LETTERS

ings

TO THE

makes

thology unusual samples clinical tive

EDITOR

it unlikely

that

the

pretreatment

and

the

more

effectiveness

rapid

across

the

in action

of the

two

full

weeks

of the

three

been more evident if we could dosage. As may be seen in figure provement

was’less Scale

dose

the

and

tended

planning ing

for

dramatic,

1 of our

the total

to go

up

for

study

dose

isomers

of the

that

would

patients

on

psychological enine

the major

influence

I. Coppen hormone

Many

studies

with patients.

the

I.

patients

normal ciates

subjects ( I ) recently

tivity

of

TRH.

My

N, Montgomery in the treatment

above

us-

Editor’s

points.

sive

Note.- The

reference

M.D. Si. Paul, Minn.

SIR:

increased

Smenaldi,

F. Mangianotti)

and

results

with

and

TRH,

administered

Thyroid-stimulating

30, 60, and

g, and

the

TRH

hormone

90 minutes

T4, and T a pathology

emotional

disturbance.

secretion 300

increase chological

used.

Only

Thus

we can logical

T3 was

and

300

2.

by

patient’s

This

TRH

300

3.

of

the

Regarding

mood

not display

depression

TO

THE

should

been

with

not

ordinarily

Psi’chiatrt’

EDITOR

welcomed

be acknowledged.

132:4. April

no

submitted

1975

500

author

to

on

space

request.

Audit

Physical

for hospitalization. to

the

understanding

of

the

problems.

and psychological that is logical

Dealing

with

treatment

auditors

examinations. in view ofitems

1 through

limits

this

course

3.

on

of standards

physicians

the care of their can be validated.

at the time of dis-

information

representing

a normal

are

and

the

an extendue

patients

and use it for

of care.

outside

organizations

who

are

so that

not

the

prepared

to

adequacy

of

psycho-

with have

Editor,

contributes

emotional

of the hospital. 4. Setting the

associates,

We

not exceed the

of the need

that

3.

reported,

a significant

material

The letters made

and

in patients

other

History

document

ofCoppen

from

print

the special section on peer review in the Dcpermit me to make some suggestions based

psy-

by

to the treatment.

does

Like

were

Paolo Pini Affori, Italy

provided to

Record

The

the

instruments

fluctuations

1974 issue,

letter

unable

is available

The committee would collect following purposes: I . Education of the staff. 2. Development and elevation

TSH

No

list

were

1974

BRAMBILLA

Psichiatrico Milano

ofthe treating physician. 9. Appropriate plans for discharge. 10. The essentials ofthe in-hospital charge.

10, 20,

increased

oftwo

endo-

5. A record of treatment. 6. Progress notes that amplify the treatment record and demonstrate the physician’s day-to-day care of the patient. 7. Instructions to nursing personnel. 8. Consultations for conditions that are outside the expertise

effect

ofTSH.

either

function.

mits.

g it

a basic

FRANCE5CA

of this

we

for Psychiatric

4. A diagnosis

g. We

15 and 30 minutes.

on

of the results

LETTERS

J

were

author

which

I. Documentation

G.

inter-

stimulation,

to that

noted

variable

in secondary

Am

with

between

hypothalamo-pituitany-thyroid

460

48-hour

at intervals

TRH

proportional

not be related that

at

three

then

and

was

in confirmation

report

intrigued

), 3,5,3’-tniiodothynonine were assayed before

the 600-g

eight-fold,

minor

effect

and

After

improvement

and they could

I were

next

(T4)

with a peak

and

Sacchetti,

by radioimmunoassay.

percent,

ofT4

in

assoac-

levels were normal before stimulation, cxof the pituitary-thyroid axis related to the

increased

to 500

energy

has an antidepressant (TSH

administration

TSH, eluding

E.

4 times

(Ti), and 3,5,3’-tetraiodothynonine intravenous

and

decided to investigate the problem. 28 to 62 suffering from secondary

aged

vals. The first dose was 600 wished to determine whether in secondary depression.

rapid

alertness

have

has a

on the premise that we need to document the quality of treatment of hospitalized patients. We must establish a psychiatric record audit committee in every hospital. This committee should be responsible for reviewing chants on a random basis to determine whether they contain the following information:

of

effect

been reported. Coppen and data refuting the antidepressant

list,

considerations.

E5COBAR,

antidepressant

(E.

6 patients

depression

an

in-

treatment

5, Peet M, et al: Thyrotrophin-releasing ofdepression. Lancet 2:433-434,

We are

hormone (TRH) in deand energizing effect in

associates

and

contrasting

We treated

and

have also presented

G. Tassi,

these

reported

psychological

patients

PROF.

as an Antidepressant

thyrotropin-releasing An antipsychotic

schizophrenic

Spoto,

have

when

Ospedale

cember SIR:

only

positive

REFERENCE

im-

of patients

test

of

that hormonal

imbalance.

Suggestions

treatment pressed

reports

the possibility

1, when

isomer.

(-)

sample

to further

Hormone

previous

its the

at week

the

a larger

JAVIER

Thyrotropin-Releasing

the

than

have

increasing

article,

for

other

on, improvement for the Hamilton Depres-

scone on

planation

fluence

effec-

and

continued

pa-

it is with and

in

study

-)

a double-blind

a higher

have

isomers

( isomer occurred was reached. From then

observed

the maximum sion

difference

accounted for this greater improvement. Although indeed to find statistically significant differences as small as the one we used, both the statistical impressions were that the ( -) isomer is the most

MERVIN

and

will

for

publication,

words,

including

they

ROSENBERG,

M.D.

Hartford,

Conn.

cx-

will be subject

be published, if found suitable, they must be typewritten

references, to the

unless usual

a special

editing.

Receipt

as space pendouble-spaced.

arrangement of letters

has will