Mark Corson

By P. Ernesto. University of Saint Francis.

It is differentiated from malingering in that malin- -289- gering is a deliberate pose buy colospa 135 mg with visa, whereas the patient is unaware of the driving forces which lead him into the Ganser syndrome (53 135mg colospa free shipping, 58 cheap colospa 135 mg online, 68, 89). Historically it has been considered a hysterical twilight state, characterized by vorbeireden, clouding of consciousness, excitement or stupor, and bizarre behavior (26, 49). More recently it has been considered a last ditch attempt to ward off a real psychosis (54), a prodromal sign of psychosis (53), or an acute epidose superimposed on an actual psychotic condition (2, 8, 61, 82). Golden and MacDonald (32) as well as Tyndel (86) see it as occupying a position intermediate between malingering and hysterical fugue states. Weiner and Braiman (89) feel that it occurs in a setting of hysteria or psychosis, and interpret it as a reaction to intolerable stress in a person who fells utterly helpless and who wishes to throw off his identity and responsibility. They argue that it is not malingering because of the uniformity seen among patients with regard to clouding of consciousness, amnesia, and approximate answers. Although the Ganser state may not result from purposive deception, the overt behavior is similar enough to malingering to make differential diagnosis an extremely difficult problem. Indeed, the examples given of the Ganser state are sometimes indistinguishable from those given for simulation, and the same inconsistencies which establish a diagnosis of Ganser syndrome are on other pages proof positive of malingering. However, Weiner and Braiman (89) point out that the Ganser patient rarely if ever offers a peculiar or approximate answer unless it is solicited, whereas the malingerer is anxious to display his peculiarities. Two differences between schizophrenia and the Ganser state have been noted: (a) the schizophrenic differs in that his responses are given explosively and impulsively rather than with great concentration and thought, and (b) the answers are often irrelevant rather than approximate (53, 58, 89). The Ganser patient also differs from the schizophrenic by being able to adapt himself to the ward situation and to carry out the tasks of the day in a manner which would be inconceivable if he had as advanced a dementia as examination seems to indicate (53). Golden and MacDonald (32) and Tyndel (86) report success in using electroshock therapy with Ganser patients, with only a few courses being necessary. However, the same treatment might be effective with the malingerer for other reasons, and therefore this is not a crucial diagnostic test. The Ganser state may clear fairly quickly with alleviation of pressures, sympathy, and psychotherapy, which can also be the case in malingering. Mental deficiency usually entails a reduced scope of awareness of the environment, failure to discriminate between the consequential and the inconsequential, difficulty in forming concepts and using symbols, and sometimes poor memory. Although low intelligence would not preclude a source from being able to supply some useful information, it might lead an interrogator to reject such a person in favor of a more intelligent source. Although a source may play dumb with regard to certain areas of discussion, it probably is not too likely that he will play dumb in general, or to the degree that he will be classified as defective. His role as a soldier suggests that he has some capacity for training and learning, and if he is a commissioned or noncommissioned officer, the odds are very much against an extremely low level of intelligence. Almost all the studies relating to the simulation of mental deficiency have employed standard psychometric tests of intelligence. In one of the earliest of these (43), naval recruits were asked to behave as if they were defectives, and then their performances were compared with those of true mental defectives. Hunt and Older found that the simulators did not act dumb enough, and as a group, their scores were higher than those attained by true mental defectives. However, more recently, Pollaczek (70) asked college males and naval recruits to simulate feeblemindedness on the comprehension, vocabulary, and similarities subtests of the Wechsler-Bellevue Intelligence Scale (Form I), and found that their mean scores did not differ significantly