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H&CP
Hospital
and Community
Eating [)isorders:
The
Changing Population
of Bulimia Patients
A Journal
of the
Patients’
Psychiatry
Accounts
of Stress and Coping
in Schizophrenia
American
November
1989
Reports
on APA’s
1989 Achievement
Award Winners
Psychiatric
Association
HALDOL
?..
DECANOATE
#{149}#{149}
tr
Su tir”
ul L )
th
schzophreriic
Ui
Siflge
1T)Ofltfly
it
p13ter1t
Th. following
is a brief summary
only. B&ors
prescribing,
se comp#{234}t pr..cribEng
information
in HALDOLand
HALDOL Dscanoats
PrOdUCtI.b&Ing.
Contrainthcatlons:
S1nce the phamiacoogic
and cliniC& actions
of HALDOL
(hafoperidol)
Decanoate are attributed to IIALDOL as the active mediCatiOn. COntraindiCatiOnS,
Warnings, and
addfhon& iformation
are those of HALDOL. Some secons
have been modified to reflect the
prolongedaction
of HALDOL Decanoate
HALDOL is contraindicated
m severe toxic centraf nervous system depression
comatose
states from any cause and m dividuafs
who are hypersensitive
to tPis drug
have Parkuisons
disease.
Warninga
Tardwe Dysafnesia
rdtve
dyskinesia, a syndrome consisting of POtentially wreversla Wwofuntary dyskinetic
movements
may deve#{234}op
in patients treated with anbpsychotic
drugs.
Although the prevalenos of the syndrome
appears to be highest among the elderly. especially
ederty women. ft is imposafble to rely upon prevalence estimates to pedt.
at the inception of
antipsychotictreatment,
which patients are Iikelytodevefopthesyndrome.
Whether antipsychotic
drug products differ in their potential to cause tardive dyskineSta is unknown. Both the risk of
developing tardive dyskinesia
and the likelihood that it will become wreversible are believed to
crease
as the duraon
of treatment
and the total cumulative
dose of antipsychotic
drugs
adtThnistered to the patient ilicrease. However, the syndrome can devafop, although much tess
commonly, after relathiely brief treatment peflods at low doses. There is no known treatment for
establishedcasesoftardivedyskinesia.
atthoughthe
syndromemayremit,
partiallyorcompletely,
if anpsychotictreatment
is wlthdrawrt
AntipsychOtiCtreatment,
itself, however, may suppress(or
partially suppress)the
signs and symptoms
of the syndrome and thereby may possibfy mask the
underlying procass. The effect that symptomatic
suppression
has upon the long-term course of
the syndrome is unknown. Given these considerations,
anpsychotic
drugs should be prescribed
k a manner
that is most likely to minimize the occurrence
of tardive dyskrneSia.
Chronic
anbpsychndctreatment
ShOtidgenerally
be reserved forpatlents
WhOSUfIerfrOm
achronicillness
that 1) is known to respond to antipsychotic
drugs. and 2) for whom aftemave,
equally effecve,
but potentially tess harmful treatments
are not avadableor
appropriate In patients whodo require
chronic treatment,
the smallest
dose and the shortest
duration of treatment
producing
a
satisfactory
cliniCaf response shou’d be sought. The need for conlinued
treatment
shou$d be
reassessed
periodically
If signs and symptoms of tardive dyskinesia appear in a patient on
arThpsychollcs
drug discondnuation
should be considered.
However, some patients may require
treatment despite the presence of the syndrome.(Forfurther
mfOrTnaOn about the description of
tardedysfoneafaand
s cnicaf detectior please referto ADVERSE REPCT1ONS)
Puro#tic
M&igIeAt
Syndroma
(NMS) A potentially
fataf symptom
compfex sometimes
referred to as Neuroleptic
Malignant
Syndrome
(NMS) has been reported in association
with
antipsychotic
drugs clinicaf manifestations
of NMS are hyperpyrexia.
muscfe hgidit
altered
mental status Qnctudkg catatonic signs) and evidence of autonomic
wretability(Wregular
pulse or
blood pressure,
tachycardsa
diaphoresi
and cardiac dysrhythmias).
Additional
signs may
itdude elevated creatine phosphokinase.
myoglobnuna(rhabdomyolysis)and
acute renal fallure
Thediagnosticevaluation
ofpatients with tts syndrome is compficate
In arriving atadiagnosis,
it is important
to entify
cases where the dWiical presentation
includes both serious medical
flness(e,
pneumonia,
systemic infection, etc)and
untreated or inadequately
treated extrapyramidal signs and symptoms
(EPS Other important considerations
in the differentet
diagnosis
inctudecentral
anticholinergic
toxicity, heat stroke, drUgfeverand
primary centralnervoussystem
(NS)
pathology.
The management
of NMS should idude
1) immediate
discontinuation
of
antipsychotic
drugs and otherdrugs notessentiaf toconcurrenttherapy,
2)intensive symptomatic
treatment and medical monitoring, and 3)treatment
of anyconcomitant
serious medical problems
for which specific treatments
are available. There is no general agreement
about specific
pharmacological
treatment regimens for uncomplicated
NMS. If a patient requires antipsychotic
drug treatment after recovery from NMS, the potential reintroduction
of drug therapy should be
carefully considered.
The patient should be carefully monitored,
since recurrences
of NMS have
been reported. Hyperpyrexia
and heat stroke, not associated with the above symptom complex,
have also been reported with HALDOL.
