationahips 8. ‘ variables (ago, sax, sdooatioo) to tho clinical variablos �.12. at patanat cltulixtcttscn (ataanonal), auruttoa o: inapttuln tuttton. soloctiqn or thornpy and dtuohnrgu uvaluntion 5.1. 3.0: unlocuod. Into. touching tuntttuttolu were :11 thortptcc arc oqaa11y avatlnblo to I11 pntiontl, - nonnincor Foundation Hospital (uppor-clusc, .Protoctant), uttsaohuontta ncntnl lualth Contor (loverclnll, Cathnlic) ind £111.16. Boaptttl (niddlo-claul, Jow1ah). In hack a canytrtton w. turn round tho dittorcaoul 1n duotgnntiona of trontnnnt, diagnoliu tad dtuehargo cvnluatton so dafforbnt an to ugh. nonpartnean difficult. Vhtla III: rolttionnhtpu tatvton Iodill varinblon 1nd 91131c31 Virilbltl var. oblarvad in each heapitnl, to 1001.1 variablo was fauna rclstcd to thc clinical variablo. 1- "01-7 hospital (53?. In an Out-Pattont Departnont utndy, sex, 8‘. 3nd narttallatata: var. found to ho rc1atod to tho acceptancand roawetion at patttuts tad fuilnr. to couplcto tho upplionttuu pIOGOII (5h), that. abatrvnt1¢nl 1; population Ianploa 10d ta coa— current Itmdios or start attituia: 1: tin Iolootion at thorapy (11,12). In a aortas o: ward obnorvation studiol; Kaplun and Lotkawttn indientsd tho significant :01. or otntt attitudes (oupocta11y turning porcannol) in thc rerorrgl tor lubaostn for lunatic thtrcp1on, and in tho tranutcr at pztiontl tron out ward to unothur. It stud. Icloctod ' 1n whaen �-13. fit. tn£1u ca .1 :finxt attitndo t1§n$ soloattoa for drag thorngz, w. g33u03$nd can ward be dontgagtnd an a "ago-avnusas' unit. 2):! van ndagtad in 8:233:34: 1259 and an shor‘lz fihornuttqr 3: the whole hangatul.) mum 8E1“ buriug *ho parioa at the convullivc thsrupy studios, man: nun psychotropic 00:90:36: were attained clinically (5,21) alootrographzgally (3h,h0,h8) ‘fid psychophrttcnllr .(aa). rho pro-ant payehophntuncology cvaluattoa progrta, b;sod on ‘hoao u§udion, was designed in gnaw-r tbs follow- ing'qunltions: I 1. fiber. ; rclntion botvooa COIII9I§XI &lt.rlttga in brcin function tad bahaviurnl Chtflflfl with psychotrOpic drug: on circuic :d-intstrntton? Ar. that. prb-troatnoat cluttcrl of plyohtatric, phy1101031ca1 and psycho- logiotl variablnl which are rolatod to ‘ho flypc at bohnvtoral adaptation? Arc ouch olultcro rclntad to thy typo and dogroo or physiolextcll chango? LI an iatt1;1 upprqxin&t19n, a doubln-blznd, fixed detach, vandal aunt‘s-ant drug study was undartakcn. Blood on our c1131ca1 cxporicaenl throo tIpCI a: compound: var. �Du. oolootod on tho boots o: thotr EEO pottoroo. 1: thin otody, 293 onhjooto woro rotoirod old 1&9 hovo oonplotod tho touting progron, tron ootohor 1959 to July 1951. 1. lohoviorol Chog‘oa In o ourvoy of tho bohoviorol Adoptotioao o: potiouto roooivin; voraoao poyohotropto compounds during 1958-59, o bohoviorol typology boood on tho arootnont rooponoo one on pro-trootnont poyohiotrto protiloo dovolopod (55). In tho pro-out otndy,tho typoloatoo oro botng tootod, old various oooouroo of bohoviorol choogo otodtod, inolnd1n‘ thoropiot ratings, coll-ratingo old various word ohoorvotaoo oooloo. woo 2. ggnr o cholo : Psychological tooko hnvo boon viovod both on indiooo of bohoviorol chonuo and on prodietivo goidoo to convulntvo thoropy. Koch o: thooo tooko and o oolootod group or uotor tooko oro now bozo; oooooood for both thoir oopoaity to rovool ohongo with voriouo drug: ood thotr oopooity to prodiot ohongo with tho drugs to this -pro.ron (hB). 3. Blootrooooogholg‘goggln In tho ooovuloivo thoropy ' otodiot, tho dogroo of slowing woo loooorod by counting tho oonoooutivo wovoo in oolootod oonploo (16). whoa tho noro oubtlo ohongoo or drug ottooto are studied, 1a noooooory to opplr loot todiouo tochniquoo (ha), ond EEG it olootronio froquonoy ontlyoio woo introdocod in August, 1959. I: nooourouont of tho pon dotlootioo for voriouo �.15- ' sooosd is_ton opoois, ropid trsqssssiss tron to nosslrsnsat or oppsrsstly sssll ohsncss is total activity and trout-soy upsets: or. sttsisod.