effects or excessive extrapyramidal symptoms. In addition, the patient consistently ran out ofat least one of her prescribed drugs before the cxpected date. Several different approaches were tried to correct any misunderstanding by the patient and her mother about administration of her medication, including changing the dosage ofall her medication to once a day before sleep. In spite of these efforts, the patient’s request for early refills persisted, and so did confusing side effects. A home visit was made to investigate the problem. The patient was found to be taking the total recommended daily number of pills out of only one bottle at a time until the contents ofthat bottle were finished. During that time she cornplaned about the side effects related to that particular drug. She then repeated the same process with subsequent bottles until all medication was gone. To combat such behavior, conferences were held with the patient, her mother, hen teacher, her case coordinator, and the school nurse. A plan was developed to administer the medications in a single dose at school.

During

weekends

and

holi-

days daily dosages were arranged in paper envelopes. In addition, the mother was encouraged to regularly accompany the patient for her clinic visits. This intervention was successful, and the patient’s psychiatric condition

This

has

significantly

case

cian should usual forms outpatients treatment

improved.

suggests that the clinicarefully consider unof noncompliance in who do not respond to

as a potential

management

failure. OSSAMA

OSMAN,

M.D.

References

for

1. Sackett DL, SnowJC: The magnitude of compliance and noncompliance, in Compliance in Health Care. Edited by Haynes RB, Taylor DW, Sackett DL Baltimore, 2.

Johns Hopkins University Press, 1979 Cadman D, Shurvell B, Davies P, et al: Compliance in the community with consultants’ recommendations for developmentally handicapped children. Developmental Medicine and Child Neurology 26(1):40-46, 1984

3. Wikler pliance

L, Stoycheff with

postdischarge

tions for retarded Community 1974 4.

J:

Parental recommenda-

children.

Psychiatry

com-

Hospital

BECKER,

M.D.

M.D.

in

behavior

the

use

of the

clinical

would benzo-

setting

avoid excessively dosages. CAlu. SALZMAN, EDISON K. MIYAWAKI,

in

order to neunoleptic

DAVID

high

M.D. M.D. M.D.

SOLOMAN,

The authors are affiliated with the Harvard Medical School, Massachusetts MentalHealth Center, Boston.

1. Santos AB, Morton WA: Use of benzodiazepines to improve management of manic agitation. Hospital and Community

35:1037-1038,

2.

1984

Psychiatry

leptics

Use

of Benzodiazepines

with

additional

intramus-

1990

Vol.

41

No.

3

1989

Al, Rodriguez-Villa combined with

for management behavior.

17):17-21,

To the Editor:We read with interest the paper by Santos and Morton (1) in the October issue on the use of benzodiazepines to improve the management of manic agitation. We were somewhat surprised that our retrospective study of lorazepam to control disruptive behavior was not cited since it is one of the few controlled studies supporting the use of benzodiazepines (2). Ourreport suggested that disruptive behavior associated with psychosis could be managed with intramuscular lorazepam, and that one consequence ofthe use of this compound was a significantly lower use ofneuroleptics to treat the patient’s psychosis. Readers may interested to know that we have recently concluded a prospective study designed to confirm these retrospective observations. We compared intramuscular lorazepam

40:1069-1071,

Salzman C, Green Benzodiazepines tive

March

E.

diazepine

of the

SweeneyjA, Von Bulow B, Shear MK, et a!: Compliance and outcome of patients accompanied by relatives to evaluation. Hospital and Community Psychiatry

334

L. LOSCHEN,

favor

References

Dr. Osman is a seniorstafffellow in the section on clinicalpharmacology at the NationallnstituteofMentalHealth in Bethesda, Maryland. Dr. Loschen is deputy chairman and associate pro/es.cor ofpsychiatty and medical education and Dr. Becker is professor and chairman ofthe department ofpsychiatry at Southern Illinois University School of Medicine in Springfield, Illinois.

EA1u.

control

and

25:595-598,

cular haloperidol on a double-blind basis for the control of disruptive psychotic behavior in patients a!ready receivinganeuroleptic for psychosis. Our results suggest that the two drugs are completely equivalent in therapeutic effect. Lorazepam may be slightly better for immediate behavioral control, and the haloperidol is slightly betterfor overall reduction of core psychotic symptoms. However, the finding that a benzodiazepine is as therapeutic as a neuroleptic

ROBERT

the

certainly

of severe

F: neuno-

disrup.. 27(suppl

Psychosomatics

1986

In Reply:

We

thank

Miyawaki,

and

Soloman

Drs. Salzman, for their letten. Our failure to cite theirstudy was an oversight. We appreciate the report of the results of their new study. The findings are very significant for patients and merit wide dissemination to practitioners. ALBERTO B. SANTOS, M.D.

W.

ALEXANDER

MORTON,

PHARM.D.

1990 H&CP

Institute

The 42nd Institute on Hospital and Community Psychiatry will be held October 7-1 1 at the Marriott City Center in Denver. James T. Barter, M.D., ofChicago is chairman of the program committee. A preliminary program that includes meeting registration forms will be published in theJune issue. To obtain additional information or to be placed on the mailing list for the preliminary program, contact Wanda Sheridan, H&CP Institute, APA, 1400 K Street, N.W., Washington, D.C. 20005; telephone, 202682-6174. The institute is one oftwo national meetings sponsored annually by the American Psychiatric Association. The 1989 institute in Boston drew almost 1,800 mental health professionals.

Hospital

and

Community

Psychiatry