http://exhibits.library.stonybrook.edu/mfp/files/original/e06d90c86c34900cbfbc862c755d6567.pdf 15ada951bb078ffb8bea42b5be5e0745 PDF Text Text IV: 10/113/60 Experieeutel Peyehietrie Presreue et niiieide neepitni A The Review veeieue prostate in the Department at Experineetei W Psychiatry have been devoted to en undereiending e: the node at W‘iherepiu “tie: or thrush undies or hreiu taxation. the principal techniieel have been edepted tree deeoriptive peyehieiry, uenrepeyehoiexy, electreeeeeyheiecrephy, linguietiee, phereeeelour, end eeeielecy. In initial etudiee It reaction were round cenvuleive iterepy. ehenzee in brain it reiete beth to iepreveuent retinge end to pro-treatment peyuhelecic variables. in our enderetendin; e: ceevuieive therepy develeped, e centre: neerephyeieiezio-edeptive view e: eaeetie therepiee eeerted ( ). In this Suuka» view psychiatric treeteente ereﬁtherepeutieeiir exteetive to the degree that brein function in nee-trebly’eitered. While ehense in brein tenetien neeeeeery to: behavioral change, the irpe e: edeptetiee, it however, veriee depending upon pre-treeinent peyoheleuiigend eeeieiecieag charecterietiee er the subject. Thee, the node at eotien ie not eeen ee eiiher 'ercenic' er 'peyehelexie' bet tether ee the intereotion at both eepeete in the individeel. further, while behevierei change in �-2- ralatad to chanson in brain function; and the adaptiva pattarn to paynhologiéﬂoharaatariatic!t praotraatnant avalaationa at 'inprovaaant'; baing spacial typan at avalnatian or ahanga, ara darivativa Jadgnanta baaad an start and tanily anpaatatiana and talarannaa. Thin hypothaaia was dovalapad and anatainad in a aariaa at atudiaa at onnvulaiva therapy. concurrant atndiaa of insulin tuna indicatad that behavioral changa hora, too. van ralatnd to tha anaat and dacraa o: prolancad cana a: rapaatad aaiauraa - than. bainx tho nanraphyaialogiélnhanaa nanixantatiana at principal prolansnd in thin thanany. Tho node at action of tha nan paychetroyic asanta anpraaaad within thin hypothaaia ( aganta would III all. ). It ran anxgaatad that thaaa b. attactiva to the dasraa that tho: indnaad paraiatant chanxaa in brain fanaticn' and that tha typa a: bahavioral raaponaa vanld ha ralatad to tha type at brain nhanza, and to pranorbid pnyehaloxigﬁ(para¢nality) pattarna. rho praaant proxrann in tha Bogart-ant an. danisnnd to atndy than. ralatianahipa in datail. Canvnlaiva Tharazz Prooana or variaua anaanraa at brain tnnatian, tha anannt of slow vat. activity in tho alantronncnphalacran and cantabnlatory and �-3H dontal languago pottorno attor aaohorbital ( ) oonottivo indiooo in oonvaloivo thorany oohaoeto. voro tho aoot In tho firot oxporioont, improvooont ratings ooro round to ho oorrolatod dirootly with tho appoaranoo or high dogrooo o: ohango indicoo ( ). 1n thoao rhooo oboorvationo woro tootod in a douhlo-hlind study in which pationto rotorrod for olootroohock woro randoaly ao~ aignod to coorooo or oithor oonvuloivo or auboonvoloivo thorapy undo: poutothal pronodioation. nigh dogrooo o: nourophyoiologie ohango ooro oboorvod only in tho aonvoloivo group; improvonont ratoo significantly highor in this group; '02. and than oubconvnloivo oohjooto uoro ro-troatod by convuloivo appliaationo, tho improvoaont rota was oinilar to tho original convaloivo group. In tho oihconvnloivo troatod oahjoota, oonoidorahlo anonnto o: oloetrieol corront paoaod hotwooh tho hitouporal oloetrodoo. It woo ooncludod, thorotoro, that tho thoropoutio agont total oloctrioal curront, or no, but an all woo not tho or nono quality aahitootod by tho grand nal ooiouro. rho otgniticaneo or tho grand nal ooiouro was turthor olahoratod 1n otudioo of tho inhalant convuloont, hoxatluorodtothylothor (Indoklon). 31-11ar dogrooo o: olootrographio ohaugo, iayrovoaont ratoo, typo: o: bohavtoral �‘hV, change and ohanxee in neuropeyohologio teak behavior were obaerved in the inhalant and in electrically treated :ronpa. It nae anon apparent, however, that not all anbjeote aaniteetin; high decreea of physiologic ohanga were rated on 'inproved'. In a deeoriptive typelogio atndy, rive patterne were doeoribed, eaperioally teraed ‘enphorio', 'hypoaanio', 'eoaatiaetien’, ’paraneid-Iithdraval', and 'panio'. While the tirat adaptive aedea were ratod ae 'nnoh inproved', the aeen ae ‘uniapreved' or 'verae‘ ( two or latter theae two were ). In etndiee of peyoholegio variablea, it nae reported that patiente rated ae 'anoh inproved' and ’reoevered' frequently aanireeted peraenality patterne similar to that deeoribod by Heinatein and Kenn ( ) an the explicit verbal denial personality. In language patterna, they expreeeed the language of denial, when dittnae brain change denial, was indnoed, exhibiting anoh aepeote an niniaiaation, diaplaoenent, oliohee,|g§g. aere treqnontly than unimproved enhaeote. high I Stale eoore ( Other indioee related to favorable ontoeae were ), and Rorschach deterninante or color, abeent aoreaent and abaent torn-oeler ( ). alao, :avorable ontoeae nae aaaooiated tith lea In thin population, educationalaohieveaont �and revels: birth ). ( Antlehellner lea and Convalelve there Seeking a way EEG slew wave eae given te eucaent the degree at peet-oeaveleive activity, an inn-anneal: at antlehelinercle cenpoand, diethaaine, vex-1e“ “sea at the eemalelve therapy preeeee. Contrary to expectatlene, diethaaiae eaueed an iaaedlate and entrained decreaee in EEG alerting. Patleitl with dental language patterae rellnxqalehed than; Instead of euphoria and well being, the eibjeete were irritable, anxieue and expreeelve a: nre-treateeet patterne. In eubjeete prior to cenvuleive or drug therapy, elethaalne induced exciteaent, tenelen, anxiety and lllaeery eeaeatlene. Sabaeqeent etadlee with ether eentral antlohelinerglo oeapeeade (VII-2299, JB-318,336, beeaetyaine) abated behavleral and electrezraphle patterns alaalar te diethaelae. Stellar deeynohrenieatien a! peet-eenvulelve EEG aleeing wee aleo noted with central eynpathealaetie hallucinogene (euphetaaine, aeeoallne, LSD-25). and baa been reported re: antihietaainee (dephanlydraalne). Theee obeervatlene led to the eaageetlea that an increaee in central ehellnergie activity eae a biocheaieal haste tor the eenvalelve �therapy process ( ). Pszshotrogic Drugs and During EEO this period,the drugs aroused interest. node of action of newer psychotropic Following the concepts derived from convulsive therapy, the neurophysiologis ohenges induced by drugs were tested within the experi-ents in an EEG Ill. experimental setting or acute setting. It was observed that phenothiasines (shlorprolasine, pronssine, triflnepronasine) induced isation and a shitting o: the spectra: to the ERG synchron- slow frequencies; leprobanate and barbiturates , en increased synchronisation and a shift of spectra: to fast frequencies; reserpine, an inoreased slowing with synchronisation at low dosages, and desynchronisatien at higher levels. Inipraaine induced desynohrenisation with a shift of frequencies to the slow bands. Other experinental oonpounds tested included phenyltoloxaline (Bristol), Deaner and (liker), wx-21h9 (Wyeth) and its vsrions BL-HlBB and oongeners trenquel (nerrill). For eaoh, no consistent electrographis.patterns energed. It teens use suggested that psychopharnaoelogio agents provide a ‘lr eliciting a variety or nenrephysielogio patterns in �.7contreet to the eingle pattern of induced oonvuleione. Furthermore, the typo of neurophysiologie alteration, ee reflected in synchrony and Iroquoooy petterns, or hehoviorel edoptetion. elow :roqnonoieo wee Inoreoein; EEG related to epooirio types EEG eynohrony and e shift to or. oeeooieted with trenquillisetion, eedetion deoreeeiog ogitotion; while deeynohronisetion and e end shift to test frequencies in eeeooieted with oxoitenent, illusions, end delnlionol idoetion. These observations orooeaeietont with hypotheeoo or Hikler ( ). The merit of such teohaiqoeo for the eeeey or psychotropic agents hoe been doeorihod ( ). new �-8Pszchcpharaacologz Evaluation Prograa The present pregraa, instituted in October 1959, is based these studies and is on designed to answer the following questions: Is there s relation between aeasurable alteration in brain function and behavioral change with psychotropic drugs on chronic administra- tion? Are there pre-treatasnt clusters of psychiatric, physiologic and psychologic variables related to the type of behavioral adanptation? - to the type and degree of physiologic change? Method: is an initial approxiaation, fixed a double-blind, dosage rendoa assignment drug study was undertaken. Based on clinical experiences with various psychotropic coapounds, three classes were selected on the basis of their patterns of :30 response. ‘The selected agents were those eith predoainent desynchronicing patterns; synchronising and slowing; or niniaal or no effect. Patients referred for drug therapy, after medical examination, and after all other medications have been discontinued are randoaly assigned to one of three classes of compounds. Patients are predoainantly middle class, urban, with high educational attainment. Hillside Hospital is a non-profit, philanthropic supported psychiatric institution, admitting voluntary �.9patients for extensive psychotherapentic treatment. of stay is seven months. are prescribed by Kean duration Convulsive and psychotropic drug therapies star! psychiatrists on referral to the Department. All treatment is adninistered by Departaental start, so that the experinentsl variables or drug dosage, route of administration, assignsent to groups, 333. are readily controlled. All patients in the hospital are available for study. all patients receive After a testing period, ho cc of medication daily tron individually labelled bottles. increased in fixed weeﬂy etepe until a nsxiaua at date, 1&0 the study period. Dosages are After weeks. reotestinz occurs. two weeks on maximum dosage, To h liquid subjects have been referred, and 110 have completed Preliainary analyses of the data are new in progress 0 avieral Chan e5 In a survey or the behavioral adaptations of patients receiving phenothiazines er iaipranine, various clusters at behaviors were developed. The typology was based on the pre~treatasnt psychiatric the treatnent reepenee and profile. In the present study, various measures of behavioral change are under study. Therapist referral questionnaires and six week evaluatione; therapist and �-10- patient two Clyde Heed Scales; Lorr Scale evaluations in interview by research psychiatrist, and Lorr ward scales; patient eelta ratings including the Johns Hopkins synpten check list and the Chicago Attitude Scalee are ancnget the neaenres being explored. lenropezchelcgz: Paychelcgic tasks are viewed both as change variables and predictive variablee. In convulaive therapy, changee ), tactile perception in aencry tasks ( ), crr ( ( or figuree ( ), rignre ground tasks ) have been ( ), Recheler«3ellevne ( and tachietcecopic recogniﬂcn , ) related to the degree of induced neuro- For each task, the degree or decrement in physiologic change. taek pertornance has been positively correlated with the amount of EEG slowing. lollcwing treatnent completion, with the return of physiologic indicee to pre-treatnent levels, performance in these peychclcgic taaka also returns to prewtreatnent levels, or higher a betternent of performance ascribed to practice eitect. Denial scores on interview ( ), Rorechack deterninante ), 1 ), auditory feedback ( ),and perception of the visual upright ( ) have been viewed ae predictive indices of the behavioral changes following nor. various tasks are new ﬁbeing Scale scores ), language patterns after ancbarbital ( ( ( Theee asseeeed with paychctrcpic agents. �.11. In the convulsive therapy studies; the lieetreencezhalogrsghzs degree of EEG slowing was measured by counting the consecutive waves in selected samples. were studied, it was When the more subtle changes or druggeftects necessary to apply less tediens techniques. Electronic frequency analysis was introduced in August 1959. By asasurenent e! the pen deflection for various frequencies free 3 to 33 cps in ten second epochs, rapid aeasnreaent of apparently saall changes in total activity and and frequency spectra are not obtained applied. Other physiologic variables include the response of £30 to intravenous chlerprcnasine; blood pressure response to sechelyl; EKG; radioactive iodine uptake, and analyses or various blood and urine element ordinarily conceived ac protective of the patient'e welfare. �Pnzghuliggualtion: rollcving thy studios at syntgotio Iguanas. pattorns ( ) in oonvnlntvo thnrspy, 0th.: anpoctu or Innguagc cﬁndind for worn their ralatiou as 1361... st «hung. in intrnporlonll with nonltdurabln nun: .xplarctlou attnr bcinvior. attic, (1T3) thn‘ typewtokoa-rutio augxoltod 11:;«1-t19 nounurOI, or connoautivo 33-pin: a: dyldic apcoch 1.: bu A useful lunar. tppliud to writing toxta or tho Hull. ran had previously buon hung. nmlu ¢ individuals, Jute intuit-d ﬂat the two index (dyad) at a ounnunieutioa an: sicniriuant not. portal tho ltttc at tho intaraction than snnlytcn or ltplrt‘. Innplnn or the participantl. tpplytn; ‘htv technique to couralsivo tiara»: pntiunta, august: in ran nonn and atnndnrd deviation worn rclntod both to tn. dogroo 0: induced use slow vuvo nctivity and to lyutaatic lan‘unxa puttorns obtained in indop-ndoat structurod iutcrvicvnc Bpocch boa... new. rupctttivc (lovarod nag: 223) and Iowa vurttblc in connocutivo canplou (inoronnod standurd dovistion) ( ). �In tnttrvidvt tutor. &nd aft-r 8h. intravunoul administration of coutrully .ctivo ngcnta, 11-11;: chtnguu rare obaorvtd. Axtntu with a prcdauinnnt lynehronisatiou ptttorn tn. on EEG uxhibttod n docroaao tn tutu 218 and inarcuao in Itnndtrd deviation or soorcs,vh11n ataynchroniliag compounds olicitcd grnttnr variability in apooch pa‘torus (lﬂOrOll. in and accrual: 13 varidbility at conntnntivo 133 noun) neuron (doeronlo 1n It;adnrd dcvistion). 