Bilder RM, Lieberman JA. Reduced temporal limbic structure volumes on magnetic resonance images in first episodes schizophrenia. Psychiatry Res Neuroimaging. 1990;35:1-13. 5. DeGreef G, Bogerts B, Ashtari M, Lieberman J. Ventricular morphology in first episode schizophrenia: a volumetric study of ventricular sub-divisions on MRI. Schizophr Res. 1990;3:18. 6. Johnstone EC, Owens DGC, Crow TJ, Frith CD, Alexandropolous K, Bydder G, Colter N. Temporal lobe structure as determined by nuclear magnetic resonance in schizophrenia and bipolar affective disorder. J Neurol Neurosurg
Psychiatry. 1989;52:736-741. 7. Rossi P, Stratta P, D'Albenzio L,
Tartaro
A, Schiazza G, di Michele V, Bolino F, Casacchia M. Reduced temporal lobe area in schizophrenia. Biol Psychiatry. 1990;27:61-68. 8. Rossi GF, Stratta P, D'Albenzio L, Tartaro A, Schiazza G, DiMichele V, Bolino F, Casacchia M. Reduced temporal lobe areas in schizophrenia: preliminary evidences from a controlled multiplanar magnetic resonance study. Schizophr Res.
1990;3:96.
9. Coffman JA, Schwarzkopf SB, Olson SC, Torello MW, Bornstein RA, Nasrallah HA. Temporal lobe asymmetry in schizophrenics demonstrated by coronal MRI brain scans. Schizophr Res. 1989;2:117. 10. DeLisi LE, Gupta SM, Hoff A, Shields A, Schwartz J, Halthore S, Anand A. Brain morphology in first episode cases of schizophrenia. Schizophr Res. 1990;3:20. 11. Reveley MA, Reveley AM, Baldy R. Left hemisphere hypodensity in discordant schizophrenic twins: a controlled study. Arch Gen
Psychiatry. 1987;44:625-632. 12. Suddath RL, Christison GW, Torrey EF, Casanova MF, Weinberger DR. Anatomical abnormalities in the brains of monozygotic twins discordant for schizophrenia. N Engl J Med. 1990;322:789-794.
13. Geschwind N, Levitsky W. Left-right asymmetry in temporal speech region. Science. 1968;161:186-187.
Bupropion Reduces Cocaine Abuse in Methadone-Maintained Patients
To the Editor. \p=m-\Cocaineabuse is
a
major problem among methadonemaintained patients.1 We recently tested the "second generation" antidepressant bupropion with six co-
caine-dependent,
methadone-maintained patients in an 8-week open pilot study. A test of the drug for the treatment of cocaine dependence was suggested by research showing that it directly influences dopaminergic transmission2 and because it possesses few of the cardiovascular and anticholinergic side effects of "first generation" antidepressants.3
Patients and Methods.\p=m-\Six methadonemaintained patients participated in the study (two males and four females; mean [\m=+-SD] age, 35 \m=+-\11years; daily mean [\m=+-\SD]methadone dosage, 60 \m=+-\20mg). All subjects were chronic intravenous cocaine users (mean [ \m=+-\SD] years of cocaine use, 12 \m=+-\8.2years) who had used at least 0.5 g of cocaine per week for 3 months previous to entry into the study. All met DSM-III-R criteria for cocaine dependence. Subjects received 100 mg of bupropion beginning on the first day and titrated up to the full dosage of 100 mg three times per day within 3 days. Each patient also met with one of the authors (A.M.) for psychotherapy once a week during the 8 weeks of the study. Outcome measures included twice-weekly urine assays for co¬ caine metabolites (enzyme multiplied immunoassay technique) and pretreatment and posttreatment assessment of psychophysiologic reactivity (skin conductance level, skin temperature, and a self-report of cocaine craving) to neutral and drugrelated cues. Five of six patients completed the study; one patient dropped out after 2 weeks due to an episode of hypomania, possibly a side effect of bupropion. The data reported below are for the five subjects who com¬ pleted the study. Within 1 week of starting
bupropion therapy,
two
patients experi¬
enced mild agitation, which disappeared with reduction of bupropion dosage to 100 mg two times per day. One patient reported mild dry mouth, which resolved after 2 weeks. There were no apparent deleteri¬ ous interactions between bupropion and methadone or, in patients who used cocaine during the study, between bupropion, methadone, and cocaine. In the eighth week of the study, four subjects reported no cocaine use, and one subject reported a substantial reduction in cocaine use. Urine toxicologie studies in the eighth week of the study showed that urine test results were positive for cocaine only in the subject reporting cocaine use. At a 3-month followup, this same subject's urine test result was positive for cocaine. No other subject had a positive urine test result for cocaine during this 3-month follow-up. Patients reported that while taking bu¬ propion they felt "emotionally stronger" and able to experience "small pleasures." This normalization of hedonic tone seemed to facilitate participation in psychotherapy, which emphasized the establishment of patient-generated goals and senses of self incompatible with cocaine use. During
posttreatment psychophysiologic assess¬ ment, there was a significant reduction in
self-reported craving to drug cues relative
to
pretreatment levels (scale: 0 indicates
craving, and 10, maximum craving: mean [ ± SD] pretreatment score, 7.4 ± 2.7; posttreatment score, 1.4 ±1.9; i[4] 3.51; P
Psychiatry. 1989;52:736-741. 7. Rossi P, Stratta P, D'Albenzio L,
Tartaro
A, Schiazza G, di Michele V, Bolino F, Casacchia M. Reduced temporal lobe area in schizophrenia. Biol Psychiatry. 1990;27:61-68. 8. Rossi GF, Stratta P, D'Albenzio L, Tartaro A, Schiazza G, DiMichele V, Bolino F, Casacchia M. Reduced temporal lobe areas in schizophrenia: preliminary evidences from a controlled multiplanar magnetic resonance study. Schizophr Res.