(52). ethos physiological vsristlos stadiod in this 3 33 bps yrogron include tho rooponso of 830 to istrsvsnoos chloru ~pro-suns, blood prosaoro rospouso to nooholyl, tho EKG, radioactive iodine optsko, and saslysss or various blood tad urine olsnsnta. h. hots Ansgzgisx rs onslrso tho dots goosrotsd in this otndy, as hsvs sovxtt tho aid or complex ststisti- colon-thud: and computational tsuilitios. Analyses or notorious, osaj‘rslstioo ”trio", factor analyses and disorisintst function onslrsoo ore connotations new in prouross with this dots at tho III? Psychophsrnsoology aortic. contsr's Biolstris Laboratory in Washington. Ill-l!!! STEPS Favorsd by s notional rososroh ' clissto and s ooopor- stivo hospital staff, thsso studio; hows proooodod vigorously. Rho ssssts for rososroh is.this sotting hi7. toss arsst ~— s solsctsd, intslligont pstisst popnlstiou rssinsnt from six to twolvo months, without individual economic linitstios of hospital stay; a sophistiostsd sdninistrstioa tolorsst or controlled studios; sud spprovsl o: s 30:26 or Birootors who dosirs 'rssosroh' as on institutional function. �~16- eeted 1n hie tiret heepitel repert 1a 1959, e epeetelty heepitel eee eeke little tepeet en the eeetel illeeee prehieee er the seeeehtty by treet— eent elehe. the eeeeeeetel treeteent e: 350 petteate e contort to the h0,000 reeident petteete in but little yeer 1n the etrte heepzltele a: La; Ieleed. I» will the eeeeel treieie. or twenty er thirty phveieieee in the erte e: peyehetherepy do exeh to help theee untertnnetee or the reeident 111 theeeende of in the mentally enbnletery nee: eetiee. he, e therepeetle [eel eleee 1e eelutfiry bet teedeqeete to ear neede. he he prepeeed, the eeewer eey lie in the deeieetiee or 'reeeereh heepttel”, ee it 1e here thet e epeeielty heepttel eee truly excel. the eherter hee been written in the neerd'e eeeertlee er reeeereh ee e heepttel ceel. with the eeeete or en exeeplery therepeette teeility, each rededteetlee eee previde the etieelee tor the centieeeue ether 9! the eeeeee er mental zlheeee end at eethode e1 therepy. Seek dedicatiee ueeld provide the etteulee tor cenperetive and controlled eeeeeeeeete e: dittereet therepeette teehniquee. Centteeed etudy 1e urgently required of the eeleettee e: petseete ter verieee therepiee; the epplieeteee end eede er eetlee e: the therepiee; end the role of eeetel end ntltee :eetere in euppertte; the exteete Le Dr. Levin hehhtee & �.17- o: oar tharaptol. tubjoctl. the hohavioral Vtrtnblou OIOII, which are tin halt: a: on: profiont ditcznltso Ichtnstn, arc taunts-raotcry. at:dy is urgtntly requirod at tho upyltonbtlltr a! aootnl tad dulnarnphtc i:riab1¢a; paybholoutcal t:§k pcrfornancu protilun; twpologinc bnaod ca b-havxoral response to dozinnd Itroaaun or drug.; and physiologicall roactivity measures. such olaantticatioan arc also oniéntial for any biochemical, phyainlogioal or tvnlunttvo study to pravado ha-nzonous 33:91.! and campgrablo outrun. ‘ Alloa§nantu tlnd requsro moaningtul indtcoo of evaluating 05833.. Pros-at global 'tnpro.uncnt“ rating: tad loeaalitttton noctur-n arfi inadequate. Whathor tho 'iatorvuuing variablo bu nilihn thnrnpy, psychothnrapy, sino,‘§héleri£irii at bohhvioril chant. max... «anti-.1»; in.” 3592;131:1511”: a: rung-«1n, drug therapy 0r ' ladguaao #:028, idlt€r££1n3n,wpsyohéphyatéal"ch:n¢cVaéufca. . family CUIOIIIO§$I5I2E2- raqniru study :33 cviilatién; Roount attains of p¢y§hottc hubjoeta has proiidcdv tho succession thit thfirs in a notrolosic factor 1a.: group a: eh: ichisophroainn. The h1¢h tacidoneo er citatro"graphic and aauroloxie éysiunetian, the 153k or behavioral Vidnficulc to all thoripiol, and tut rclontlcna course a: �-18 o illncts nascent: involvontut in thin clustcr. Such a substrate aunt bo-olourly sought by tho app11egt19n of biochemical, nourophyniolegioal and opia daiiologionl toehuiquu to Vitus elation or you; pcyohutio hubgccta. 