Two weeks dose range-finding and four weeks repeated dose oral toxicity study of a novel reversible monoamine oxidase B inhibitor KDS2010 in cynomolgus monkeys

A novel reversible monoamine oxidase B inhibitor, KDS2010, has been developed as a therapeutic candidate for neurodegenerative diseases. This study investigated its potential toxicity in non-human primates before human clinical trials. Daily KDS2010 doses (25, 50, or 100 mg/kg) were orally administered to cynomolgus monkeys (1 animal/sex/group, 4 males and 4 females) for 2 weeks to determine the dose range. One male was moribund, and one female was found dead in the 100 mg/kg/day group. One male was also found dead in the 50 mg/kg/day group. The death was considered an adverse effect in both sexes since distal tubules/collecting duct dilation and hypertrophy in the epithelium of the papillary duct were observed in their kidneys. Based on dose range finding results, KDS2010 (10, 20, or 40 mg/kg/day) was administered orally for 4 weeks, and animals were given 2 weeks for recovery. No significant changes were observed during daily clinical observations and macro-and microscopic examinations, including body weight, food consumption, hematology, clinical chemistry, and organ weight. And, the kidney was seen as the primary target organ of KDS2010 in the 2 weeks study, but no adverse effect was observed in the 4 weeks study. Therefore, 40 mg/kg/day is considered the no-observed-adverse-effect level in both sexes of cynomolgus monkeys.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43188-023-00182-4.

Claustral MeCP2 Regulates Methamphetamine-induced Conditioned Place Preference in Cynomolgus Monkey

The claustrum, a brain nucleus located between the cortex and the striatum, has recently been highlighted in drug-related reward processing. Methyl CpG-binding protein-2 (MeCP2) is a transcriptional regulator that represses or activates the expression of the target gene and has been known to have an important role in the regulation of drug addiction in the dopaminergic reward system. The claustrum is an important region for regulating reward processing where most neurons receive dopamine input; additionally, in this region, MeCP2 is also abundantly expressed. Therefore, here, we hypothesized that MeCP2 would be involved in drug addiction control in the Claustrum as well and investigated how claustral MeCP2 regulates drug addiction. To better understand the function of human claustral MeCP2, we established a non-human primate model of methamphetamine (METH) - induced conditioned place preference (CPP). After a habituation of two days and conditioning of ten days, the CPP test was conducted for three days. Interestingly, we confirmed that virus-mediated overexpression of MECP2 in the claustrum showed a significant reduction of METH-induced CPP in the three consecutive days during the testing period. Moreover, they showed a decrease in visit scores (frequency for visit) for the METH-paired room compared to the control group although the scores were statistically marginal. Taken together, we suggest that the claustrum is an important brain region associated with drug addiction, in which MeCP2 may function as a mediator in regulating the response to addictive drugs.

SYNCRIP controls miR-137 and striatal learning in animal models of methamphetamine abstinence

Abstinence from prolonged psychostimulant use prompts stimulant withdrawal syndrome. Molecular adaptations within the dorsal striatum have been considered the main hallmark of stimulant abstinence. Here we explored striatal miRNA–target interaction and its impact on circulating miRNA marker as well as behavioral dysfunctions in methamphetamine (MA) abstinence. We conducted miRNA sequencing and profiling in the nonhuman primate model of MA abstinence, followed by miRNA qPCR, LC–MS/MS proteomics, immunoassays, and behavior tests in mice. In nonhuman primates, MA abstinence triggered a lasting upregulation of miR-137 in the dorsal striatum but a simultaneous downregulation of circulating miR-137. In mice, aberrant increase in striatal miR-137-dependent inhibition of SYNCRIP essentially mediated the MA abstinence-induced reduction of circulating miR-137. Pathway modeling through experimental deduction illustrated that the MA abstinence-mediated downregulation of circulating miR-137 was caused by reduction of SYNCRIP-dependent miRNA sorting into the exosomes in the dorsal striatum. Furthermore, diminished SYNCRIP in the dorsal striatum was necessary for MA abstinence-induced behavioral bias towards egocentric spatial learning. Taken together, our data revealed circulating miR-137 as a potential blood-based marker that could reflect MA abstinence-dependent changes in striatal miR-137/SYNCRIP axis, and striatal SYNCRIP as a potential therapeutic target for striatum-associated cognitive dysfunction by MA withdrawal syndrome.