Usage at Pregnancy: (see PRECAUTIONS
Usage in Pregnancy) Combined Use With Lithium:
(see PRECAUTiONS
Drug lnteracIions
General: Bronchopneumonia,
sometimes
fata has followed
use of antipsychotic
drugs,
including haloperidot
Prompt remedial therapy should be instituted if dehydration,
hemoconcentration or reduced pulmonary
ventilation
occur, especially
in the elderly. Decreased
serum
cholesterol
and/or cutaneous
and ocular changes have been reported with chemically-related
drugs, although not with haloperidol. SePRECAUTIONS
lnforrnationforPatients
formnformation
on mental and/orphysicalabilitles
and on concomitant
usewith other substances
Precautions:
Administer
cautiously to patiente (1) with severe cardiovascular
disorders
due to
the possibility
of transient hypotension
and/or precipitation
of anginal pain (if a vasopressor
is
required, epinephrine
should not be used since HALDOL may block its vasopressor
activity and
paradoxical
further lowering
of blood pressure
may occur; metaraminol,
phenylephrine
or
norepinephnne
should be used
(2) receiving anticonvulsant
medication
with a history of
seizures, or with EEG abnormalities,
because 1-IALDOL. may lower the convulsive threshold. If
indicated, adequate antbconvulsant
therapy should be concomitantly
maintained;
(3) with known
allergies or a history of allergic reactions to drugs (4) receiving anticoaguIant
since an siolated
instance of interference occurred with the effects of one anticoagulant
(phenmndione
Concomitent antiparkinson
medication,
if required, may have to be continued after HALDOL is discontinued because of different excretion rates; if both are discontinued simultaneously,
extrapyramidal
symptoms may occur. Intraocular pressure may increase when antichotnergic
drugs, induding
antiparkmnson drugs are administered
concomitantly
with HALDOL. When HALDOL is used for
mania in bipolar disorders, there may baa rapid mood swing to depression. Severe neurotoxicity
my occur in patients with thyrotoxicosis receiving antipsychoticmedicatior
induding HALDOL.
The 1, 5, 10 mg HALDOL tablets contain FD&C ‘hallow No. 5 (tartrazine)
which may cause
-
-
-
allergic-type reactions(mduding
bronchial asthma)in certain susceptible individuals, especiallyin
thosewhohaveaspinn
hypersensitivity.
Information lbrPataints:
Mental and/or physical abilities required for hazardous tasks or driving
may be itnpaire
Alcohol should beavoidedduetopossibleadditiveeffects
and hypotension.
Drug lnteraction&
Patients receiving lithium plus haloperidol should be monitored dosely for
early evidence of neurological
toxicity and treatment discontinued
promptly if such signs appear.
As with other antipsychotic
agents
it should be noted that HALDOL
may be capable of
potentiatingONSdepressants
such as anesthetics opiates, and alcohoL
CarcinogenesI
Mutagenesis
andlmpairment
olFertility:
No mutagenic potential of haloperidol
decanoatewasfound
in theAmes Salmonella microsomal activation assay.
Carcmnogenicity
studies using oral haloperidol
were COnduCted in Wistar rats (dosed at up to 5
mkg
daily for 24 months)and in AJbmnoSwiss mice (dosed at up to 5 mqjkg daily for 18 months).
lntheratstudysurvivalwaslessthanoptimal
inaIIdosegroup
reducingthenumbero(
ratsatrisk
fordevelopin9tumors.
However, althougharelatlvelygreaternumberofratssurvlvedtotheendof
the study in high dose male and female groups, these animals did nothave agreater incidenceof
tumors than control animals. Therefore,
although
not optimal, this study does suggest the
absence of a haloperidol
related increase in the incidence of neoplasia in rats at doses up to 20
timestheusualdaily
human doseforchronicorresistant
patients. In femalemiceat5and20tlmes
the highest initial daily dose for chronic or resistant patient
there was a Statistically significant
increase in mammary gland neoplasia and total tumor incidence; at 20 times the same daily dose
there was a statistically significant
increase in pituitary
gland neoplasia. In male mice, no
statistically significant differences
in incidences
of total tumors or specific tumor types were
noted
Antipsychotic drugs elevate prolactin leveI
the elevation persists during chronic administration. Tissue culture experiments indicate that approximately
one-third of human breast cancers
are prolactin dependentin
littr4 afactorof potential importanceifthe
presaiptionofthesedrugsis
contemplated in a patient with a previously detected breast cancer. Although disturbances such
as galactorrhea,
amenorrhea,
gynecomastia,
and impotence
have been reported, the dinicaf
significance
of elevated serum prolactin levels is unknown for most patients. An increase in
mammary neoplasms has been found in rodents after chronic administration
of antipsychotic
drugs. Neitherdinical
studies norepidemiologicstudiesconductedtodate,
however, haveshown
an association
between chronic administratiOn
of these drugs and mammary tumorigenesis
the
availableevidenceisconsideredtoolimited
tobecondusiveatthistime.
Usage in Pregnancy:
Pregnancy Category C. Sate use in pregnancy or in women likely to
become pregnant has not been established, useonly if benefitclearlyjustifles
potential hazardsto
the fetus.
MirsingMother
Infants should not benursedduring
drug treatment.
Pediatric
Usa Controlled trials to establish
the safety and effectiveness
of intramuscular
administration
in children have not been COnduCted
Adv.rsi
Reactions:
Adverse reactions following
the administratiOn
of HALDOL (haloperidol)
Decanoate
are those of HALDOL. Since vast experience
has accumulated
with HALDOL,, the
adverse reactions are reported for that compound
as well as for HALDOL Decanoate. As with all
injectablemedications,
local tissuereactions
havebeen reportedwith
HALDOL. Decanoate.
cNS fects
Extrapparnkia!
Reactions-Neuromuscular
(extrapyramidal)
reactions have been
reported
frequently,
often during the first few days of treatment
Generally
they involved
Parkinson-like symptoms which when first observed were usually mild to moderately severe and
usually reversible. Other types of neuromuscular reactions (motor restlessness,
dystonia, akathisia, hyperreflexia
opisthotonos,
oculogyric
crises) have been reported far less frequently, but
were often more severe. Severe extrapyramidai
reactions have been reported at relatively low
doses. Generally, extrapyramidal
symptoms are dose-related
since they occur at relatively high
doses anddisappear
or become less severe when thedOseis
reduced. AntiparkirisOn
drugs may
berequired.
