Somatic Therapy Research Articles

Sexuality in patients with restricted breathing

Sexuality in chronic diseases is of increasing significance. In the majority of patients with chronic lung diseases, sexual activity is reduced. Most available data on this topic are based on patients with chronic obstructive pulmonary diseases (COPD). Dyspnea, cough, muscular weakness, and the associated reduction of physical activity are the main causes of reduced sexual activity in COPD patients. In addition to direct somatic-physical effects of COPD, the associated psychosocial deficits and adverse effects of medication contribute to sexual dysfunction. An intact communication between physician and patient is an important issue within a therapeutic strategy. Applying both treatment and behavioral strategies enables even patients with severe lung diseases to be sexually active. Somatic therapy consists of both systemic medication and local interventions to treat sexual dysfunction. If oxygen therapy is indicated, it should be administered also during intercourse. In patients with chronic ventilatory failure, sexual activity may profit from noninvasive mechanical ventilation.

Human gene therapy and the slippery slope argument.

The article investigates the validity of two different versions of the slippery slope argument construed in relation to human gene therapy: the empirical and the conceptual argument. The empirical version holds that our accepting somatic cell therapy will eventually cause our accepting eugenic medical goals. The conceptual version holds that we are logically committed to accepting such goals once we have accepted somatic cell therapy. It is argued that neither the empirical nor the conceptual version of the argument can provide a conclusive moral reason for banning somatic cell therapy. According to a third interpretation, referred to as the arbitrary result argument, the many apparent similarities between somatic cell therapy and eugenic-based human genetic engineering drive us to make principled choices concerning what differences and similarities between the two practices should be regarded as morally (ir)relevant. Decisions of this kind are likely to have unpredictable moral consequences. Thus formulated, the slippery slope argument has much plausibility. One objects to somatic cell therapy not so much because of what is at the bottom of the slope on which it lies, but because it is on a slope of which one does not know what is at the bottom. While the arbitrary result argument does not provide a conclusive reason for prohibiting human gene therapy, it reminds of a very important thing: when making bioethical decisions, we should be as specific and as consistent as possible about our basic moral and medical concepts.

Status and potential of gene therapy in clinical medicine. Assessment of an emerging health technology through systematic survey of clinical gene therapy protocols and published results.

Somatic gene therapy is a new method in the rapidly expanding field of molecular medicine. Due to recent encouraging results and the promising prospect for some disease groups, Norwegian health authorities wanted to assess somatic therapy with evidence-based standards for strategic use. This article presents the results of this assessment, discussed in the context of the policy-making process in Norway, including ethical and legislational considerations. Clinical gene therapy protocols, ongoing or completed with published results, where available, were identified through a systematic survey of descriptive protocols and publications. Preclinical literature was also reviewed. Gene therapy is dominated by preclinical and clinical research. Most of the gene therapy protocols identified are in early phases (phases I and II) with only a few patients in each study. Of the protocols included in the assessment, only three phase III studies are represented. Except for the use of soluble antisense oligonucleotides against cytomegalovirus eye infection, gene therapy is presently not an established treatment modality. Promising results have been observed in treatment of cancer and cardiovascular diseases and, most recently, in inherited severe combined immunodeficiency and hemophilia. Several interesting principles addressing a large panel of conditions are currently being developed and tested. Gene therapy is developing into an important medical concept that needs to be included within the Norwegian healthcare system. It is recommended that the Norwegian Ministry of Health and Social Affairs fund a national program to boost infrastructure in selected scientific groups both in preclinical and clinical research. The national procedures regulating approval of gene therapy trials should be made more efficient while at the same time allowing for proper control and ethical considerations. It is emphasized that gene therapy trials should be carefully monitored for side effects.

The Experience of Breath as a Therapeutic Intervention – Psychosomatic Forms of Breath Therapy. A Descriptive Study about the Actual Situation of Breath Therapy in Germany, Its Relation to Medicine, and Its Application in Patients with Back Pain