Surgical removal of a telemetry system in a cynomolgus monkey (Macaca fascicularis): a 12-month observation study

BACKGROUND

Telemetry is a wireless implanted device that measures biological signals in conscious animals and usually requires surgery for its removal when the study is finished. After removing the device, the animals are either used for other studies or euthanatized.

CASE PRESENTATION

Herein, we report the case of a living cynomolgus monkey (Macaca fascicularis) that was used for the entire experimental period, instead of euthanasia, after surgical removal of an implanted telemetry system. Radiography was used to determine the status of the implanted telemetry, following which, a repair surgery was performed for removing the system; clinical signs were used to preserve the life of the cynomolgus monkey. Postoperative clinical signs, food consumption, hematology, and serum biochemistry were examined during the 12-month observational period. No abnormal readings or conditions were observed in the subject after implant removal.

CONCLUSIONS

This study may be a useful case report for living cynomolgus monkeys in telemetry implantations used throughout the study period. We suggest minimizing the suffering and improving the welfare of these animals.

KDS2010, a Newly Developed Reversible MAO-B Inhibitor, as an Effective Therapeutic Candidate for Parkinson's Disease

Monoamine oxidase-B (MAO-B) is a well-established therapeutic target for Parkinson's disease (PD); however, previous clinical studies on currently available irreversible MAO-B inhibitors have yielded disappointing neuroprotective effects. Here, we tested the therapeutic potential of KDS2010, a recently synthesized potent, selective, and reversible MAO-B inhibitor in multiple animal models of PD. We designed and synthesized a series of α-aminoamide derivatives and found that derivative KDS2010 exhibited the highest potency, specificity, reversibility, and bioavailability (> 100%). In addition, KDS2010 demonstrated significant neuroprotective and anti-neuroinflammatory efficacy against nigrostriatal pathway destruction in the mouse MPTP model of parkinsonism. Treatment with KDS2010 also alleviated parkinsonian motor dysfunction in 6-hydroxydopamine-induced and A53T mutant α-synuclein overexpression rat models of PD. Moreover, KDS2010 showed virtually no toxicity or side effects in non-human primates. KDS2010 could be a next-generation therapeutic candidate for PD.

KMRC011, an agonist of toll-like receptor 5, mitigates irradiation-induced tissue damage and mortality in cynomolgus monkeys

In the study here, the potential applicability of KMRC011 - an agonist of toll-like receptor-5 - as a countermeasure for radiation toxicities was evaluated. Following a single 5.5 Gy total body irradiation (TBI, surface absorbed dose = 7 Gy) of Co⁶⁰ γ-rays, mortality rates and degrees of pathological lesions that developed over 80 days were compared in monkeys that received TBI only and a group that was injected once with KMRC011 (10 μg/kg) after TBI. Compared to the TBI-only hosts (80%), the death rate was significantly improved by the use of KMRC011 (40%), all deaths in both groups occurred in the period from Days 19-24 post-TBI. Further analysis of monkeys that survived until the end of the experiment showed that AST and ALT levels were elevated only in the TBI group, and that radiation-induced tissue damage was alleviated by the KMRC011 injection. Additionally, expression of cell death-related proteins was lower in tissues from the KMRC011-treated hosts than in those in the TBI-only group. Other measured parameters, including body weight, food uptake, and hematological values did not significantly differ between the two groups over the entire period. The results of this study, thus demonstrate that KMRC011 could potentially be used as a medical countermeasure for the treatment of acute radiation exposure.

Thirteen-week oral toxicity study of fermented ginseng, GBCK25, in Sprague-Dawley rats

Ginseng (Panax ginseng) is commonly used in Asia as a medicinal herb. In particular, fermented ginseng, GBCK25, has been recently developed to increase ginsenoside absorption. It also has other beneficial biological effects such as hemodynamic and anti-inflammation functions. Here, we investigated the potential toxicity of GBCK25 in Sprague-Dawley rats following 13 weeks of GBCK25 treatment by oral gavage at doses of 250, 500, or 1000 mg/kg/day and reversible toxic effects over a 4-week recovery phase. Ten male and female rats per group were randomly allocated to the main toxicology groups and five male and female rats per group were allocated to the 0 and 1000 mg/kg/day recovery groups, respectively. There was no mortality; significant clinical toxicity or microscopic findings; and changes in body weight, food consumption, hematological parameters, serum biochemistry, or absolute and relative organ weights in any of the groups. In conclusion, there were no toxicological changes upon repeated oral gavage of GBCK25 at doses of 250, 500, or 1000 mg/kg/day in Sprague-Dawley rats over 13 weeks. The no-observed-adverse-effect level of GBCK25 was 1000 mg/kg/day in both sexes of Sprague-Dawley rat.

