680
Correspondence
BIOL PSYCHIATRY 1990;27:671-685
were present in 10 of these cases. As can be seen in Table 2, the percentages of nonsuppression were lower for other psychiatric diagnoses. In summary, in the present study 106 out of 259 (40.9%) consecutive patients admitted in a Brazilian Psychiatric Hospital were nonsuppressors to DST. Depression (54.7%), drug use (47.6%), other medical disorders (43.6%), and alcoholism (41.5%) were the most prevalent diagnoses associated with nonsuppression. However, taking into consideration all factors interfering with DST, 46.2% of nonsuppressors could be false-positives, whereas in 17 out of 23 nonsuppressor depressive patients these variables could also explain test results. In conclusion, in view of the poor living conditions of our population, the deficiencies of the health care system, and widespread use of medications with poor medical supervision, the DST should be used cautiously, if ever, in Brazil and other third world ce~ntries. Florence Kerr t E.A. Carlini t Carol Sonenreich 2
tDepartamento de Psicobiologia Escola Paulista de Medicina Silo Paulo, Brazil 2Hospital do Servidor Ptiblico Federal Silo Paulo, Brazil
References American Psychia~c Association (1987): The dexamethasone suppression test: an overview of its current status in psychiatry. Am J Psychiatry 144:1253-1262. Anma GW, Baldessarini RJ, Omsteen M (I98:~): The ~xamethasone suppressiontest for diagnosis and prognosis in psychiatry. Arch Gen Psychiatry 42:1193-1204. Avery DH, Osgood T, Ishiki DM, Wilson I.G, Keuny M, Dunner DL (1985): The DST in psychiatric outpatients with generalized anxiety disorder, panic disorder, or primary affective disorder. Am J Psychiatry 142:844848. Carroll BJ (1985): Dexamethasone suppression test: a reviewof contemporaryconfusion.J ¢lin Psychiatry 46:1324. Carroll BJ (1986): Informed use of the dexamethasone suppression test. J Clin Psychiatry 47 (suppl 1): 10-12. Carroll BJ, Feinberg M, Greden JF, Tarika J, Albala AA, Haskett RF, James NMcl, Kronfol Z, Lohr N, Steiner M, de Vigne JP, Young E (1981): A specific laboratory test for the diagnosis of melancholia. 3tandardization, velidafio~t,and clinicalutility.Arch Gun Psychiatry 38:1522. Dratcu L, Calil HM (1989): The dexa~thasone suppression test: its relationshipto diagnoses, severityof depression, and response to treatment. Prog Neuropsychoplmrmacol Biol Psychiatry 13:99-117. Frochtengarten ML, Villares JCB, Maluf E, Carlini EA (1987): Depressive symptoms and the dexammhasone suppression test in parkinsonian patients. Biol Psychia. try 22:386--389. Kraus RP, Gmf P, Brown GM (1988): Drugs and the DST: need f~r a reappraisal. Am J Psychiatry 145:666-674.
1his work was partially financed by Fundacio de Amparo i Pesquisa de S~o Paqlo (FAPESP) and Associ~AoFundo de Incentivo ~ Psicofarmacologia (AFIP).
Verapamil in Stuttering To the Editor: R has been difficult to find pharmacological treatments of chronic stuttering in adults that are both effective and without intolerable side effects (Ingham 1984). Zach~L~ab (1980) reported promising results with the calcium channel-blocker verapamil. However, this study had major methodological limitations (e.g., a single-blind trial with no objective speech data). We carried out a double-blind, placebo-con-
trolled trial of verapamil in a cross-over experimental design with multiple, objective measures of stuttering severity. As we repoi~ed in this journal (1989), verapamil was found to be significantly more effective than placebo in 2 of 4 speech measures in this brief (l-week) trial. At a 6-month follow-up, only 2 of the original l0 patients were still taking the drag. However, both of these patients reported that their speech continued to be substantially improved. Recently we completed a 2 l/2-year follow-up of these 2 patients. Both are still taking verapamil (180-
Correspondence
BIOL PSYCHIATRY 1990;27:671-.685
240 mg daily) and report no side effects from the medication. Both report also that their speech continues to be better than it has been for as long as they can remember. They report also that failure to take the verapamil for a day or so (e.g., forgetting to do so, temporarily running out of the medication) is followed by a return of more stuttering. Their rates of dysfluency while reading a 1000 syllable story (RD) and speaking extemporaneously for 3 min (SD) are given in Table 1 along with the corresponding dysfluency rates on initial (baseline) testing and at the 6-month follow-up. The results we published in 1989 are more modest Table 1. Effect of Verapamil on Rates of Dysfluency in Patients with Chronic Stuttering 6-month 2s/2-year Baseline follow-up follow-up Patient A (38-year-old female) RD SD Patient B (59-year-old male) RD SD
6 9
4 7
2 4
48 36
17 34
11 26
Abbreviations: RD, reading dysfluency; SD, speaking dysfluency.