0th.: 1:33:33. nasuuroo under study includu dintronln r0110: quottontl, colt-rotoronco, tad potion. It 1- aucxoutod are potont tuchaxquos to: and poyuholusie ultorttioa 1n tuna. and that than. paycholinsutstte nut-urns ﬁho operational unnlyiun a: phylialogta crises: at payohopharnuoologic acunta C ). �aotiolg‘io Studio: 2h. cuncral prdbiun 0: tbs rolatiuu at liaitl tautarl to choico tad rocuitu o: parchiatrio troutucnt. and tho Ipoeitic prdblun at tho rolnticn at it... taatars pittcrnn, within tun instieutioa. and to a cutie: at population ), uduoatiun, ago. place a: birth In on: tinny ( utmdioa. 13d ta in. rorcrrul learn .3 tau California I nail. var. nixnitieuntly rciatod to thc type .1 thnripr roe-iv'd ind tho utiliuntion o! ndaunctiv. hoapittl nitric... ndnantod hid paiinntl uh. var. old-r, poorly Than, night: I acorou und warn tar.i;n-horn, pnrtieuinrly Einicrn lnropo, utro ngat 11301: to be rotorrtd fur oloctro— shook. Thou. rnlntianahipl were pro-nail: iudupondcut a: diagnnlol. within tho crunp at cloctrolhock putiontl, rottrrnl {or In rclltod to 36? vac .100 g cocond Iﬁuuy at this tin. tor in... factora. group ( ). durstioa or hospituliaation, dilohurxu ovuluutina and dincnoa¢n wars :0lniod to the can. 000111 taetcru. Fur «suspic, patiunta hoapituliuod tar Sh. Ihnrtolt patina var. oidoat, had thi icast oducution, war. nest likely to hivc and had in. high I again boon tornign born scar... titular, nativoaborn, str- �uduoatod, lunar 1 real. Ilﬁrl pttiontn v'ro hospltnllscd tho lnagost. Inn's rolttsonuhipl bald trnu within tronincnt typo and had thn rithln diutunaﬁao 31330. On allohurxo, .14.: pttttutu not! tavurubli rttlngo. In not, valiant. rutad ti rooovcrod or IIOh luprovnd htd thq hlxhott F scarce, lunat odnuuttou :ad var. acct likaly to ho rarclxn born. In a study at patlont rtrulal a: 30!, 01:11.: ro- lutlonlhtpu wort obncrvcd ( ). that. rolgtlounhlpi If. no! undo: ntndr in tho out-pttlantxdopartnoat, sad in a trlw hospital cunpnrattvc Itaay. In tn. lnttor Itudr. th- population! or thrco hunptlalc in which :11 thrupltu are equally arullnbla to all p¢tluata, - sonniugor roundatlau lllplttl (Ippir-cltll, Protoltant), nascaohau-ttn unnttl Xcslth c ntnr (lavdroclnao Catholla) and 3311314. noopltll (nlddln-clnnn Jalluh) boin; alaoaacd. It but Etna postulntod that lhunc rcl:t1¢ulhlpl rctlact tho tntlncncu at .00131 bunksround on plynhologlcnl pronoun, nah u hubltul undo: at axprcsslon. tho putt-tn a: nontal action tr. undo: Ir. ”turn or Th. onutwibution emulation um 0: than. tactorc to antaru tho tad patsont-thtrnpttt lllnsal, atlﬁr. �Exporinuutal Plyohiatrio Progr;ul nt Hillside ﬁespitnls A Max Review rink, H.D. the Depurtneut of Experimental Psychiatry, Kill-id. Hospital, Glen Oaks, 1.1., l.I. From V: 11/60 �v: 11/22/50 Experimental Psychiatric Prograns at Hillside hospital: A Review various programs in the Department of Experimental Psychiatry have been devoted to an understanding or the node of action or psychiatric therapies through studies or brain function. The prin(ipnl techniques have been adapted tron descriptive psychiatry, nenropeychelcgy, electroencephalography, linguistics, pharaacology, and sociology. In initial studies of convulsive therapy, changes in brain function were found to relate both to evaluations of improvement and to pro-treatment peyohologic variables. is our understanding or convulsive therapy developed, a general neurophysiologicadaptive view of soaatic therapies emerged ( l ). In this view psychiatric treataents are therapeutically effective to the degree that brain tnnction in measurably altered. While change in brain function is necessary for behavioral change, the type of adaptation, however, varies depending upon pro-treatment psycholozic and sociologic characteristics of the subject (2). Thus, the node of action is not seen as either 'orgenic’ or "psychologic' but rather as the interaction of diffuse neurophysiologic changes and adaptive mechanisms. further, while behavioral change is related to changes in brain function, and the adaptive pattern to pre-treatnent psychologic characteristics, evaluations of 'inprovenent', being special types of evaluation of change, are derivative Judgments based on start and {anily expectations and tolerances (2). The �-2... amine series "or studies of convulsive therapy. concurrent etudiee of ineulin ccna indicated that behavioral change here, too, was related to the onset and degree e: prolonged cone or repeated seizures - these being the principal aanitestatiens or prolonged neurophysiologic change in thie therapy (3,h). The node of action or the new psychotropic agente was also expressed within this hypothesis (5,6). It use suggested that these agents weuld be effective to the degree that they induced persistent changes in brain function and that the type or behavioral response would be related to the type of brain change, and to preeorhid peycholegic (personality) patterns. the present prograne in the Department are designed to study these relationships in """""'m. hypS‘iEiSii‘ﬁ; a.‘+‘¢i3§.ia'gua‘ .. .. «'WIfahlr‘ehnebtn ”1.5"; detail. GOHVVLSIvg IBERAP! PROCESS or various neaeuree of brain function, the aecuut or slow wave actiéity in the electroencephhlcgraa (7,8) and contahulatcry and denial language patterns atter anoberhital (9,10) were the sensitive nest indices (11) in convulsive therapy subjects. In one experieent, improvement ratings were correlated with the appearance of high degrees or change in these indices (7,10). These observations were thsted in a double-blind etudy in which patients referred for electrcehcck were randomly assigned te ceureee of either convulsive or subccnvuleive therapy under pentothal prenedication. High degrees of neurophyeiclcgic change were observed only in the cenvuleive group; improvement rates were significantly higher in this grog); and when snbconvulsive subjects �-3- epplicetiene, the inprevcnent rete wee sieiler tn the originel convulsive group (2). In the enbccnvnleive treeted subjects, ceneiderehle emanate er electric current pessed between the bitenperel electrodes. It sppeered that the therepeutic egent use not the totel electrical current, ger es, but en e11 or none quelity eenitested by the grend eel seizure (8,12). the significsnce cf the grend eel seizure wee exenined in studies of the inhalant ccnvnleent, hexetlnorodiethylether (Indoklon). Sieiler degrees at electrogrephic cheese, iepreveeent retes, types at hehevicrel change end cheeses in nenrepsychclegic tesk behevier were observed in the inhelent end in electricelly treated groups (13). It wee seen epperent thet net ell subjects lenitccting high degrees 0: physielegic chenge were reted es 'iepreved'. In e descriptive typelegic etndy, rive petterns were described, eepirieelly tereed 'enphcric', 'hypeeenic', 'seeetieetien', bereneidovithdreeel', end 'penic'. While the first tee of these edeptive nodes were reted es 'nuch inpreved', the letter two were seen es 'uniepreved' er 'ecrse' (It). In stndiee of psychelcgic veriebles, it wee reported thet peticnts reted es 'ench improved' end ’reccvered' frequently menitested perecnelity petterns siniler to thet described by Heinetsin end Kehn es the explicit verbel deniel personelity. In lengnege petterns, petients expressed the 'lengnege or deniel', when diffuse brein chenge wee induced, exhibiting such aspects es explicit deniel, nininisetien, displeceeent, cliches, etc. eere frequently then nniepreved subjects. Other indices releted to revereble were re-treeted by convulsive �4,ontooae were high 1 Scale ecore (15), and Rorechach deterrinante or color, absent movement and abeent torn-color (16,17). In thie population, also, favorable outcome wee aeeociated with low educational echievenent and foreign birth (18). ilfICXOLIEERGIO courovlnc one GGIVVLSIVE 2323‘?! Seeking a way to augment the degree of poetoconvnleive activity, EEG anticholinergic compound, diethasine, was given intravenously at variene stages of the convulsive therapy proceee (19). Contrary to expectations, dietharine caused an innediate and sustained decrease in EEG slowing. Patiente with denial language patterns relinquished then. Inetead of euphoria nelow wave and well being, tho on ethecte irritable, anxione and expreeeive of pre-troataent patterne. In subjects prior to convulsive or drug therapy, diethaoine induced excitement, tension, anxiety and were illusory sensations. Snbeequeht etndiee with other central anticholinergic coapounde (WIH-2299, JB-318,336, benactycinc) ehoued behavioral electrographic patterne eiailar to dicthasine. Similar deaynchrenination of poetaoonvuleive EEG cloning wee also noted with central eyapathoniaetic hallucinogene (amphetamine, neecaline, LSD-2S), been and hae reported for antihietaainoe (diphenylhydraaine). These obeervatiene led to the suggeetion that an increaee in central cholinergic activity wae a biochemical basic for the convulsive therapy proccoe (20). and PSIOROERGPIG DRUGS AND EEG this period, the node of action of newer psychotropic aroused interest. Following the concept: derived from During drnge convuleive therapy, the nenrephyeiologic changes induced by drnge �-5- tested within the sane acute experimental franework of the EEG setting. It was observed that phencthiacinee (chlcrpronazine, proaasine, triftuopronanine) induced EEG synchronisation and a shifting of the spectra: to the slow frequencies; neprebanate and barbiturates, an increased synchronization and a shift of spectrum to fast frequencies; reserpine, an increased slowing with synchrono isatien at low dosages, and desynchronizaticn at higher levels (5,6). Inipraaine induced desynchronisatien vith a shift of frequencies to the slow bands (21). Other experinental oerponnds tested included BL-H188 and phenyltolexaaine (Bristol), Deaner and its various cengeners (hiker), wr~21h9 (Wyeth) and frenqnel (Merrill). For each, no consistent electrographic pattern was recorded. It was suggested that psychepharnacclogic egents provide a means for eliciting a variety of neorophysiclogic patterns in contrast to the single pattern of induced convulsions. Furthernore, the type of neurophysiologic alteration, as reflected in EEG synchrony and frequency oatterns, was related to specified types of behavioral adaptation. Increasing EEG synchrony and a shift to slow frequencies were associated with tranquillisaticn, sedation and decreasing agitation; while desynchronieation and a shift to fast frequencies was associated with excitement, illusions, and delusional ideaticn (6,20). These observations are consistent with hypotheses of Wikler. The advantages of EEG techniques for the assay of new psychotropic agents have already been reported (6). were V �-6PSYCHOPHARHACOLOGI EVALUATION PROGRAM besed on