from the mean scores of the mentally defective control group. However, all -291- these authors would agree that simulated mental deficiency cannot be identified on the basis of total score alone unless that total score is extremely low and there is contradictory information available. Hunt and Older (43) report that the malingerer tries more items than the defective and gets them incorrect; whereas the defective does not even attempt many items. However, some malingerers attempt only a few items, but they undertake and answer correctly some of the difficult problems after failing easier items. This tendency to pass difficult items after failing easy ones has been reported by Crowley (18), Goldstein (33), and Hunt and Older (43), and reflects the inability of the malingerer to estimate properly the difficulty of a question. This behavior is out of keeping with the typical test performance of the true defective who shows little scatter on most intelligence tests. Also, Crowley(18) noted that the female malingerers used in her study tended to give foolish, nonsensical answers which often were wildly exaggerated or bizarre. The malingerers displayed a better speaking vocabulary than the defectives, and answered more quickly on hard questions, but more slowly on easy ones. Pollaczek (70) constructed a key for malingering derived from three subtests of the WechslerBellevue Intelligence Scale. Examination of the key suggests that malingerers tended to do too well on vocabulary and similarities, but did quite poorly on comprehension. Thus the malingerer may misconstrue feeblemindedness as a condition in which the person is unable to show judgment in even the simplest social situations, but is able to form concepts, think abstractly, and attain a rather literate level. Krout (50) suggests that the test be administered twice to note inconsistent behavior. The simulator may come out with the same score, but he may change some wrong answers to other wrong answers, or he may even spoil some answers which were correct on the first administration. Krout also suggests that the examination of the suspected malingerer should begin with the most difficult questions and take the person back to a point near imbecility. If he cannot answer even the simplest questions, he is probably trying to be consistently defective and is malingering. Hunt (42) indicates that the malingerer and the defective may both give wrong answers, but that there are qualitative differences either in the answers or in the manner of reaching the answers. On arithmetic, for example, the defective may combine the elements of the problem incorrectly and thereby arrive at the wrong answer.

The major dietary sources of vitamin K are green leafy vegetables and certain vegetable oils order 135mg colospa otc. Clinically buy generic colospa 135mg online, vitamin K is used primarily to prevent or cure deficiency- related bleeding in newborns and patients with malabsorption syndromes and to reverse the anticoagulative effects of vitamin K antagonists 135 mg colospa with mastercard. A major limitation of most of the studies is that the fact of intramuscular administration of vitamin K was difficult to establish retrospectively for a substantial proportion of subjects, although the results of the analyses based on individual records and on imputed hospital policies for vitamin K administration are similar. In the studies in which a suggestion of an association was observed, selection bias may have accounted for the result. The possibility cannot be entirely excluded of a small increase in the risk for acute lymphoblastic leukaemia occurring at ages around those of the peak incidence in childhood in children given intramuscular administration of vitamin K. The few studies that investigated oral administration of vitamin K found no increase in the relative risk for leukaemia. Phylloquinone is rapidly cleared from the circulation by the liver, metabolized to metabolites with shortened side- chains and excreted in the bile and urine. Phylloquinone rarely has toxic effects, and the few serious immunological compli- cations observed have been attributed to the vehicle of solubilization. Menadione may cause haemolytic anaemia and induce cellular damage by arylating protein-bound and soluble thiols or by inducing oxidative stress. No adverse effects have been reported in mothers or infants after administration of vitamin K during pregnancy, whereas