Thought Disorder in Amphetamine Psychosis: A Case Report V. SIOMOPOULOS, M.D.
Amphetamine psychosis is a psychotic reaction which follows chronic oral or intravenous use of amphetamines, or less frequently, in sensitive indivduals, a single large dose. According to Connell, l who did the first extensive study of this condition, amphetamine psychosis presents with typical paranoid ideation, vivid auditory, visual, and sometimes tactile hallucinations, and changes in affect, all occurring in a setting of clear ct'nsciousness. Delusions of parasitosis, with picking and excoriation of the skin and stereotyped repetitious behavior with a "compulsion" to take apart mechanical objects are not uncommon in the clinical picture. 2 There is an accompanying sense of change in the patient's body image and a constant preoccupation with pseudophilosophical and pseudoscientific concerns. 2 Described as early as 1938,:1 amphetamine psychosis received increasing attention in the last two decades because of its clinical resemblam.e with paranoid schizophrenia, a resemblance which not only raises questions of differential diagnosis between the two conditions, but also opens new avenues of research in the etiology of schizophrenia. Today, amphetamine psychosis is considered as a "model psychosis" and an important clue to the biological mechanisms of schizophrenia. Obviously, the delineation of clinical similarities and differences between amphetamine psychosis and schizophrenia is important from both the clinical and research point of view. Be1l4 considered the presence of visual hallucinations as favoring the diagnosis of amphetamine psycho!'is, when the question of differential diagnosis is raised, whereas Griffith et a)5 considered the visual hallucinations of amphetamine psychosis as an indication of toxicity, a symptom of toxic organic psychosis unrelated to the specific psychotomimetic effects of the drug. Griffith et aP have questioned even the presence of auditory hallucinations in amphetamine psychosis, which they consider as imitating a paranoid state rather than true schizophrenia. Another controversial aspect of amphetamine psychosis concerns the presence of thought disorder in its clinical picture. Be1l 4 found no evidence of thought disorder in a large number of patients with this condition and considered this finding as an important clinical feature in the differential diagnosis between schizoDr. Siomopoulos is Staff Psychiatrist, II1inois State Psychiatric Institute, Assistant Clinical Professor of Psychiatry, University of Illinois, Abraham Lincoln School of Medicine.
42
phrenia and amphetamine psychosis. Similarly, Griffith et al,ri using human volunteers, who had previously abused amphetamines, induced an experimental amphetamine psychosis with delusional ideas of persecution, ideas of reference, blunted affect, and personality alterations. but not true thought disorder. On the other hand, Angrist and Gershon," repeating Griffith's experiments, but using larger doses of racemic amphetamine sulfate, produced an amphetamine psychosis in which bizzare and fragmented associations and disruptions in syntax were present, among other psychotic symptoms. Recently, Cohen 7 referred to the presence of a resistant thought disorder in patients with amphetamine psychosis. even long after the hallucinations subsided, but he did not specify the type of thought disorder he observed. The term "thought disorder" commonly refers not to abnormal thought content, but to disturbances in the form of thinking, such as loosening of associations, neologisms, concreteness, or impairment of syllogisitc reasoning. This paper reports a case of amphetamine psychosis with the type of thought impairment variously known as primary process thinking (Freud), paralogic thinking (Von Domarus), or paleologic thinking (Arieti), which has been- traditionally considered as a pathognomonic feature of schizophrenia and schizophrenic-like states. As far as I know there have been no reports in the literature in which this type of thought disorder has been described in association with amphetamine psychosis. CASE REPORT
