hypertensive
crisis.
use extreme erythromycin
caution in prescribing for a patient receiving
antidepressant
It is important
medication,
to
whether
it is a tnicyclic, monoamine oxidase inhibitor, on lithium carbonate. All the antidepressants have potentially toxic side effects, and there is a danger
in rapidly
dumping
them
into
the bloodstream. E. BERNSTEIN,
ANNE
M.D.
Dr. Bernstein is clinicalprofessorofpsychiatry at Columbia University College
of Physicians York
and
Surgeons
in New
City.
1. Depourtere I, Peters U, Vantrappen G, et al: Erythromycin modulates motilin receptor density in rabbit (abs). Gastroenterology 96(no 5, part 2):A1 19, 1989 2. Janssens J, Vantrappen JL, Urbain M, et al: The motilin against erythromycin normalizes impaired gastric emptying time in
diabetic
gastroparesis
(abs).
Gastroenter-
ology 96(no 5, pant 2):A237, 1989 3. Sarna 5K, Soergel TC, Koch JE, et al: Effects oferythromycin on human gastrointestinal motor activity in fasted and fed states (abs). Gastroenterology 96(no 5, part 2):A440, 1989 4. Vantrappen G, Janssens J, Tack E, et al: Erythromycin is a patent gastrokinetic in diabetic gastroparesis (abs). Gastroenterology 96(no 5, part 2):A525, 1989
Research
Design
Clarified
To the Editor: It has come to our attention that an important sentence was inadvertently omitted from the published tided “An pie With
version of our article enAdvocacy Model for PeoLong-Term Psychiatric
Disabilities,” November
which appeared 1989 issue (pages
1 1 74).
Because
sentence
might
impression employed
the
absence
convey
in the 1169of this
an inaccurate
of the research design in the original study, we
are writing
to provide
the complete
information.
The sentence in question should have appeared on page 1 1 7 1 of the in the
first
paragraph
the heading
“Experimental
As it stands,
the article
under
design.” refers
to only
two randomly assigned groups. The omitted sentence, enclosed in parentheses, read: ‘We also employed a minimum treatment placebo group to which some potential subjects
Hospital
randomly assigned before conto participate was requested,
but we have
not
and
Community
Psychiatry
included
this group
in the analyses presented This sentence was intended form
search three
readers
that
design
the
below.” to in-
original
ne-
did in fact incorporate
randomly
assigned
groups.
Two related issues deserve mention at this time. The first involves the reason for not including the placebo group in the article, the second involves statistical
relevant
to the conclusions
while issues
present-
ed in the article.
As for the
References
article,
were sent
first
issue,
the
main
thrust of the article was to show the differences between subjects who received the experimental intervention (client support and nepresentation [CSR) services) and those who did not. In the original design, the placebo group was included to facil-
Childhood
Sexual
Abuse
To the Editor: In the February issue, Dr. Jacobsen and Ms. Herald (1) reported on the relevance of childhood sexual abuse to adult inpatient care. I cannot endorse strongly enough their points about clinicians’ histonical failure to inquire about childhood and adolescent sexual abuse and the importance of making routine inquiry into sexual abuse. At our seven-county rural cornmunity mental health center, routine inquiry into sexual abuse is a mandatory facetofour intake, and similar
inquiry is required in all active treatment cases. Staff report that the information obtained has resulted in more appropriate diagnoses and has had
significant
impact
on treatment
planning and client response to treatment. It has also pointed up needs for
itate the explication ofany observed diffenences between experimental
staff inservice training in attitudes, inquiry techniques, and treatment related to sexual abuse. Our most
and control dependent
for any intesting. We
recent patient
aspect
(ages 12 to 87, 59 percent halfpneviously hospitalized),
subjects, hypothesis
not
were notaddressingthis
of the
study in the published article. We are including this aspect and other issues ofinterpretation in a separate manuscript, scheduled for completion by fall 1990.
cent
data indicate that in our outcaseload of 1 ,27 5 persons
of females
males
had
minor
female, 57 pen-
and
23 percent
of
experienced
major
on
childhood
on adolescent
sexu-
al abuse.
As for the second issue concerning statistical tests and their impact on the conclusions drawn in the atide, including all of the randomly assigned placebo cases in the analysis does not change the conclusion that subjects in the experimental condition were hospitalized for fewer days than control group subjects. The combined control group of no-newtreatment controls and placebo con-
I do question the investigators’ apparent focus on physical contact between an adult and a child or adolescent in their definition of major
tnols were
adults older
hospitalized
for an aver-
age of2 1 .5 days, compared with 15.4 days for recipients (t=-1.7 1, df= 47 1, p
crisis.
use extreme erythromycin
caution in prescribing for a patient receiving
antidepressant
It is important
medication,
to
whether
it is a tnicyclic, monoamine oxidase inhibitor, on lithium carbonate. All the antidepressants have potentially toxic side effects, and there is a danger
in rapidly
dumping
them
into
the bloodstream. E. BERNSTEIN,
ANNE
M.D.