than those reported by Zachariah (1980); only 2 of our 10 subjects (20%) elected to continue with the drug. However, it is very promising that these 2 subjects have continued to improve over an extended period without side effects. We hope that other clinicians will try verapamil with chronic adult stutterers, a generally recalcitrant patient group. We would like to hear of their results. John Paul Bradf Thomas W. McAllister' Trevor R.P. Price2 mDepartment of Psychiatry University of Pennsylvania Philadelphia, PA 19104 2Department of Psychiatry Medical College of Pennsylvania Allegheny Campus Pittsburgh, PA 15212
References Brady JP, Price TRIP, McAilister TW, Dietrich K (1989): A trial of verapamil in the treatment of stuttering in adults. Biol Psychiatry 25:626-630. Ingham RJ (1984): Stuttering and Behavior Therapy. San Diego, CA: College-Hill Press. Zachariah G (1980): Verapamil in the managementof stammering. Antiseptic 77:87-88.
Antiseptal Autoantibodies in Schizophrenia To the Editor: Heathet al. (Biol Psychiatry 25:725-733, 1989) recently reported that serum from 96% of unmedicated schizophrenic patients contained IgG autoantibodies specific for the septal region of rhesus monkey brain, in contrast to 0% of control subjects and 6% of medicated schizophrenics. We were unable to reproduce this finding (Knight et al. Biol Psychiatry, in press). In an attempt to resolve this unexpected discrepancy, we sent 12 coded serum samples on dry ice to Dr. Heath. The results from Heath's laboratory did not ,bear any apparent relationship to the origin of the serum samples, nor to their own previously reported findings.
681
John G. Knight Allison Knight David B. Menkes Paul E. Mullen University of Otago Department of Psychological Medicine Medical School Dunedin, New Zealand
Response To the Editor: Correspondence with Knight revealed departures from our described protocol when he and his colleagues attempted to replicate our findings. When he subsequently sent us coded samples for analysis in
Correspondence
BIOL PSYCHIATRY 1990;27:671-685
were present in 10 of these cases. As can be seen in Table 2, the percentages of nonsuppression were lower for other psychiatric diagnoses. In summary, in the present study 106 out of 259 (40.9%) consecutive patients admitted in a Brazilian Psychiatric Hospital were nonsuppressors to DST. Depression (54.7%), drug use (47.6%), other medical disorders (43.6%), and alcoholism (41.5%) were the most prevalent diagnoses associated with nonsuppression. However, taking into consideration all factors interfering with DST, 46.2% of nonsuppressors could be false-positives, whereas in 17 out of 23 nonsuppressor depressive patients these variables could also explain test results. In conclusion, in view of the poor living conditions of our population, the deficiencies of the health care system, and widespread use of medications with poor medical supervision, the DST should be used cautiously, if ever, in Brazil and other third world ce~ntries. Florence Kerr t E.A. Carlini t Carol Sonenreich 2
tDepartamento de Psicobiologia Escola Paulista de Medicina Silo Paulo, Brazil 2Hospital do Servidor Ptiblico Federal Silo Paulo, Brazil
References American Psychia~c Association (1987): The dexamethasone suppression test: an overview of its current status in psychiatry. Am J Psychiatry 144:1253-1262. Anma GW, Baldessarini RJ, Omsteen M (I98:~): The ~xamethasone suppressiontest for diagnosis and prognosis in psychiatry. Arch Gen Psychiatry 42:1193-1204. Avery DH, Osgood T, Ishiki DM, Wilson I.G, Keuny M, Dunner DL (1985): The DST in psychiatric outpatients with generalized anxiety disorder, panic disorder, or primary affective disorder. Am J Psychiatry 142:844848. Carroll BJ (1985): Dexamethasone suppression test: a reviewof contemporaryconfusion.J ¢lin Psychiatry 46:1324. Carroll BJ (1986): Informed use of the dexamethasone suppression test. J Clin Psychiatry 47 (suppl 1): 10-12. Carroll BJ, Feinberg M, Greden JF, Tarika J, Albala AA, Haskett RF, James NMcl, Kronfol Z, Lohr N, Steiner M, de Vigne JP, Young E (1981): A specific laboratory test for the diagnosis of melancholia. 3tandardization, velidafio~t,and clinicalutility.Arch Gun Psychiatry 38:1522. Dratcu L, Calil HM (1989): The dexa~thasone suppression test: its relationshipto diagnoses, severityof depression, and response to treatment. Prog Neuropsychoplmrmacol Biol Psychiatry 13:99-117. Frochtengarten ML, Villares JCB, Maluf E, Carlini EA (1987): Depressive symptoms and the dexammhasone suppression test in parkinsonian patients. Biol Psychia. try 22:386--389. Kraus RP, Gmf P, Brown GM (1988): Drugs and the DST: need f~r a reappraisal. Am J Psychiatry 145:666-674.