Context: Breath is a central element both in Eastern spiritual practice and in breath therapy, a treatment developed in Germany over the last 90 years. Among physicians, little is known about the working methods, goals, basic concepts, providers, and benefits for specific medical diagnoses of breath therapy. Objective: To investigate the actual circumstances of breath therapy in Germany, its relation to medicine, and its application in patients with specific diagnoses. Design: Descriptive study. Setting: Germany. Study Subjects: Members of the national association of breath therapists. Instrument: Questionnaire developed at Berlin Free University Medical Center in collaboration with the national association of breath therapists. Outcome Measures: Degree of approval/disapproval to given answers to semi-closed questions. Results: Breath therapy, as practiced in Germany, is a therapeutic method distinct from somatic therapy and psychotherapy. It is primarily applied by nonmedical therapists in a private practice setting. Through the experience of physical sensations from the nonmanipulated breath rhythm, this method provides a physically grounded, deep personal experience of an integrated sense of self. Breath therapy appears to be particularly helpful in patients with chronic back pain. Conclusions: Results suggest that breath therapy brings about its therapeutic effect through enhanced proprioception which, as other studies have shown, is deficient in patients with chronic back pain. This first descriptive study on breath therapy is limited by the use of self-reports from therapists which cannot control for provider bias. This therapeutic intervention deserves further investigation and controlled clinical research.

Etica científica y embriones congelados

Scientific Ethics is the theory and praxis of decisions. Philosophical Ethics is presented as the theory and praxis of the good. As the good differs among cultures, Philosophical Ethics is dependent on the endo-cultural good conception. The decision (included that one of adhesion or not to a world vision) depends on neuro-psychic specific factors: i) cognitive factors that include mostly the knowledge of the alternatives and their consequences and the ideological or religious conception of good in relation to the alternatives; ii) affective factors that make alternatives pleasant, unpleasant or neutral, attractive, repulsive or neutral; iii) emotional factors that associate to alternatives anger, peace or neutrality, sadness, happiness or neutrality; iv) value factors that assign importance, triviality or neutrality to alternatives, or assign them significance, irrelevancy or neutrality. There are unspecific factors such as the psychic energy, desire or others. Mixed factors such as attitude, motivation, intention and others. Scientific Ethics deals with the mind as a materio-energetic process which is different from the soul, eggs and embryos of any species are full individuals of that species, because, they have initiated a copy of their genome that specify, give autonomy and define them as individuals. For Scientific Ethics to leave frozen embryos like that for ever, to defrost and get rid of them or to use their cells for science are synonymous of killing them. To defrost them to use their cells as stem cells for somatic cell therapy or to implant them into uteri to continue their development is to maintain alive their cells, but only the implantation allows their maintenance as individuals, thus, being the only compatible with the Christian ethics. The compatibility of these alternatives with other ethics is discussed.

Obsessive-Compulsive Disorder: Contemporary Issues in Treatment

Back to table of contents Previous article Next article Book Forum: Obsessive-Compulsive DisorderFull AccessObsessive-Compulsive Disorder: Contemporary Issues in TreatmentJAMES W. JEFFERSON, M.D., JAMES W. JEFFERSONSearch for more papers by this author, M.D., Madison, Wis.Published Online:1 Mar 2001https://doi.org/10.1176/appi.ajp.158.3.509-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This is a big book—661 pages with a list of contributors that encompasses many of the names in the field of obsessive-compulsive disorder (OCD), including some international flavor and even a touch of the pharmaceutical industry. There are some notable omissions, which could be editorial oversights or just overburdened authors for whom the invitation to write came at the wrong time. Be that as it may, Goodman, Rudorfer, and Maser have produced an obsessive-compulsive tour de force that rivals the magnus opus of Jenike et al. (1) in breadth, depth, and overall readability (and it is 2 years ahead in copyright date—2000 versus 1998).Since the two books have some authors in common, I thought it would be worth doing some chapter comparisons. My dismay at finding the identical 1891 quotation beginning the chapters on body dysmorphic disorder in both books melted away with the realization that the more recent chapter was not a knockoff but, rather, a fresh and timely view of the disorder by its preeminent investigator. On the other hand, the neurosurgery chapters shared much verbatim verbiage.So much for comparisons; what about content? The book bypasses the basics, such as a chapter on epidemiology (not even found in the index) and clinical features of OCD, and begins with a discussion of boundary, spectrum, and subtyping issues. The focus then shifts to pathophysiology and etiology (which remains as elusive as ever), and next to overviews on assessment and outcome measures (to set the stage for the main thrust of the book, which is treatment). At least a few words in the assessment chapter on the Children’s Yale-Brown Obsessive Compulsive Scale would have been welcome.Treatment is the book’s strongest suit, with 73 pages devoted to cognitive behavior therapy, 205 pages to medications and other somatic treatments, and 45 pages to combined treatments. Obviously, the meat of the matter is somatic therapy, and this is where I would go for comprehensive, in-depth reviews of standard as well as more creative interventions. Treatment resistance is dealt with in many of the chapters, and, fortunately, there is much of substance to be found. There is no question that among the anxiety disorders, OCD is the only one for which there is a substantial body of information on managing treatment-resistant or refractory patients. What I consider to be a rather glaring omission is the fact that there is no chapter on the treatment of child and adolescent OCD. This, in turn, may account for an absence of information on immune therapies such as plasmapheresis.As an aside, both books have hyphenated obsessive-compulsive correctly, in keeping with DSM-IV, which, for reasons unknown, in a maneuver best referred to as the conservation of the hyphens, removed the DSM-III-R hyphen from post-traumatic stress disorder and transferred it to the unhyphenated obsessive compulsive disorder.All in all, Obsessive-Compulsive Disorder: Contemporary Issues in Treatment is a very substantial contribution to the field and well worth the investment of anyone with more than a passing interest in OCD.Edited by Wayne K. Goodman, Matthew V. Rudorfer, and Jack D. Maser. Mahway, N.J., Lawrence Erlbaum Associates, 2000, 661 pp., $69.95.Reference1. Jenike MA, Baer L, Minichiello WE: Obsessive-Compulsive Disorders: Practical Management, 3rd ed. St Louis, Mosby, 1998Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 158Issue 3 March 2001Pages 509-a-510 Metrics History Published online 1 March 2001 Published in print 1 March 2001