Dr. Bernstein is clinicalprofessorofpsychiatry at Columbia University College
of Physicians York
and
Surgeons
in New
City.
1. Depourtere I, Peters U, Vantrappen G, et al: Erythromycin modulates motilin receptor density in rabbit (abs). Gastroenterology 96(no 5, part 2):A1 19, 1989 2. Janssens J, Vantrappen JL, Urbain M, et al: The motilin against erythromycin normalizes impaired gastric emptying time in
diabetic
gastroparesis
(abs).
Gastroenter-
ology 96(no 5, pant 2):A237, 1989 3. Sarna 5K, Soergel TC, Koch JE, et al: Effects oferythromycin on human gastrointestinal motor activity in fasted and fed states (abs). Gastroenterology 96(no 5, part 2):A440, 1989 4. Vantrappen G, Janssens J, Tack E, et al: Erythromycin is a patent gastrokinetic in diabetic gastroparesis (abs). Gastroenterology 96(no 5, part 2):A525, 1989
Research
Design
Clarified
To the Editor: It has come to our attention that an important sentence was inadvertently omitted from the published tided “An pie With
version of our article enAdvocacy Model for PeoLong-Term Psychiatric
Disabilities,” November
which appeared 1989 issue (pages
1 1 74).
Because
sentence
might
impression employed
the
absence
convey
in the 1169of this
an inaccurate
of the research design in the original study, we
are writing
to provide
the complete
information.
The sentence in question should have appeared on page 1 1 7 1 of the in the
first
paragraph
the heading
“Experimental
As it stands,
the article
under
design.” refers
to only
two randomly assigned groups. The omitted sentence, enclosed in parentheses, read: ‘We also employed a minimum treatment placebo group to which some potential subjects
Hospital
randomly assigned before conto participate was requested,
but we have
not
and
Community
Psychiatry
included
this group
in the analyses presented This sentence was intended form
search three
readers
that
design
the
below.” to in-
original
ne-
did in fact incorporate
randomly
assigned
groups.
Two related issues deserve mention at this time. The first involves the reason for not including the placebo group in the article, the second involves statistical
relevant
to the conclusions
while issues
present-
ed in the article.
As for the
References
article,
were sent
first
issue,
the
main
thrust of the article was to show the differences between subjects who received the experimental intervention (client support and nepresentation [CSR) services) and those who did not. In the original design, the placebo group was included to facil-
Childhood
Sexual
Abuse
To the Editor: In the February issue, Dr. Jacobsen and Ms. Herald (1) reported on the relevance of childhood sexual abuse to adult inpatient care. I cannot endorse strongly enough their points about clinicians’ histonical failure to inquire about childhood and adolescent sexual abuse and the importance of making routine inquiry into sexual abuse. At our seven-county rural cornmunity mental health center, routine inquiry into sexual abuse is a mandatory facetofour intake, and similar
inquiry is required in all active treatment cases. Staff report that the information obtained has resulted in more appropriate diagnoses and has had
significant
impact
on treatment
planning and client response to treatment. It has also pointed up needs for
itate the explication ofany observed diffenences between experimental
staff inservice training in attitudes, inquiry techniques, and treatment related to sexual abuse. Our most
and control dependent
for any intesting. We
recent patient
aspect
(ages 12 to 87, 59 percent halfpneviously hospitalized),
subjects, hypothesis
not
were notaddressingthis
of the
study in the published article. We are including this aspect and other issues ofinterpretation in a separate manuscript, scheduled for completion by fall 1990.
cent
data indicate that in our outcaseload of 1 ,27 5 persons
of females
males
had
minor
female, 57 pen-
and
23 percent
of
experienced
major
on
childhood
on adolescent
sexu-
al abuse.
As for the second issue concerning statistical tests and their impact on the conclusions drawn in the atide, including all of the randomly assigned placebo cases in the analysis does not change the conclusion that subjects in the experimental condition were hospitalized for fewer days than control group subjects. The combined control group of no-newtreatment controls and placebo con-
I do question the investigators’ apparent focus on physical contact between an adult and a child or adolescent in their definition of major
tnols were
adults older
hospitalized
for an aver-
age of2 1 .5 days, compared with 15.4 days for recipients (t=-1.7 1, df= 47 1, p