1his work was partially financed by Fundacio de Amparo i Pesquisa de S~o Paqlo (FAPESP) and Associ~AoFundo de Incentivo ~ Psicofarmacologia (AFIP).
Verapamil in Stuttering To the Editor: R has been difficult to find pharmacological treatments of chronic stuttering in adults that are both effective and without intolerable side effects (Ingham 1984). Zach~L~ab (1980) reported promising results with the calcium channel-blocker verapamil. However, this study had major methodological limitations (e.g., a single-blind trial with no objective speech data). We carried out a double-blind, placebo-con-
trolled trial of verapamil in a cross-over experimental design with multiple, objective measures of stuttering severity. As we repoi~ed in this journal (1989), verapamil was found to be significantly more effective than placebo in 2 of 4 speech measures in this brief (l-week) trial. At a 6-month follow-up, only 2 of the original l0 patients were still taking the drag. However, both of these patients reported that their speech continued to be substantially improved. Recently we completed a 2 l/2-year follow-up of these 2 patients. Both are still taking verapamil (180-
Correspondence
BIOL PSYCHIATRY 1990;27:671-.685
240 mg daily) and report no side effects from the medication. Both report also that their speech continues to be better than it has been for as long as they can remember. They report also that failure to take the verapamil for a day or so (e.g., forgetting to do so, temporarily running out of the medication) is followed by a return of more stuttering. Their rates of dysfluency while reading a 1000 syllable story (RD) and speaking extemporaneously for 3 min (SD) are given in Table 1 along with the corresponding dysfluency rates on initial (baseline) testing and at the 6-month follow-up. The results we published in 1989 are more modest Table 1. Effect of Verapamil on Rates of Dysfluency in Patients with Chronic Stuttering 6-month 2s/2-year Baseline follow-up follow-up Patient A (38-year-old female) RD SD Patient B (59-year-old male) RD SD
6 9
4 7
2 4
48 36
17 34
11 26
Abbreviations: RD, reading dysfluency; SD, speaking dysfluency.
than those reported by Zachariah (1980); only 2 of our 10 subjects (20%) elected to continue with the drug. However, it is very promising that these 2 subjects have continued to improve over an extended period without side effects. We hope that other clinicians will try verapamil with chronic adult stutterers, a generally recalcitrant patient group. We would like to hear of their results. John Paul Bradf Thomas W. McAllister' Trevor R.P. Price2 mDepartment of Psychiatry University of Pennsylvania Philadelphia, PA 19104 2Department of Psychiatry Medical College of Pennsylvania Allegheny Campus Pittsburgh, PA 15212
References Brady JP, Price TRIP, McAilister TW, Dietrich K (1989): A trial of verapamil in the treatment of stuttering in adults. Biol Psychiatry 25:626-630. Ingham RJ (1984): Stuttering and Behavior Therapy. San Diego, CA: College-Hill Press. Zachariah G (1980): Verapamil in the managementof stammering. Antiseptic 77:87-88.
Antiseptal Autoantibodies in Schizophrenia To the Editor: Heathet al. (Biol Psychiatry 25:725-733, 1989) recently reported that serum from 96% of unmedicated schizophrenic patients contained IgG autoantibodies specific for the septal region of rhesus monkey brain, in contrast to 0% of control subjects and 6% of medicated schizophrenics. We were unable to reproduce this finding (Knight et al. Biol Psychiatry, in press). In an attempt to resolve this unexpected discrepancy, we sent 12 coded serum samples on dry ice to Dr. Heath. The results from Heath's laboratory did not ,bear any apparent relationship to the origin of the serum samples, nor to their own previously reported findings.
681
John G. Knight Allison Knight David B. Menkes Paul E. Mullen University of Otago Department of Psychological Medicine Medical School Dunedin, New Zealand
Response To the Editor: Correspondence with Knight revealed departures from our described protocol when he and his colleagues attempted to replicate our findings. When he subsequently sent us coded samples for analysis in