Severe depression: is there a best approach?

A major depressive episode can be categorised as severe based on depressive symptoms, scores on depression rating scales, the need for hospitalisation, depressive subtypes, functional capacity, level of suicidality and the impact that the depression has on the patient. Several biological, psychological and social factors, and the presence of comorbid psychiatric or medical illnesses, impact on depression severity. A number of factors are reported to influence outcome in severe depression, including duration of illness before treatment, severity of the index episode, treatment modality used, and dosage and duration of and compliance with treatment. Potential complications of untreated severe depression include suicide, self-mutilation and refusal to eat, and treatment resistance. Several antidepressants have been studied in the treatment of severe depression. These include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline (norepinephrine) reuptake inhibitors, noradrenergic and specific serotonergic antidepressants, serotonin 5-HT(2) receptor antagonists, monoamine oxidase inhibitors, and amfebutamone (bupropion). More recently, atypical antipsychotics have shown some utility in the management of severe and resistant depression. Data on the differential efficacy of TCAs versus SSRIs and the newer antidepressants in severe depression are mixed. Some studies have reported that TCAs are more efficacious than SSRIs; however, more recent studies have shown that TCAs and SSRIs have equivalent efficacy. There are reports that some of the newer antidepressants may be more effective than SSRIs in the treatment of severe depression, although the sample sizes in some of these studies were small. Combination therapy has been reported to be effective. The use of an SSRI-TCA combination, while somewhat controversial, may rapidly reduce depressive symptoms in some patients with severe depression. The combination of an antidepressant and an antipsychotic drug is promising and may be considered for severe depression with psychotic features. Although the role of cognitive behaviour therapy (CBT) in severe depression has not been adequately studied, a trial of CBT may be considered in severely depressed patients whose symptoms respond poorly to an adequate antidepressant trial, who are intolerant of antidepressants, have contraindications to pharmacotherapy, and who refuse medication or other somatic therapy. A combination of CBT and antidepressants may also be beneficial in some patients. Electroconvulsive therapy (ECT) may be indicated in severe psychotic depression, severe melancholic depression, resistant depression, and in patients intolerant of antidepressant medications and those with medical illnesses which contraindicate the use of antidepressants (e.g. renal, cardiac or hepatic disease).

Surgical Treatment of Mental Illness: Impact of Imaging

Surgical Treatment of Mental Illness: Impact of Imaging

How fast are antidepressants?

For years, investigators have tried to determine the speed of onset of antidepressant drugs. Claims that particular drugs may produce a faster response in patients than other agents have been made, but such claims have never been confirmed. The authors reviewed reports from studies of the speed of onset of antidepressant therapies and other studies that revealed information on this topic. We compiled a list of factors that can affect the results of such studies and interpretations of study results. In addition, we reviewed literature concerned with methods of speeding up antidepressant responses. No antidepressant medication currently available has been shown conclusively to have a more rapid onset of action than any other. However, some methods of augmentation may have the potential to speed responses. Somatic therapies such as electroconvulsive therapy, phototherapy, and therapeutic sleep deprivation may be the fastest options available at this time. All available antidepressant medications are usually taken for several weeks before future responders will display a significant therapeutic benefit. If a patient does not show at least a 20% improvement within the first 2 to 4 weeks of treatment, the treatment regimen should be altered. For patients who do show early benefits from a medication trial, one can expect additional benefits to accrue over an 8- to 12-week period and to improve overall outcome compared with those slower to respond. Future trials need to address methodological confounds, but a truly "faster antidepressant" will probably require new neuroscience technology.

