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Biomedical subjects

J J Ratey

Publications and source records attributed to J J Ratey.

At least 19 recordsLinked to original sources
PubMed1993

The effects of clozapine on severely aggressive psychiatric inpatients in a state hospital.

BACKGROUND: After noting a dramatic reduction in aggression and agitation in five psychotic inpatients residing on a specialized unit for the severely aggressive, the authors conducted a retrospective chart review to assess the possible role of clozapine treatment in this change. METHOD: The authors culled 12 months of nursing data, including progress notes, orders for seclusion, and mechanical and chemical restraint, to tabulate the frequency of aggression before and after the initiation of clozapine treatment, and looked at ratings on the Brief Psychiatric Rating Scale and periodic review reports to assess overall clinical change. RESULTS: The results of the review indicate that although psychotic symptoms were not greatly affected by the drug, the overall frequency of assaults, self-abuse, and the use of seclusion, mechanical restraint, and chemical restraint was reduced in the subjects. CONCLUSION: The authors conclude that because the reduction of aggression and agitation coincided with clozapine treatment, it is likely that clozapine was responsible for the change. The authors propose possible reasons for this effect and suggest that controlled studies are needed to substantiate these preliminary results.

Adult↗
PubMed1993

The psychopharmacology of aggression: toward a new day.

Psychiatrists should reconsider the use of neuroleptics and benzodiazepines as the primary treatment for aggressive behavior, as these drugs do not have a specific anti-aggressive effect. They reduce aggression often at the cost of grave side effects (e.g., tardive dyskinesia, akathisia, and cognitive dulling). Newer regimens such as beta-blockers, serotonin-agonists and serenics have fewer side effects, and do not negatively affect cognitive or attentive functions, allowing for more effective rehabilitation of the patient. These drugs are more specific, and positively influence the four axes of cognition, attention, arousal, and mood regulation, which, if unbalanced, can lead to a higher "noise" level, and thus increased agitation and aggression.

Aggression↗
PubMed1992

Defense behavior and coping in an autistic savant: the story of Temple Grandin, PhD.

The causal factors in the behaviorally defined syndrome of autism remain unclear, although the past decade has brought to bear two significant developments that shape our view of the disorder. The first of these developments is a growing body of biomedical research that indicates there are multiple etiologies associated with the disorder. This research has allowed for the formation of subgroups based upon neuroanatomical, neurobiological, and neurophysiological abnormalities (Damasio 1984; Piggot 1979; Ritvo et al. 1990). The second is neuropsychological research indicating that the socioemotional deficits are primary to the disorder and may underlie much of the behavioral symptomatology (Fein et al. 1986). These areas of concern undoubtedly have enhanced our understanding of the disorder, yet in their achievements they may too easily absorb what we know about autistics who experience a chronic state of physiological hyperarousal, evidence of which has been found in neurophysiological studies (Delius 1967; Hutt et al. 1965), neurochemical studies (Lake et al. 1977), psychopharmacologic studies (Ratey et al. 1987a), and behavioral studies (Kinsbourne 1980; Kootz et al. 1982; Tinbergen and Tinbergen 1972; Zentall and Zentall 1983). These individuals, perhaps constituting a subgroup of their own, experience an inner state of disorganization that markedly impairs their functioning (Sands and Ratey 1986).

Adaptation, Psychological↗
PubMed1992

A psychoanalytic study of eating disorders: I. A developmental profile of 67 index cases.

Much has been written in both the professional literature and lay press regarding the sociocultural basis for the current increase in eating disorders. The typical victims of these afflictions appear to be intelligent adolescent girls from middle and upper class families (Garfinkel and Garner, 1982). Although the general pressure for thinness, mastery, and achievement among women in our culture undoubtedly help shape the course of illness, these social mores do not appear to be its root causes. The data presented here suggest strongly that the truly eating-disordered individual has a history of disturbances in early relationships, leading to a lack of security and pronounced difficulties in trusting others, and in simply being an authentic individual in the presence of others. As such these individuals share many characteristics of others with severe personality disorders such as inner emptiness, problems with identity, fear of abandonment, and peer relationships (Clarkin et al., in press), but differ in the expression of these basic defects or in solutions found to compensate pathologically for these core deficiencies. Therefore, although contemporary cultural ideals and values may supply the shape of the disorder, these individuals would have fared badly in any social climate although their presentation of illness may have differed (Bemporad et al., 1988). It is this profound underlying personality pathology that necessitates prolonged treatment for any hope of amelioration. Later reports will address this indication with a description of the results of therapy.

Adult↗
PubMed1992

Paramenstrual aggression in mentally retarded adult ameliorated by buspirone.

OBJECTIVE: This case examined the efficacy of buspirone therapy as a reductive technique for severe treatment resistant paramenstrual aggression. METHOD: Aggressive outbursts of an institutionalized mentally retarded adult were analyzed and correlated with menstrual cycling. Behavior was closely monitored, and after ineffective trials of antipsychotics, benzodiazepines and beta blockers, a trial of buspirone was initiated. RESULTS: Buspirone therapy resulted in a marked decrease in aggressive incidences, and substantial increases in desirable behaviors. As a result of the subjects improvement, doses of concurrent psychotropic medications were reduced or discontinued altogether. CONCLUSIONS: The authors conclude that buspirone is an effective pharmacotherapy for paramenstrual aggression in the developmentally disabled, and encourage similar experimentation when behavior seems to be otherwise untreatable.

Adaptation, Psychological↗
PubMed1992

Nadolol to treat aggression and psychiatric symptomatology in chronic psychiatric inpatients: a double-blind, placebo-controlled study.