present progree, instituted in October 1959, is these studies end is designed to ensver the following questions: Is there e reletion between eeesureble elteretien in brsin function end behevierel chenge with psychotropic drugs on chronic edninistretion? Are there pre-treetnent clusters of psychietric, physiologic end psychologic veriehles releted to the type of behevierel edsptetien? And, ere such clusters related to the type end degree of physiologic ohenge?Method: is en initiel epproxinetion, e double-blind, fixed dosege rendon eseignnent drug study wes underteken. Besed on our clinicel experiences with verious psychotropic coeponnds tree 195k to 1959, three clessss were selected on the besis of their patterns of EEG response.' the egents selected were those with either predoeinent desynohronising petterns, synchronising end slowing, or mini-e1 or no effect. Petients referred for drug therepy, etter nedicel exeeination, end etter ell other eedicetions heve been discontinued ere rendonly essigned to e conpennd in one of these three cleeses. Petients ere predominently middle eless, urhen, with high eduoetionel etteinnent. Hillside Hospitel is e nonnprﬂtit, philenthropie supported psychietric institution, ednitting volantery petients for extensive psychetherepentic treatment. The noen duration or stey for petients is seven months. Convulsive end psychotropic drug therepies ere prescribed by stetf psychietrists The �.7. referral to the Departaent. All treatment is administered by Departaental start, so that the experimental variables of drug dosage, route of adainistration, assignment to groups, 232' are on readily controlled. All patients in the hospital are available for study. After a testing period, all patients receive he so of liquid aediestion daily tron individually labelled bottles. Dosages are increased in fixed weekly steps until a aaxiaua at h weeks. After two weeks on maxiaua dosage, ro~testing oeeurs. Io date, 1&0 subjects have been referred, and 110 have eonpletod the study period. Preliainary analyses of the data are new in progress. Behavioral Change: In a survey of the behavioral adaptations of patients reeeiving phenothiasines or iaipraaine during 1958-59, various clusters of behaviors were developed. The typologies were based on the treataent response and on pre—treatnent psychiatric profiles. In the present study, the typologies are being tested, and various measures of behavioral change are being studied. These include therapist referral questionnaires and six week evaluations, therapist and patient Clyde Hood Scales; Lorr Scale evaluations in interview by two research psychiatrists, and Lorr Ward Scales; and patient sel£~ratings including the Johns Hopkins syaptoa check list and the Chicago Attitude Scales. lenrogszehelegx: Psycholozie tasks have been viewed both as ehanze variables and predictive variables. In convulsive therapy, changes in aenory tasks (22), tactile perception (23,2h), WeehslerBollevne (13), CF! (13), figureagronnd tasks (25): and taehistoseopie recognition of figures (26) were related to the degree or induced 0% �.8neurophyeiolegic change. for each task, the degree of decrement in tank portornance was found to be positively correlated with the enount of EEG cloning. Following treatnent completion, with the return or phyeiologic indicee to pre-treatnent levelo, performance in these paychologic tacks aloe returned to pro-treatment levels, or higher - e hetternent of performance ascribed to prectice effect. Denial ecoree on interview (27), Rorschach determinante (16,17), I Scale coerce (15,17), language patterne after anoberhital (28), auditory teedheck end perception of the vienal upright have been viewed as predictive indicee of the behavioral chengee following 36!. Thole veriene tasks are now being eeeeeeed with psychotropic egente, for their capacity to chenge with verione agents, or their capacity to predict change. Electroencephelogrephze In the convnleive therepy etndiee, the degree of RIG cloning nae neaenred by counting the consecutive waves in selected eenplee (7). When the more subtle changes or drug effect- are etndied, it ie neoeeeary to apply leee tedious techniques. Electronic frequency enelyeie wee introduced in inguet 1959. By neaenrenent of the pen deflection for vaﬁione frequenciea from 3 to 33 ope in ten eecond epoche, repid eeeenreeent of apparently enall chengee in total activity and frequency epectra are new obtained and epplied. Other phyeiologic variablee etndied in thie progren include the reepenee er era to intravenous ohlorprenaeine; bleed preeeure reeponee to neoholyl; the EKG, radioactive iodine npteke, end analyeee o: varioue blood and urine elenente. E 5 �PSIGROLIHGBISIIGS series of studies in the Departnent have been devoted to ternal lenguege patterns. Following the etudies of syntactic lenguage petterns (28) in convuleive therepy, other espects of lenguage were studied for their relation es indicee or chenge in interpersonal behavior. darts; otter considerable exploretion with verious linguistic neesures, nuggested thet typeutoken-retioe (2!!) of consecutive senplos or dyadic speech nay be e enetnl index (29,30). While 213 hed previously been applied to written texts or the language senples of indiriduels, Jeffe indicated that the two pereon eonnunicetion (dyed) wee e acre significent index of the etete of the interaction then enelysee or concrete eenples of the participants. Ayplying this technique to convulsive therapy petionte, changes in 21! neon end etenderd deviations were releted both to the degree of induced ERG slow ueve ectivity end to syntactic lenguege petterne obteined in independent structured interviews. Speech heeene more repetitive (lowered nean 113) and nkre verieble in consecutive eenplee (increesed etenderd devistion)§(31). In Another interviews hetero end otter the intrevenous edeinistretion or centrelly ective egente, einiler chengee were observed. Agente with e predominent synchronization pettern on the EEG exhibited e decreese in mean or: and increase in standard deviation of scores, while deeynchronieing conpounde elicited greater variability in speech petterne (increase in TTR neon) end decreeee in veriehility of consecutive eoorss (decreeee in etenderd devietion) (32). Other lengnege neeeures studied included dietrese~relie£ quotients, self—reference, and elteretion in tense end person. �«10- It was luggontod that then. psycholingukatic nonsuroa tr. techniques for the opcrational annlyaoa or physidlagic and psychologic ctr-eta of psychopharuteologic ugcnts (32). potent �.11 .3001030910 STUDIES In the course or these psychiatric programs, considerable interest wee engendered in the tenily organization to which patients returning. Also, the general problem of the relation of social factors to choice and results of psychiatric treatment, and the specific problem of the relation of these factors to the referral patterns led to a eeriee of pepnletion studies. In one study (33), education, ego, place or birth and score on the California I scale were significantly related to the type or therapy received and the utilization of addonotive hospital services; Thus, patients who were older, poorly educated, had higher P scores and were foreignhorn, particularly Eastern Europe, were most likely to he referred for electroshock. These relationships were present independent of diagnoses. Within the group o: electroshock patients, the tire for referral for BC! was also related to these factors; In a second study (18), duration of hospitalization, discharge evaluation and diagnoses were related to the eaae social factors. For example, patients hospitalized for the shortest period were oldeet, had the least education, were most likely to have been foreign» born and had the higher 1 Scale scores. Younger, native-born, more educated, lower 1 Scale score patients were hospitalized the longest. these relationships held true within treatment type and within diagnostic close. On discharge, older patients had the nest favorable ratings. In 30?, patients rated as recovered or much improved had the highest 1 scores, least education and were most likely to he foresighorn. In another study or patient refusal of nor, similar relationships knee observed (3h). were �Theee reletionehipe ere new under etudy in the Out-Petient Depertnent, end in e tri—hoepitel conperetive study. In the letter etudy, the population: or three hoepitele with preveiling differing cliente, in which e11 therepiee ere equally eveileble to e11 petiente, - Kenninger Peundetion Hoepitel (upper-ollee, Proteetent), Hheeeehueette lentel ﬂeelth Center (leverceleee, Getholio) end Hilleide noepitel (niddle-eleee, Jewieh) ere being eeeeeeed. It hee been postulated that theee reletionehipe reflect the influence of eociel beckgrouud on peychologicel processes, such ee hebituel petterne of eennunieetien and nodes of expreeeion. The contribution of these factors to the pattern or mental illneee, end the petient-therepiet interaction ere under etudy. �-13SEHMAB! . on. Dopartnontal programs are a clustor of intsrrslatsd studios toonssod about common population sonplos. Within Hillside Hospital, rosoaroh laboratories in Bioohonistry, and in Hsdieino are aotiro; and other laboratorios in psychodynanic psychiatry aro boing dovolopod. In this Dopartaont, various disciplinos aro participants,rsprssonting a gradual growth of six ysars. Furthsr growth and tho dirsotions o: ensuing studios sro dopondsnt on tho results of tho studios doscribod bars; as wall as tho growing institutional avaronsss that roooaroh is an intogral part or the hospital's operation and budgots - as such as troatnont and staff training. �”lh‘ Reterenaea Authors at the {alleving references include the following staff nenbere: Hex Pink, Hex Pollack, Robert L. Kuhn, Joseph Jette, xertin 3. Green, Eric Kerp, Hyman Karin, Doneld F. Klein, George Ireuthener, Arnold G. Blnnberg, Ittheniel S. siegel, Abrehen Keplen end Henry 1. J. Hillside Reap. 113, 19583 3. J. lééa 18h6, 1958) A Go., 325, 19593 J. Letkewite. 2. Die. Harv. 8:1. 12: Eilleide Heepitel‘gt 13h, 1955) h. J.A.H.A. Q} 197, 19571 5. Pszehozhernecolegz Frontiers, Little, Brown 6. Heuregazehozherneeologz, Eleerier, hhl, 1960; 7. A.H.A. Arch. Neural. Psychiet. 1Q: 516, 19573 8. Die. Kerr. 5:3. 12: 227,19583 9. J. Hillside Heep. g. 3, 1955; 10. Arch. lenrol & Peychiet. 1g. 23, 1956. 11. First Int'l can . leurol. Sc1., Pergenon, 613, 1959: 12. Jeur. Herr. Kent. Die. $29: 117. 19603 13. A.H.A. Arch. Gen.Paychiet. (in press); lh. Unpublished nenneerﬁﬁtg 13. Jenr. Herr. & ' Bent. Die. ggg: 187, 1960; 16. J. leurepeyehiet. 1: 2&2, 19603 1?. Jour. lerv. Kent. Die. ggg. 2h3, 19593 18. A.H.A. Arch. Gen. Psychiet. 1; S65, 1959: 19. A.H.A. Arch. laurel. & Peychiet. ﬁg: 20. EEG Clin. Neurophyeiel. 15¢ 359, 1960. 380, 19583 21. Gened. Psych. Aeeee. J. A: 1668, 19591 22. Cent. Neural. 23. J. Hillside Hoep.‘§: 2&1, 1957; 1g: 88, 19563 2k. Am. J. Psychol. 13: 38h, 19593 25. A.H.A. Arch. Neural g: 5&7, 19601 26. Free. 1? Int. Pezehel., lerth-Hellend, 238, 1959; 1%. J. Heuropeyohiet. 1} hS. 19593 28. Pezehezethelegz of Guaranieetien, Grnne & Stretton, 126, 19583 29. J. Hillside Heep. g; 207, 1957; 30. Psyehiet. 3;. 2&9, 1958. Gong. �.1531. Jour. lorv. Hunt. D13. 120: 235, 19603 Pazchiutric Drug Thorazz, 0.6. that‘s, 29, 19603 3b. Unpublished Hannueript. Boap. g: 216, 195?) 32. ngnnieu at 33. J. Hillsid- �lap-rtnaltal Fuyuhtutrac 2701:... at 3:11:14. luapitcls A title: In: fink, Fran tau ntpnrtuaut ”’F‘ul. 91“ “kl. 7!: U I, 1;!50 K.B. a: sxpurtnuutnl Psychiatry, 1111.14. 10.1.; '0’. �/ [, ‘e VI //y 11/22/60 layoviunntal ruyuhtutrto Procrnnn u‘ [1113140 loapltnlu A Icvtou It. Virtoun program: 1: an. nupartnant of xxpcrtnantal Payoh‘airy 531‘ but: dcvutod to an underttnndtn: of tho sad. at ﬂl‘itl at payuh1n$r1¢ thnruptta through studina at brtiu tunetiun. rho principal inshnign¢¢ invo boon adapted {ran doneriptiv. plyuilutry.vnanrapiyuhology, oloetronnotphnlocrnphy. lingututtcl, phuruaaolﬂtyg and socinlocy. 