Persistent extrapyramidal
reactions have been reported and the drug may have to be
discontinued
in such cases. WtIidraWaIEmergent
Neurological
Sqis-Abrupt
discontinuation
of
short-term
antipsychotic
therapyisgenerallyuneventful.
However, some patientsonmamntenance
treatment experience transient dysldnetlC signs after abrupt withdrawal In certain cases these
are indistlngulshablefrom
iardiveDysklnesia”
exceptforduration.
It isunknownwhethergradual
withdrawal will reduce the occurrence of these sign
but until further evidence is available
HALDOL should be gradually
withdrawrt
Tardtve Dysklflesia-As
with all antipsyChOtiC agents
HALDOL
has been associated
with persistent dyskinesia
l#{228}rdivedyskinesia,
a syndrome
consisting
of potentially
wreversibI
involuntary,
dyskinetic
movement
may appear in some
patients on long-term therapy or may occur after drug therapy has been discontinued. The risk
appears to be greater in elderly patientson
high-dose therapy, especially femalet The symptoms
are persistent
and in some patients appear Wreversibl
The syndrome ia characterized
by
rhythmical
involuntary
movements
of tongi*
fa
mouth or jaw (ag., protrusion
of tongi*
putting of cheeks, puckering of mouth, chewing movements).
Sometimes
these may be accompanied by involuntary
movements
of extremities and the trunk. There is no known effective
treatment
for tardlve dyskinesl
antiparkinson
agents usually do not alleviate the symptoms of
this syndrome It is suggested that all antipsychotic agents be discontinued if these symptoms
appear. Should it be necessary
to reinstitute treatment,
or increase the dosage of the agent, or
switch toadifferent
antipsychotic
agent, this syndrome may bemasked. It has been reported that
fine vermicular
movement
of the tongue may be an early sign of tardive dyskinesia
and if the
medication
is stopped at that time the full syndrome may not deveIo
Tardive DyStOnIa-4tbrdiVe
dystonla, not associated
with the above syndrome,
has also been reported
l#{228}rdive
dystonia is
characterized
bydelayedonsetofchoreicordystonicmovements,
isoften persistent, and hasthe
potential ofbecoming
irreversibla
Other NS Effects-Insomnia,
restIessnes
anxiety, euphoria,
agitation, drowsiness
depression,
lethargy, headach
confusior
vertiga grandmalSeLzUreS,
and
exacerbationofpsythoticsymptomstbiduding
hallucinations,
andcatatono-hkebehavioral
states
which mayberesponsive
todrug withdrawal and/ortreatmentwithantichoIinergicdrug
Body as a Wh
Neuroleptic malignant syndrome (NMS hyperpyrexia
and heat stroke have
been reported with HALDOL. (See WARNINGS for further information
concerning
NMS)CardiovascularElfects
l#{228}chycartha,hypotension,
hypertension
and ECG changes. Hei7tOibgicEffeCtS
Reportsof
mild, usuallytransientleukopenlaandleukocytosis,
minimaldecreasesin
redbIOOdCeII
counts anemia, or a tendency toward tymphomonocytosis;
a9ranulocytosis
rarely reported and
only in association
with other medication. Liver fects
Impaired liver function anti/or jaundice.
Dermaibkiglc
Reeotlore Maculopapular and acneiform reactions lsolated cases of photosensitivity, loss of hair. Endocrine Deorcfers
Lactation,
breast engorgement,
mastalgia,
menstrual
irregularities,
gynecomastia,
impotence,
increased
libido, hyperglycemia,
hypoglycemia
and
hyponatremia.
GastrolntestlnalElfect&Anorexia,constipation,dlarthea,
hypersaliVatiOn,dyspepwe, nausea and vomiting. Aubnomic
Reactbns
Dry moutt
blurred visior
urinary retention,
diaphoresis,
and priapism. Respkafory
8fects
Laryngospasm,
bronchospasm
and increased
depthof reapiratiort Speda!Senses
Cataracts retinopathy andVISU&dIStUrbanCe
Other: Cases
of sudden and unexpected
death have been reported in association
with the administration
of
HALDOL Thenatureo(theevidenoemakes
itimpossibletodeterrninedeflnitively
whatrole, if any,
HALDOL played in the outcomeof
thereportedcases.
The possibititythat
HALDOLcaused
death
cannot, of cours
beexduded,
but it is tobekeptin
mindthat sudden end unexpecteddeath
may
occur in psychotic
patients when they go untreated
or when they are treated with other
antipsychotlcdrugt
IMPOR1PJ4T: Full dlrectlonsforuseshouldb.r.adb.for.HALDOLorHALDOLDcanoa.js
admlnlstersd
orprescrlbed.
For Information
on symptoms and treatment of ov.rdosag.,
see full prescribing
Informsdon
The short-acting
HALDOL injectable
form is intended only for acutely agitated psychotic
patients with moderately severetovery
severesymptoms.
7 2088
1%
MCNEIL
PHARMACEUTICAL
MCNEILAB
INC
SpnngHouse
PA 19477
Sustained drug levels
with a single monthly dose
HALDOL
DEANOATE
(HALOPERIDOL)
INJECTION
Sustained
_______
from
protection
relapse
________
Please see brief summary
on next page.
of Prescribing
Information
During dose adjustment
or episodes of exacerbation of psychotic symptoms.
HALDOL
Decanoate
therapy can be supplemented
with short-acting
forms
of HALDOL
(haloperidol)
The side effects of HALDOL
Decanoate
are those of HALDOL.The
prolonged
action of HALDOL
Decanoate
should be considered
in
the management
of side effects
McNEIL
PHARMACEUTICAL
McNE1LAB
NC
SprngHousePA
9477
This
calls
With
Asleep
at the switch.
for a switch in antidepressants.
PAMELOR
there
is little
Yet all the efficacy
daytime
sedation.16
of amitriptyline.7
1/F
PAMELOR
(nortriptyline HC1)
The active metaboilte
PAMEWR may impair the mental and/or physical abilities required for the performance of hazardous tasks,
such as operating heavy machinery or driving a car;
therefore, the patient should be warned accordingly.