vitamin K deficiency is teratogenic. The safety of vitamin K in pregnancy has not been adequately studied experimentally. Neither phylloquinone nor menaquinones have been adequately studied for muta- genicity. Menadione acts as a bacterial mutagen in several specific strains of Salmo- nella typhimurium and Escherichia coli. There is inadequate evidence in experimental animals for the carcinogenicity of vitamin K substances. Overall evaluation Vitamin K substances are not classifiable as to their carcinogenicity to humans (Group 3). Cancer, 76, 406–415 Rote Liste Sekretariat (1998) Rote Liste 1998, Frankfurt, Rote Liste Service GmbH, pp. Volume 31 Volume 40 Volume 51 Some Food Additives, Feed Some Naturally Occurring and Coffee, Tea, Mate, Methyl- Additives and Naturally Synthetic Food Components, xanthines and Methylglyoxal Occurring Substances Furocoumarins and Ultraviolet 1991; 513 pages 1983; 314 pages (out-of-print) Radiation 1986; 444 pages Volume 52 Volume 32 Chlorinated Drinking-water; Polynuclear Aromatic Volume 41 Chlorination By-products; Some Compounds, Part 1: Chemical, Some Halogenated Hydrocarbons Other Halogenated Compounds; Environmental and Experimental and Pesticide Exposures Cobalt and Cobalt Compounds Data 1986; 434 pages 1991; 544 pages 1983; 477 pages (out-of-print) Volume 42 Volume 53 Silica and Some Silicates Occupational Exposures in Volume 33 1987; 289 pages Insecticide Application, and Polynuclear Aromatic Some Pesticides Compounds, Part 2: Carbon Volume 43 1991; 612 pages Blacks, Mineral Oils and Some Man-Made Mineral Fibres and Nitroarenes Radon Volume 54 1984; 245 pages (out-of-print) 1988; 300 pages Occupational Exposures to Mists and Vapours from Strong Volume 34 Volume 44 Inorganic Acids; and Other Polynuclear Aromatic Alcohol Drinking Industrial Chemicals Compounds, Part 3: Industrial 1988; 416 pages 1992; 336 pages Exposures in Aluminium Production, Coal Gasification, Volume 45 Volume 55 Coke Production, and Iron and Occupational Exposures in Solar and Ultraviolet Radiation Steel Founding Petroleum Refining; Crude Oil 1992; 316 pages 1984; 219 pages and Major Petroleum Fuels 1989; 322 pages Volume 56 Volume 35 Some Naturally Occurring Polynuclear Aromatic Volume 46 Substances: Food Items and Compounds, Part 4: Bitumens, Diesel and Gasoline Engine Constituents, Heterocyclic Coal-tars and Derived Products, Exhausts and Some Nitroarenes Aromatic Amines and Mycotoxins Shale-oils and Soots 1989; 458 pages 1993; 599 pages 1985; 271 pages Volume 47 Volume 57 Volume 36 Some Organic Solvents, Resin Occupational Exposures of Allyl Compounds, Aldehydes, Monomers and Related Hairdressers and Barbers and Epoxides and Peroxides Compounds, Pigments and Personal Use of Hair Colourants; 1985; 369 pages Occupational Exposures in Some Hair Dyes, Cosmetic Paint Manufacture and Painting Colourants, Industrial Dyestuffs 1989; 535 pages and Aromatic Amines Volume 37 1993; 428 pages Tobacco Habits Other than Volume 48 Smoking; Betel-Quid and Areca- Some Flame Retardants and Volume 58 Nut Chewing; and Some Related Textile Chemicals, and Exposures Beryllium, Cadmium, Mercury, Nitrosamines in the Textile Manufacturing and Exposures in the Glass 1985; 291 pages Industry Manufacturing Industry 1990; 345 pages 1993; 444 pages Volume 38 Tobacco Smoking Volume 49 Volume 59 1986; 421 pages Chromium, Nickel and Welding Hepatitis Viruses 1990; 677 pages 1994; 286 pages Volume 39 Some Chemicals Used in Plastics Volume 50 Volume 60 and Elastomers Pharmaceutical Drugs Some Industrial Chemicals 1986; 403 pages 1990; 415 pages 1994; 560 pages Volume 61 Volume 70 Supplement No. In the past 3 decades there has been vast expansion in the range of new drugs and their formulatons. For this purpose, an Apex Body and a Core Group with the following compositon were consttuted: Chairman: Secretary, Ministry of Health and Family Welfare, Govt. Gupta, Head, Department of Pharmacology, All India Insttute of Medical Sciences, New Delhi 4. Sheth, Vice-President, The Internatonal Pharma- ceutcal Federaton, The Hague, The Netherlands 8. Singh, Secretary-cum-Scientfc Director, Indian Pharmacopoeia Commission, Ghaziabad 9. Praveen Aggarwal, Department of Emergency Medi- cine, All India Insttute of Medical Sciences, New Delhi 3. Dr Veena Gupta, Consultant, Department of Radiotherapy, Safdarjung Hospital, New Delhi 4. Gupta, Head, Department of Pharmacology, All India Insttute of Medical Sciences, New Delhi 