LETTERS
TO
THE
EDITOR
increased desire to become violent toward these supposed impostors. He has made several elaborate plans to torture his parents and children in order to find out the ‘truth. Robert Weinstock, M.D. previously reported a case of Capgras
that approximately 50% of untreated schizophrenic patients have cineradiographic abnormalities of esophageal function (cricopharyngeal dysfunction and pooling of contrast material within the valleculae and pyriform sinus region). Administration
ities
of chlorpromazine had no effect on these abnormal2). The effect of phenothiazine drugs on the respiraciliary activity is certainly better established, although
(I
tory
‘
syndrome
,
of unknown clinical importance. However, I think that Dr. Solomon may have overlooked the major point that I wished to make: regardless of etiology, it is not the aspiration that kills these patients, be they acutely ill schizophrenics or women in labor, but the pH of the gastric aspirate (3). Thus, I offered the recommendation for antacid medication as a preventive measure. Concerning the specific questions raised about the patient I reported on, I offer the following information. Physical and neurological status remained within normal limits up to the agonal event except as noted in the case report. A mechanically soft diet was prescribed and hand feeding was frequently required. There was no known feeding four or five hours prior to death. The patient was not secluded or restrained during on a mattress I would like ated by a bolus
“
,
the week before his death: he preferred to lie placed on the floor of a large room. to emphasize that this patient was not asphyxiof food as in the ‘ ‘caf#{233} coronary syndrome.”
that
actually
led
to violence
(letter
to the
editor,
July 1976 issue). Treatment with fluphenazine decanoate and oral fluphenazinc in combination have lessened my patient’s previously strong impulses to harm his parents and children, although he still thinks about it occasionally. However, the delusion about the identity of his family still remains. D.L. New
Vinlizing SIR:
esting
Influences,
Jerome data
Sexual
D. Goodman,
which
the
M.D.
he presents
ior of Hypersexual support
Behavior, has
,
Delinquent
Girls’
that
are
hypothesis
there
‘
M.D. N.Y.
IQ
and
to good
CRANE, York,
collected effect in
(June
important
very
inter-
‘The Behav1976 issue) to ‘
biological
de-
terminants of behavior. There are two points, however, with which I take issue. The first of these, tangential to Dr. Goodman’s work, is the unfortunate and perhaps unintended implication that contraceptive availability contributes to ‘problem sexual behavior. In fact, there is evidence suggesting that a pattern of regular sexual intercourse is usually established before a teenager takes action to obtain contraception (1 2). It appears that many young women in today’s culture are prepared to risk pregnancy rather than abstain from coitus. The second point relates to the hypothesized above-average intelligence of girls exposed to vinlizing influences during or before childhood. It would be interesting to know the lQs and socioeconomic status of the parents of the girls in Dr. Goodman’s sample: it is possible that their intelligence could be explained by these factors alone. For example, after publication of the Ehrhardt and Money (3) study cited by ‘
REFERENCES
1. Hussar 2. Hussar
“
AE: Sudden unexpected death. JAMA 210:1764, AE: Swallowing in schizophrenia. Ann Intern 1970
73:343-344,
3. Ribaudo
CA:
Pulmonary
aspiration.
Am J Med 50:510-520, ROBERT
F.
Ann
Polarization
terms
“dynamically been
‘
‘biological’
oriented’
appearing
Brown’s Joel
BORT,
Capable
or
‘
regularly
recent
Kotin’s
M.D.
Arbor,
overview
letter
‘ psychiatrists ‘analytically in the Journal.
Mich.
article
(July
(April
1976 issue) and use these polarities.
1976 issue)
and flexible
as opposed to oriented’ ‘ have Dr. Bertram
‘
clinicians
I know
simply
such typologies: such clinicians are comfortable theories of illness and the spectra of therapies. grows
1971
or Specialization? The
SIR:
1%9 Med
more
crowded
and
tense,
polarization
in many
EDWARD
Dr.
Goodman,
it was
discovered
that,
although
areas
come
into
psychiatry
insufficient
REFERENCES 1. Settlage DSF, Baroff S. Cooper D: Sexual experience of young teenage girls seeking contraceptive assistance for the first time. Perspectives in Family Planning 5:223-226, 1973 2. Sorensen RC: The Sorensen Report: Adolescent Sexuality in Contemporary America. New York, World Publishing Co. 1973 3. Ehrhardt AA, Money I: Progestin-induced hermaphroditism: IQ and psychosexual identity in a study of ten girls. Journal of Sex
Research
M.D. Calif
PASTOR,
Burlingame,
3:83-100,
1967 VIRGINIA
ABERNETHY,
Nashville, More
Violent
SIR:
of
I
like to describe
syndrome
my experience
in a 27-year-old
treating
married
a case
man
1350
on him.
Tenn.
His
conversations
Am J Psychiatry
with
/33:/
me oflate
/ November ,
have
1976
shown
Dr.
Goodman
Replies
with
three children. The primary diagnosis in this patient is schizophreniform psychosis with paranoid features. He is convinced that his parents and children are strangers who are being paid by an unnamed foreign power and are trying to spy
PH.D.
Capgras
would
Capgras
daughters
born to progestin-treated mothers had higher IQs than did control subjects, their IQs were not elevated in comparison to their own sisters who had not been androgenized in utero.
do not fit
with various As the world
increases. Political, economic, and social extremes greater focus: it is perhaps in that context that may be seduced into dividing itself up where basis for division exists in reality. AVRUM
Dr.