.
References:
I Thompson IL U, Thompson Wi.. Ileating depressIon tncvclics, tetracvclics. and other options. Modern Medicine
August 1983:5187109
2. (;eorgota A Affectivedisorden pharmacotherap.
In Kaplan HI. Sadock BJ,
eds Cornprebensur
Textbook of Ps’cbsalr; IV Italtimore. Md WIlliams &
Wilkins. 1985,1:821833. 3. ByeC, Clublev M, Peck 8W 1)rowsiness. mpairedper.
lormance and tricvclic antidepressanidrugs
llrJClEn Pbarmacol
1978.6 155
161 4. Kupler DJ. Spiker 15G. Rossi A. Col’le ‘A. Shaw 1, Illrich K. Nortriptline
and KEG sleep in depressedpatients. BwlPsycbsatr
982.17 535546 5. Blackwell B, Peterson GR, Kuzma RJ, Ilosteiler RM. Adolph Alt The effect of five
iricvclic antidepressanison salivary flowand mood in healih volunteers Cornrnurncalson.c
in Psivbopbarmacol.
19110i:255-26l 6. hayes FE. Krisioff CA
Adverse maclions to five new anlidepressanis C/rn Pbarrn 1986.5 471-480 7.
Ziegler yE. Clavion I, Biggs JT A comparisoii siud of amiiriptvline and
noriripivline with plasma levels Arch Ceo Psivhsalrs: May 1977:.ti607.b12.
Contraindlcaiions:
I) Concurrent use with a monoamine
oxidase
(MAO) inhibitor, since hyperpyretic crises. severe convulsions. and fatali.
lies have occurred when similarlricyclic
aolidepressantswere
used in such
combinations,
MAO itihibilors should be discontinued
for at least two
weeks before treatment with Pamelor
(nortriptyline
HCI) is started 2)
1lpersensilivity
to Pamelor
(norlriptyline
MCI) cross-sensitivity with
other dibeiizazepines
is a possibilits 3) The acute recovery period after
myocardial infarction
Warnings:
Give only under close supervisioii to patients with cardiovascular disease, because of the tendency of the drug to produce sinus tachvcardia and to prolong
conduction
time.
ms-ocardial
infarction.
arrhythmia.
aiid strokes have occurred The atitihvpertensive
action of
guanelhidine
and similar agents may be blocked. Itecause of its anlichohioergic activity; nortriptyline
should be used with great caution in palieiitswho have glaucoma or a histor) of urinary reteiilion
Patieotswith a
history of seizures should be followed closely. sitice iiortriptIine
is known
to lower the convulsive threshold Great care is required in hyperthyroid
palieiits or those receiving thyroid medication, since cardiac arrhythmias
may develop Nortriptvliiie
mas impair tie mental aiidinr phssical atuli-
.
(G 1989 Sandoz
Pharmaceuticals
Corporation
of amitriptyline
ties required for the performance of hazardous tasks. such as operating
machinery or driving a car; therefore, the patient should be warned accordingly. Excessive consumption of alcohol may have a potentiating ctfed, which mas- lead to the danger of increased suicidal attempts or
overdosage, especially in patientswith historiesof emotional disturbances
or suicidal ideation.
The concomitant
administration
of quinidine
and nortriptyhine
may
result in a significantly longer plasma half-life, higher A.ti.C. and lower
clearance of nortriptyline.
Usein Pregnancy-Safe
use duringpregtiancy
andlactation
has notbeen
established. therefore, in pregnant patients, nursing mothers, or women
ofchildbearing
potetitial, the potential benefits must be weighed against
the possible hazards
(Ise in Children -Not recommended for use its children, since safety atid
effectiveness in the pediatric age group have not been established.
PrecautIons:
Use in schizophrenic patients may result in an exacerba-
lion of the psychosis or may activate latent schizophrenic symptoms; in
nveractiveoragitatedpatients,
increasedanxietv
andagitation
may occur;
in manic-depressive
patients, symptoms ofthe manic phase may emerge
Administration
ofreserpine during therapy with a tricychic antidepressant
has been shown to produce a ‘stimulating
effect in some depressed patients. Troublesome patient hostiliti- may be aroused. Epileptiform
seizures may accompatly administration
Close supervision and careful
ad)ustment of dosage are required when used with other antichohinergic
drugs and sympathomimetic
drugs. Coticurrent administration of cimeti-
dine can produce chitiically significant increases in the plasma concentralions ofthe tricvchic antidepressant.
Patietits should be informed that the
responseto alcohol may be exasserated. When essential, may be administered with electroconvulsive therapy, although the hazards may be in.
creased t)iscontiiiue the drug for several days, ifpossible, prior to elective
surgery The possibility of a suicidal attempt by a depressed patient re
mains after the ititialion of treatment; in this regard, it is important that
the least possiblequantits
ofdrugbedispensed
at any given lime Both dcnation and lowering of blood sugar levels have been reported.
A case of significant hypoglycemia has beeii reported in a type II diabetic
patient maintained oii chlorpropamide
(250 mgiday), after the addition
of nortriptyline
(125 mWdav).