Differential Cellular Tropism of Lentivirus and Adeno-Associated Virus in the Brain of Cynomolgus Monkey

Many researchers are using viruses to deliver genes of interest into the brains of laboratory animals. However, certain target brain cells are not easily infected by viruses. Moreover, the differential tropism of different viruses in monkey brain is not well established. We investigated the cellular tropism of lentivirus and adeno-associated virus (AAV) toward neuron and glia in the brain of cynomolgus monkeys (Macaca fascularis). Lentivirus and AAV were injected into putamen of the monkey brain. One month after injection, monkeys were sacrificed, and then the presence of viral infection by expression of reporter fluorescence proteins was examined. Tissues were sectioned and stained with NeuN and GFAP antibodies for identifying neuronal cells or astrocytes, respectively, and viral reporter GFP-expressing cells were counted. We found that while lentivirus infected mostly astrocytes, AAV infected neurons at a higher rate than astrocytes. Moreover, astrocytes showed reactiveness when cells were infected by virus, likely due to virus-mediated neuroinflammation. The Sholl analysis was done to compare the hypertrophy of infected and uninfected astrocytes by virus. The lentivirus infected astrocytes showed negligible hypertrophy whereas AAV infected astrocytes showed significant changes in morphology, compared to uninfected astrocytes. In the brain of cynomolgus monkey, lentivirus shows tropism for astrocytes over neurons without much reactivity in astrocytes, whereas AAV shows tropism for neurons over glial cells with a significant reactivity in astrocytes. We conclude that AAV is best-suited for gene delivery to neurons, whereas lentivirus is the best choice for gene delivery to astrocytes in the brain of cynomolgus monkeys.

Protective effects of Orostachys japonicus A. Berger (Crassulaceae) on H2O2-induced apoptosis in GT1-1 mouse hypothalamic neuronal cell line

Oxidative stress is a major cause of neurodegenerative diseases, so the protection of neuronal cells from reactive oxygen species can be beneficial for the prevention and treatment of these diseases. Methanol extract of Orostachys japonicus A. Berger (Crassulaceae), a traditional oriental medical herb, was shown to have a protective effect on H2O2-induced apoptosis in GT1-1 mouse hypothalamic neuronal cell line which was detected by flow cytometry after propidium iodide staining. Among fractions of O. japonicus, chloroform fraction had the highest protective effect, and water fraction had no protective effect suggesting that the active ingredients might be hydrophobic compounds.

Reliability and validity of the interview and self-report versions of the BASIS-32

The psychometric properties of the interview and self-report versions of the BASIS-32 were compared. A total of 120 severely mentally ill adults enrolled in psychosocial rehabilitation were randomly assigned to either a self-report or an interview condition. The BASIS-32 had good internal consistency and test-retest reliability on most subscales; coefficients were higher in the self-report condition. Only the interview version of the psychosis subscale had unacceptable internal consistency. Validity correlations were generally good for the symptom subscales but disappointing for the functional domains. The subscale scores did not discriminate between diagnostic subgroups.

Predicting length of stay in an acute psychiatric hospital

OBJECTIVE

Multivariate statistical methods were used to identify patient-related variables that predicted length of stay in a single psychiatric facility. The study investigated whether these variables remained stable over time and could be used to provide individual physicians with data on length of stay adjusted for differences in clinical caseloads and to detect trends in the physicians' practice patterns.

METHODS

Data on all patients discharged over two six-month periods were collected at an acute psychiatric inpatient facility. Stepwise multiple regression analyses were conducted on the two datasets.

RESULTS

The results from both analyses revealed that five variables significantly predicted length of stay and were stable over time. They were a primary diagnosis of schizophrenia, the number of previous admissions, a primary diagnosis of a mood disorder, age, and a secondary diagnosis of an alcohol- or other drug-related disorder. For some physicians, the mean length of stay of their patients differed significantly from the length predicted by the regression model--generally, it was shorter.