,
an
SIR: In reply to Dr. Abernethy’s comments, I am aware that contraceptive measures do not necessarily engender problem sexual behavior in a direct causal relationship. On the other hand, availability of contraceptive devices, information, and supportive understanding ofearly sexual experi-
TO
THE
EDITOR
increased desire to become violent toward these supposed impostors. He has made several elaborate plans to torture his parents and children in order to find out the ‘truth. Robert Weinstock, M.D. previously reported a case of Capgras
that approximately 50% of untreated schizophrenic patients have cineradiographic abnormalities of esophageal function (cricopharyngeal dysfunction and pooling of contrast material within the valleculae and pyriform sinus region). Administration
ities
of chlorpromazine had no effect on these abnormal2). The effect of phenothiazine drugs on the respiraciliary activity is certainly better established, although
(I
tory
‘
syndrome
,
of unknown clinical importance. However, I think that Dr. Solomon may have overlooked the major point that I wished to make: regardless of etiology, it is not the aspiration that kills these patients, be they acutely ill schizophrenics or women in labor, but the pH of the gastric aspirate (3). Thus, I offered the recommendation for antacid medication as a preventive measure. Concerning the specific questions raised about the patient I reported on, I offer the following information. Physical and neurological status remained within normal limits up to the agonal event except as noted in the case report. A mechanically soft diet was prescribed and hand feeding was frequently required. There was no known feeding four or five hours prior to death. The patient was not secluded or restrained during on a mattress I would like ated by a bolus
“
,
the week before his death: he preferred to lie placed on the floor of a large room. to emphasize that this patient was not asphyxiof food as in the ‘ ‘caf#{233} coronary syndrome.”
that
actually
led
to violence
(letter
to the
editor,
July 1976 issue). Treatment with fluphenazine decanoate and oral fluphenazinc in combination have lessened my patient’s previously strong impulses to harm his parents and children, although he still thinks about it occasionally. However, the delusion about the identity of his family still remains. D.L. New
Vinlizing SIR:
esting
Influences,
Jerome data
Sexual
D. Goodman,
which
the
M.D.
he presents
ior of Hypersexual support
Behavior, has
,
Delinquent
Girls’
that
are
hypothesis
there
‘
M.D. N.Y.
IQ
and
to good
CRANE, York,
collected effect in
(June
important
very
inter-
‘The Behav1976 issue) to ‘
biological
de-
terminants of behavior. There are two points, however, with which I take issue. The first of these, tangential to Dr. Goodman’s work, is the unfortunate and perhaps unintended implication that contraceptive availability contributes to ‘problem sexual behavior. In fact, there is evidence suggesting that a pattern of regular sexual intercourse is usually established before a teenager takes action to obtain contraception (1 2). It appears that many young women in today’s culture are prepared to risk pregnancy rather than abstain from coitus. The second point relates to the hypothesized above-average intelligence of girls exposed to vinlizing influences during or before childhood. It would be interesting to know the lQs and socioeconomic status of the parents of the girls in Dr. Goodman’s sample: it is possible that their intelligence could be explained by these factors alone. For example, after publication of the Ehrhardt and Money (3) study cited by ‘
REFERENCES
1. Hussar 2. Hussar
“
AE: Sudden unexpected death. JAMA 210:1764, AE: Swallowing in schizophrenia. Ann Intern 1970
73:343-344,
3. Ribaudo
CA:
Pulmonary
aspiration.
Am J Med 50:510-520, ROBERT
F.
Ann
Polarization
terms
“dynamically been
‘
‘biological’
oriented’
appearing
Brown’s Joel
BORT,
Capable
or
‘
regularly
recent
Kotin’s
M.D.
Arbor,
overview
letter
‘ psychiatrists ‘analytically in the Journal.
Mich.
article
(July
(April
1976 issue) and use these polarities.
1976 issue)
and flexible
as opposed to oriented’ ‘ have Dr. Bertram
‘
clinicians
I know
simply
such typologies: such clinicians are comfortable theories of illness and the spectra of therapies. grows
1971
or Specialization? The
SIR:
1%9 Med
more
crowded
and
tense,
polarization
in many
EDWARD
Dr.
Goodman,
it was
discovered
that,
although
areas
come
into
psychiatry
insufficient
REFERENCES 1. Settlage DSF, Baroff S. Cooper D: Sexual experience of young teenage girls seeking contraceptive assistance for the first time. Perspectives in Family Planning 5:223-226, 1973 2. Sorensen RC: The Sorensen Report: Adolescent Sexuality in Contemporary America. New York, World Publishing Co. 1973 3. Ehrhardt AA, Money I: Progestin-induced hermaphroditism: IQ and psychosexual identity in a study of ten girls. Journal of Sex
Research
M.D. Calif
PASTOR,
Burlingame,
3:83-100,
1967 VIRGINIA
ABERNETHY,
Nashville, More
Violent
SIR:
of
I
like to describe
syndrome
my experience
in a 27-year-old
treating
married
a case
man
1350
on him.
Tenn.
His
conversations
Am J Psychiatry
with
/33:/
me oflate
/ November ,
have
1976
shown
Dr.
Goodman
Replies
with
three children. The primary diagnosis in this patient is schizophreniform psychosis with paranoid features. He is convinced that his parents and children are strangers who are being paid by an unnamed foreign power and are trying to spy
PH.D.
Capgras
would
Capgras
daughters
born to progestin-treated mothers had higher IQs than did control subjects, their IQs were not elevated in comparison to their own sisters who had not been androgenized in utero.
do not fit
with various As the world
increases. Political, economic, and social extremes greater focus: it is perhaps in that context that may be seduced into dividing itself up where basis for division exists in reality. AVRUM
Dr.
,
an
SIR: In reply to Dr. Abernethy’s comments, I am aware that contraceptive measures do not necessarily engender problem sexual behavior in a direct causal relationship. On the other hand, availability of contraceptive devices, information, and supportive understanding ofearly sexual experi-