Nausea and vomiting in early pregnancy/hyperemesis gravidarum. Current status of psychosomatic factors

Although Hyperemesis gravidarum (HG) is still a disease of unknown aetiology psychosocial aspects are involved in the genesis of this disease. Based on experiences in our department and on actual literature psychosocial aspects and therapeutic approaches of HG are presented. Predisposing factors of HG are stress, inadequate information about pregnancy or delivery and problems in the marital relationship. Feelings of ambivalence towards pregnancy, a distorted perception of reality, the unconscious refusing of a wanted child and the worry about a relation between nutrition of the foetus and the HG have influence on the development of the HG. The role of the social context, especially the mother, of expectations towards vomiting and of secondary gain in the genesis and the evaluation of HG is explained. Therapeutical approaches beside the known somatic therapies are acupuncture, the electric stimulation of the N. vestibularis and different methods of psychotherapy, which can include the partner or other persons from the social context. In some cases an intensified therapy under in-patient conditions can improve therapeutic results. Psychosocial factors are involved not only in the genesis of HG, but also in the duration and intensity of symptoms as well as in the resistance especially, towards isolated somatic therapeutical approaches. When psychosocial factors are taken into account in the search for a cause and the treatment of HG results of treatment are more successful and persist over a longer time.

Depression and insomnia: questions of cause and effect.

Chronic insomnia is a risk factor for the development of psychiatric disorders, including depression, as well as a prodrome of major depressive episodes, a consequence or complication of depression that often persists beyond the clinical episode, and a prognostic indicator of long-term illness course and treatment response. In addition, sleep is physiologically abnormal in persons at risk for depression; for example, shortened REM sleep latency is present not only during clinical episodes of depression, but also before the clinical episode in subjects at risk for depressive illness. Although insomnia usually disappears as depression is treated, it may persist, indicating heightened vulnerability to depressive relapse or recurrence. Physiological changes in sleep related to depression correlate with the likelihood of response to psychotherapy alone and may also identify which patients are unlikely to do well with psychosocial treatment and, therefore, to need somatic therapy in order to preserve recovery. Electroencephalographic (EEG) sleep changes also correlate with the speed of response and with the brittleness or durability of response (i.eprobability of relapse or recurrence). These observations suggest a close relationship between the regulation of sleep and the regulation of mood. The importance of this relationship is further underscored by recent brain imaging studies of sleep and sleep deprivation in patients with major depression. For example, therapeutic sleep deprivation (TSD) may serve as both a catalyst of rapid antidepressant activity and as a probe of treatment resistance. TSD's effects on brain metabolic rates, especially in limbic areas, may correlate with a therapeutic response to a night of sleep loss and to antidepressant medication. Finally, treating chronic insomnia with newer selective serotonin reuptake inhibitor (SSRI) antidepressant medication may represent an opportunity for preventing complications of insomnia, including depressive illness.

Electroshock (ESK) and electroconvulsive therapy (ECT)

To discuss the ethical and legal basis of ECT use in Italy, one year after the regulation set up by the Minister of Health. Literature review and presentation of authors' personal opinions. Despite being the oldest somatic therapy still practised in psychiatry, ECT effectiveness has been systematically evaluated only during the last 20 years, and its clinical indications have become progressively restricted. Yet there are wide variations between countries and within each individual country about the extension, the modalities and the indications for its use. ECT seems to be practised mainly in large scale public psychiatric hospitals and in private clinics, but its use in systems following a community approach is very limited. Wide variations exist also with reference to the severity of regulations imposed by governments or suggested by professional associations. The extent of education and auditing by university centres varies considerably, but is generally considered unsatisfactory. There are still some reports about possible political and repressive use of ECT in some countries, especially developing ones. The authors consider that every national system of care should have a clear policy and clear regulations about ECT. The provisions set up by the Italian Minister of Health seem to be consistent with Italian health policies and psychiatric community care.

DEPRESSION AND THE DYING OLDER PATIENT

Depression remains a source of considerable suffering among dying older adults. Unfortunately, clinical depression commonly is overlooked in this vulnerable population and often goes untreated. An overview of diagnosing depression in older patients is presented. Various risk factors for depression in the palliative care setting are examined. The somatic therapies that are available for treatment consideration in older, depressed adults nearing death are reviewed.