A 29-year-old white married unemployed man came to the outpatient clinic of the hospital with the complaints of marked anxiety and the fear that he was "going insane," His past history included several arrests and convictions for burglary and aggravated battery, as well as a psychiatric hospitalization a few years ago, when he was diagnosed as having "drug addiction" and a sociopathic personality." He admitted using a variety of drugs (heroin, codeine, paregoric) for many years until about a year ago, when he stopped using these drugs and began instead to use Desoxyn (methamphetamine hydrochloride) alone. He related that once or twice a week he would dissolve about 15 tablets of Desoxyn (5 mg. strength) into boiled water and then inject the solution intravenously in 2-4 divided doses over a 24-hour-period. Following the last injection, he would stay up all night reading books on biology, medicine, and psychology, meditating, or looking at things through a microscope, which he bought a few months ago in order to find out more about the "secrets of Nature." On examination, he was oriented, coherent and relevant. Almost throughout the interview he kept pulling the hair Volume XVII
AMPHETAMINE PSYCHOSIS-SIOMOPOULOS on the top of his head in a stereotyped manner. Asked why he was doing this, he replied that this was a "tic" he acquired a few months ago. His thought disorder became apparent, as he further explained that a few months ago he came to believe that "twisted" hair in his head may cause cancer of the brain and schizophrenia, and he had to "untwist" it to prevent the occurrence of these illnesses. He was extremely concerned about it, since his father had died of a brain tumor a few years earlier. His preoccupation with "hair" was pervasive. He pointed out that hair and sperm under the microscope look like worms; therfore, they are worms, that the testes are bags of worms, and that the intestines and the brain and the whole human body are just big worms. Ideas of grandiosity and persecution were also pr..:sent. He called attention to the fact that he was born on July 17, that Caesar's first name was Julius and that since the Romans celebrated the founding of Rome on the 17th of each month, it was more than likely that Julius Caesar was born on July 17. Since the patient was also Roman (Italian), he reasoned that he was Julius Caesar reincarnated. He expressed the belief that "police agents are everywhere"; he worried tbout "what they are doing to our food" and pointed out that the milk is not only pasteurized, but also homogenized, which means that "they poison our genes with milk." It is of interest that he denied ever having hallucinations. COMMENT
The case reported above represents a typical case of amphetamine psychosis. There is a history of antisocial behavior and chronic drug abuse, but the specific symptoms suggestive of amphetamine psychosis appeared only after the patient began using amphetamines. These symptoms included paranoid ideation of grand:ose and persecutory nature, stereotyped behavior, and pseudoscientific preoccupations. Hallucinations were absent from the clinical picture, in agreement with Griffith's findings, but there was a typical thought disorder of the type known as paralogic (paleologic) thinking, a disorder of cognition frequently found in schizophrenic patients. According to Arieti,8 who did extensive studies of schizophrenic cognition, a patient using the paleologic mode of thinking accepts identity not on the basis of identical subjects or wholes but on the basis o~ identical predicates or parts. Thus, a schizophrenic patient of mine thought she was Kim Novak, the Hollywood actress, when she learned that she and Kim Novak had attended the same school. Another patient thought he was a policeman because his driver's license had a stur on it. This type of thinking takes place consciously or unconsciously and is dynamically determined by the patient's motivations. Drives, wishes, and fears "take over," as it were, the patient's cognition and lead to misevaluations of certain aspects of reality intimately connected with these drives, wishes, and fears. In our case, this type of thinking is illustrated by the patient's belief that he is Julius Caesar, his belief that "twisted" hair may cause cancer of the brain or schizophrenia ("twisted" hair = "twisted" brain), Jan.lFeb.lMarch, 1976
I