1n chungoa brats convululvu thcrtpy, at initial attain: functian nova round ta rtlatc both to ovuluution- o: inpruvaucnt In ptywholaciéﬁznrinblca. Al 0‘? undarnttudtnu and to pru~tr¢3tncut or eonvulaivw thcrupy dovelupad, a genera: nouroyhynialozic1 ( usergnd slanttw ). In this via: thorapxos a! vita udtpttvc uiif‘i‘rxplnttonlly thy dogtoo to ottactivo troutueutn payihtntrtu this brain function 13 uncuurahly nl‘nrnd. will. Chung. in brain function 1- noatnsary tar bchuvtorul ch:u¢o, the twp. or nd:p$¢tton, paywhologiédnna hurtvnr, vnrtoo «avoiding upon pro-‘rontncnt Itoiuloxliﬂcharactnrtutio: 02 sh. cuhdoot (2). Thus, tho use. or uotlcn 1. not soon as ulthar 'oralnle' or *poynhologic' but rathcr and chaugua of nourophyaiologio distant tan lattruaticn a. adnptivo 3008331.... turthcr, uh$lo bohtvtirtl chins. 1a rnluted to ohnngns in brain ttnottaa,‘nnd the nanptivt patio!» t0 prt-triatuont psychologte thirtetcricttot, 07:1nat10nu a: ’1Iprovcunat', but»: npuottl $79.! or uvlzuntiou or chnnxo, arc atrtvutivs stagnant. hated an :tatt and £1.11: oxpootutions and inlcrtaonu (2). �n2- ?hiu hypothuain Ill dovulopca and nuntstncd an a £021.! a! ntuditl qt cunvulstvn thnrnpy. ctncurrcnt aﬁudios a: tuuulia can. tnd1¢utod taut hohsvtor¢1 chant. horn. too, wua.r¢1ntod to tn. lutot ind accrue or piniongut can: a: ropaatod stature. - that. b.1uc tho prinaxpul manifestations at proloncod nonrcrhysioloctcaﬂ an that»: (ink). chm: in It: made if aoStoa of tho new pcyahotropio «goat; vac also nithta thin hypothesis (5,6). It nan ouggontod that ﬁhouo tgan%a would ho affectivc to tho 403:0. that ghoy induced paratatant ch:ugau 1a brgtn fanatian and that the typo at bchaviur;l rampaano Inuld to rolttud to tho typo or brain ohaagc, and to prcaorbtd payohologit (paruunultﬁr) patturnt. Tho prisont pruxruan in tin Btpartltat ‘20 4331¢u§d to study th.ue volitianuhipt in unprosuud _d¢tti1. E E III 13‘ £88 a: turtou: nanutrnn at brain tunusiaa, thc alount a: slaw var. atttvity ta ta. cinctrcunoupphagzrin (1,8) tad contcbulutary and 60.1.1 Inasmuch pattora: nttur unobarbital (9.10) not. thu unit uoaca‘:vc that... (11) 1a .0I7‘101VD thorny: subjects. In on. naportnont, tapruvclnnt ratings wire ctrruxttod with the upponrnacc .1 itch dgcrooa or change in thou. inexact (7.10). dtnbin-bltnd 1a 1n abnorvntiana tkntot a a‘udy ”‘2. it... Itiuh patiohta rotorrod for clootrguhock var. rand-n1: nustgncd to court‘s o: otthor ocnvulutvu 0r aubconvulttvo therapy under anurophytlologiénchaagt pqntothnl prcnodtonttal. nigh dugrtul or v!ra obuarvod only in tun convulitvn grnupg inprcvon-nt rutct varnixuitiouutly higher in this ﬁriﬁtj and vhaa subconvuluiv: nubjoeto �U). * v.20 ru-trontad by couVIInivo upyliuutiona, ﬁlo tuprovcnnnt rut. um: lintzsr to the orictual convtlaivt group (2). In the anboouvulaivo treated Inhannta, uuuutdar;b1¢ Quaint. or altntria «arrout yauaca hotuocu tho hitanporul cluotrodoc. It Ipptﬂrtd that the thorupautic taunt wan not tho total cloatrle.1 currunt, aggugg, but an :11 or non. quality nan££.ctnd by thc grand In: lotuuru (8,12). Th. algnittenuao at ﬁhc grand In! I'liir. van~cxan1uod in etudiat of tho inhalant aouvnlsnnt, insurlugrodtothylcth¢r (13692105). ﬁinilur 4.3!... of alsetro~ graphic ehsngc, ﬁngvovwnaut tutti, typos or bghgviortl ahtugo and changes In nourvysyuholoxtiﬂgatk bahavivr nﬁro observcd in tic tnhallnt tn ulcatrieally treatud groups (13). It at. anon npyaroat $hat act :11 tubjaats Ianiroatins high tugraou or physiologxc chnngo warn rttod ts '1npravod'. Ia a dcsaripttva typolngtn study, :31. ptttarna wire doacrihad, impartcnlly turned 'ouphnrlu', 'hypounnio', 'sonlttnatiuu', $0!!ﬂ.1£¢'1‘hdtlﬂl1'. and 'punlo‘. ﬁhtlo the ttrat tun of than. udnpt11¢ .04.: nor: rttud I. 'nugh taprovod', ¢ho latter two were noun as 'Iuinprovvd' or 'uoraa' (1%). In station a: ysyuh01031£#VIrinb1on, it run vaportod that pctxnnta rntcd as 'I‘ch improvud* and 'reaovurad' frequently ltnituntcd puruonnltky puttcrut liuillr ta that diaeribod by ﬁctuutnin and Ink: is ﬁhu laplacit vorbal 4.31.1 pornonality. 'In 1!:zunxo ynﬁtoras, patiantn capraastd thu 'lnazuugu a: doninl', than ditthln brain ohnagc In: Indueca, txhiblttus anon napocﬁa an txpltctt dintsl, Izaiuisataun, ditylne¢noat, cliches, g§g&_uorc traqu.ntly thug untuwravcd cubaoctu. Other 134130: taint-d to tnvorsblo and �.3. hash I 5341. acct. (15), and Roruuhaeh dotarnintnts «Olav, nbsaut novunaat and nbaont t-rn-calor (16,17). In thia popu1&tttn, also, :avurablo outatuu at. taaoctntod with 10v uduaattgnnl uahxuvannnt tad {truism birth (18). tutu... it?! at sitting a way to nuancat tun digit. of pentatonvulitvu :39 $1.! utvu nitzvity, ta anttahozanorciu coupltnd, «totEutzno, was giro: tutrnvonoualy at various :tngos or tht ccavulutvc thor‘py - proutll (19). doa$r¢ry to oxyaetntiaal, ditthnlinc eaunod In lunadiatd and «attained ¢aer¢aan in EEG cloning. Patiunta with donstl lagging. putt'ruu rulaaqntshad than. Inttcud or atphorin aha wall hasng, thc lubjoota vat. irritqblc, anxious and prrO181V. or pramtrnatnnnt patterns. In aubaastv prior ta eonvulaiva a: drug thnrapy, diothantnu andueod uxaitanont, tan-ion, anxiety and illusory nontatsunc. ﬁuhaoqncht ntndica with 9th.: «antral antioholinurutc ae-paunda (VII-8299. 33-318,336g hanaotyttno) aboucd behavioral sad cloctrogruvhlc pattarau elitist to daoth‘xino. atnilnr datynahrontnnttau o: postuconvulaivt 330 niacin; was ‘10. notod with «Mt-'11 amnion-tutu: hunuinnuo (nphounno, «suntan, nan-as). Ind ht: been rcpur‘od for tatihiatantnoa (diphunyihylrauinc). that. thiarvaticnu 10d $a tut mugxultion thtt «a incrtano 1n coutrnl ottltnargia activiiy VQI a btoahouscal haul: for thy convulaivc ttorapr greats: (26). rsmgonauo nma an no During this parted, tho mod. 0: sctlaa cf ucv¢r psychotrepic drug. trout-d intnrnst. rollcving tho caaouptc doravca tron ' J2 otavulntvu ‘harupr, thu nc‘rophgwiologio outage: inanood by drug. �.5... f tutti! I1th1n tun 3.x. aautc oxpcrinautu1 trunnuork at th. E39 usttinx. It It: thaurvod thtt phonothitslnos (ohlorpronasiac, any. prangnlnc, tritanaprolaaxna) :nduood axe ayauhrontauttou and a oh£tt1ng of tho upcetrun to tho .10! frequaaotts; Improbaghtc cad barbiturates, an incrouuud IyuchrnaxsatSOB and a shirt 0: spoctrnn to inst (recitation; roanrpiuo, an Inorouood ulcvtns with Iyaohrouw inattua at . dying... and douynchronisatioa at night! 10'010 (5,6). 2.133.313. tainted ﬁctynohrtnisnttua with a ah1:% ct :rcquauaicu fa the a!” but: (21). ”‘ng Gina: expirtnnatal annpounda tul‘cd inaludod nz~uxaa and phtnyaioltlslino (ariatol), nectar tad its variant aoneaaors (33:99), wtatlh9 (37"h) and trﬁnquol (lorrill). tor cash, an I0|tiutcut olnctrucraphia putters it. recordta. psyuhoyhnrtnollaciéwazoats wgu that staccatod It pruvtd. u nearaphyuiolotiéﬂpat§cran u for of 1a nasal eliciting varicty ctutraat t¢ tho sags}: psttura or induced scavalnionu. furthtrnouroyhyntolugidJtlttrttion, sh. a! type .02., I: rotlon$ad in as: aynohrcny and IFC‘ICRGI ynttcrna, nun rolnt.‘ to apoottiud typo: a: behavioral stuptntsdn. InorOtttuc nae aynchrony tad a shirt GO aluu fvnqncactou aura nauoatttud with trangutlltzn‘tua, notation uni docrnﬁatng agitatious stilt angynohraatua£tua and a shirt tn tu't tragucncloa It: antacxntta with excitouaut, tlluuionu. tad dolnntcntl ilcatton (6.20). than: aha-trutionu are conclt‘aut with hypothaloa o: Hitler. 2h. advantagon at are tuchntquco tn: the 300.7 or not payuhntropzc ugcntu haw. nlroady b¢0u reportcd (6). low �2h. presuut progrnn, instttnﬁod in Outabcr 1959. 1a banal an sh... attitua and in 6.113304 £0 .3380? $8. I’llavinc quantlultu In £3.90 t rolutlon hotutcn Innuurublo altovtttua in 53:13 tunc‘ian and bohnvtoral «hung. with payuho- airbus. unnaatatrttian? 120 that. proeﬁrtntnoatfqlua§oru gt paynhxatrao, ptyctulcciéinnd ptyuhmlc¢1£&variahzoa rolgtud to in. tropic drugs an typa 0: hohnviornl adiptntttn? And, art such cluntora rolntod to the typo and 403200 at phyutologle ohuuxo?# ‘gggaggs AI ua.1n1t1n1 ayproxinattcn, a doublnuhlind, sized Gonna. random Isntgnncnt drug study clinical In. undertnktn. luccd on our varitu' piyuhctropto coup-sud; tron 195k to 1959, thrco clan... unto 0.100%04 an tho 5‘31! or that: patﬁnrun or 310 ro‘ponao. tho slant. scloutnd wit. that. rich oxpcrzoncoa with caﬁhcr proloninan‘ dunynuhrouiutax pattcrnu, Irhahrontutng and nlyvinc, or nintnal or no errant. Pattoutu r-rorrud in: drug therapy, IItOf nudist: tun-auntaon. and art-r :11 other nodicntiouu hay. boon diucoattuucd are randomly usutgacd to ‘ compound.1n an. or that. ‘hrio «lacs... Pa‘icnto are pvodonlnnuﬁly Ilddlo eluot, urban, utﬁh high oiiontaonnl :t‘linlont. 1111.14. 80-pita1 1a a nou-pritit, philanthtopie supported psychiatric tnutttutton, .duitttng voluntary pattoutn {or txtonntvn puyuhothurcpoutie troitntut. fin loan duration or its: fer patients in novon months. convuiaivc and puychotropao drug thnrnpics It. pronortbud by star: payuhxntriota �.1. A11 thc trlatnnut in aduluintorad by to naparﬁutu‘. rottrrll Da’artniatul stuff, no that the axpcraanutal vartthlta or drag daoaco, rant. 0! adutaictrnttua, aaotguunut to groupu, 333, &r¢ roadtly controllod. 111 patiantu in thc hoapttal arc «v.113blu for titty. Attor‘a tutti»: ptrtod, 111 puticnt: rocuivc he so or liquid ‘nndtogttoa daily tron 1nd:vtd:ally inhallcd bettlco. Dos;¢o: at: incrcnscd in ttxnd tOIIII atop: tutti a u.x:uun at h ucnku. Artur tun wank: on nixtnau 4.111., ro—tnatlnx ¢o¢ura. to dn‘o, 1&0 vuhjaoto but. hon: rtturtod, and 110 have outplatod tn. study period. Proltniunry analyst: of tho data At. an: in on prozroau. Ichuvigral GhlI‘Oi In a tutti: u: tho bnhnviorul adnptnstonu of pt‘tuuta rcaoiviag pitucthiasiutl or inipruutua during 1958-59, variauc clustorn at bchnvtora var. duvolopad. 1h. typalocton wore but-d on tho trontatut rcapiaat and on pr0~trlntauut ptyuh1&tr1c protilus. In $3. pruncut sitar, tho typoloxint at. being tested, and variant scalarot at behavtoral ahtug. at. being atudtod. It... inaluac thorlyitt ritorrnl quortiouuairoc I1: cvaluntiono) therapiat tad puts-at Glyn. Road s¢nlang burr aoglu .valuntiona 1n int¢rviov by two rnutnrch psychiatrtnta. and Lorr Hard Scale.) and puttout unit—ratings 15013413: ‘ho Johan toutinl symptul about lint and the stints. Attstnda 50:10:. boon both vtcvod I‘Vl tank. as Psycholnglc lutrggangglogzg thing: vsrtnhlou sud pradlcttvo variablou. In convulsivo thorgpy, chingo¢ in Inner: tanks (22), tactile paraoption (23,2h), wcohnlcro Bolltvu‘ (13). err (13). flatro‘3rocnd talk. (25). ‘nd tachlntQUQOptu recognition a! figure: (26) war. relatcd to thy Court. or induocd and ﬂ‘Ok am �neurophyutczogaggihnngu. In: 9.03 tack, tn. dcxroo at docruuont tn rouui ta b. poatttvny ocrr'lutod with the ‘llk vortoruuncn nus assist a! :36 closing. lollewaac trout-oat aonalation, with the rotur: a: phybitloxialiaaauca t. prootroatnnnt lovnln, performing. payahologidﬁkasku in than: also raturnud to pro-trontnont lcvuln, or higher ~ a buttarntnt 02 purrornnnco ascribed to practi¢o afloat. Donia: start. on interviﬁw (27), aoroohach dotorl1nuntn (16,17), r 8.11. Idﬂvit (15,17), ltngunzu pntﬁarns attnr tnobnrbttal (28), andatary toodbuck and porcuption if the 11:ua1 Iyrscht have bcan v10v0d a: prcdlattvu attains at tho hchavioral outages following 362. fhauo vurinuo tank. are at: being Isa-anon with paychctropio :.£?:1.1p agon$s, alpncxty capacity to prudiot chaago. t. cling. wl‘h vurtona anout319igfﬁhotr §;I¢§ronniqggg;o‘gughzg In tn. convulttvn therapy ntndlnt. the intro. of as» slaving was latsurod by counting tho oonncauttv. wave- 1» lolcotad :unpi:a (7). lab.» ta. not. nubtlchohuazoo at uttoetl arc ltudiod, it in uooclaury to gyply lula'ttdionn toohntquoa. Iltctroulc Iroqutncy nnnlrlia wt: introduacd 1h Angint 1959. 8y nauaurounat 0: th. pun doticetion for vaﬁﬂoal rrnquoneius Iran 3 ta 33 8?! 1n ttn ataoaa epochs, rapid nanuurcnnat o: upptrintly nlnll august. in total activity nnd troguoncy aptctrl arc new obtatnnd drug tad applied. ethn- play-1.1.316" in thin program include tha rtlpautn I: :36 to iatrnvontua chlorpronnsinzj blood protauro reapnunu to the nut, pullout!" 1041” mute, and a: turtouv blo.d and urin. elegantl. man" “at“ ”any” “an“ w: 9! 