1990;3:96.
9. Coffman JA, Schwarzkopf SB, Olson SC, Torello MW, Bornstein RA, Nasrallah HA. Temporal lobe asymmetry in schizophrenics demonstrated by coronal MRI brain scans. Schizophr Res. 1989;2:117. 10. DeLisi LE, Gupta SM, Hoff A, Shields A, Schwartz J, Halthore S, Anand A. Brain morphology in first episode cases of schizophrenia. Schizophr Res. 1990;3:20. 11. Reveley MA, Reveley AM, Baldy R. Left hemisphere hypodensity in discordant schizophrenic twins: a controlled study. Arch Gen
Psychiatry. 1987;44:625-632. 12. Suddath RL, Christison GW, Torrey EF, Casanova MF, Weinberger DR. Anatomical abnormalities in the brains of monozygotic twins discordant for schizophrenia. N Engl J Med. 1990;322:789-794.
13. Geschwind N, Levitsky W. Left-right asymmetry in temporal speech region. Science. 1968;161:186-187.
Bupropion Reduces Cocaine Abuse in Methadone-Maintained Patients
To the Editor. \p=m-\Cocaineabuse is
a
major problem among methadonemaintained patients.1 We recently tested the "second generation" antidepressant bupropion with six co-
caine-dependent,
methadone-maintained patients in an 8-week open pilot study. A test of the drug for the treatment of cocaine dependence was suggested by research showing that it directly influences dopaminergic transmission2 and because it possesses few of the cardiovascular and anticholinergic side effects of "first generation" antidepressants.3
Patients and Methods.\p=m-\Six methadonemaintained patients participated in the study (two males and four females; mean [\m=+-SD] age, 35 \m=+-\11years; daily mean [\m=+-\SD]methadone dosage, 60 \m=+-\20mg). All subjects were chronic intravenous cocaine users (mean [ \m=+-\SD] years of cocaine use, 12 \m=+-\8.2years) who had used at least 0.5 g of cocaine per week for 3 months previous to entry into the study. All met DSM-III-R criteria for cocaine dependence. Subjects received 100 mg of bupropion beginning on the first day and titrated up to the full dosage of 100 mg three times per day within 3 days. Each patient also met with one of the authors (A.M.) for psychotherapy once a week during the 8 weeks of the study. Outcome measures included twice-weekly urine assays for co¬ caine metabolites (enzyme multiplied immunoassay technique) and pretreatment and posttreatment assessment of psychophysiologic reactivity (skin conductance level, skin temperature, and a self-report of cocaine craving) to neutral and drugrelated cues. Five of six patients completed the study; one patient dropped out after 2 weeks due to an episode of hypomania, possibly a side effect of bupropion. The data reported below are for the five subjects who com¬ pleted the study. Within 1 week of starting
bupropion therapy,
two
patients experi¬
enced mild agitation, which disappeared with reduction of bupropion dosage to 100 mg two times per day. One patient reported mild dry mouth, which resolved after 2 weeks. There were no apparent deleteri¬ ous interactions between bupropion and methadone or, in patients who used cocaine during the study, between bupropion, methadone, and cocaine. In the eighth week of the study, four subjects reported no cocaine use, and one subject reported a substantial reduction in cocaine use. Urine toxicologie studies in the eighth week of the study showed that urine test results were positive for cocaine only in the subject reporting cocaine use. At a 3-month followup, this same subject's urine test result was positive for cocaine. No other subject had a positive urine test result for cocaine during this 3-month follow-up. Patients reported that while taking bu¬ propion they felt "emotionally stronger" and able to experience "small pleasures." This normalization of hedonic tone seemed to facilitate participation in psychotherapy, which emphasized the establishment of patient-generated goals and senses of self incompatible with cocaine use. During
posttreatment psychophysiologic assess¬ ment, there was a significant reduction in
self-reported craving to drug cues relative
to
pretreatment levels (scale: 0 indicates
craving, and 10, maximum craving: mean [ ± SD] pretreatment score, 7.4 ± 2.7; posttreatment score, 1.4 ±1.9; i[4] 3.51; P