CONCLUSIONS

The results demonstrate that patient-related predictors of length of stay in a single psychiatric hospital can be identified using relatively simple statistical procedures and can be consistent across a large dataset and over time.

An outcome study of Missouri's CSTAR alcohol and drug abuse programs

The Comprehensive Substance Abuse Treatment and Rehabilitation (CSTAR) program is described, and a study of its services is presented. The CSTAR program is a community program with wrap-around services and intensive case management. Eleven domains typically affected by substance abuse were measured, plus satisfaction with treatment services. A retrospective study of 280 clients at 10 facilities was done, and results analyzed separately by General Programs. Women with Children programs, and Adolescent programs. A small sample of clients who were early in their treatment was re-interviewed 90 days later. Data were also examined according to length of stay in the program. Results were consistently positive, and increased with length of time in the program.

Missouri's statewide outcomes study: lessons and surprises from the public sector

Demand is increasing for statewide outcomes initiatives and greater focus on studies of treatment effects for publicly funded patients. Such initiatives pose enormous challenges in management--to involve key stakeholders, to protect confidentiality, and to comply with methodological standards. The state of Missouri is taking a leadership role in this direction.

A psychiatric hospital 100 years ago: I. A comparative study of treatment outcomes then and now

OBJECTIVE

The authors' goal was to compare distribution of diagnoses, length of stay, and readmission rates for every 16th patient admitted to the St. Louis County Insane Asylum (now St. Louis State Hospital) between 1886 and 1904 with those for every 16th patient admitted to the hospital between 1978 and 1980.

METHODS

A sample of 369 cases was drawn from the archival admission records, and 380 cases were selected from recent admissions. Descriptive data from the archival records were used to make DSM-III diagnoses. Data on length of stay and number of readmissions were collected from case records.

RESULTS

The historical sample had fewer cases of major mental illness, longer mean lengths of stay, and fewer mean readmissions than the modern sample.

CONCLUSIONS

Differences in the clinical characteristics of the two samples may be explained by differences between the two periods in treatment philosophies, admitting policies, and presence of alternative resources for accommodating long-term chronic patients.

Identifying psychiatric suicides for research purposes

Unusual accidental deaths recorded for former public psychiatric patients during a 3-year period in Missouri were compared with data previously published on suicide and undetermined deaths. Demographic and diagnostic data suggested that undetermined deaths resemble suicides, while the remaining unusual accidents do not. For purposes of estimating incidence or prevalence, it is recommended that "undetermined deaths" might well be combined with suicides, while the remaining accidents should not.

Measurement of symptom and behavior change in chronic psychiatric patients using the Missouri Inpatient Behavior Scale

Scores on eight scales of the Missouri Inpatient Behavior Scale changed significantly during the last 6 mo. prior to discharge of chronic public psychiatric patients. Improvement in chronic patients appears to occur primarily in day-to-day competence, communication, and affect.

The Missouri Inpatient Behavior Scale

The Missouri Inpatient Behavior Scale (MIBS) is described, and data are presented from the Missouri automated mental health information system (N = 12,106). The factor structure for MIBS was replicated and shown to be robust. Data on intrascale consistency and interscale correlations are presented, as well as a validity study that showed MIBS to be sensitive to changes on acute-receiving services and a comparison of MIBS and NOSIE-30 scores.

Mortality variations among public mental health patients

Earlier studies of mortality of psychiatric patients are reviewed, and agreements and inconsistencies related to age, sex, diagnosis and cause of death are noted. The authors then analyze 5,268 deaths during a 5-year period of current or former patients in Missouri public psychiatric hospitals and mental health clinics, calculating mortality ratios that are simultaneously age-, sex-, diagnostic-, and cause-specific. The results are used to construct a quantitative model. The ratios vary most with cause, then diagnosis, least with sex. Influenza and pneumonia contribute most to patient mortality; patient death rates for cancer are lower than population rates at all ages. There are substantial interactions of diagnosis with cause and sex. Among those diagnosed organic brain syndrome, who have the highest overall ratios, the ratios are extra high for females and for influenza and pneumonia, relatively low for external causes.