115‘ 8 �tho atadlco in napnrtuont hurt beta dovctoa .: to torn;1 1.33133: puﬁtcruu. iylzoving it. stutits ct syntactic lung‘tgu pattern: (:8) tn asavulitvo ihsrapy, uﬁhor capogts at 11:51:30 vuru Ituaxod for tkcir r01:$£on an iudSQIa of change in intovpornonnl bohtvtor. .Jattc, urtnr oonoiiertblc omnlorutian with Various linguistic consecutivn or that suggcitaa typo~tokoa~rtttol (I?!) lilltrit, ho t 1nd»: (19.30). man. «mm: at and“ apneh it! hid prtvionoly §ncn npplicd tn urittua $311: or en. 1:ngungo nanplou of indivﬁdulil, 3.1!. indicated that the two pcrnou cou~ nuatcttton (47") was 1 nor. liznitignnt indox at tho itttn at tho interacting than auulylou or i¢paratu snnpxoa of tho ptrtitiplutl. tpplying than toohutque ﬁt convulltvu shtrnyy patients. chanson 13‘!!! noun and atundnrd «aviation. var. r01¢tnd both to in. deavco or induced 3:3 ulot wire aat1viti and to uyutnet1c lunxttxo pattern. ob$ttnca 1n indopondtut atruatnral interviouu. apauah 5.01:. no»: rupo‘tttvc (lowered noun If!) and nor. vartnhlo in coautcutivu nunplon (in-ruaI04 utnndurd d¢v1at10n) (31). In intarvtawl but-r. and alter tho mutrtvvaonu aduanlatrtttoa at ecutrally activa astutu, 31:11:: Ihlngil Int. obnurvod. taint. with n yrcdouinant lynchruatxgtion pnttorn on tn. £86 oxhibitcd a 4.120ntt in net: 191 cud inﬂfilti tn itandnrd duvxatioa o: necros, viii. dotynchrouising ealputuda 01101106 groatcr variability in tyccch pattcrus (1:090... in RI! Inna) tad dtcrunan in v.r1ub111%y of coauoeutiva scorn. (duorouun 1n ntandnrd deviatian) (32). 6th.: languaga notnnrnl atudiod includod diatroccurolior quttt¢ata, uclt-rutcruncc, and alttrntion 1n tunnu and paracn. Antﬁhar 30:10. m tutu �.19. nu: sagsoaﬁcd that ﬁt... yuywhcltnxutstta Inaiurcs tgo pa‘cat incantqutl for sh: operational unnlytns o: phyaiologig%und yi:¢h¢1¢¢1€?£ttactn a: ycychopharanaolugse taunt: (32). It �aggggaggzc $233133 It ta. court. at ‘ thou. plyuhta%r1e protraaa, comaidartblo InﬁnrOtt Ian unguudarcd in at. tantly organisation to which pttttnto turn rcturntnc. Also, its ginornl problem at tho ralntiou or stein! M chase. and a: pnychutric treat-out, and the Ipttifia prathn a! the rnlutiau of thtli factor. in tht rarogrul puttarna lad to a aortic at papulatian studsus. In on: study (33). ﬁduaattua. ﬂgi, plus: ct birth cud score on tho Galltarnia r Iallc wort ticnttioaatly ralctad to the may. at therapy rocoivod und the utilatniton at adainottva hotpttnl aortic... rhui, pgttont; aha var. older, pearl! uduantcd, had hishar I neuron And aura tarnishhnru, ptrtiuularlyranstnrn invent. wart neat ltkuly to be 90:0rfﬂd tar ¢ls¢trouhooh. that. rclationahlpl worn proaont indopiadont or atlxntnoa. within tic sunny 3: cluo‘ronhack patiuntu, $3. tins for rotttrnl for 3a: 3:: ulna rolntnd to ﬁhoau factora. In t nocand ntud: (18), dnru‘ton a! harpitnliantion, discharge uvnluattan and asucnoun: vova rolniod ta tho Ian. social flotara. fur uxauplo, patient: harpitlltuna for it. uhortcnt ported EOE. oldest, had in. lcaaﬁ education, v¢ro punt llkcly ta hnvc baou farcicaioru and had the hiahﬁr t ﬁnal. user‘s. Younger, uttivowborn, not. nénuatod, lava: ! 89.10 a¢oro yuttonta worn hospit.11sod thu taunt-t. I)... rnlntinanhipl htld trnc within troutlant typt and within diagnoatic 0131!. on dinohargt, 014.: patients had tan unit tavorablc ratings. In :61, patients rated as renovated or sunk improvod had tho highoat r 3.0!... lasat aduantion and war. moat 113.1: ta b. rurattg* born. In anoﬁhcr study or p;t1cat textual a: new, 01.11;: rolattun~ ships tutu obsorvad (3h). an». nun: �.12“ ‘ thc under antarctiout in study not volatiiauh1pa If. It... Dtpnrtutnt, and in I triuhtnpttnl coupura‘tvo study. In tho 133%.: utuﬂy, tho pcpn1n%1ona at ﬁbre. haupttclu uttk provatltac dittcvtng $0 .11 pttaoutt, :11 wits! aquully in thoruptcs arc I'lillhlt cltuutu, - Ionian:- muauw Iowan (mu-«nu, run-mu, hunk» nottn lontil ﬂunl‘h cantor (lowiroclnns, ctthnlta) ‘34 ltllllio loaptt&1 (naddzcvcliuu, icwioh) It. ﬁning tanouacd. It ha. bcon thy rotlooﬁ antlntnco .2 social rolutiandhtpt it... ha011ruund on payth.lo¢1all prrcanuou, such ll habitual pnttnraa or contagiouttun and gods: of «sproutioa. {ha cantrthlﬁton 0! than. tnotara to tho patﬁorn o: ncaﬁal 111303., and thy ptticIt-thnrtpiot intoruottou are undo: atnﬁy. postultttd that �.13- may; it. nipnr$uoat:1 99032.3: are a oluutar a! interrolntod studios tocuunod about cannon pnpulntauu annplcu. within ltllltdo Iblpttnl, restart! ltboratoricu 1a niaehauiltry, and in nadtctno if. aattVQ; and 0th.: inbnrntorina 1a puyuhodyulnto puynhtntry Ar.hmaac aqvolcpud. In tat; Dtpnrtnont, various diacipllnoo tr. vartttayaats,roprtuoatzn: a gradual cravth a: :1: 33.3.. tartan: grcuth and t8. ﬂirtation. a: tanning 31341.. tr. dapoudont .a tau rostlta at tho attain. dotcrahtﬁ hart; no will a: th§ (rowing £Il$1titt¢ll1.nilrin031 that ruaonrch in an tutogral part of thy httpitul't opcrnttcu and budgu‘n . II that ll trcntnnat and otutt training. �~13:- kahuna” fauna: uni-cue“ that“ m £0.11.ng rut: hum" m rink, ﬂu hunk. “but 1.. tum, Jinnah um, Int-u I. Erna, 3”,. Km, In" mu, ma: 3'. £1.13. Guru Imam, ”and a. auburn. “that“ 8. 33.301, abun- Inn: at! nary J. Mint“... Aim" at tho J. “11.1“ lap. 93 197, 1957; .3. J. mun. Hospital at 1958; 2. Ms. 3.. .113. In". 81.. 3:2: h. 4.1.11.1. 1.1m... Iron 131;. 1955; h 5. ms h “mule 1min”, a c... .325. 1339; 6. ¢h02m00§2u. naval". Mal, 19603 7. Add. not. loan)... a 1-31.31». ﬂ: $16, 1957: 0. Mn. In". an. '33: ”7.19563 9. J. i111.“- llup. g: 3, 1955: 19. Arab. 18116, 1958; ”my; 1.956. :3, rennin. t ﬁt 11. nm In“). 3” In“ 1. Sci. , Penman, 613. u. “an Em. that. 31!. 122' 117. 19691 13. 1.3.1:. Int-.1 Mm“. 1959) arch. Gun. pan); ﬁnalist“ autumn 15. Jar. low. but. ml. ms 15?, 1960: 16. a. lunpuehut. 3,: an, 1960; 1?. am. it". lat. M... m; 11:). 1959: 18. Mid. Arch. on. ”want. .13 555. 1959; 19. Add. Auk. Int-1. I: "youth £9: no. 1958; 21. g: (in 1h. can“. 8!, 1,563. usual. can Emlyn“. 9,3: 359. uni. Anna. 3. A: 1668, 1959: to. no 13. 3. Hanna. luv. g: 1950. 2:. 21:1, 1957: car. lmol. 2h. a. J. luau: g: Shh 1m; 8&. 17.19%: Gong. 238, 1959] 901350;” law-mama, m, 335. 4. 28. 19593 lmopoychiu. u. chhgzﬂhclaa at y «1-. 35.11.14. Buy. 5 1953; 126, Gun 29. Mutton, cwuuia, g: 207. 19573 30. urchin. 3.2») 2139, 1958. 1?} 381:. 19593 25. MILL. Arch. �. «150 ‘1-.. O 3'1. :"9: ‘.".¢ "”‘o ﬁt‘t > ‘ ‘ hip. g: 216, 195'!) g 31:. w! ”5’ 1,69} M', uranium-a Mnuonph 3.6; 2’. 196°, 3!. W 33. ‘¢ 31.11.14. �Experimental Psychiatric Programs at Hillside Hospital: A Max Review Fink, MnD. the Department of Experimental Psychiatry, Hillside Hospital, Glen Oaks, L.I., N.Y. From VI: 1/61 �Experimental Psychiatric Programs at Hillside Hospital A Review various programs in the Department of EXperimental Psychiatry have been devoted to an understanding of the mode of action of psychiatric therapies through studies of brain function. The principal techniques have been adapted from descriptive psychiatry, neuropsychology, electroencephalography, linguistics, The pharmacology, and sociology. In initial studies of convulsive therapy, changes in brain function were found to relate both to evaluations of improvement and to pre~treatment psychological variables. As our understanding of convulsive therapy developed, a general neurophysiologicadaptive view of somatic therapies emerged (1). In this view psychiatric treatments are seen as therapeutically effective to the degree that brain function is measurably altered. While change in brain function is necessary for behavioral change, the type of adaptation, however, varies depending upon pre—treatment psychological and sociological characteristics of the subject (2). Thus, the mode of action is not seen as either "organic" or "psychologic" but rather as the interaction of diffuse neurophysiologic changes and adaptive mechanisms. Further, while behavioral change is related to changes in brain function, and the adaptive pattern to pre-treatment psychologic characteristics, evaluations of 'improvement’, being special types of evaluation of change, are derivative Judgements based on staff and family expectations and tolerances (2). �-2This hypothesis was developed and sustained in a series of studies of convulsive therapy. Concurrent studies of insulin coma indicated that behavioral change here, too, was related to the onset and degree of prolonged coma or repeated seizures - these being the principal manifestations of prolonged neurophysiological change in this therapy (3,h). The mode of action of the new psychotropic agents was also eXpressed within this hypothesis (5,6). It was suggested that these agents would be effective to the degree that they induced premorbid psychologic (personality) patterns. The present programs in the Department are designed to study these relationships in detail. CONVULSIVE THERAPY PROCESS 0f various measures of brain function, the amount of slow activity in the electroencephalogram (7,8) and confabulatory and denial language patterns after amobarbital (9,10) were the most sensitive indices (11) in convulsive therapy subjects. In wave one experiment, improvement ratings correlated with the appearance of high degrees of change in these indices (7,10). These observations were tested in a double-blind study in which patients referred for electroshock were randomly assigned to courses of either convulsive or subconvulsive therapy under pentothal premedication. High degrees of neurophysiological change were observed only in the convulsive group; improvement rates were were �-3- significantly higher in this group; and when subconvulsive subjects were rc-treated by convulsive applications, the improvement rate .was similar to the original convulsive group (2). In the subconvulsive treated subjects, considerable amounts of electric current passed between the bitemporal electrodes. It appeared that the therapeutic agent was not the total electrical current, per sez but an all or none quality manifested by the grand mal seizure (8,12)o significance of the grand mal seizure was examined in studies of the inhalant convulsant, hexafluorodiethylether (Indoklon). Similar degrees of electroThe graphic change, improvement rates, types of behavioral change and changes in neuropsychological task behavior were observed in the inhalant and in electrically treated groups (13). It apparent that not all subjects manifesting high degrees of physiologic change were rated as 'improved’. In a descriptive typologic study, five patterns were described, empirically termed 'euphoric', 'hypomanic', 'somatization', 'paranoid-withdrawal', and ‘panic'. While the first two of these adaptive modes were rated as 'much improved', the latter two were was soon seen as *unimproved' or 'worse' (1h). variables, it was reported that patients rated as 'much improved' and 'recovered' frequently manifested personality patterns similar to that described by Weinstein and Kahn as the explicit verbal denial personality. In language patterns, patients expressed the 'language of denial', when diffuse brain change was induced, exhibiting such aspects as In studies of psychological �-h- explicit denial, minimization, displacement, cliches, 222. more frequently than unimproved subjects. Other indices related to favorable outcome were high F Scale score (15), and Rorschach determinants of color, absent movement and absent form-color (16,17). In this population, also, favorable outcome was associated with low educational achievement and foreign birth (18). ANTICHOLINERGIC COMPOUNDS AND CONVULSIVE THERAPY Seeking a way to augment the degree of post-convulsive slow wave activity, an anticholinergic compound, diethazine, EEG was given intravenously at various stages of the convulsive therapy process (19). Contrary to expectations, diethazine caused an immediate and sustained decrease in EEG slowing. Patients with denial language patterns relinquished them. Instead of euphoria and well being, the subjects were irritable, anxious and expressive of pre-treatment patterns. In subjects prior to convulsive or drug therapy, diethazine induced excitement, tension, anxiety and illusory sensations. Subsequent studies with other central anticholinergic compounds (WIN-2299, JB-318,336, benactyzine) showed behavioral and electrographic patterns similar to diethazine. Similar desynchronization of post-convulsive EEG slowing was also noted with central sympathomimetic hallucinogens (amphetamine, mescaline, LSD-25), and has been reported for antihistamines (diphenylhydraminc) These observations led to the suggestion that an increase in central cholinergic activity was a biochemical basis for the convulsive therapy process (20). �PSYCHOTROPIC DRUGS AND EEG During this period, the drugs aroused mode of action of newer psychotropic interest. Following the concepts derived from convulsive therapy, the neurophysiological changes induced by drugs were tested within the same acute experimental framework of the EEG setting. It was observed that phenothiazines (chlorpromazine, promazine, trifluopromazine) induced EEG synchronization and a shifting of the spectrum to the slow frequencies; meprobamate and barbiturates, an increased synchronization and a shift of spectrum to fast frequencies; reserpine, an increased slowing with synchronization at low dosages, and desynchronization at higher levels (5,6). Imipramine induced desynchronization with a shift of frequencies to the slow bands (21). Other experimental compounds tested included BL-M188 and phenyltoloxamine (Bristol), Deaner and its various congeners (Biker), WY-21h9 (Wyeth) and frenquel (Merrill). For each, no consistent electrographic pattern was recorded. It was suggested that psychopharmacological agents provide a means for eliciting a variety of neurophysiological patterns in contrast to the single pattern of induced convulsions. Furthermore, the type of neurophysiological alteration, as reflected in EEG synchrony and frequency patterns, was related to specified types of behavioral adaptation. Increasing EEG synchrony and a shift to slow frequencies were associated with tranquillization, sedation and decreasing agitation; while desynchronization and a shift to fast frequencies was associated with excitement, illusions, �and delusional ideation (6,20). These observations are consistent with hypotheses of Wikler. The advantages of EEG techniques for the assay of new psychotropic agents have already been reported (6). �97PSYCHOPHARMACOLOGY EVALUATION PROGRAM _______an.._________.