Biological Therapies for Obsessive-Compulsive Disorder

Two treatments have demonstrated efficacy in OCD, exposure and response (ritual) prevention (EX/RP) and pharmacotherapy with serotonin reuptake inhibitors (SRIs). In this article, which is the third in a three-part series, the authors present an overview of the role of biological treatments for OCD. The evidence for the efficacy of the serotonin reuptake inhibitors (clomipramine and the five selective serotonin reuptake inhibitors "SSRIs" fluvoxamine, fluoxetine, paroxetine, sertraline, and citalopram) as monotherapy for OCD is reviewed. The authors also discuss the rationale for choosing among these agents for specific patients. Research on other types of medication monotherapies for OCD is also discussed. The authors then cover strategies for treatment-resistant OCD, including combining EX/RP and SRI medication treatment, combining clomipramine and an SSRI, use of augmenting medications, and use of intravenous clomipramine. Findings concerning the use of other somatic therapies for treatment-resistant OCD, including electroconvulsive therapy, neurosurgery, plasma exchange/IV immunoglobulin/maintenance antibiotics, and transcranial magnetic stimulation, are also reviewed. Finally, the authors discuss what is known about matching treatments to patients with certain specific symptom clusters, how long to continue maintenance medication treatment, and how to terminate treatment.

Vagus nerve stimulation: a new tool for brain research and therapy∗

Biological psychiatry has a long history of using somatic therapies to treat neuropsychiatric illnesses and to understand brain function. These methods have included neurosurgery, electroconvulsive therapy, and, most recently, transcranial magnetic stimulation. Fourteen years ago researchers discovered that intermittent electrical stimulation of the vagus nerve produces inhibition of neural processes, which can alter brain electrical activity and terminate seizures in dogs. Since then, approximately 6000 people worldwide have received vagus nerve stimulation for treatment-resistant epilepsy. We review the neurobiology and anatomy of the vagus nerve and provide an overview of the vagus nerve stimulation technique. We also describe the safety and potential utility of vagus nerve stimulation as a neuroscience research tool and as a putative treatment for psychiatric conditions. Vagus nerve stimulation appears to be a promising new somatic intervention that may improve our understanding of brain function and has promise in the treatment of neuropsychiatric disorders.

Aspects of conservative sciatic pain.

Successful multimodal conservative treatment of sciatic pain will prevent unfavorable results of life discectomy and accelerates the natural course. In assessment of modalities of conservative treatment of sciatic pain, somatic and psychosomatic aspects have to be considered. Severe neurological deficits caused by lumbar disc herniation have to be treated surgically. Conservative treatment of sciatic pain follows the etiopathogenetic hypothesis of a centrally triggered and radicularly terminated inflammation; it reflects the biopsychosocial paradigm. Inflammatory alterations in the disc and psychosocial peculiarities of the patients prove this disease model. Conservative treatment of sciatic pain does not determine its, but works by the combined operation of different but etiopathogenetic or scientifically efficient means. Somatic therapy aims at blocking the inflammatory cascade by peridural and systemic antiphlogistic drugs, sufficently applied analgethics and temporally limited bedrest. Physiotherapy and sports therapy for remobiliziation will follow. Psychosomatic therapy works through relaxation, support and interpretation. Physiotherapy, relaxation and verbal intervention work prophylacally, too. The patient-doctor relationship plays a crucial role in conservative treatment of sciatic pain.

Psychosexual counseling and specific interventions in psychogenic erectile dysfunction

In the light of highly successful somatic therapies psychotherapeutic interventions in erectile dysfunction are nowadays less considered. But they are nevertheless highly effective and needed according to the psycho-somatic nature of the condition. In this article we present an etiologic framework of psychogenic erectile dysfunction as well as the diagnostic approach and therapeutic interventions. Finally we discuss the need for an increased research in the combination of psychotherapeutic and medical therapy.

