Sodium Amytal Interview Research Articles

Sodium amobarbital: Historical perspectives and neurorehabilitation clinical caveats

The sodium amobarbital (amytal) (SA) interview is a technique that has been utilized in the treatment of a variety of disorders since its introduction in 1929. Since that time, there has been an assortment of research conducted showing its value in both differential diagnosis and treatment of multiple conditions. Notwithstanding the substantive amount of experience with the technique and its application to a myriad number of clinical conditions, it remains a seldom used procedure in clinical practice and certainly in neurorehabilitation. This paper will review the history of SA, as well as summarize the literature published over the past two decades on the clinical applications of SA to provide readers with a foundation for the utility of this agent, as well as the sodium amytal interview (SAI) in neurorehabilitation clinical practice. Special emphasis will be placed on the use of the SAI in individuals with functional disorders that may be seen in the neurorehabilitation setting, as well as various classes of pain disorders.

The March Toward Evidence Based Criteria for Mass Trauma Intervention

“Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention” is a landmark paper which will turn the page on how psychosocial intervention after mass trauma is viewed henceforth. This comprehensive synthesis of the modern literature done by 20 outstanding experts from 5 different countries will set the bar for the delivery of evidence-based psychosocial care as well as for a new generation of outcome research in this emerging field. It is not that our profession has been absent from the table when it came to participating in the mental health care of people involved in individual or mass trauma; to the contrary, psychiatrists and our colleagues have applied state of the art thinking to mass trauma for at least 60 years, as illustrated by Lindemann’s insight into the management of grief from the Boston Grove fire ( Lindemann 1944 ) with roots that go back to Freud and beyond (Freud, 1920). The military provided experience in this area to a generation of psychiatrists entering practice as well as setting up our academic departments after World War II. A philosophy of sending soldiers back to duty quickly evolved as did sophisticated techniques at the time of hypnosis and sodium amytal interviews as a form of treatment (Ripley & Wolf, 1947). Many therapists had training in psychoanalytic/ psychodynamic therapy and their ability to understand psychological defenses greatly influenced the treatment approaches to patients presenting after trauma (Menninger & Nemiah, 2000)). The contribution of civilian psychiatrists coming from many areas of psychiatry, including consultation/liaison psychiatry programs, utilized a combination of many of these techniques as well as the latest pharmacology to treat PTSD. For many years, a technique devised by a firefighter paramedic who became a psychologist greatly influenced the delivery of care to groups who experienced trauma. That was the Critical Incident Stress Debriefing (CISD) devised by Jeffrey Mitchell which was initially used widely by fire departments throughout the world (Mitchell, 1983). This approach relied on reliving and discussing traumatic experiences in a group setting with the assistance of a trained leader. It has to be appreciated that the overwhelming majority of therapists who became Psychiatry 70(4) Winter 2007 354

Catatonia Causing Permanent Cognitive Impairment: A Case Study

We describe a case of psychogenic malignant catatonia resulting in permanent cognitive impairment. Catatonia is a neuropsychiatric syndrome characterized by catalepsy, negativism, mutism, muscular rigidity, and mannerisms, often accompanied by autonomic instability and fever. Little is known about the long-term cognitive consequences of the syndrome. Medical history includes neurologic examination, neuropsychological evaluation, electroencephalographic data, magnetic resonance imaging, sodium amytal interview, and treatment with electroconvulsive therapy. Selective deficits in executive function and an anterograde amnesia were evident a week post-ECT treatment and continued to be present at follow-up after 2 years and 8 months. The permanent cognitive impairments are considered in the context of catatonia as a frontal lobe syndrome.

Serial Sodium Amytal Interviews in the Clinical Setting

The purpose of this study was to review the authors' experiences with serial sodium Amytal (amobarbital) interviews and to compare these results with those found in the literature. A chart review of 21 patients with suspected conversion disorder evaluated by Amytal interview was conducted retrospectively. Presenting symptoms included movement disorders, focal neurologic deficits, chronic pain, "spells," and pseudoseizures. The serial Amytal interviews confirmed the presence of psychopathology noted on admission and revealed underlying psychosocial stressors. In 2 of 21 patients, agents other than Amytal were used after the first interview. This series confirms that the serial Amytal interview has utility in the clinical setting as a diagnostic and therapeutic tool.

Psychogenic mechanisms of prolonged autobiographical retrograde amnesia

Abstract Much of the previous literature on retrograde amnesia (RA) has emphasized either psychogenic or neurologic explanations. Two cases of persistent RA for autobiographical material after cerebral dysfunction are described, including 9-year follow-up data. Each case had both psychogenic features and evidence of left temporal lobe dysfunction, although the latter was transient in one case. For these cases there was no likely neurologic explanation for RA, and the data suggested psychogenic etiology. Distinguishing features of neurologic and psychogenic causes of RA are summarized. It is recommended that researchers investigating presumptive cases of RA of neurologic origin rule out psychogenic explanations through hypnosis or sodium amytal interviews and careful review of history.