__u~m._______. present program, instituted in October 1959, is based on these studies and is designed to answer the following questions: Is there a relation between measurable alteration in brain function and behavioral change with psychotropic drugs on chronic administration? Are there pre-treatment clusters of The psychiatric, physiological and psychological variables related to the type of behavioral adaptation? And, Method: As an are such clusters related to the initial approximation, a double-blind, fixed dosage random assignment drug study was undertaken. Based on our clinical experiences with various psychotropic compounds from l9Sh to 1959, three classes were selected on the basis of their patterns of EEG response. The agents selected were those with either predominant desynchronizing patterns, synchronizing and slowing, or minimal or no effect. Patients referred for drug therapy, after medical examination, and after all other medications have been discontinued are randomly assigned to a compound in one of these three classes. Patients are predominantly middle class, urban, with high educational attainment. Hillside Hospital is a non-profit, �-8- philanthropic supported psychiatric institution, admitting voluntary patients for extensive psychotherapeutic treatment. The mean duration of stay for patients is seven months. Convulsive and psychotropic drug therapies are prescribed by staff psychiatrists on referral to the Department. All treatment is administered by Departmental staff, so that the experimental variables of drug dosage, route of administration, assignment to groups, 323. are readily controlled. All patients in the hospital are available for study. After a testing period, all patients receive no cc of liquid medication daily from individually labelled bottles. Dosages are increased in fixed weekly steps until a maximum at h weeks. After two weeks on maximum dosage, re-testing occurs. To date, 1ho subjects have been referred, and 110 have completed the study period. Preliminary analyses of the data are now in progress. Behavioral Change: In a survey of the behavioral adaptations of patients receiving phenothiazines or imipramine during 1958-59, various clusters of behaviors were developed. The typologies were based on the treatment response and on pre-treatment psychiatric profiles. In the present study, the typologies are being tested, and various measures of behavioral change are being studied. These include therapist referral questionnaires and six week evaluations; therapist and patient Clyde Mood Scales; Lorr Scale evaluations in interview by two research psychiatrists, and Lorr Ward Scales; and patient self-retina including the Johns Hopkins symptom check �-9- list the Chicago Attitude Scales. Neuropsychology: Psychologic tasks have been viewed both as change variables and predictive variables. In convulsive therapy, changes in memory tasks (22), tactile perception (23,2h), WechslerBellevue (13), OFF (13), figure-ground tasks (25), and tachistoscopic recognition of figures (26) were related to the degree of induced neurophysiological change. 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 physiologic indices to pre-treatment levels, performance in these psychological tasks also returned to pretreatment levels, or higher - a betterment of performance ascribed and to practice effect. Denial scores on interview (27), Rorschach determinants (16,17), F Scale scores (15,17), language patterns after amobarbital (28), auditory feedback and perception of the visual upright have been viewed as predictive indices of the behavioral changes following ECT. These various tasks are now being assessed with psychotropic agents, for both their capacity to change with various agents and their capacity ts predict change. Electroencephalography: In the convulsive therapy studies, the degree of EEG slowing was measured by counting the consecutive waves in selected samples (7). When the more subtle changes of drug effects are studied, it is necessary to apply less tedious techniques. 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 now obtained and applied. Other physiological variables studied in this program include the response of EEG to intravenous chlorpromazine, blood pressure reaponse to mecholyl, the EKG, radioactive iodine uptake, and analyses of various blood and urine elements. �-11PSYCHOLINGUISTICS series of studies in the Department have been devoted to formal language patterns. Following the studies of syntactic language patterns (28) Another in convulsive therapy, other aspects of language were studied for their relation as indices of change in interpersonal behavior}. Jaffe, after considerable exploration with various linguistic measures, suggested that type-token-ratios (TTR) of consecutive samples of dyadic speech may be a useful index (29,30). While TTR had previously been applied to written texts or the language individuals, Jaffe indicated that the two person communication (dyad) was a more significant index of the state of the interaction than analyses of separate samples of the participants. Applying this technique to convulsive therapy patients, changes in TTR mean and standard deviations were related both to the degree of induced EEG slow wave activity and to syntactic language patterns obtained in independent struuctured interviews. Speech became more repetitive (lowered mean TTR) and more variable in consecutive samples (increased standard deviation) (31). In interviews before and after the intravenous administration of centrally active agents, similar changes were observed. Agents with a predominant synchronization pattern on the EEG exhibited a decrease in mean TTR and increase in standard deviation of scores, while desynchronizing compounds elicited greater variability in samples of speech patterns (increase in TTR mean) and decrease in variability �-12- of consecutive scores (decrease in standard deviation) (32). other language measures studied included distress-relief quotients, self-reference, and alteration in tense and person. It was suggested that these psycholinguistic measures are potent techniques for the operational analyses of physiological and psychological effects of psychopharmacologic agents (32); �SOCIOLOGIC STUDIEE In the course of these psychiatric programs, considerable interest was engendered in the family organization to which patients returning. Also, the general Problem of the relation of social factors to choice and results of psychiatric treatment, and the specific prohlem of the relation of these factors to the referral patterns led to a series of population studies. In one study (33), 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. Thus, patients who were older, poorly educated, had higher F scores and were foreignborn, particularly in Eastern Europe, were most likely to be referred for electroshock. These relationships were present independent of diagnoses. Within the group of electroshock patients, the time for referral for ECT was also related to these factors. In a second study (18), duration of heapitalization, discharge evaluation and diagnoses were related to the same social factors. For example, patients hospitalized for the shortest period were oldest, had the least education, were most likely to have been foreign-born and had the higher P Scale scores. Younger, nativeborn, more educated, lower F Scale score patients were hospitalized the longest. These relationships held true within treatment type and within diagnostic class. On discharge, older patients had the most favorable ratings. In ECT, patients rated as recovered or much improved had the highest F scores, least education and were most likely to be foreign-born. In another study of patient were �refusal of similar relationships were observed (3h). These relationships are now under study in the Out-Patient Department, and in a tri-hospital comparative study. In the latter study, the populations of three hospitals with prevailing differing clients, in which all therapies areenually available to all patients, - Menninger Foundation Hospital (upper-class, Protestant), Massachusetts Mental Health Center (lower-class, Catholic) and Hillside Hospital (middle-class, Jewish) are being assessed. It has been “postulated that these relationships reflect the influence of social background on psychological processes, such as habitual patterns of communication and modes of expression. The contribution of these factors to the pattern of mental illness, and the patient-therapist interaction are under study. ECT, �SUMMARY Departmental programs are a cluster of interrelated studies focussed about common population samples. Within Hillside The HOSpital, research laboratories in Biochemistry, and in Medicine are active; and other laboratories in psychodynamic psychiatry are being developed. In this Department, various disciplines are participants, representing a gradual growth of six years. Further growth and the directions of ensuing studies are dependent on the results of the studies described here; as well as the growing institutional awareness that research is an integral part of the hospital's operation and budgets - as much as treatment and staff training. �~16- References Authors of the following references include the following staff members: Max Fink, Max Pollack, Robert L. Kahn, Joseph Jaffe, Martin A. Green, Eric Karp, Korin, Donald F. Klein, George Krauthamer, Arnold G. Blumberg, Nathaniel S. Siegel, Abraham Kaplan and Henry Hyman J. Lefkowits. 1. J. Hillside Hosp. 6: 197, 1957; 2. Dis. Nerv. Sys. 12: 3. J. Hillside Hospital h: 13h, 1955; 113, 1958; h. J.A.M.A. 166: 18h6, 1958; 5. Psychopharmacology Frontiers, Little, Brown 6. Neuropsychopharmacology, Elsevier, hhl, 1960; 7. A.M.A. Arch. Neurol. & Psychiat. 18: 516, 1957; 8. Dis. Nerv. Sys. 12: 227, 1958; 9. J. Hillside Hosp. A: 3, 1955; 10. Arch. Neurol & Psychiat. 16: 23, 1956. & Co., 325, 19593 11. First Int'l Cong. Neurol. Sci., Pergamon, 613, 1959; 12. Jour. Nerv. Ment. Dis. 129: 117, 1960; 13. A.M.A. Arch. Gen. Psychiat. (in press); 1h. Unpublished manuscript; 15. Jour. Nerv. Ment. Dis. 129: 187, 1960; 16. J. Neuropsychiat. l: 2h2, 1960; 17. Jour. Nerv. Ment. Dis. 128: 2h3, 1959; 18. A.M.A. Arch. Gen. Psychiat. l: 565, 1959; 19. A.M.A. Arch. Neurol. & Psychiat. 82: 20. EEG Clin. Neurophysiol. 13: 359, 1960. 380, 1958; J. g: 1663, 1959; 22. J. Hillside Hosp. 6: 2hl, 1957; 21. Canad. Psych. Assoc. 16: 88, 1956; 23. Conf. Neurol. 2h. Am. J. 25. A.M.A. Arch. Neurol. g: 5&7, 1960; Psychol. 13: 38h, 1959; 26. Proc. XV Int. Cong. Psychol., North-Holland, 238, 1959; 27. J. Neuropsychiat. l: h5, 1959; 28. Psychopathologx of �-17- m Communication, Grune ' & Stratton, 126, 19583 29. J. Hillside Hosp. 6: 207, 1957; 30. Psychiat. g3: 2&9, 1958. 31. Jour. Nerv. Ment. Dis. 130: 235, 1960; Psychiatric HOSp. Drug Therapy, C.C. Thomas, 29, 1960; 6: 216, 1957; 3h. Unpublished Manuscript. 