Age group differences in depression on MMPI D scale

Much of the work that has been done to the present in exploring age differences in the assessment of depression has utilized normally aging populations. This research has indicated that present depression scales may yield many false positives for depression because of the large number of somatic items that these scales contain. An important question is whether this same finding would hold in psychiatric populations, which are the ones most likely to be subject to diagnosis. The present study was designed to supply information in that area. The D-scale responses of the MMPI for 6,964 patients were factor-analyzed. Results indicated significant differences in the expression of depression for three age groups--20-39, 40-59 and 60+ years. A central core of items that accounted for one-half of the variances for all three groups was found. Additional items appeared across the age groups with greater to lesser significance in terms of the variance accounted for producing distinct qualitative differences. Concern over declining physical well-being was not part of the central core of depression for the older group in this psychiatric population.

Suicide rates among public mental health patients

Age-specific suicide rates are presented, based on 207 white patients of the Missouri Department of Mental Health who were identified as having committed suicide during 1972-74. Results, divided by age, sex, diagnosis and patient status, are compared with other studies. Male inpatients are about five times more likely to commit suicide compared to the general population, while female inpatients are about 10 times more likely to do so. In both sexes, the rate is greatest for the diagnosis of major affective disorder. A history of psychiatric treatment increases the suicide risk more for women than for men, although male patients are still about twice as likely to commit suicide than are female patients. A quantitative model is presented which describes the relative influence of age, sex and diagnosis on suicide rates.

Symptomatology of depression in black and white patients

This study compares the symptoms of public mental health patients diagnosed as having a depressive disorder, and then relates its findings to the previous literature concerning black-white differences in mental illness. Results of this study corroborate previous observations that a somewhat smaller proportion of black admissions than white admissions are diagnosed with a depressive disorder and that a higher proportion of black admissions are diagnosed with a schizophrenic disorder. Some black-white differences in depressive symptoms were corroborated-notably, slightly higher percentages of hostility, dangerousness, and somatic complaints in blacks-and these appeared to be independent of socio-economic status.

Measuring the relationship of public psychiatric admissions to rising unemployment

The results of a correlational analysis of the relationship between monthly state unemployment statistics and admissions to eight Missouri Department of Mental Health facilities are presented. Over a period of 100 months, readmissions, rather than new admissions, showed the strongest positive relationship to unemployment. A second study-a retrospective analysis of admissions before and after a major increase in unemployment-supported the results of the correlational analysis. A third analysis of subset of the original sample, comprised of patients unemployed at the time of admission, suggests that public facilities are more accessible to the unemployed during times of economic adversity. The findings on the relationship of readmission rates to the state of the economy have important implications for policy on deinstitutionalization. The planning, development, and evaluation of community care programs should include consideration of employment data.

A computerized mental patient classification system

This paper presents the detailed logic and flow of a computerized actuarial report system based on the patient's demographic and clinical information routinely collected in a state mental health information system. Probability statements regarding the patient's diagnostic classifications, likelihood of harm to self and others, probable psychotropic drug prescription, likelihood of unauthorized absence, and prediction of length of stay are presented in the report. The multivariate linear discriminant function and linear regression are used in the calculation of the posterior probabilities and the predicted value of length of stay.

Patients of a public state mental health system who commit suicide

Twelve per cent of suicides in Missouri during a 3-year period were identified as having been patients of the state mental health care system by computer matching of death certificate tapes and a statewide case registry file. The percentage of Missouri suicides who had been patients varied markedly among age groups. Compared to nonpatient suicides, the patient suicides had a more equal male/female ratio and were younger. Diagnostically, schizophrenia, alcoholism (among males), and affective disorder (among females) were prominent. Nonwhites had a low incidence of suicide. The significance of the patient status at the time of death is discussed.

A comparison of suicide and undetermined deaths in psychiatric patients

Those people who had previously been patients of the Department of Mental Health of Missouri who died in the three year period 1972 through 1974 and whose deaths were designated as suicide or "undetermined whether purposely or accidentally inflicted," were identified by matching statewide death tapes against the DMH data base. The demographic characteristics of the two groups are compared to ascertain if the members of the undetermined group are essentially similar to the suicides, as has frequently been hypothesized. It is found that, in general, the similarities are in areas which would not have had a direct influence on the medical examiner/coroner's verdict, whereas, the differences do highlight areas which could cause an indecisive verdict. The significance of the undetermined deaths is discussed.