Adverse
Reactions:
(.‘ardioi-ascular-t-lypotension.
hperteosion.
tachycardia,
palpitation,
myocardial
infarction,
block, stroke. Ps’cbialric-Confusional
with hallucinations,
disorientation,
arrhythmias,
heart
stales (especially in the elderly)
delusions;
anxiety, restlessness, agi-
tation, insomnia, panic, nightmares; hypomania; exacerbation of psychosis. Neurologic-Numhness,
tingling,
paresthesias of extremities;
incoordination,
ataxia, tremors, peripheral neuropathy; extrapyramidal
symptoms, seizures, alteration in EEG patterns; tinnitus.Anlicbolinergic
-E)ry mouth and, rarely, associated sublingual adenitis; blurred vision,
disturbance of accommodation, mydriasis; constipation, paralytic leus;
urinary retention, delayed micturition, dilation ofthe urinary tract.Allergic-Skin
rash, petechiae, urticaria, itching, photosensitizatioti (avoid
excessive exposure to sunlight): edema (general or offace and tongue),
drug fever, cross-sensitivity with other tricychic drugs. HemalologicBone marrow depression, iticluditig agranulocylosis; eosinophihia; pur.
pura; thrombocytopenia. Ga.s’lmmlestinal-Nausea
and vomiting, anorexia, epigastric distress, diarrhea, peculiar taste, stomatitis, abdominal
cramps, black-tongue. Endocriiw-Gynecomastia
in the male, breast enlargement and galaclorrhea in the female; increased or decreased libido,
impotence; testicular swellitig; elevation or depression ofblood sugar hendo; syndrome of inappropriate
ADH (antidiuretic
hormone)
secretion.
Other-Jaundice
(simulalitig
ohstructis’e(, altered liver function; weight
gain or less; perspiration. flushing; urinary frequencs; nocturia; drowsi-
hess, dizziness, weakness, fatigue; headache; parotid swelling; alopecia
Wilhdrauejl
Si’rn/itovns-Though
these are not indicative of addiction,
abrupt cessation oftreatmeot
after prolonged therapy may produce nausea, headache, and malaise
Overdosage:
Toxic overdosage may result
iii
confusion, restlessness,ag
itation, vomiting,
hperpyrexia,
muscle rigidits; hyperactive
reflexes,
tachscardia,
ECG evidence of impaired conduction,
shock, congestive
heart failure, stupor. coma. atid CNS stimulation with consulsiotis (ohlowed by-respirators depressioti l)eaths have occurred with drugs of this
antidote is known; general supportive measures are indicated, with gastric lavage
(PAM-Z17-1/13/891
class. Nospecific
SANDOZPHARMACEUTICALS
Corporonon,
#{163}
Hanover,
NJ
07936
i201 i 503-7500
PAM-289-
1 3R
I had an important
dream last night
Therapist
the
Analysand
premier
was holding
Fontainebleau
Therapist
The American
interdisciplinary
Orthopsychiatric
Association
organization
Meeting
in Miami,
its Annual
Hotel.
in mental health
Florida, at the
--
Hmmm
-
TA
It was spring, April 25-29, 1990. There were at least 150
educational
events
full-day institutes,
workshops,
panels,
general sessions
and poster groups. They covered over 80
subject areas, ranging
from adolescence
to women’s
issues.
T
Hmmm
TA
There were social events, too, so I got to network
with lots
of mental health professionals
psychiatrists,
psychologists,
social workers,
psychiatric
nurses,
counselors,
educators,
attorneys,
and others.
T
Hmmm
TA
There was that ORTHO spirit of shared interdisciplinary
learning
and commitment
to social issues.
T
Hmmm
TA
Best of all, I remembered
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workshops,
and
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Education
Credits were available,
too.
What do you think it all means?
It means you should sign up quickly. And by the way, where
can Igeta preliminary
program anda membership
application?
T
-
Contact: Dept. C ORTHO
19 West 44th Street Suite
Whether
American
Heart
Association
The American
Orthopsychiatric
Association
1616 New York, NY 10036 1-212-354-5770
you
a psychiatrist
WE’RE
FIGHTING FOR
YOUR LIFE
are
seeking
.
.
a new
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an employer
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Psychiatric
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Fergusson,
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Psychiatric
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K Street
N.W.,
Washington,
D.C.
(202) 682-6108
20005
effective
The
synapse-crossroads
for
serotonin
(
IL
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-
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i..?;
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-
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-
-
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.
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In depression
AC#{174}
fluoxetine hydrochloride
“a potent
Effectively
serotonin
reuptake
inhibitor...
represents
a new class
of antidepressants’1
relieves
depression*
Unlike
the tricyclics,
Prozac
specifically
inhibits
serotonin
uptake.
Its minimal
action
on other
neurotransmitters
may explain
its
favorable
side-effect
profile.
Fewer side
therapy
effects
Avoid using
concomitantly
to Prozac
MAO inhibitors
or in proximity
Rash
and/or
urticaria
occurred
4% of clinical
trial patients
A wide
margin
20-mg
once-a-day
in
of safety
to disrupt
Side effects
are generally
mild and
manageable,
and include
nausea,
anxiety/nervousness,
insomnia,
and drowsiness
therapy
PROZAC...
A specifically
different
antidepressant
I. CurrTherRes
1986;39:559-563.
defined
by DSMlll.
*As
See adjacent
page
for brief summary
prescribing
FL.4907.T-949301
of
information.
©1989.
DISTAPR000CTS
COMNY
Prozaca
fluoxetine
hydrochloride
Brl.tSummmy:
Coitths
InformatIon.
package
Ifterature
for complete
ladicatlos: Prozac is indicated forthetreatmentof depression.
Ceetrafadfcatfes: Prozac is contraindicated in patients known to be hypersen.
sitiveto ii.
Waralus: Monoamine Oxase Inhibitcws -Data on the effects of the cornblood use of fluoxetne and MAO intbitors are IThted. Thor cornbrned use
shoufd be avoided. Based on experience with the cornbsned adlTdntstralion of
MAOIs and tricycfcs, at east 14 days shoutd elapse between discontinuation
of an MAO inttlbltorand initiation oftreatrnent wfthfluoxetine.
Because of thelong hat-lives of fluoxetine and tis active metatiOtite, at least
five weeks (approxirnatety five hat-lives of norfluoxetine) should ofapse
between discontinuation of fluoxetine and initiation of therapy with an MAOI.
Administration of an MAOI within five weeks of discontinuation of fluoxetine
mayincreasethe hskofseciousevents.WhileacausalreiobonsNptofluoxetne
has not been established, death has been reported to occur fofiosing the
ioltiation of MA therapy shortly after discontinuation of fluoxetise.