32. ngamics of 33. J. Hillside �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, electro— encephalography, 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 8: 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 insulin 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). l. 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-mal seizure (9, 23, 42). The signiﬁ- �EXPERIMENTAL PSYCHIATRIC RESEARCH 161 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 “euH H 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 Convulsz've Therapy: Seeking a way to augment the degree of postconvulsive EEG slow-wave activity, an anticholinergic compound diethazine, was given intravenously at various stages of the convulsive therapy process (20, 24). Unexpectedly, diethazine caused an immediate and sustained decrease 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 excitement, 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). 3. Psychotropic Drugs and EEG: Following these studies, the neurophysiological changes induced by drugs were tested within an �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 (31), 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 staﬂ 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 therapies. 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 clusters 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. (13) Neurology, 4:211, (15) ibid., 76:23, 1956; 1956; (18) EEG Clin. (20) ibid., 10:207, 1958. (21) ]. Am. Med. Assn., 166:1846, 1958; (22) Dis. Nero. Sys., 192113, 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 Communication, 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. Nero. Ment. Dis., 128:243, 1959. (31) Arch. Gen. Psychiat., 1:565, 1959; (32) EEG Clin. Neurophysiol., 11:398, (11) This Journal, 10:84, 1961; (12) ibid., 10:97, 1961; 1954; (14) Arch. Neurol., Psychiat, 72:233, 1954; (16) ibid., 78:516, 1957; (17) Conf. Neurol., 16:88, Neurophysiol.,9:180,1957; (19) ibid., 10:162, 1958; �EXPERIMENTAL PSYCHIATRIC RESEARCH 169 1959; (33) ibid., 12:243, 1960; (34) Canad. Psychiat. Assn. ]., 4:1668, 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. ]. Psychiat., 116:839, 1960; (40) Neuro-Psychopharmacol., 1:441, Elsevier, 1960. (41) J. Nerv. Ment. Dis., 130:235, 1960; (42) ibid., 1302187, 1960; (43) Arch. Neurol., 2:547, 1960; (44) Dynamics of Psychiatric Drug Therapy, Springﬁeld: Thomas, 29, 1960; (45) J. 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. (51) ]. Nerv. Ment. Dis., 132:153, 1961; (52) Medicina Experimentalis (in press); (53) VA Conf. Psychopharmacology (in press); (54) Arch. Gen. Psychiat., 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. ��IIIIIIII, IIII III IIIII, IIIIII I mill‘iﬂﬁl IIIIIIIIII IIIII 3,963.4. 16"”1WI m3 “It W “WI IIII. 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Round in At‘ttudou Pros-nu, tbs troutnont Stat! rink, 3.: lab}. on lbnnnru; 1321:0300: on ’uynhophnrnnaologia hut-wt, AH, ensue, my. link, 3.: BilB‘lIiOl a: Ptythologicnl and ltoohcnietl Synthosou Occurring Duran: 10907097 tron Parana-cl, by lagoon, 8., Andornnnn, K.: It“. ABA, III. rank, n.: laurophyuiologic«Adaptive 1:0! or canvulutvo rhorupy Bound table on 'luarophyutological chin... with iloetroconvulsivo rhurapy', ARA, chioaao, ”by. rank, u.a chn1runn, coat. on Ila tad Eula: Paychcpharnnaoloxy. World CongrOII of Plyuhlutry, Houtrutl, Juno. rink, u.: 336 troqnoucy tad rnynhotropio Bras Activity, nautuchn Arbuitoaunoxnschttt tit luurnpnychopharnukolozio, hub-r: , Supt. rank, n.: In. convulsive thorapy Press-a, Itstoru nil-our: Paynhtntrtc Sacioty, at. tonic, ectobar. rink, 1.: Ila and lulnn rayohophlauaaolony, 2.1a notioutl Ioaosrch contoronoo, lovonhor. :14 lohuvtor, link, n.2- Plyohotrtplc Brunt, train Function ancona county 8.010%: a: Icurology 33¢ Puychintry, Duct-bar. �Q .2“ 5195.9’ and :39 r11okcr rruqnaaay 3.: critical x»rp 3911:511Sty ; Study, Sulturl Payohaiuztcnl Lauoutu‘tul, Pundnlphu , lurch. 11.13, 3.: rypolou at thnviorsl Gunman with Ph¢ngthtuuiao ﬁndicntlan, Gout. nu auhtsophrcutn, at. Elisabeth' a lcupztal, J;n., W‘shingtan. Pollack, n.:' 3.1. a: ltur01&¢tea1 Dyntunotlon 1n tho childhood schizophraninn, Lynx. arthapuyohiatric Auioc., 8.3., Burah. in Pollack, n.: scatnl £Ipo¢ta of Paytltnirtc Ironinout YA V1 Aunnnl Problcnn, Hothtdologia loupst‘la: first nsonareh can:., Bantinuaﬁt, Karen. “ or Sinnlﬁantous StimulaPullnck, H.s attordcrcd Pgraopt1¢n ttou a: rsoc-aad Hand: A Ravine and thaory, Sac. 3101. Payohtnt., Atlantic Gity, Juan. 810301, 1.: Diagnosis and truatnon‘ 1n Thrao Pnywhtntrto noapitala, An. Saelologtcal Lss¢o., 8%. Louis, Aug. �\ PUBLICATIONS OF DR. MAX FINK 1950 1. 2a. Subdural Hematoma Developing During Hospitalization, Amer. J. M. 1950 Dr. (With Green). 107: 381-383, Pszchiat. Patterns in Perception of Simultaneous Tests of Face and Hand, Trans. Amer. Neurol Assoc. 72: 250, 1950 (with Drs. _' Ereeni. & Arch. Neurol. ibid, Pszchiat. ﬁg: 355-362, 1951. M.B. Bender and M. .... 3. 1952 Test as a Diagnostic Sign of Organic Mental Syndrome, Neurologz, 2: h6-58, 1952 (with Drs. M.B. Bender and M. Green}. Tactile Perceptual Tests in the Differential Diagnosis of 1952 21-31, Hillside J. Hosp. 1: Disorders, Psychiatric (with Dr. M.B. Bender). A Clinical Evaluation of Carotid Angiography, Conf. Neurol. 13: 181-195, 1952 (with Dr. J.M. Stein). Exosomesthesia, or Displacement of Cutaneous Sensation into 1952 Amer. Assoc. 1Q: Neurol. Trans. Space, Extra-personal .B. Ben er . (with Drs. M.F. Shapiro an & 1952. h81-h90, Neurol. Arch. éﬁ: ibid, Pszchiat. .... Order of Dominance in Cutaneous Perception, Trans. Amer. Neurol. Assoc. 7h: 238-2h0, 1952 (with Drs. M.B. Bender and M. Green}. Patterns of Perceptual Organization with Simultaneous Stimuli, Arch. Neurol. & Ps chiat. 13: 233-255, l95h (with Drs. M.B. The Face-Hand '- Bender and M. areani. 1953 8. 9. HeDeielopment of Perception of Simultaneous Tactile Stimuli in 1953 (with Dr. M.B. 27-3h, 3: Neurologz Normal)Chi1dren, Bender . Perception of Simultaneous Tactile Stimuli by Mentally Retarded Adults, J. Nerv. Ment. Dis. 117: h3-h9, 1953 (with Drs. M.B. Bender and M. Green). �-210. 11. Spinal Fluid Findings Following Cerebral Angiography, Neurol— ( 1953 with Dr. J.M. Stein). 137, ogz'g: A Statistical Study of a Psychoanalytic Hypothesis: Absence of a Parent as a Specific Factor Determining Choice of Neurosis J. Hillside Hosp. 3: 67-71, 1953 (with Dr. S. Tarachows. 12. 13. Effects of Barbiturates on Perception, Trans. Amer. Neurol. Assoc. 15: 1953 (with Drs. M.B. Bender, P. Bergman and M. Nathanson). Homosexuality with Panic and Paranoid States (Case Report) J. Hillside Hosp. 3: 16h-19o, 1953. l95u Standardization of the Face-Hand Test, Neurology, h: 211-217, l95h (with Dr. M. Green). 1955 Test in Patients with Mental Illness, J. Hillside Hosp. 3: 3-13, 1955 (with Drs. R.L. Kahn and E.A. Weinstein}. Delusional Reduplication of Parts of Body after Insulin Coma Therapy, J. Hillside Hosp. A: 13h-1h7, 1955 (with Drs. R.L. Kahn and D. Graubert). The Amytal 16. 195 O\ 17. 18. 19. Relation of Amobarbital Test to Clinical Improvement in Electroshock, Arch. Neurol. & Ps chiat. 16: 23—29, 1956 (with Drs. R.L. Kahn and E.A. Weinstein). Evaluation of High-Dose Reserpine Therapy for the Relief of Anxiety, J. Hillside Hos . g: 67-77 (April) 1956, (with Drs. M. Wachspress, 1.5. Blumberg and J.S.A. Miller). Relation of Changes in Memory and Learning to Improvement in Electroshock, Conf. Neurol. lé’ 88-96, 1956 (with Drs. H. 20. Korin and S. Kwalwasser). Denial of Blindness Following Cerebral Angiography, J. Hillside Hosp. 5: 238-2h5, 1956. �-321a. Quantitative Studies of Slow Wave Activity Following Electroshock, EEG. Clin. Neuro hysiol. 8: 158 (abst) web.) 1956 (with Dr. §.E. Kahn). Relation of EEG Delta Activity to Behavioral Response in Electroshock: Quantitative Serial Studies, A.M.A. Arch. Neurol. & Psychiat. 18: 516-525, 1957 (with Dr. 5.5. Kahn). 1957 22a. Clinical Response to Megimide, EEG. Clin. Neurophysiol. 2: 180, 1957 (with Dr. M. Green). Clinical and Electroencephalographic Effects of Megimide in Patients without Cerebral Disease, Neurology 8: 682-685, EEG and 1958, (with Dr. A Green). Unified Theory of the Action of Physiodynamic Therapies, J. Hillside 26. M. Hosp. é: 197-206, 1957. Perception of Embedded Figures After Induced Altered Brain Function, Amer. Psychol. lg: 361, 1957 (with Dr. R.L. Kahn). Social Factors in Selection of Therapy in a Voluntary Mental Hos . g: 216-228, 1957 (with Drs. Hospital, J. Hillside R.L. Kahn and M. Pollacﬁ}. Role of Stimulus Intensity in Perception of Simultaneous Cutaneous Electrical Stimuli, J. Hillside Hosp. é: 2h1-250, 1957 (with Dr. H. Korin). 1958 27. Changes atholo grune & 28. 29a. in Language During Electroshock Therapy, in Psycho- of Communication, Ed. Hoch, P. and Zubin, gtratton, 1958, {with Dr. R.L. Kahn). J., Lateral Gaze Nystagmus as an Index of the Sedation Threshold, EEG. Clin. Neurophysiol. 12: 162-163, 1958. Effect of Diethazine on EEG and Significance for Theory of EEG. Clin. Neurophysiol. 19: 207-208, Therapy, Coggulsive 19 . Effect of Anticholinergic Agent, Diethazine, on EEG and Behavior: Significance for Theory of Convulsive Therapy, A.M.A. Arch. Neurol. & Psychiat. 82: 380-387, 1958. �-uidem, Biol. Psvchiatr THE-195. 29c. New 30. 31. ‘ 32. 33a. b. Bha. b. YorE, ed. Masserman, , J., Grune & Stratton, Experimental Studies of the Electroshock Process, Dis. Nerv. Sys.. 12: 113-118, 1958, (with Drs. Kahn and Green}. Comparative Study of Chlorpromazine and Insulin Coma in the Therapy of Psychosis, J. Amer. Med. Assoc. 166: 18h6-1850,1958 (with Drs. R. Shaw, G. Gross, and E.§. Coleman). Electroencephalographic Correlates of the Electroshock M. 1958 Green). Dr. Nerv. (with Dis. 227, Bye. l2: Process, Experimental Studies of Convulsive and Drug Therapies in Theoretical Implications, A.M.A. Arch. Neurol. Psychiatry: & 1958 (ﬁEtE‘ﬁ?§T'§TE?'EEEE‘ 80: 733-73h (abst.), PSﬁchiat. an . . reEK). Alteration of Brain Function in Therapy, in Ps & N. Brown Co., Ed., Frontiers, Kline, Little, cho harmacolo y BosEon, 1958, Pp. 325‘3320 Effect of Anticholinergic Compounds on Post-Convulsive EEG Behavior, EEG. Clin. Neurophysiol. lg: 776 (abst.). Effect of Anticholinergic Compounds on Post-Convulsive EEG and Behavior of Psychiatric Patients, EEG. Clin. Neurophysiol. 13: 359-369, 1960. and 1959 35. 36. 37a. b. Effects of Diffuse Altered Brain Function on Perception, in Proc. XV Int. Con . Psychol., North Holland Publ., Amsterdam, [959, PP. 238-259 (with ﬁrs. R.L. Kahn and H. Kojéﬁ)..lk~u-Al Diff rences in Psychological Factors Affecting Individual Jwﬁfgvﬁt Behavioral Response to Convulsive Therapy, 2h3-2h8, 1959 (with Drs. R.L. Kahn and M. Po ac 128: Significance of EEG Pattern Changes in Psychopharmacology, EEG. Clin. Neurophysiol. 11: 398 (abst.) 1959. EEG and Behavioral Effects of Psychopharmacologic Agents, Neuro-Ps cho harmacolo y, ed. Bradley, P., Elsevier, REE-HES, T950. Amsterdam, 38ayr / Electroencephalographic and Behavioral Effects of Tofranil: Canad. Psych. Assoc. J. h: 1668-1713., 1959. v.9w. �-5; (abst.), 38b. Idem, EEG. Clin. Neurophysiol. 13: 2h3-hh 39. Relation of Tests of Altered Brain Function to Behavioral Change Following Induced Convulsions, The First International Con ress of Neurolo ical Sciences (III: EEG, Clinical Neuro— and EEIIepsyi, Pergamon,‘fondon, 1959, pp. STE-519 physiology W a n and H. Korin). ran 1960. . a of Set in the Perception of Simultaneous Tactile Stimuli, Am. Jour. Psychol. 13: 38h-392, 1959 (with Dr. H. The Role Korin). Personality Factors in Behavioral Reaponse to Electroshock l: J. Neuropsychiatrz Therapy, Kahn . h5-h9, 1959 (with Dr. R.L. Wm: Sociopsychologic Aspects of Psychiatric Treatment in A Voluntary Mental HOSpital: Duration of Hospitalization, Discharge Ratings and Diagnosis, A.M.A. Arch. Gen. Ps chiat. """ _1_: 565-571., 1959 (with Drs. R.L. and M. Pol ac . 1960 h3. Efficacy of Divided and Single Dose Schedules in Insulin Therapy, Coma J. Am. P8 Drs. A.G. BlumEerg and hh. h5. h7. h8. 1960 (with Eaderman). in Verbal Transactions with Induced Altered Brain Function, JNMB-IBO: 235—239, 1960 (with Drs. J. Jaffe and R.L. Kahn).: S;uw.UUub‘Jua'but Drug Induced Changes in Intervi w Patterns: Linguistic and Neurophysiologic Indices, in ‘__Dynamics of Psychiatric Drug Therapy, ed. G.J. Sarwer-Foner, C.C. Thomas, Springfield Changes 9“ pp. h6. 