Profile of Mood States: the factors and their physiological correlates

Spontaneously occurring mood states and various physiological indices were evaluated on three occasions in a group of eight healthy males. Results reveal that significant positive correlations exist among five of the six factors comprising the Profile of Mood States (POMS). This finding is related to previous research on the POMS and varied methodologies utilized in those reports. Reliable positive correlations of the POMS factors Depression and Tension with heart rate and diastolic blood pressure were obtained. The Anger factor of the POMS also correlated positively and significantly with heart rate. These findings are discussed in terms of the relationship between POMS factors and anxiety.

Surface ultrastructure of the tegument of Clonorchis sinensis newly excysted juveniles and adult worms

The tegumental structures of newly excysted juveniles and adult worms of Clonorchis sinensis were studied using scanning and transmission electron microscopy. After excystation the juvenile's tegumental surface is characterized by knoblike protuberances and is armed almost entirely with numerous rows of small spines encircling the body. These spines are double- or triple-pointed on the anterior portion of the body and become single-pointed posteriorly. Four types of presumed sensory structures were observed as follow: A) ciliated knoblike papillae and B) nonciliated platelike papillae, both of which are arranged in rougly a bilaterally symmetrical pattern dorsally, ventrally, and laterally; C) rounded swellings of nonciliated papillae on the lips of the ventral and oral suckers, which are characterized in the transmission electron microscope by a rounded dense body in the apical bulb; and D) a sensory receptor with a bulbous projection having the appearance of a modified cilium, which was not found with SEM likely owing to its being enclosed by an extension of the tegument. In full-grown adult worms, the tegumental surface is knobbed or lobulated in various forms without surface spines. The tegumental structures in the adults appear to be clearly differentiated from those in the juveniles. Upraised, buttonlike papillae, each topped by a short cilium, which are similar to the Type A papillae in the juveniles, are distributed thickly around the oral and ventral suckers, and are rather randomly scattered over the remainder of the body. Some nonciliated swollen papillae were found on the lip of the ventral sucker.

Using Internal Inconsistency To Identify Unreliable Ratings

This paper describes the development and testing of an internal inconsistency scale to help identify unreliable clinical ratings. The scale consists of pairs of logically inconsistent items which have been chosen and scored using a combination of rational and statistical procedures. Evidence is presented to indicate that the scale measures rater inconsistencies rather than patient "inconsistencies," that using inconsistency scores to eliminate unreliable ratings improves factor score reliabilities, and that increasing the number of items for random assignment of possible rating values systematically increases the inconsistency score. Although the inconsistency scale was constructed specifically for the Missouri Inpatient Behavior Scale (MIBS), the methodology is potentially applicable to other rating scales.

Predicting length of stay by patients hospitalized for alcoholism of drug dependence

Involuntary admission, admission while intoxicated, hostility and denial of problems were associated with early dropout from an alcoholism treatment program, as were unemployment, younger age and having a spouse or someone else to live with.

Accuracy of actuarial and clinical predictions for length of stay and unauthorized absence

Multivariate-equation predictions of length of hospital stay and probability of unauthorized absence were compared with similar predictions made by clincians and actual outcome for 167 patients drawn from a random sample of admissions during a two-month period at five state hospitals. The computer proved to be about as accurate as clinicians in predicting length of stay. Neither computer nor clinician was able to usefully predict unauthorized absence because of its infrquent occurrance. Use and improvement of such actuarial predictions within the Missouri automated data base were discussed.

Computer prediction of psychotropic drug assignment in state mental facilities: effect of eliminating alcoholics from the study sample

A previous study on assignment of four major categories of psychotropic drugs to psychiatric inpatients generated the hypothesis that patients assigned minor tranquilizers consisted of two distinct sub-groups, one of which consisted of diagnosed alcoholics. The present study confirmed that hypothesis. More importantly, it found that minor tranquilizer assignment to non-alcoholic inpatients was a virtually random procedure. The general ability of predicting psychotropic drug assignment via a statistical model was nevertheless supported.

Simple algorithms for predicting psychotropic drugs assigned to psychiatric inpatients

The ability of simple algorithms, primarily diagnostic, to assign classes of psychotropic drugs to psychiatric inpatients in agreement with actual clinical decisions was investigated. Overall agreement (hit-rates) ranging from 48 to 65 percent were found across four major drug groups: major tranquilizer, antidepressant, minor tranquilizer, and no psychotropic drug. These hit-rates may be compared with multivariate formulae developed in earlier studies that achieved hit-rates ranging from 62 to 77 percent. Agreement among clinicians (about 70 percent) appears to be the limiting factor in most studies of this type.