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Phenylpropanolamine effects
LETTERS Phenylpropanolamine effects Sir: In the article "The differential diagnosis of catatonic states," by Dr. Alan Stoudemire (Psychosomatics 23:245-252, 1982), the drug phenylpropanolamine should have been included as an etiologic agent for catatonia that may clear spontaneously within several days. Phenylpropanolamine is found in such a multitude of prescription and over-the-counter drugs that its use and abuse may go undetected without a meticulous drug history. Theodore J. Marshall, M.D. Pensacola, Fla. Dr. Stoudemire replies: You may want to refer to a recently published article (Escobar JI, Kamo MD: Chronic hallucinosis from nasal drops. JAMA 247: 18591860, 1982), which indicates that psychotic episodes have been associated with sympathomimetics. However, I am not aware of their causing a catatonic syndrome. Unless adequate documentation from the medical or psychiatric literature can be provided for this clinical observation, or you have a case report that can reliably establish such a side effect, at the present time I do not feel that it would be appropriate to list this as an etiologic agent for catatonia. Alan Stoudemire, M.D. Duke University
Irritable bowel Sir: I read "The efficacy of group therapy for patients with irritable bowel syndrome," by Drs. Wise, Cooper, and Ahmed (Psychosomatics 23 :465-469, 1982), with great interest since I had recently OCTOBER 1982 • VOL 23 • NO 10
published a paper that included the discussion of an irritable bowel syndrome (lBS) patient treated with a behavioral method. 1 The authors used a combination of educational lectures, behavioral techniques, and a group therapy method to achieve a 30% success in reduction of gaseous symptoms. The symptomatic distress levels were significantly lower following treatment, according to the report. Were the reduced gaseous symptoms in 30% of the patients due to the behavior therapy alone?2 The patients who received more medication and followed the authors' method reportedly had less phobic anxiety. Was this due to the combined treatment? The decreased symptomatic distress level following treatment was noteworthy, as there was little improvement in the somatic complaints of the IBS. The report does not make clear what the medication levels were and how this affected treatment outcome. Jerome H. Feldman, M.D. New York REFERENCES 1. Feldman J, Meyding GF: Use of the amobarbital interview to determine appropriate behavior therapy. Am J Psychiatry 139:676-677.1982. 2. Garrick lR: Behavior therapy for irritable bowel syndrome. Gen Hosp Psychiatry 3:48-51, 1981.
Dr. Wise replies: We cannot identify the specific therapeutic components that led to symptomatic improvement in our study population. The intervention utilized included supportive, didactic, and behavioral strategies. Its utility lies in its positive acceptance by individuals who focus upon somatic complaints in lieu of
emotional difficulties. It would be unsound to compare our pre-test correlation of medications and phobic anxiety levels and the pretest/post-test measurement of symptomatic relief. We would speculate that individuals who utilized more medicine were more conscious of symptoms endorsed in the phobic anxiety dimension of the SCL-90. This may relate to the personality constructs of field dependency and locus of control. Thomas N. Wise, M.D. Georgetown University
Analgesics on market Sir: In the paper entitled "Recent clinical approaches to pain treatment" (Psychosomatics 23 :33-40, 1982), Drs. Flinn and Yung were incorrect in stating that butorphanol and nalbuphine are not yet on the market in the United States. Jeffrey S. Pevnick, M.D. St. Louis Dr. Flinn replies: Dr. Pevnick is correct in pointing out that butorphanol and nalbuphine are now on the market in the United States. Both are potent analgesics with narcotic agonist and antagonist properties. They are said to have a low physical dependence liability,I.2 although this has been challenged.) Both are now approved for parenteral use in the relief of moderate to severe pain. Don E. Flinn, M.D. Texas Tech University REFERENCES 1. Facts and Comparisons. SI. louis, Facts and Comparisons. 1981, pp 246 dog. 2. Miller PP: Evaluation of nalbuphine hydrOchlOride. Am J Hosp Pharm 37942-949. 1980. 3. Hoy RH: AsseSSing the literature on nalbuphine. Am J Hosp Pharm 38:469-470,1981.
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Irritable bowel Sir: I read "The efficacy of group therapy for patients with irritable bowel syndrome," by Drs. Wise, Cooper, and Ahmed (Psychosomatics 23 :465-469, 1982), with great interest since I had recently OCTOBER 1982 • VOL 23 • NO 10
published a paper that included the discussion of an irritable bowel syndrome (lBS) patient treated with a behavioral method. 1 The authors used a combination of educational lectures, behavioral techniques, and a group therapy method to achieve a 30% success in reduction of gaseous symptoms. The symptomatic distress levels were significantly lower following treatment, according to the report. Were the reduced gaseous symptoms in 30% of the patients due to the behavior therapy alone?2 The patients who received more medication and followed the authors' method reportedly had less phobic anxiety. Was this due to the combined treatment? The decreased symptomatic distress level following treatment was noteworthy, as there was little improvement in the somatic complaints of the IBS. The report does not make clear what the medication levels were and how this affected treatment outcome. Jerome H. Feldman, M.D. New York REFERENCES 1. Feldman J, Meyding GF: Use of the amobarbital interview to determine appropriate behavior therapy. Am J Psychiatry 139:676-677.1982. 2. Garrick lR: Behavior therapy for irritable bowel syndrome. Gen Hosp Psychiatry 3:48-51, 1981.
Dr. Wise replies: We cannot identify the specific therapeutic components that led to symptomatic improvement in our study population. The intervention utilized included supportive, didactic, and behavioral strategies. Its utility lies in its positive acceptance by individuals who focus upon somatic complaints in lieu of
emotional difficulties. It would be unsound to compare our pre-test correlation of medications and phobic anxiety levels and the pretest/post-test measurement of symptomatic relief. We would speculate that individuals who utilized more medicine were more conscious of symptoms endorsed in the phobic anxiety dimension of the SCL-90. This may relate to the personality constructs of field dependency and locus of control. Thomas N. Wise, M.D. Georgetown University
Analgesics on market Sir: In the paper entitled "Recent clinical approaches to pain treatment" (Psychosomatics 23 :33-40, 1982), Drs. Flinn and Yung were incorrect in stating that butorphanol and nalbuphine are not yet on the market in the United States. Jeffrey S. Pevnick, M.D. St. Louis Dr. Flinn replies: Dr. Pevnick is correct in pointing out that butorphanol and nalbuphine are now on the market in the United States. Both are potent analgesics with narcotic agonist and antagonist properties. They are said to have a low physical dependence liability,I.2 although this has been challenged.) Both are now approved for parenteral use in the relief of moderate to severe pain. Don E. Flinn, M.D. Texas Tech University REFERENCES 1. Facts and Comparisons. SI. louis, Facts and Comparisons. 1981, pp 246 dog. 2. Miller PP: Evaluation of nalbuphine hydrOchlOride. Am J Hosp Pharm 37942-949. 1980. 3. Hoy RH: AsseSSing the literature on nalbuphine. Am J Hosp Pharm 38:469-470,1981.
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