BACKGROUND: Considerable evidence indicates that the lipophilic beta-blocker propranolol is useful in treating organically based aggression. This study looked at the efficacy of a more hydrophilic beta-blocker, nadolol, to treat aggression in chronic psychiatric inpatients. METHOD: Forty-one chronic psychiatric inpatients with an average of one aggressive outburst per week (defined by the Overt Aggression Scale [OAS]) were entered into a double-blind, placebo-controlled study lasting 17 weeks. The OAS was used to track aggression on a per-incident basis, while the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impressions scale (CGI) were used to track clinical status. RESULTS: Nadolol subjects showed a significant decline in frequency of aggression compared with controls (p = .026) and a significant decline in the BPRS total score (p = .007) and in the subfactors "hostility and suspicion," "negative symptoms," and "signs of hyperarousal/tension." There was no significant change in CGI "severity of illness" ratings between groups, although the nadolol group was significantly improved from baseline at every subsequent time period while the placebo group was unchanged throughout the study. CONCLUSION: Nadolol is of significant benefit in the treatment of aggression in chronic psychiatric inpatients. This drug does penetrate the brain over time, but the success of a drug whose primary locus of action is peripheral may implicate a bimodal mechanism of action, i.e., a role for the CNS and the soma in the maintenance of aggression.

Adult↗
PubMed1991

Neurocognitive disorders in psychiatry: a case example of diagnostic and treatment dilemmas.

We present a case example that illustrates the diagnostic and treatment difficulties engendered by adult psychiatric patients with primary behavioral problems and neurocognitive disorders. In the case cited, the neuropsychological evaluation plays a significant role in reconceptualizing a patient who had accrued multiple psychiatric diagnoses including schizophrenia, borderline personality, and impulse control disorder. Formal examination revealed deficits in language, executive, and attentional functions that were far greater than had been expected and led to a major change in treatment strategy, including successful trial of imipramine and nadolol and more structured milieu therapy. The cognitive deficit and intrapsychic conflict models are used to demonstrate the critical aspects of our diagnostic reclassification of the patient to Neurodevelopmental Disorder of Unknown Etiology and Auditory Attention Deficit Disorder.

Adult↗
PubMed1991

Combination of treatments for attention deficit hyperactivity disorder in adults.

Three adults with DSM-III-R diagnoses of attention deficit hyperactivity disorder were treated with a combination of a psychostimulant and nadolol. Previous treatment with only a psychostimulant had not been effective or had not been tolerated. The combination treatment resulted in an increase in attention and focusing capacities, along with a decrease in anxiety, impulsiveness, and somatic discomfort. These improvements suggest an effective regimen for treatment-resistant adults with attention deficit hyperactivity disorder.

Adult↗
PubMed1989

Developing a unit for mentally retarded-mentally ill patients on the grounds of a state hospital.

For some time patients with the dual diagnosis of mental retardation and mental illness have been recognized as a distinct patient population, but development of programs meeting their special needs is slow. In October 1986 a Massachusetts state psychiatric facility opened a rehabilitative program for such patients in a separate 40-bed unit on the hospital grounds. All patients admitted to the Specialized Habilitative and Rehabilitative Environment (SHARE) program had long histories of institutionalization, and many had been treated with neuroleptic drugs for several years. Most patients now attend day programming, and a few have been able to move on to less restrictive environments. Patients' average neuroleptic dosage has been substantially reduced. This progress has been made in spite of such program-development problems as the need to change staff's long-held perspectives about dual-diagnosis patients, lack of funding, and high staff turnover.

Health Services Needs and Demand↗
PubMed1989

Buspirone therapy for maladaptive behavior and anxiety in developmentally disabled persons.

The authors used buspirone, a new anxiolytic agent that has a low side effect profile, to treat 14 developmentally disabled individuals who demonstrated anxiety as well as aggressive and self-injurious behaviors. Nine of the 14 individuals responded favorably to the drug. The authors present case reports for 3 of the responders and discuss the clinical implications of buspirone therapy.

Adjustment Disorders↗
PubMed1988

Hysteria, anorexia and the culture of self-denial.

Anorexia and hysteria seem to be expressions of age-specific conflicts intensified by constrictive cultural ideas and certain kinds of familial constellations. The disorder that ensues appears to represent the individual's desperate attempt to escape the conflicts of adult life according to models offered by the prevailing cultural values.

Anorexia Nervosa↗
PubMed1987

Open trial effects of beta-blockers on speech and social behaviors in 8 autistic adults.

We began open trials of beta-blockers, as adjunctive medication, in eight consecutive autistic adults. The immediate result across all patients was a rapid diminution in aggressivity (Ratey et al., 1987). As time on the drug increased, subtler changes in speech and socialization emerged. While results of open trials must be interpreted with caution, these changes were significant and lasting. We speculate that these effects may be the result of a lessening of the autistic individual's state of hyperarousal. As the individual becomes less anxious, defensive and dearousing behaviors are relinquished and more social and adaptive behaviors appear. There is a concomitant improvement in language, though it is unclear whether lost skills are recouped or new ones developed. Further research is indicated.

Adult↗
PubMed1987

Autism: the treatment of aggressive behaviors.

Eight consecutive cases of adults with the diagnosis of early infantile autism and who were treated with a betablocker are presented. Each had been on various and multiple drug, educational, and behavioral regimens to help control aggressive and self-abusive behavior. Most had been institutionalized from an early age, and a broad range of IQs and speech capacities are represented. Results show the betablockers to have a remarkable effect potentiating measurable diminution in previously intractable aggressive behavior and in many cases the decrease or withdrawal of their neuroleptic.

Adrenergic beta-Antagonists↗