5. Kabra, Paediatric Pulmonology Division, Depart- ment of Paediatrics, All India Insttute of Medical Sciences, New Delhi 6. Khilnani, Department of Medicine, All India Insttute of Medical Sciences, New Delhi 7. Dr Jai Prakash, Principal Scientfc Ofcer, Indian Pharma- copoeia Commission, Ghaziabad 8. Sheth, Vice-President, The Internatonal Pharma- ceutcal Federaton, The Hague, The Netherlands 9. Singh, Secretary-cum-Scientfc Director, Indian Pharmacopoeia Commission, Ghaziabad 10. Dr Hemant Singh Bhadauria, Pharmacology, All India Insttute of Medical Sciences, New Delhi 2. Dr Arun Kumar Dahiya, Pharmacology, All India Insttute of Medical Sciences, New Delhi 3. Dr Shefali Gulat, Pediatric Neurology, All India Insttute of Medical Sciences, New Delhi 5. Dr Pooja Gupta, Pharmacology, All India Insttute of Medical Sciences, New Delhi 6. Dr Ashish Kakkar, Pharmacology, All India Insttute of Medical Sciences, New Delhi 9. Dr Biswa Mohan Padhey, Pharmacology, All India Insttute of Medical Sciences, New Delhi 12. Dr Aarohan Pruthi, Pharmacology, All India Insttute of Medical Sciences, New Delhi 15. Dr Sudhir Chandra Sarangi, Pharmacology, All India Insttute of Medical Sciences, New Delhi 17. Dr Pramil Tiwari, Natonal Insttute of Pharmaceutcal Educaton and Research, Mohali, Punjab, India 20. During this period, there have been tremendous advance- ments in therapeutc strategies and newly available drugs. Valuable inputs that emerged during the meetngs of the Core Group and the inputs received in responce to the pre-print version circulated have given this editon a unique feature by incorporatng value added informatons.

When extrapolations are made from published material of this sort generic colospa 135mg without prescription, they are presented as hypotheses generic colospa 135mg on-line, and in every instance require testing and validation order colospa 135mg free shipping. The interest of scientists in employing drugs in research transcends an interest in drug effects, per se. Drugs constitute valuable tools for experimentation directed toward developing basic physiologic and psychologic knowledge, such as the study of neurophysiologic correlates of symbolic and psychodynamic processes. Work by scientists in such areas is also likely to increase knowledge of drugs which may be applicable to interrogation. Methodologic Problems in Determining the Applicability of Drugs to Interrogation Procedures A large initial section of this report is devoted to a survey and discussion of the nonspecific effects of drugs and to the difficulties involved in discriminating these effects from the pharmacologic effects of the drugs used. The time spent in describing some of these nonspecific factors is needed to illustrate how the many variables involved complicate the problem of making a judgment regarding the present or potential usefulness of a drug for either therapeutic or intelligence purposes. This section has been included to point out some of the problems which require consideration in designing well-controlled studies in this area. The complexity inherent in psychopharmacologic research requires the integration of all levels of research on drug action: biochemical, neurophysiological and psychological. These problems are multiplied and prediction is lessened when the actions of drugs on living human beings are considered, rather than on isolated nerves, tissues, or animals of simpler neural structure. This reviewer has included only very few bibliographical references to work with animals, and yet a significant portion of excellent experimental, psychologic studies involve animals. This relative omission can be explained by the problem being one unique to human beings: the use of language symbols to communicate and interact with other human beings. A review of the literature illustrates a variety of effects produced by pharmacologically inert substances which simulate medication -129- (placebos). Depending on the personality of the subject and the circumstances under which the placebo is administered, 30 to 50 per cent of individuals show or experience a reaction. Well-designed studies can distinguish the pharmacologic effect of a drug from the placebo effect. The possibility is raised that an interrogator might exploit the "placebo phenomenon" with a susceptible subject, instead of employing a pharmacologically active drug. An examination of the literature demonstrates that the effects of drugs vary with