RashandAccampanyingEvents
Durrng premarketingtestin of morethan
5,600 US patients givenfluoxetine. approximately 4% developed a rash and/or
urticaiia Arnon9 these cases. almost a ttsrd were withdrawn from treatment
because of the rash and/or systemic iopns or symptoms associated with the
rash Ctnical findings reported in association with rash inctudefever, teikocytosis, arlhratgias. edema, carpat tunnel syndrome, respiratory distress,
fymphadenopathy. proteinuria, and mOd transarninase elevation. Most patents
snproved prornptty wftf discontinuation of fluoxetine and/or adiIsCtIVe treat.
rnentwith anbtsstaminesorsteriods, and all patientsexperiencin9theseevents
were reportedto recover completely.
Two patients are known to have developed a serious cutaneous systemic
dkiess. In neither patient was there an unequivocal diagnosis. but one was
considered to have a koikOcytOctastic vascutitis, and the othe a severe
desquamatlng srome
that was considered variously to be a vascultis or
erythema multiforme Several other patients have had systemic syndromes
suggestive of serum sickness.
Whether the association of rash and other events constitutes a true fluoxetine-induced syndrome. or a chance association of rash wfth the other signs
and symptoms ofdifferentetioiogy orpathogenests, is uoknowabteatttss pont
Hi the drugs development
Reassuring io the knowledge, cted above. that no patient is repOrtedtO have
sustained lasting injury. Even though almost two thirds of those developln a
rash continued to take fluoxetine without any consequence, the physicas
should discontinue Prozac upon appearance of rash.
Precasitfess: Ger,eraI-.pgj..rj
still lnapmr$a-Anxiety. nervousness. and
insomnia were reported by 10% to 15% of patents treated with Proust. These
symptoms lud to drug discontinuation in 5% of patients treated with Prozac.
Metat.#{225}ppetleaistWeiufi-Significant
weight loss. especially io urejerweight depressed patients. may be an undesirable result of treatment with
Prozac.
In controlled ckrdcal trials, approamatety 9% of patients treated with Prozac
experienced anorexia. This incidence is approximately sixfold that seen in
placebo controls. A weight loss of greaterthan 5% of body weight occurred in
13% of patients treated wfth Prozac compared to 4% of placebo- and 3% of
thcycbc-antidepressant-treated patients. Howeve only rarely have patients
been discontinued from treatmentwith Prozac because of weight loss.
Acfl1aLg1Ma1aL1ty11ania-During
premailteting testing, hypomania
or masea occurred in approximately 1% of fIUOXetIne-treatedpatents. Actvation of rnaniaThypomarna has also been reported in a small proportion
of patients with Major Affective tssorder treated with other marketed antidepressants.
eliIim-Twetve
patients among more than 6,000 evaluated worldwide in
the course ofpremarketing developmentoffluoxetine expenencedconvutsions
(or events described as possibly having been seeures). a rate of 0.2% that
appears to be similar to that associated with other marketed antidepressants.
Prozac should be lotroduced with care in patients witha ldstory of seizures.
fl#{231}-The possibility of a suicide attempt is inherent io depression and
may persist until signdlcant remission occurs. Close supervision of high-risk
patents should accompany initial druf therapy. Prescriptions for Prozac
should be written for the smallest quantity of capsulus consistent with good
patient mana merit. Uiorderto reducethe risk of overdose.
-
m*r active metabolite (seven to nine days), changes in dose wilt not be fully
reflected in plasma for several weeks. affecting both strategies for titration to
finof dose and withdrawal from treatment (see Clinical Pharmacology and
Dosage and Administration(.
yse in PatientsWlth ConcomitarII(pess-Clinicalexperience
with Prozac in
patents with concomitant systemic illness is liMed. Caution is advisable in
using Prozac in patients with diseases or conditions that could affect
metabolism or hemodynannic responses.
Ftuoxetine has Sll been evaluated or used to any appreciable extent in
patents with a recent history of myocardiof infarction or unstable heart disease. Patents withthesediagnoses were systematically exckidedfrom chnical
studies during the products premarket testing. However, the electrocarctograms of 312 patients who received Prozac in double-blind thalu were retrospectively evaluated; no conduction abnormalities that resulted in heart block
were observed. The mean heart rate was reduced by approxrinately three
beats/met.
In sebects with cirrhosis of the hve the cluarances of fluoxetne arid fls
active metabolite, norftuoxetine, were decreased, thus increasing the eliminalion hat-lives of these substances. A lower or iou frequent dose should be
used In patients with cirrhosis.
Since ftuoxetine is extensively metabolized, excretion of unchanged drug in
urine is a minor route of ebmetation. However, until adequate numbers of
patents with severe mel tinpeirment have been evaluated during chronic
treatmerewith ftuoxetine, d should be used with caution io such patients.
lt1erferpce Wh Coaatve l
Motor Perfprnce-Any
psychoactive
drug may impair fudgment. thinfong, or motor skills, and patients should be
cautioned about operating hazardous machinery, including automobiles, until
they are reasonably certain that the drag treatment does not affect them
adversely.
!nfoimatkit for Patients
Physicians are advised to discuss the following
issues with patientstorwhoni they prescribe Prozac:
Because Prozac may impan ient
thinltmg, or motor skills, patients
should be advised to avoid driving a car or operating hazardous macfunery untiltheyare reasonably cettainthattheir performance is nOtaffected.
Patients should be advised to nformthofr physician Stay aretaldng or plan
totalte any prescription or over-the-counter drugs oralcohol.
Patients shoofd be advised to notify their physician il they become pregnant
or intendto become pregnant during therapy.
Patients should be advised to notifytheir physician rithey are breastfeedlng
an infant.
Patients should be advised to notifytheir physician if they develop a rash or
hives.
Laboratory Tests -There are no specitic IabOratOrytestS recommended.