Multiple Personality Disorder: A Neuroscience and Cognitive Psychology Perspective

This session was held at the Western Pittsburgh Institute and Clinic (WPIC) at the University of Pittsburgh School of Medicine. In addition to discussing a case of multiple personality disorder and the controversies and components to the diagnosis, a videotape of a sodium amytal interview was shown. Articles listed in the bibliography were preassigned for reading. Panelists included Harold C. Stemlicht, MD; James Payton, MD; and Gerhardt Werner, MD. The article was edited by Michael Rancurello, MD.

Use of Sodium Amytal Interview in the Assessment of Complex Chronic Pain Patients

Use of Sodium Amytal Interview in the Assessment of Complex Chronic Pain Patients

Use of sodium amytal interview in the assessment of complex chronic pain patients

Use of sodium amytal interview in the assessment of complex chronic pain patients

A case report of dissociative pseudodementia

The authors report the case of a patient admitted to a medical hospital for seizures and considered for more than 1 month to be demented. Psychiatric examination revealed a fluctuating cognitive capacity, suggesting a psychogenic etiology. Following a sodium amytal interview, the patient's symptoms dramatically resolved. Diagnosis, treatment, and the importance of considering dissociative pseudodementia are discussed.

Use of Sodium Amytal Interviews in Prepubertal Children: Indications, Procedure, and Clinical Utility

The sodium amytal interview has been successfully used to diagnose and treat certain adult psychiatric disorders. However, reports of its use in prepubertal children have been limited. This paper describes a safe and effective method of performing a sodium amytal interview in a child. Indications for its use are discussed and five case vignettes are presented. Subjects were psychiatric inpatients aged 9–12 for whom the interview speeded diagnosis and therby improved treatment. These cases illustrate that in certain clinical situations a properly performed sodium amytal interview is a useful tool in the diagnosis and treatment of prepubertal children.

Hypnotic recall of aircrash cause.

Abstract Hypnotic techniques can be used to help a patient recall suppressed material which implicates him in a devastating disaster. The cause of an air crash was found after 2 short. hypnosis sessions, where other orthodox methods used over a period of 2 years had failed. The method can be used in all cases of amnesia. The patient is made to hallucinate a threatening situation, and his hallucination gives a clue to the basic problem. He is then made to hallucinate a pleasant scene, which gives an indication of the method he uses to escape from the problem. This is repeated at the second session for confirmation. If the patient does not bring up the required material by free association under hypnosis, a dissociation of the personality is induced in which the observing ego watches what the experiencing ego is doing to cause the accident. The results demonstrate that in this case, at least, hypnotic techniques were more successful than sodium amytal interviews, free association, psychiatric interviews, ph...

Necrophilia, brief review and case report

The authors present a brief review of the literature on necrophilia and describe an example of inhibited necrophilia, in which the necrophilic fantasies were brought to light through a series of sodium amytal interviews. The psychodynamic origins of the perversion are discussed, with emphasis on the sadistic elements. It is suggested that necrophilic fancies are more common than is generally realized.

Narcosynthesis immediately following insulin shock; five-year follow up and supplementary report.

The same favorable results as reported for the original group of 11 patients were obtained in the second larger group justifying the conclusion that narcosynthesis immediately following insulin coma appears to deserve its place in the treatment of mental disease, and especially seems worth while in patients who have previously not responded either to insulin coma therapy alone, or to the prognostic pre-insulin sodium amytal interview. This type of treatment on the basis of this study not only seems to hasten considerably the recovery of the patients and lessen appreciably their hospital stay, but also seems to produce a more prolonged and well-sustained recovery. In fact, 10 out of 11 patients of the preliminary group have adjusted satisfactorily outside the hospital for periods of over 5 years, and 26 of the 30 patients of the second group have also made satisfactory extra-institutional adjustment for periods of 3 to 5 years without recurrence of symptoms of mental illness.

Clinical Notes

The action of intravenously administered sodium amytal in 500 patients in military and civilian practice has been analyzed from the standpoints of its usefulness in diagnosis, treatment, prognosis, and investigation of etiology of bodily disorders arising from problems of personality adjustment. The drug has been found useful chiefly as follows: I. Diagnostically a. In distinguishing between irreversible, structurally determined disorders and functional disorders of organ systems. b. In distinguishing between neurosis and malingering. c. In the elucidation of dynamically significant situational conflicts. II. Therapeutically a. In the alleviation of troublesome symptoms. b. When data obtained during sodium amytal interview was used in formulation to the patient or when the reassuring value of the reversibility of symptoms was used, or in the use of hypnotic or post-hypnotic suggestion. III. Prognostically, in determining the depth of a disturbance and its susceptibility to treatment. IV. From an investigative standpoint in rendering modifiable the bodily disturbances of various diseases. The most suitable subjects for narcoanalysis by means of sodium amytal are those with disorders of personality adjustment of relatively short duration. The drug is less useful in diagnosis or treatment of patients with rigid personalities or longstanding patterns of disability. Sodium amytal is a highly useful tool in medicine but it is in no sense a specific or automatic agent. It is only of substantial value in the hands of an appropriately skilled physician who utilizes the state which the drug induces to gain diagnostic or therapeutic leverage.