his belief that our genes are poisoned by homogenized milk. Generally, his thought processes are permeated by predictative identifications. Thought disorder in the form of looseness of associations is not present. This is consistent with an earlier finding, which I reported elsewhere,9 that patients with this type of thinking show very little, if any, associative disturbances. The question may be raised whether the delusional ideas of this patient, more specifically the paleologic mechanisms underlying these ideas, are a direct amphetamine effect or represent an awakening by the drug of a latent schizophrenic condition. Most authors today, following Connell's original suggestion, consider the symptoms of amphetamine psychosis as direct psychotomimetic effects and reject the view that the drug unmasks a latent schizophrenic illness. On the other hand, bridging the gap between psychopathological manifestations, such as paleologic thought processes and the central psychopharmacological events a$sociated with amphetamine intake should be an extremely difficult undertaking. The pathogenesis of amphetamine psychosis is not known. It is known that in experimental animals amphetamines release norepinephrine and dopamine centrally and cause stereotyped behavior which can be reversed by dopamine blocking agents, such as Haldol and Thorazine. Amphetamine psychosis itself is reversed by these agents. It has been proposed lo that amphetamines lead to excessive dopaminergic activity in the limbic system considered to be responsible for th~ schizophrenic-like picture of amphetamine psychosis, which takes on a paranoid flavor by the stimulatory effect of norepinephrine. It is not unlikely that inhibition of serotoninergic neurons in the raphe nuclei of the midbrain may also be involved. I I Whatever the underlying pharmacological mechanisms of amphetamine psychosis might be, amphetamines seem to cause, from a descriptive point of view, a state of affective (limbic) hyper-arousal. If affects (drives, fears, wishes) may "take over" in schizophrenia to lead to faulty evaluations and perceptions of reality. amphetamine psychosis might as well be conceptualized as a pharmacologically-induced "affective (I i m b i c) takeover," leading to the same type of misevaluations of reality-a hypothesis I already put forward in another publication. l l Paleologic thinking is not uncommon in schizophrenia, but it is not always easy to detect. Although in the case reported here the presence of paleologic thinking was quite apparent, I would suspect, that there might be cases of amphetamine psychosis in which this type of thought disorder may pass undetected. The case reported in this paper suggests similarities between schizophrenia and amphetamine psychosis in an area heretofore unexplored. 1601 West Taylor St., Chicago, I11inois 60612. 43
PSYCHOSOMATICS REFERENCES 1. Connell, H.P.: Amphetamine Psychosis. Chapman and Hall Ltd., London, 1958. 2. Ellinwood, E. H., Jr.: Amphetamine Psychosis: Individuals, Settings and Sequences. In Current Concepts on Amphetamine Abuse. Edited by E. H. Ellinwood, Jr. and S. Cohen. Rockville, Md., National Institute of Mental Health, 1972, pp. 143-157. 3. Young. D., Scoville, B.W.: Paranoid Psychosis in Narcolepsy and the Possible Danger of Benzedrine Treatment. Med. Clin. N. America. 22:637, 1938. 4. Bell, D.S.: Comparison of Amphetamine Psychosis and Schizophrenia. Brit. J. Psychiatry. III :701, 1955. 5. Griffith, J.D., Fann. W.E., Oates, J.A.: The Amphetamine Psychosis: Experimental Manifestations. In Current Concepts on Amphetamine Abuse. Edited by E. H. Ellinwood, Jr. and S. Cohen. Rockville, Md., National In-
stitute of Mental Health, 1972 pp. 185-191. 6. Angrist, B., Gershon, S.: Some Recent Studies on Amphetamine Psychois: Unresolved Issues. In Current Concepts 011 Amphetamille Abuse. Edited by E. H. Ellinwood, Jr. and S. Cohen. Rockville, Md., National Institute of Mental Health, 1972, pp. 193-204. 7. Cohen, S.: Amphetamine Abuse. I.A.M.A .• 231:414, 1975. 8. Arieti, S.: The llltraphsychic Self, Feelillg, Cognitioll, and Creatil'ity in Health and Memal l/lness. Basic Books, New York, 1967. 9. Siomopoulos, V.: Paralogic Involvement of the Notion of Awareness in Schizophernic Thinking. Psychiat. Quart. 44:305. 1970. 10. Snyder, S.: Madlless and the Brain. McGraw-Hili, 1974. 11. Siomopoulos, V.: Amphetamine Psychosis: Overview and a Hypothesis. Dis. Nerv. Systm, Vol. 36 6, 336-339, June 1975.