5: Eh. quontiona broador or 110:. than. arc son. Ittdiud in thc prosrtlz in cxyurimontul psychiatry ot-tho pant aovan yéura. than. programs, and the cantonporury projaots-in hiaahuniatry and in medicino, providc nod-1s It hootuatrgp studios andor;lkon with linitod uupport. ‘A dodieltion at lilllidOIHinitll as a ncaonrch Institutc I111 providc tho neodca £96“. and impetus for tha Iciontltia and hunnnitcriun forces at the oonnnntty to Join in a connea endeavor to roaclva the problems or the tantally £11. fiho 1n “orznn1¢* �LGRROUIOG‘OIIi‘ Participanfil in than. procraua inalndo thprouont ac-bcru a: fih- Dopartnnnt or Expnrtnoutnl tuyohiatry: Its lalnoat, acrtln A. Orton, thrthna Iaplnu, Brio Karp, Beunld 1. £1.13, Joha 0. truncr. an: Pollack and Arthur 33113.3. turner associntad includod Kurl tuner-nun, Joseph 4:230, lobart L. Kahn, Hyman Koran, Goircu Kruathunor, ln£h3n101 81.3.1; and angry J. Lorkauats, untold Intonvur, lid ntrrc Alan. It. couporn$1on 0! Arnold a. Blunborc ot~ Bopartaont of Hodictnn in the protont program in srqtntully the ropor‘s liltod horn are the roault at tun collnboratian of this. tartar. and fit. prutoastonll atQtta a: $h| h0upita1.vha an?! unnttnttnxly or tuttr tin. acknuwlodgnd. and that: nooduw111. �W J. innum- mug. 3:21, 1. was, 67, 1956; 6. 1953; 3. 3. 1955; ha 1952; 93.59201, My 1951; 10. £535.21.» aggmh, man, 53339229, 33539216. 7. 1957; 9. 1951; wgaév. 2. 1951; 1955; 5. 19575 gnu“ 12. 1961; and 35;: 33:81:, J. gag. 13. ”surfing, £3211, 195k; 1!... Arch. Home)... 16. 1956; 15. 195!“ 33311923, 353 3:233, 11. 91, 1961: and. ”an“. 13.516, 1951; can. gut. . 33:88, 11. human-.101. 3:180. 1957! 19. 10:207, 1958; 21. 22. 91!. 21;. Arch. and. Im. haul. 733, 19583 ' Jon. “or. M Ann. 1956; 18. no 011:. 32:162. 1953; 20.3113 }_6_§:18h6, 1958; 23. 3333.21221, 1958; 25. 1958; and £9: £33380, . cg ’E‘L‘E 26. Iowa. 33682, 1958; 21. Pazohoutholqz 323. 323113. 1958; w. at Gal-Inna», Brno & Suntan, 126, 1958; 28. PatchesGo. 1959; 325, a Iron Luna, , zbnrnuohg nation, 29. Pros. xv 139. can. Pulp»)... lath fioluud Pthln 238, 1959: 30. 3921.3, 1959. 31. Arch. 00:. PI:«but. $3565, 1959; 32. Egg cm. lam-gm“ . M 531668. 1959: 35- Pros. 33:398. 1959; 33. 6256. Porch. Luna. .1. 0.3.. Install. 501., Forum, 613, 31;. Plzchn . 133381;, 19595 31. J. 1959; 300911011. 35.2w. 36. 1960.: I“. nor. J. 11155, 1959-; �38. Ila 3113. "‘£32Ez.1.13 $30359, 1969; 39. Aunt. J. Plzdhzut. ;;§t839, 19601 ho. lonro~rozghgzhurnneologzll: n(‘) kl. Jeur. Harv. Rant. 31-. $§91235, 1960; ha. ibid $293187, 1960) h}. Arch. H.353 . 3.5h7. 1960; bk. nganien or Puyuhintrio Brag rhorugl, $9, 0.8. rhonnl, 19603 £5. 3. retrogjzoh. $3252, 1960; hé. 130:. J. Pazchuthor. $3; h7. Intro-tszghaghuguncolagz‘gc30, Elsovicr, 19613 hB. than 3:381, 1961: M9. Azeh Gan. rqzuhil . 5:259, 1961; 50. thid 2130, 1961. 56, 19611 ' orv. Rant. 91.. £2gn153, 19613 52. 535:, taint Eggorinontalcs (in prosl)£ 53. '5 can :wggvahogharuneo » (1n 5h. 890111 pro-I): 2‘; Inn‘s; (in prose); SS. Bupub~ lishoa §anulcript3 56. Pszohiltrz 3;:2h9, IQSB; 5?. Arch Gen. Paychiat. 23652, 1960. 51. Jour. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Published Works Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Experimental psychiatric research at Hillside: review and prospect. J Hillside Hosp. 10:15969. Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-02-01-003-57-023 Date A point or period of time associated with an event in the lifecycle of the resource 1961 Creator An entity primarily responsible for making the resource <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a> Subject The topic of the resource Published Works -- Articles and Reviews Relation A related resource The Max Fink Collection Description An account of the resource Reprint and [preprint]. Reprint from JOURNAL OF THE HILLSIDE HOSPITAL Volume X Nos. 3-4 July-Oct. 1961 Rights Information about rights held in and over the resource <a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a> Source A related resource from which the described resource is derived Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York). Language A language of the resource en-US Format The file format, physical medium, or dimensions of the resource application/pdf Publisher An entity responsible for making the resource available Contributor An entity responsible for making contributions to the resource Published