116: 839-h0, chiat. %. ’ Jaffe 1960, (With Drs. Jo Social Attitude (California and R.L. Kahn). Scale) and Convulsive Therapy -JNMB 130: 187-192, 1960 (with Drs. R.L. Kahn and M. Pollack). 5.“,"wllua-Du‘ Figure-Ground Discrimination After Induced Altered Brain Function, A.M.A. Arch. Neurol. 3: 5h7~551, 1960 (with Drs. R.L. Kahn and M. PollacES. F Prognostic Value of Rorschach Criteria in Clinical Reaponse to Convulsive Thera 1960 2h2-2h5, J. Neuropsychiatrz y, l: Kahng. (with Dr. R.L. r .2” //£ .'V ' '.. / «n: Ln 1 I aré/a /->" -'- f, 4' _.” ‘. a“ ’34 45.114.” 7;” gay” n)/m / (j " 6.. ff) ,1"? ' "'4 K p (1 ‘ H y ,y /" m; «1" (rm *4 I 3 . , w V if“. r 51:3 ‘ /7w,« 5mm... x {5" ‘ ‘*' 4'" /‘ (a 3.1;,' A A.' g ”z " e, p/fivJ’J‘ “l ' W. “if 3 f/ a 3 (f ‘- , / ’5 K £9 / 3%» u �- 1961 h9. Modification of Psychotherapeutic Transactions by Altered Brain Function, Amer. J. Psychother. 1E: hé-SS ( with R.i. Kahn). Neuropsychologic Response Patterns of Some Psychotropic Drugs, Neuro-Psycho harmacology 3: 38l-38h, ed. E. Rothlin, Elsevier, Amsterdam (with M. Pollack, E. Karp, G. J. Jaffe, SO. H. Esecover and Krauthamer and D.F. Klein). 51. Problem of Antagonists to Psychotropic Drugs, 30-320 ibid, Inhalant-Induced Convulsions, A.M.A. Arch. Gen.Psychiat. h: 259-266, (with R.L. Kahn, E. Karp, M. Pollack, M.A. Green, B. Alan and H.J. Lefkowits). 53. Behavioral Patterns in Convulsive Therapy, A.M.A. Arch. Gen. Psychiat. E: 30-36, (with R.L. Kahn). Sh. Sociopsychological Characteristics of Patients Who 132: Refuse Convulsive Therapy, Jour. Nerv. Ment. Dis. —' """"“"“"""""""" M. 153-157, (with Pollack). SS. EEG Techniques in Study of Psychotropic Drugs, Acta of on Techniques for Study of Psychotro ic Int'l Meeting Drugs, Soc. Tipografica Modense, Modena, 1951. Withdrawal Symptoms Following Discontinuation of Imipramine Therapy, Amer. J. Psychiat. 118: 5h9-SSO (with J.C. Kramer and D.F. Klein}. 52. Experimental Psychiatric Research at Hillside: Review and Prospect, J. Hillside HOSEital 19: 159-169, 1961. Prediction of Individual Patient Response to Convulsive Therapy, VA Coo erative Chemothera y Studies in Psychiatry é: 317-325, 1951. Social Aspects of Psychiatric Treatment in Three HospiVA Coo erative Chemotals: Methodological Problems, 202-205, 1951 (with Studies in thera Psychiatry é: M. PoElack, N. Siegel and R.L. Kahn). Quantitative Electroencephalography and Human Psychopharmacology: Frequency Spectra and Drug Action, Medicina Experimentalis i: 36h-369, 1961. '7 -.\,A.-r-w, . -ﬁm... , _. ,, .1 . um.» . .4 m A~ a ‘R .1.” �1961 c" h9. Modification of Psychotherapeutic Transactions by Altered Brain Function, Amer. J. Psychother. 15: h6- SS ( with J. Jaffe, H. Esecover and R. f. Kahn).“ Neuropsychologic Response Patterns of Some Psychotropic Drugs, Neuro-Psycho harmacology 2: 381- 38h, ed. E. Rothlin, Amsterdam (with M. Pollack, E. Karp, Elsevier, G. Krauthamer and D. F. Klein). Problem of Antagonists to Psychotropic Drugs, 30'320 ibid, Inhalant- Induced Convulsions, A. M. A. Arch. Gen.Psychiat. h: 259- 266, (with R. L. Kahn, E. Karp, M. Pollack, M. A. Green, B. Alan and H. J. Lefkowits). 53. Behavioral Patterns in Convulsive Therapy, A.M.A. Arch. Gen. Psychiat. E: 30-36, (with R.L. Kahn). 5h. Sociopsychological Characteristics of Patients Who Refuse Convulsive Therapy, Jour. Nerv. Ment. Dis. 132: 153-157, (with M. Pollack). 55. 56. Techniques in Study of Psychotropic Drugs, Acta of Int’l Meeting on Techniques for Study of Psychotro ic Drugs, Soc. Tipografica Modense, Modena, 1951. Withdrawal Symptoms Following Discontinuation of Imipramine Therapy, Amer. . Psychiat. 118: Sh9—SSO (with JKlein}. EEG J. C. Kramer and D. F. CriticalEEGFlicker Frequency and EEG Alpha: A Reliability Clin. Neuro hysiol. (with E. Karp and Study, M. Pollack}. ‘ Neurophysiologic-Adaptive View of Convulsive Therapy, J. Neuropsychiat: Disordered Perception of Simultaneous Stimulation of Face and Hand: A Review and Theory, Biological PsychiaM. IV: (with Pollack). try, Factors Associated with the Selection of Applicants for Out- Patient Psychiatric Treatment, Social Issues. (with The N. Siegel and R. L. Kahn). �1962 I..— 61. 62. Critical rlicker Frequency and Alpha: EEG Olin. lenroghzeio1., __c Study, EEG and x. Pollack). A Reliability 1962 E. Karp (with , of Action of Convaleive Therapy: The Neurophysioe logic-Adaptive View, J. Neurogezchiats, ;; 231-233, 1962. The node Disordered Perception of Simultaneous Stimulation of Pace and Hand: A Review and Theory, Biolo icel Pe chiatr , IV Ede Jo 6h. Hortil, Ch‘pe 31, (With He P011.Ck)e Tachietoeoopic Perception After Induced Altered Brain Function: Influence of Hental Set, J.l.H.D., : , 1962, (with 1!. Pollack, 11.1.. Kahn and E. Kerp). Psychiatric Reaction Petterne to Inipraline (Torranil), 1962 D.F. Au. Jour. Pezchiat., __: (with Klein). , 66. Behavioral Reaction Patterns with Phenothiasinee, A.M.A. 1962 D.F. Arch. Gen. Pczphiat., __: (with Klein). , Quantitative Electroencephalography and Hanan Peychopharaacology. II: Drug Patterns, in EEG Correlate of Behavior, ed. 6. Glaser. 68. Iniprenine an an Adjunct to Phenothianine Therapy, Cong. Pezchiatrz, __c , 1962 (with J.c. Kramer end D.F. Klein). �69. Motivation in Psychotherapy, (with 70. H. Co . Po ohintr , z , 1962 Siogol). Rating Sooloo as Bohoviorol cpango Hoaauroo in Payohophorna1962 cology, v.1. Coon. Chonothor. St. in Pozchiat., 1: , (with DJ. Klein) . ��1. 195“ ~- 1 ‘ .3)... Standardlzatlm of the Faee=~Hand Test, 1H1 . 1. . . ~..‘-.~-:- 1- _. 1.1,..1 "9:“ .1: (mthM. _Neumlog:’21'1=12'17*,~ if} ‘ -.1955 ; 157° 1.'i That 1n Patlents w1th Mental Illness, J1 .axld . (With . R9 Ed A01m; 126111). Kahn Ly} of ‘Deltslmal Redupllcatlm of Parts Insuhn after «)1...’ R1 13911147 Kahn L1 D1 and (mth H0321“; i151 Coma Therapy, - . ' A I ' . - .3 . of ' Relatmn E17 1 ' 1 ~ . . f;-';tal ____ 19.1 mmlxla 201 . Denlal S1. _ = ' of Bhndness Pollowmg Cerebral Angh , cal .2231 1”” 'bo ‘ ’ Response ' ; to Meglmde, ﬁle ”j 1197:206 r 213-1 f; '1' ; 1. . 1... =1. ‘ 3. 1 1 1 ’ 3 , of Megumde in Patlents mthout (mth M1 Greenl1 »"."I_phalog'aph1c Effects Cerebral Insease, Neum'Ly 18;". 682-685, A Umfled Theory of the Aenm of PhysL; . 231 5.; ‘ 1957? - . «11 ‘ . 1 111111111311, .. J1 ,~ » 1 . . ; . 1 1 1. _ . Percep'aen of Enbedded ﬁgures After Induced Altered Iram hmctlon, Arlen -_Ps »12 361, (with R1 L1 Kahn)1 ‘“‘ﬁf_= _ . , 1 . E ' '1 2511 i 1 261: Soclal Factors 1n Selectman of - 3 17'.“- ‘3 " 3 , ‘ Quantltauve Studlee 80f Slow Wave Act1v1ty Follcmno Electroshock, 158 (Feb1) Absmct (with R1; L1 Kahn)1 . :,li .‘7 ' Evaluatlcm Of High-Dose Fez-35': Therapy for the Rehef of Annety, J1;;H:LlJ.81de_ M1. A1 G1.B (mth (Apml), Wadxspress, .1 3057515 57.77, 'Relatlcn of Changes 1n Learnmg to Improvement in Electroshodt, and ("3.11.12 'arld '85:." K' waSSer) (mm Hﬁ 88"96 '18” - 5? ~1 Test to Chnlcal Improvement 1n Bleetmshock,‘ Arch New?“ Psichlat1; Chmagoﬂﬂe23-29, (w1th R1 L1 Kahn and E1 A1 Welnsteln) 1 . 1955 ' .” ‘ lay an . a Voluntary kntal Hospltal, J 1 H11151de:. "i 3 �, _ j, . ,R-Pwmmgw;wwﬁssuu 955.3,umnm'», a. . . ,_ . hock ' fef'lheor‘y sP: Con " '- 4 ,l 5x2 Therapy, Po Koch and Jo Zubin (Edltors), {Gr-me s‘ Stmtton, New. .p 125-139, '1; wt, methazme, on EEG and Behavmr- SIgmfIcance unease . , g3; 380-387 . Q Q . ‘ :1:- . . ,s \‘..:- '- 1‘s u.“ I, ILJMMJI-L‘LL . ,' ' a . . : u QL‘_=A-uzca-m‘:& :‘ﬁ'u was '.Q“ ‘ ,.Q.- .ijhV‘. 19 227 ' , . ‘ (w1‘th ’Ms I ‘n)s, .“v Q Bwemnental Studles 'o‘f Oonvuls1ve and Drug Theraples In Psyclua} 'Inphcanons, Arch Neurol“ Psychlato, meaty, 80 733-734Abstract, (mth Alterauon 1:, of Emu Functlon in Therapy, Em s C00, mule, :uezs Effect of ArrtIcholmec No pp‘325-332 1959., and BehaVIor of 19600 359=339. "101ﬁ12 as an Post-Oonvu131ve Psyehla' a'ilfie Panents , Electr-éeneeﬂ f: ,. L EEG 1959 I ‘ ' 35-0) I as "Effects In Proc. ‘XV Into Kalm Ro and 238-239 Austerdam), L; Holland, pp Amt}: en Percepuon, 1:0 BehaVIoral Response IndIVIdual DIfferenees In Rio Psyduologleal Factors Affectmg Ls Ka‘r-m and 'Convulswe Therapy, J]° new mento msquzsjzuaszua (szth Mo was of mffuse Altered Bram thctlm Pode) 9 , I. \ SIgnIeranoe of EBG Pattern Changes In Psychhanralogy, Neum 111.551010» 11k. 398 Abs ' . H ' 1: ��1951 (tmued) ' M031”Kahn)e 1 is Who Refuse Cmvulswe Therapy, Somyeheloglcal maractemstlcs of Patlents M, Pollackh J3, mm n‘ento (mth 153457 2132 Tea‘zmqmu 1:: Study of Psyebopm Draws, 3x3, £13.,”31103 EEC 360: _; 7" 1 ‘ 5;; ' ‘EJS'EID . : '- Masque ‘ * _, one Pollemng mcontlnuauan C46 51‘9‘9550 (With - 159631:sta . insauz, E . Ele ' 60;; E Jo - ..-. _ ,. . :é'. « ,1 I ’* « :1 E? 1629; i. /63 1 Eggs ijhActlm elol wlswe of _N_:;3:3c::ruat13 23133233 The Mode (21": gist}; ‘ .j.-_. 650 - ilj. 1%.th 31,-- Mp 362-36 J o , : . 1 . _ ;~' , A 1:29 Fa Klemh " ' The NemphysmloglesAdaptlve View, . of Face and Hand: A ;{~i‘;:"_‘"fw5at':0n‘ " 7'" : “22"430, (Wlth Mo Renew " Press, Inc;..,_ (Elenmn "(-2 . 0n: Pellack, 3 rehens Inﬂuence Of Ra Lo Kat-1n ~3PM1;]th4!a“.179-173 (szth 1 1"*0. Reactim Pattems 1:0. Im:.jjf;":;i‘:: 2132:4138, (mth ‘ Rehablllty Study, Electroence’ho M‘. Pollack). and Karp 'Z‘iiMy: -i; _‘ _ 3'4“ 3...»... i: '7 -5' . ’ , 1 . 2 :Tadustoscoplc Perception After Induced Altered Brain Mental Set, :Lonerve '65:) KIM)9 "‘ ' Alter-o ' 80u63 (nth E0 and Theory} «Jo-worn" 3 ~ 3111- 'Dlsordered Perceptmn Of 51ml1‘1_‘{-Ifi; E61!» ' F0 sane-3690 "anneal Fucker Frequency and EG Alpha New York)Chapta E Impnamme Therapy, and 13-0 -» : - 1962 . 2* dMe- «maﬁa -Quant1tauve Spectra and Drug Acum, Mada . g 61 off. _, Expemnental Psychlatmc Research at Hlllslde Renew and Prospect, Ja Hlllszlde _ Ej’V j:.at £118 ‘ r ;-;- +2 {j - ’“V Nu and Slegel)‘, ��Publications - 1963 and Human Psychopharmacology, (Abstracts, 1961 Meeting, Mbntreal), Electroenceph. clin. Neurophysiol. lg; 133-137. 7/~ EEG 72. Multiple Item Factors as Change Measures in Psychopharmacology, Psychopharnacologia M: #3-52, (with D. E. Klein). 13‘ Quantitative Electroencephalography in Human Psychopharmacology II: Drug Patterns, In: G. 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Cromwell, and M. Brown). and Im1pram1ne of Chlorpromaz1ne on Perceptual Analytic Effects Ability, Perceptual Responsivity and Memory as Revealed in Rorschach Responses, J. nerv. ment. Dis., (with I. Belmont, M. Pollack and A. Willner). (In Press) �Nm~£xpcrim1ts1 B. ‘9. 1. BookRevimdeattm 23m" use, 33 W W3 Diffcmtial Trcctmnt and R. D. Win: and w. Simon, 1:. c. sispringficld. Illinois); 1959." 121-122. in Schizoplmmic. m. Revicwqé' Amh. Experimental Studies of the Mode of Action of Electroccnvulsivs Therapy Jun-Otto. Ottosoon (Editor) . get; pm KIWI c ("ET—MW, {swam Scam. 6'39 PM The i A Symbol Wo_ ” V“ .. 3"me m 1 clin. .3. Will J. Hillside (Bateugf’: “' R. 001m 1956. 111.7. Home 8101. 1952, Psychiatry H. Bruin (Editor), Pittsbm‘gh‘ﬁ 1961. ENG. 11093., 1962, 31;: Review“? .. W Doomtraliutim of Psychiatric Services and Ccntinuity Milbcnk of Md, 1961, CmL3thliM Pictorial Fund, Na York. 1982. Ravi“. ”of mm of. mm: cad m._ War, 1963, 3.: Jm» Intmticncl Dicticnm ' ’ in Clinical Medicine, harm KUniv. Pittsb‘n‘gh Press, on 0 (Esmgfyﬂwkgaﬁi 1361. E: :52. MMMHMNWNL '15.!) Psychic Graphs-M. of Pour “yﬂxginsgiﬁwﬂmiﬂﬁ V 78-79. ”W, Us 1;)“, C. C. Homology and WWW, cog, . a“ Wit: for Electra; Indicgtdgrs QumtiStctua cmvulc wk 'Ihcmpy. latter to the tar. {an};m. of ﬁg. 23: 292-293. P " mm Mt m, Emmi/1953. in of Inubmctim to Physical chiam,"w: Scrgcnt and E. Slctcr ”"W, An» 4 ' a; 1983*; and Wilkins new, 1mm“ (In mas) Review-dahntcl Mitch. ' , Cap 42.: ! ”1/ @3234 � 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 Research Files and Unpublished Works 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 [Hillside] Hospital annual report (folder title). Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-03-01-001-0-008 Date A point or period of time associated with an event in the lifecycle of the resource 1956-1960 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 <a href="http://id.loc.gov/authorities/subjects/sh85113021">Research Files</a> and Unpublished Works -- Hillside Hospital, Glen Oaks, NY, 1953-1965 Relation A related resource The Max Fink Collection Description An account of the resource Experimental Psychiatric Programs at Hillside Hospital - A Review (several). 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 Research