Academy of Psychosomatics Medicine Committee Chainnen-1976-1977 1. Membership and Credentials-Bernice Sachs, M.D. 2. Constitution and By-Laws:-Thomas C. Kalkhof, M.D. 3. Audit and Finance and Budget-Thomas C. Kalkhof, M.D. 4. Educational Directorate, Research and Scientific Committee-H. Keith Fischer, M.D. 5. Annual Meeting Committee-Co-Chairmen: Barney M. Olin, M.D.• and Joseph V. Fisher, M.D. A. Program Committee-Barney M. Olin, M.D. B. Convocation Subcommittee-Thomas C. Kalkhof, M.D. C. Local Arrangements Subcommittee-Joseph V. Fisher, M.D. 6. Public Relations Committee-Jerome J. Harris, Ph.D. 7. Nominating Committee-H. Keith Fischer. M.D. 8. Future Sites of Meetings Committee-M. J. Martin, M.D. 9. Publication Committee:-
B. Best Journal Paper, 1975-Joseph V. Fisher, M.D. 11. Liaison with other Organizations:American Psychological-Wendell Swenson, Ph.D. American Psychiatric Association-John J. Schwab, M.D. American Academy of Family Physicians-Joseph V. Fisher, M.D. American Medical Association-John M. Coleman. M.D. American College of Cardiology-Louis Bishop, M.D. and Henry Russek, M.D. American College of Psychopharmacology-Alberto DiMascio, Ph.D. ASCH-Bernice Sachs, M.D. ? Nursing Association-Irving Frank, M.D. ITAA-Carlton Thornwall. M.D. American Dental Association-John Manhold, Jr., D.M.D.
The three subcommittee chairmen are co-chairmen of the overall Publication Committee: A. Publication Board-Wendell Swenson, Ph.D. B. Ad Hoc Business and Finance Committee-John H. Maohold, Jr., D.M.D. C. Psychosomatics-Wilfred Dorfman, M.D.
12. Regional Representatives:East-Claus B. Bahnson, Ph.D. South-William Webb, M.D. West-Fred Henker, M.D. Midwest-Robert Niven, M.D. Hawaii-Ram Gurashani, M.D. Canada-David Keegan, M.D.
10. Journal Awards Committee:A. Student Award Paper:-Alberto DiMascio, Ph.D.
13. Ad Hoc Committee on Executive Director's Contract:Thomas Kalkhof, M.D.
44
Volume XVII
Amphetamine psychosis is a psychotic reaction which follows chronic oral or intravenous use of amphetamines, or less frequently, in sensitive indivduals, a single large dose. According to Connell, l who did the first extensive study of this condition, amphetamine psychosis presents with typical paranoid ideation, vivid auditory, visual, and sometimes tactile hallucinations, and changes in affect, all occurring in a setting of clear ct'nsciousness. Delusions of parasitosis, with picking and excoriation of the skin and stereotyped repetitious behavior with a "compulsion" to take apart mechanical objects are not uncommon in the clinical picture. 2 There is an accompanying sense of change in the patient's body image and a constant preoccupation with pseudophilosophical and pseudoscientific concerns. 2 Described as early as 1938,:1 amphetamine psychosis received increasing attention in the last two decades because of its clinical resemblam.e with paranoid schizophrenia, a resemblance which not only raises questions of differential diagnosis between the two conditions, but also opens new avenues of research in the etiology of schizophrenia. Today, amphetamine psychosis is considered as a "model psychosis" and an important clue to the biological mechanisms of schizophrenia. Obviously, the delineation of clinical similarities and differences between amphetamine psychosis and schizophrenia is important from both the clinical and research point of view. Be1l4 considered the presence of visual hallucinations as favoring the diagnosis of amphetamine psycho!'is, when the question of differential diagnosis is raised, whereas Griffith et a)5 considered the visual hallucinations of amphetamine psychosis as an indication of toxicity, a symptom of toxic organic psychosis unrelated to the specific psychotomimetic effects of the drug. Griffith et aP have questioned even the presence of auditory hallucinations in amphetamine psychosis, which they consider as imitating a paranoid state rather than true schizophrenia. Another controversial aspect of amphetamine psychosis concerns the presence of thought disorder in its clinical picture. Be1l 4 found no evidence of thought disorder in a large number of patients with this condition and considered this finding as an important clinical feature in the differential diagnosis between schizoDr. Siomopoulos is Staff Psychiatrist, II1inois State Psychiatric Institute, Assistant Clinical Professor of Psychiatry, University of Illinois, Abraham Lincoln School of Medicine.