Drug Interactions -As with all drugs, the potential for interaction by a
varietyofmechanisms (ie, pharmacodynamic, pharmacokinetic drug inhibition
or enhancement etc( is a possdiilfty (see Accumulation and Slow Elimination
-
undei’ClInical
jpcesaaii-There
have been greater than twofold increases of
previouslystabte plasmatevelsofotherantidepressantswhen
Prozac has been
administered in combination with these agents (see Accumulation and Slow
Elimination underClinicat Pharmacology).
Qepiln&laaLs-The
hall-We of concurrently administered diazepam
may be prolonged in some patients (see Accumulation and Slow Ehmination
underClinical Pharmacology).
ecanseoxoonpilwad
tration of ftuoxetne to a patient taking another drug that is tightly bound to
protein (eg, Coumadin, digitotdn) may cause a shOt in plasma concentrations
potentially resulting in an adverse effect Conversely, adverse effects may
result from displacement of proteIn-bound fluoxetine by other tightly bound
drugs (see Accumulation and Slow EIiminationunrCknicat
Pharmacology).
#{231}NS-Actlve
Drpos-The nsk of using Prozac In combination with other
CNS-acilve dru#{231}s
has not been systematically evaluated. Consequently, canton is advised il the concomitant administration of Prozac and such drugs
is requiced (see Accumulation and Slow Elimmation under Clliuicat Pharmacology).
Electroconvulsive Ttaany-There
are no chrilcat studies establishing the
benefit of the combined use of ECT and fluoxetine. A single report of a
prolonged seizure in a patlentonftuoxetine has been reported.
Carcinogenesis, Mutagenesis. Impairment of Fortuity- There is no esidence of carcinogenicity, mutagenicty, orimpatrmentoffertikty
with Prozac.
The dietary administration of fluoxetine to rats and mice for two years at
tevelsalentto
approximately 7.5and9.Otimesthe maximum human dose
(80 mg) respectively produced nOevidence of carcinogenicity.
Ruoxetine and norftuoxetine have been shown to have no genotoxic effects
based on the following assays: bacterial mutation assay, DNA repair assay in
cultured rat hepatocytes, mouse tymplioma assay, and in vivo sisterchromatld
exchange assay in Chinese hamster bone marrow cells.
Twolertility studies conductedin ratsatdosesofapproeimatetyfiveandine
times the maximum human dose (80 tog) indicated that fluoxetne had no
adverseeffectsonfertkty.
Askghtdecreaseinneonatal survivalwasnoted, but
this was probably associated with depressed maternal food consumption and
maximum daily human dose (80 mg) respectively and have revealed no
esidence of harm to the fetus due to Prozac. There are, however, no adequate
and well-controlled studies in pregnant women. Because animat reproduction
sluclies are not always predictive of human response, lIds drug should be used
du0
PregnanCyOOtYdCluartYneeded.
on totoranii delnieryin humans is
unknowr
Nursing Mothers -ft is not known whether and, il so, in what amount this
drug or its metabolites are excreted in human milk. Because many drugs are
excreted in human mif#{231}
caution shoutd be exercised when Prozac is admimsteredtoanursingwornan.
Usage in Children- Safety and effectiveness in children have not been
established.
UsageintheEldertyProzac has not been systematically evaluated molder
patients: however, severof hundred elderly patents have participated in dllnicat
studies with Prozac, and no unusual adverse age-related phenomena have
been elentified. However, these data are insuffIcient to rule out possible
age-related differences during clwonic use, particularly in elderly patients who
have concomitant systemic illnesses orwho are receiving concommtantdrugs.
IM,onaimnofa -Severof cases of hyponatremia (some with serum sodium
lowerthan 1 10 mmot/L)have beenrepOrted.The hyponatremiaappearedto be
reversiblewhen Prozac was discontinued. Althoughthese cases were complex
with varying possible etiologies, some were possibly duetOthe syndrome of
inappropriate antidiuretic hormone secretion (StADH). The majority of these
occurrences have been in older patients and in patientstaking diuretics orwho
wereotherwise volume depleted.
Adverse Reactiess: Coinv-nonty Observed -The most commonly observed
adverse events associated wlththe useof Prozac and not seen atan equhialene
incidence among placebo-treated patients were: nervous system complaints.
including anxiety, nervousness, and insomnia; drowsiness and fatigue or
astheisa; tremor; sweating; gastrointestinal complaints. including anorexia.
nausea, and diarrhea; and dizziness orlightheadedness.
Associated With Discontinuation ofTreatment -Fifteen percent of approximately 4,000 patients who received Prozac in US premartietin9 clinical trials
discontinued treatment due to an adverse event. The more common events
causing discontinuation included: psychiatric (5.3%), prImarily nervousness.
anxiety, and insomnia; digestive (3.0%), primarily nausea; nervous system
(1 .6%), primarily dimness; body as a whole (1.5%),
primarIly asthensa and
headache; and shin (1 .4%), primarily rash and pruritus.
TAStE
1.TREATMB4T-EMERGENTAOVERSE
E30’tRtNcE
C Pt.AC080-CONTROILED
I3JNICALTRLALS
ian
Body
SynOnV
Osms
Headache
LkWeu
audey
Petzac
5-1,7301
20.3
Prozac#{149}
(fluoxetine hydrochloride, Dista)
PliceSo
IN-mel
1.9
15.5
0.5
7.1
6.3
5.5
2.4
3.3
1 1
1.3
1,7
2.0
14.9
13.u
11.6
9.4
7.9
5_7
4.2
16
16
Body
1.5
Prnz
a’vers.rve’r
N=i,73O
Anthem
Sitectluo,viral
Pain.Snb
Fuvw
Pali.chenl
Allergy
k*iinza
4.4
3.4
1.6
1.4
1.3
12
1.2
‘
-
Au-0
syndrona
2ngles
-
ranon
Koadacte.