the attitude and motivation of the person administering the medication and the person interviewing the informant. The sex and intelligence of the subject, the presence of mental or physical illness, the occurrence of biologic rhythms (e. The method of sampling the verbal behavior of an individual under the influence of a drug, directive, nondirective, free-associative, etc. For these reasons, it is recommended that a variety of sampling methods be used in experimental studies. The Efficacy of Drugs in Uncovering Information When one examines the literature for experimental and clinical studies that bear directly on the use of drugs in interrogation procedures, one finds relatively few studies. Reports dealing with the validity of material extracted from reluctant informants, whether criminal suspects or experimental subjects, indicate that there is no "truth serum" which can force every informant to report all the information he has. Experimental and clinical evidence indicate that not only the inveterate criminal psychopath may lie or distort under the influence of a drug, but the relatively normal individual may, with many drugs, successfully disguise factual data. Less well-adjusted individuals, plagued by guilt and depression, or suggestible individuals, who are compliant and easily swayed, are more likely to make slips revealing withheld information. Even they may, at times, unconsciously distort information and present fantasies as facts. The anesthetic action of the drug, as in narcosis with barbiturates, can interfere with cerebral functioning and promote the presentation of fantasy material as fact, or otherwise alter the form of verbalizations to render them relatively unintelligible. It would be very difficult under these circumstances for an interrogator to tell when the verbal -130- content was turning from fact to fantasy, when the informant was simulating deep narcosis but actually falsifying, which of contrary stories told under narcosis was true, and when a lack of crucial information coining from a subject under a drug meant the informant had none to offer. To derive useful information from an interrogation in which drugs are employed, an interrogator would have to consider and weigh many important factors: the personality of the subject, the milieu, other sources of evidence, the rapport obtained, and the skill of the questioning. These and other factors affect the validity of information obtained from an informant under sedation. Specific Effects of Drugs in Interrogation Situations Advantages and limitations of a number of different types of pharmacologic agents as adjuncts to interrogation can be examined by reviewing clinical and experimental data from the works of psychiatrists, neurologists, psychologists, physiologists, and pharmacologists. Barbiturates tend to increase contact and communication, decrease attention, decrease anxiety, decrease psychotic manifestations, and make the mood more appropriate and warmer. When combined with interview techniques that aim at arousing emotions, strong emotional reactions may be catalyzed for psychotherapeutic purposes. Barbiturates have been found helpful in detecting whether an individual is feigning knowledge of the English language and in getting mute catatonic schizophrenics and hysterical aphasics to talk. They are of no avail, however, in remedying the speech defects of true aphasics, even transiently. The use of barbiturates has helped to get more reliable estimates of intelligence and personality through psychological tests, particularly in emotionally upset individuals. The use of various stimulant and antidepressive drugs has been explored, for diagnostic and therapeutic purposes in psychiatric practice, but not to any extent for interrogation. Amphetamine, pipradrol, methylphenidylacetate have in common the capacity to produce an outpouring of ideas, emotions, and memories. An injection of amphetamine following an intravenous barbiturate is said to provoke a striking onrush of talking and activity from psychiatric patients. Without adequately controlling his study, one author claims that methamphetamine produces such a strong urge to talk that the criminal who feigns amnesia or withholds vital information cannot control himself and thus gives himself away. Iproniazid, an antidepressive drug which is relatively slow and sometimes dramatic in its thera- -131- peutic effect, should be considered for experimentation.