42
phrenia and amphetamine psychosis. Similarly, Griffith et al,ri using human volunteers, who had previously abused amphetamines, induced an experimental amphetamine psychosis with delusional ideas of persecution, ideas of reference, blunted affect, and personality alterations. but not true thought disorder. On the other hand, Angrist and Gershon," repeating Griffith's experiments, but using larger doses of racemic amphetamine sulfate, produced an amphetamine psychosis in which bizzare and fragmented associations and disruptions in syntax were present, among other psychotic symptoms. Recently, Cohen 7 referred to the presence of a resistant thought disorder in patients with amphetamine psychosis. even long after the hallucinations subsided, but he did not specify the type of thought disorder he observed. The term "thought disorder" commonly refers not to abnormal thought content, but to disturbances in the form of thinking, such as loosening of associations, neologisms, concreteness, or impairment of syllogisitc reasoning. This paper reports a case of amphetamine psychosis with the type of thought impairment variously known as primary process thinking (Freud), paralogic thinking (Von Domarus), or paleologic thinking (Arieti), which has been- traditionally considered as a pathognomonic feature of schizophrenia and schizophrenic-like states. As far as I know there have been no reports in the literature in which this type of thought disorder has been described in association with amphetamine psychosis. CASE REPORT
A 29-year-old white married unemployed man came to the outpatient clinic of the hospital with the complaints of marked anxiety and the fear that he was "going insane," His past history included several arrests and convictions for burglary and aggravated battery, as well as a psychiatric hospitalization a few years ago, when he was diagnosed as having "drug addiction" and a sociopathic personality." He admitted using a variety of drugs (heroin, codeine, paregoric) for many years until about a year ago, when he stopped using these drugs and began instead to use Desoxyn (methamphetamine hydrochloride) alone. He related that once or twice a week he would dissolve about 15 tablets of Desoxyn (5 mg. strength) into boiled water and then inject the solution intravenously in 2-4 divided doses over a 24-hour-period. Following the last injection, he would stay up all night reading books on biology, medicine, and psychology, meditating, or looking at things through a microscope, which he bought a few months ago in order to find out more about the "secrets of Nature." On examination, he was oriented, coherent and relevant. Almost throughout the interview he kept pulling the hair Volume XVII
AMPHETAMINE PSYCHOSIS-SIOMOPOULOS on the top of his head in a stereotyped manner. Asked why he was doing this, he replied that this was a "tic" he acquired a few months ago. His thought disorder became apparent, as he further explained that a few months ago he came to believe that "twisted" hair in his head may cause cancer of the brain and schizophrenia, and he had to "untwist" it to prevent the occurrence of these illnesses. He was extremely concerned about it, since his father had died of a brain tumor a few years earlier. His preoccupation with "hair" was pervasive. He pointed out that hair and sperm under the microscope look like worms; therfore, they are worms, that the testes are bags of worms, and that the intestines and the brain and the whole human body are just big worms. Ideas of grandiosity and persecution were also pr..:sent. He called attention to the fact that he was born on July 17, that Caesar's first name was Julius and that since the Romans celebrated the founding of Rome on the 17th of each month, it was more than likely that Julius Caesar was born on July 17. Since the patient was also Roman (Italian), he reasoned that he was Julius Caesar reincarnated. He expressed the belief that "police agents are everywhere"; he worried tbout "what they are doing to our food" and pointed out that the milk is not only pasteurized, but also homogenized, which means that "they poison our genes with milk." It is of interest that he denied ever having hallucinations. COMMENT