The American Psychiatric Press Textbook of Psychopharmacology, second edition

Back to table of contents Previous article Next article Book ReviewFull AccessThe American Psychiatric Press Textbook of Psychopharmacology, second editionCarlos A. Zarate Jr., M.D.Carlos A. Zarate Jr.Search for more papers by this author, M.D.Published Online:1 Jul 1999https://doi.org/10.1176/ps.50.7.978AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The science of psychopharmacology is developing so rapidly that it is increasingly difficult to keep up with what is published. The second edition of the American Psychiatric Press Textbook of Psychopharmacology summarizes the rich abundance of information in an exceptional way.This second edition consists of 1,095 pages, 48 chapters in four sections, and an appendix. The first section, edited by Joseph Coyle, covers principles of psychopharmacology. These chapters, which have been updated and improved, nicely summarize what is known to date about neurotransmitters, second-messenger systems, neuroanatomy, electrophysiology, animal models of certain psychiatric disorders, the pharmacokinetics and pharmacodynamics of psychotropic medications, and neuroendocrine and immune-system pathology in psychiatric disease.This section is written in a clear and concise way that makes it appealing and easy to understand even for those who don't read this kind of material regularly. Besides the general updating, what has been added to this section, and significantly enhances it, are the chapters on animal models of anxiety disorders and Alzheimer's disease and the chapter on neuroendocrine and immune-system pathology.In the second section, editors Dennis Charney and Herbert Meltzer offer a state-of-the-art presentation on classes of drugs, also updated from the first edition. These chapters review the somatic therapies used in psychiatry—antidepressants, anxiolytics, antipsychotics, drugs for the treatment of bipolar disorder, and other agents such as cognitive enhancers, sedative-hypnotics, and stimulants. Venlafaxine now has its own chapter, as does electroconvulsive therapy.Section 3, edited by David Kupfer, reviews theories on the biology of mood disorders, schizophrenia, anxiety disorders, substance abuse-dependence, eating disorders, Alzheimer's disease, and personality disorders. This material is excellent, as in the first edition. The latter two chapters are new.The final section, edited by Donald Klein, reviews the psychopharmacological treatment of the major psychiatric disorders and of special populations, such as medically ill patients, the elderly, and pregnant women. A chapter on insomnia has been added. An appendix reports on promising drugs for axis I disorders that recently arrived on the U.S. market, are in development, or never arrived on the market.The list of contributors is impressive; many are considered the top experts in their respective areas. This textbook is well integrated, easy to read, and practical to use. It is clear that the editors have made an effort to avoid duplication of material. The references are updated, and the indexing is very good.The second edition maintains the high level of quality of the first and at the same time has significant improvements. It will benefit a wide audience, including medical students, psychiatric residents, and psychiatrists as well as general physicians, psychiatric nurses, social workers, and case managers. Every psychiatric clinician should have this book as a standard reference text in psychopharmacology.Dr. Zarate is director of the bipolar and psychotic disorders program at the University of Massachusetts Medical School in Worcester.edited by Alan F. Schatzberg, M.D., and Charles B. Nemeroff, M.D., Ph.D.; Washington, D.C., American Psychiatric Press, 1998, 1,095 pages, $120 FiguresReferencesCited byDetailsCited byNone Volume 50Issue 7 July 1999Pages 978-978 Metrics History Published online 1 July 1999 Published in print 1 July 1999

Characterization of a human cell clone expressing cytochrome P450 for safe use in human somatic cell therapy.

We have previously demonstrated the therapeutic effect and efficacy of implantation of cells genetically modified to express cytochrome P450 2B1 in a nude mouse tumor model. The cells are encapsulated in polymerized cellulose sulphate and injected into preformed tumors. Upon administration of ifosfamide, the P450 enzyme converts the ifosfamide into antitumorigenic toxic metabolites at the site required, thereby significantly reducing tumor burden. Feline kidney epithelial cells were chosen for these studies, because they are easy to culture and can readily be transfected. However, these cells are not suitable for eventual use in human patients, since they are known to express endogenous retroviruses that are able to infect mammalian cells. They thus represent a safety risk. Here we describe the establishment of a human cell line that has been genetically modified to express the same cytochrome P450 construct and their characterization. The usefulness of mitomycin C treatment, both to protect the cells from the toxic metabolites that they produce and to incapacitate these cells from replicating, should they escape from the capsules, has also been investigated.

The history of electroconvulsive therapy in the United States and its place in American psychiatry: A personal memoir

The history of electroconvulsive therapy (ECT) in the United States is traced from its crude beginnings in 1940 to its emergence as a highly sophisticated and effective treatment for many severe psychiatric disorders. The general distrust of all somatic therapies in the 1930s and 1940s expressed by many prominent psychiatrists (both analysts and nonanalysts) contributed to an ambivalent relationship between ECT and the rest of American psychiatry. The media coverage of ECT is reviewed, and suggestions for dealing with the antipsychiatry movement and anti-ECT prejudice are discussed.