Looking backwards: a possible new path for drug discovery in psychopharmacology

The history of psychopharmacology is littered with type II errors--the rejection of effective compounds in the specious belief that they were inefficacious because they had failed to beat placebo in a controlled trial. Revisiting some of these drugs to establish their receptor profile, and then determining what patentable compounds now on the shelf match that profile, might represent a possible future pathway to drug discovery. This article looks at the special circumstances in which numerous potentially effective drugs were withdrawn in the United States.

[The growing need for health care of the middle classes in Central Europe 1880-1930]

After 1850 medicine took on a new character, switching from a remedy for desperation to an everyday lifestyle habit. By examining the increase in recourse to medical care and the data on the availability of beds in private nursing homes, it is possible to assess the economic and social changes which took place as well as the conditions of family life and relations to disease. In this context, the role of women and their influence on the other members of the family is fundamental.

Multiple chemical sensitivity: pseudodisease in historical perspective

Multiple chemical sensitivity as a "disease" has emerged as a descendant of food allergy, which, in the 1920s and 1930s, was considered to be responsible for much human suffering and symptoms of disease. After the onmarch of the clinical ecological movement in the 1950s, interest has been focused on the environment, and concern about food allergies and chemical sensitivity has reached epidemic proportions. "Active hazardous waste sites" and "workers exposed to toxic chemicals" are at the top of the list of public worries. The public believes manufactured chemicals to be more dangerous than natural ones, although toxicologists regard the risks as equal. Originally, symptoms of patients were explained as "allergies", but since the 1960s the concept of "chemical sensitivities" has become a big-time diagnosis. The ideas of the clinical ecologists diffused rapidly into the community aided by public media. Today organizations like "Chemical Victims" and "National Foundation for the Chemically Hypersensitive" have thousands of members. Although the diagnosis of the disease is very vague, suffering patients believe that the clinical ecologists can offer them something that traditional medicine cannot: sympathy, recognition of pain and suffering, a physical explanation for their suffering, and active participation in medical care. Ecologic medicine thus soared in the patients' esteem, not just because of the content of the objective diagnoses that ecologic practitioners were able to supply, but because of the subjective nature of the doctor-patient relationship they were able to offer.

Somatization and chronic pain in historic perspective

Practitioners today are confronted with an avalanche of difficult to treat patients with chronic pain for 2 reasons: (1) The culture increasingly encourages patients to conceive vague and nonspecific symptoms as evidence of real disease and to seek specialist help for them; and (2) the rising ascendancy of the media and the breakdown of the family encourage patients to acquire the fixed belief that they have a given illness, often a trendy nondisease such as repetition strain injury or chronic fatigue syndrome. In historic terms, many of these complaints, especially sensory ones featuring chronic pain and chronic fatigue, are relatively new. Patients tend to adopt them on the basis of what the culture considers to be legitimate illness, whereby different patterns exist for men and women.

The borderland between neurology and history. Conversion reactions

The epidemic of conversion reactions taking place at the end of the twentieth century is a result of long-term changes in the presentation of functional illness. These changes often are a response to deeper issues in the culture about what constitutes legitimate organic disease. This epidemic also is a response to short-term changes in the attributions to which patients ascribe their illnesses. Such attributions are heavily influenced by the media, and clinicians must be on guard against both long- and short-term changes as they affect the presentation and attribution of illness.

Inpatient treatment of persistent somatization

Patients with disabling, persistent somatization pose significant challenges in clinical management. This study describes 92 patients treated on an inpatient psychosomatic medicine unit for persistent somatization. The most important factor in defining clinically significant subgroups of these patients was mood. Compared with depressed somatizing patients, nondepressed somatizing patients had chronic illnesses of early onset, had symptoms that were not correlated with current life stressors, and were generally unresponsive to treatment. There were few clinical predictors of treatment outcome apart from the duration of symptoms, the presence of mood disturbance, and a history of stable interpersonal relationships.

Changes in Family Life and Challenges in Primary Care: The advent of the postmodern family

Fragmentation of the postmodern family affects several aspects of primary care. In prevention, the physician-patient relationship is most important in forestalling abuse. In morbidity and diagnosis, single or socially isolated patients are more vulnerable to diseases, such as total allergy syndrome. In acute care, fragmentation increases the number of elderly patients in hospital. And in rehabilitation, the two-career family is no longer able to supplement hospital nursing care as it once did.