The case reported above represents a typical case of amphetamine psychosis. There is a history of antisocial behavior and chronic drug abuse, but the specific symptoms suggestive of amphetamine psychosis appeared only after the patient began using amphetamines. These symptoms included paranoid ideation of grand:ose and persecutory nature, stereotyped behavior, and pseudoscientific preoccupations. Hallucinations were absent from the clinical picture, in agreement with Griffith's findings, but there was a typical thought disorder of the type known as paralogic (paleologic) thinking, a disorder of cognition frequently found in schizophrenic patients. According to Arieti,8 who did extensive studies of schizophrenic cognition, a patient using the paleologic mode of thinking accepts identity not on the basis of identical subjects or wholes but on the basis o~ identical predicates or parts. Thus, a schizophrenic patient of mine thought she was Kim Novak, the Hollywood actress, when she learned that she and Kim Novak had attended the same school. Another patient thought he was a policeman because his driver's license had a stur on it. This type of thinking takes place consciously or unconsciously and is dynamically determined by the patient's motivations. Drives, wishes, and fears "take over," as it were, the patient's cognition and lead to misevaluations of certain aspects of reality intimately connected with these drives, wishes, and fears. In our case, this type of thinking is illustrated by the patient's belief that he is Julius Caesar, his belief that "twisted" hair may cause cancer of the brain or schizophrenia ("twisted" hair = "twisted" brain), Jan.lFeb.lMarch, 1976
I
his belief that our genes are poisoned by homogenized milk. Generally, his thought processes are permeated by predictative identifications. Thought disorder in the form of looseness of associations is not present. This is consistent with an earlier finding, which I reported elsewhere,9 that patients with this type of thinking show very little, if any, associative disturbances. The question may be raised whether the delusional ideas of this patient, more specifically the paleologic mechanisms underlying these ideas, are a direct amphetamine effect or represent an awakening by the drug of a latent schizophrenic condition. Most authors today, following Connell's original suggestion, consider the symptoms of amphetamine psychosis as direct psychotomimetic effects and reject the view that the drug unmasks a latent schizophrenic illness. On the other hand, bridging the gap between psychopathological manifestations, such as paleologic thought processes and the central psychopharmacological events a$sociated with amphetamine intake should be an extremely difficult undertaking. The pathogenesis of amphetamine psychosis is not known. It is known that in experimental animals amphetamines release norepinephrine and dopamine centrally and cause stereotyped behavior which can be reversed by dopamine blocking agents, such as Haldol and Thorazine. Amphetamine psychosis itself is reversed by these agents. It has been proposed lo that amphetamines lead to excessive dopaminergic activity in the limbic system considered to be responsible for th~ schizophrenic-like picture of amphetamine psychosis, which takes on a paranoid flavor by the stimulatory effect of norepinephrine. It is not unlikely that inhibition of serotoninergic neurons in the raphe nuclei of the midbrain may also be involved. I I Whatever the underlying pharmacological mechanisms of amphetamine psychosis might be, amphetamines seem to cause, from a descriptive point of view, a state of affective (limbic) hyper-arousal. If affects (drives, fears, wishes) may "take over" in schizophrenia to lead to faulty evaluations and perceptions of reality. amphetamine psychosis might as well be conceptualized as a pharmacologically-induced "affective (I i m b i c) takeover," leading to the same type of misevaluations of reality-a hypothesis I already put forward in another publication. l l Paleologic thinking is not uncommon in schizophrenia, but it is not always easy to detect. Although in the case reported here the presence of paleologic thinking was quite apparent, I would suspect, that there might be cases of amphetamine psychosis in which this type of thought disorder may pass undetected. The case reported in this paper suggests similarities between schizophrenia and amphetamine psychosis in an area heretofore unexplored. 1601 West Taylor St., Chicago, I11inois 60612. 43
PSYCHOSOMATICS REFERENCES 1. Connell, H.P.: Amphetamine Psychosis. Chapman and Hall Ltd., London, 1958. 2. Ellinwood, E. H., Jr.: Amphetamine Psychosis: Individuals, Settings and Sequences. In Current Concepts on Amphetamine Abuse. Edited by E. H. Ellinwood, Jr. and S. Cohen. Rockville, Md., National Institute of Mental Health, 1972, pp. 143-157. 3. Young. D., Scoville, B.W.: Paranoid Psychosis in Narcolepsy and the Possible Danger of Benzedrine Treatment. Med. Clin. N. America. 22:637, 1938. 4. Bell, D.S.: Comparison of Amphetamine Psychosis and Schizophrenia. Brit. J. Psychiatry. III :701, 1955. 5. Griffith, J.D., Fann. W.E., Oates, J.A.: The Amphetamine Psychosis: Experimental Manifestations. In Current Concepts on Amphetamine Abuse. Edited by E. H. Ellinwood, Jr. and S. Cohen. Rockville, Md., National In-
stitute of Mental Health, 1972 pp. 185-191. 6. Angrist, B., Gershon, S.: Some Recent Studies on Amphetamine Psychois: Unresolved Issues. In Current Concepts 011 Amphetamille Abuse. Edited by E. H. Ellinwood, Jr. and S. Cohen. Rockville, Md., National Institute of Mental Health, 1972, pp. 193-204. 7. Cohen, S.: Amphetamine Abuse. I.A.M.A .• 231:414, 1975. 8. Arieti, S.: The llltraphsychic Self, Feelillg, Cognitioll, and Creatil'ity in Health and Memal l/lness. Basic Books, New York, 1967. 9. Siomopoulos, V.: Paralogic Involvement of the Notion of Awareness in Schizophernic Thinking. Psychiat. Quart. 44:305. 1970. 10. Snyder, S.: Madlless and the Brain. McGraw-Hili, 1974. 11. Siomopoulos, V.: Amphetamine Psychosis: Overview and a Hypothesis. Dis. Nerv. Systm, Vol. 36 6, 336-339, June 1975.
Academy of Psychosomatics Medicine Committee Chainnen-1976-1977 1. Membership and Credentials-Bernice Sachs, M.D. 2. Constitution and By-Laws:-Thomas C. Kalkhof, M.D. 3. Audit and Finance and Budget-Thomas C. Kalkhof, M.D. 4. Educational Directorate, Research and Scientific Committee-H. Keith Fischer, M.D. 5. Annual Meeting Committee-Co-Chairmen: Barney M. Olin, M.D.• and Joseph V. Fisher, M.D. A. Program Committee-Barney M. Olin, M.D. B. Convocation Subcommittee-Thomas C. Kalkhof, M.D. C. Local Arrangements Subcommittee-Joseph V. Fisher, M.D. 6. Public Relations Committee-Jerome J. Harris, Ph.D. 7. Nominating Committee-H. Keith Fischer. M.D. 8. Future Sites of Meetings Committee-M. J. Martin, M.D. 9. Publication Committee:-
B. Best Journal Paper, 1975-Joseph V. Fisher, M.D. 11. Liaison with other Organizations:American Psychological-Wendell Swenson, Ph.D. American Psychiatric Association-John J. Schwab, M.D. American Academy of Family Physicians-Joseph V. Fisher, M.D. American Medical Association-John M. Coleman. M.D. American College of Cardiology-Louis Bishop, M.D. and Henry Russek, M.D. American College of Psychopharmacology-Alberto DiMascio, Ph.D. ASCH-Bernice Sachs, M.D. ? Nursing Association-Irving Frank, M.D. ITAA-Carlton Thornwall. M.D. American Dental Association-John Manhold, Jr., D.M.D.
The three subcommittee chairmen are co-chairmen of the overall Publication Committee: A. Publication Board-Wendell Swenson, Ph.D. B. Ad Hoc Business and Finance Committee-John H. Maohold, Jr., D.M.D. C. Psychosomatics-Wilfred Dorfman, M.D.
12. Regional Representatives:East-Claus B. Bahnson, Ph.D. South-William Webb, M.D. West-Fred Henker, M.D. Midwest-Robert Niven, M.D. Hawaii-Ram Gurashani, M.D. Canada-David Keegan, M.D.
10. Journal Awards Committee:A. Student Award Paper:-Alberto DiMascio, Ph.D.
13. Ad Hoc Committee on Executive Director's Contract:Thomas Kalkhof, M.D.
44
Volume XVII