OiiUS
Dinrihea
Muue
21 1
12.3
0
Hemere
Tascharw
GaiSciudedSo
MaciSo
0-799)
1.9
3.1
1.1
-
1.1
11
15
llppw
ConceiSiSo
10.1
70
Slnosaums
Couofi
Prwnu
0
6
2.8
2.7
19
1.3
2.6
2.3
2.1
16
14
18
2u
I 6
9.5
8.7
64
4.5
6.0
15
Hntthusheu
3.3
Paliutatlons
kJh1-U
18
13
34
2.4
18
1.6
1.0
2.9
13
Padi.back
P5i1.
Pad.nancle
2.0
1.2
1.2
1_i
10
1.9
14
84
27
24
3.8
1.8
1.4
4.3
-
1.1
14
10
14
4
tisul
Mnnslruallun.
-
Swual
19
nausulion
Lkinwyvact
uweduon
Vofon
iSnftuteice
Evmer-debyaBost
-
bocytopenia.
Ovsrdesae: Human EApefience -As of December 1987, there were two
deaths among approximately 38 reports of acute overdose with fluoxetine,
either alone or in combination with other drugs and/or alcohol. One death
OIVOIVOd a combined overdose with approximately 1,800 req of ftuoxetine and
an undetermined amount of maprotfine. Plasma concentrations of fluoxetine
and maprotiline were 4.57 mg/I and 4.18 mg,Q respectively. A second death
involved three drugs yielding plasma concentrations as follows: ftuoxetine,
1.93 maJL; norfluoxetjne, 1.10 ng/L; codeine, 1.80 mg/i,; temazepam, 3.80
m
other patient who reportedly took 3.000 mg of ftuoxetine experienced
tWo grand mat seizures that remitted spontaneously without specifIc anticonvutsant treatment (see Management of Overdose). The actual amount of drug
absorbed may have beer, less duetovomiting.
Nausea and vomiting were prominent in overdoses involving higher fluoxetine doses. Other prominent symptoms of overdose included agitation, restlessness, hypomania, and other signs of CNS excitation. Except for the two
deaths noted above, allotheroverdose cases recovered without residua.
-
PV24720PP
11117991
-
Additiona!infornsationavallabietotheprofess,on
16
1.2
MN
Pharmacology(.
Jjypflai-Ftve
patients receiving Prozac in combination with tryptophan
experienced adverse reactions, including agitation, restlessness, and gastroritestinal distress.
Monoamine Osidase trVtibitors-See Warnings.
unset
14C1OENCE
Incidence in Controlled Clinical Trials -Table 1 enumerates adverse events
thatoccurred atafrequency of 1% or moreanong Prozac-treated patmentswho
participated in controlledtrlals comparing Prozac with placebo. The prescriber
should be aware that these figures cannot be used to predict the incidence of
side effects in the course of usual medical practice where patent charactorls.
tics and other factors differ from those that prevailed in the clinical trials.
Similarty.the citedfrequencies cannot becompared withflgures obtainedfrom
othercknical investigations invohang differenttreatments, uses, and mnvestigatots. The cited figures, however, do provide the prescribing physician with
some basis forestimating the relative contribution ofdrug and nondrug factors
tothe side-effectincidence rate iota pogulation studied.
Other Events Observed During the Preinai*eting Evaiua.tioei of Prozac
During clmnicaltesting in the US, multiple doses of Prozac were administereiltO
approximately 5.600 subcts. Untoward events associated with thisexposure
were recorded by clinical investigators using descriptive terminOlOgy of their
ownchooslng. Consequently, itisnotpossibletoprov$dea
meanlngfulestimate
of the proportion of individuals experiencing adverse events without first
grouping simllartypesofuntowardeventsintoahmited
(ii, reduced) numberof
standardized eventcategories.
Inthetabulatlons which follow, a standard COSTARTDictionary terminology
has been usedto classify reported adverseevents. ThefrequenCieS presented.
therefore, representthe proportion ofthe 5.600 individuals exposed to Prozac
who experienced an event of the type cited on at least one occasion while
receiving Prozac. Af reported events are inckidedexceptthose afready listed in
tables, those COSTART terms so general as to be uninformative, and those
events where a drug cause was remote. It is important to emphasize that,
althoughthe events reported did occurduringtreatmentwith
Prozac, they were
not necessarily caused by it
Events arefurtherclassifled within body system categories and enumerated
in order of decreasing frequency using the following definitions: frequent
adverse events are defined as those occurring on one or mona occasions in at
least 1/lOOpatients; infrequentadverse events arethose occurring in 1/bOb
1/1,000 patients; rare events arethose occurring in lessthan 1/1,000 patients.
Qth’ as a Whol-Frequent:
ctdbs; Infrequent chills and fever. cyst, face
edema. hangover effect
pain, malaise, neck pain, neck rigldfty, andpehac
pain; Rare: abdomen enlarged, celkifits, hydrocephafus, hypothermia, 11
syndrome, monhliasis, and serum sickness.
Cvas#{231}til Sv-Mfre
angina pectoris, arrhyThmia, homer.
rhage, hypertenmon, hypotension, migraine. postural hypotension, syncope,
and tachycardia; Rare: AV block (first-degree), bradycardl bundle-branch
block, cerebral ischemia, myocardial infarct, thrombophlebitis, vascular
headache, and ventriculararrhythmia.
flyyg-Frequent
increased appetite: Infrequent: aphihous
stomatitis, dysphaa, eructation. esophagitis, gastrltis, gingivitis, glossitis,
liver function tests abnormal, melons, stornathtis, and thirst Rare: bloody
diarrhea. cholecystitls, chofelitlilasis, colitis, duodenal ulcer, intents, focal
incontinence, hematemesis, hepatitis, hepatomegaly, hyperchlorhydrla,
acreased salivation, ice,
liver tenderness, mouth ulceration, salivary
gland enlargement stomach utoer, tongue discoloration, andtongue edema.
5,fl5$,yste-!nfrequent:
hypothyroidism; Rare: goiter and hyperthyroidism.
jJfpjfJfJ,,ymtgbuSystecr-!nfroquent:
anemia and lymphadenopathy;
Rare: bleedIng time increased, blood dyscrasia. leukopenia, lymphocytosis,
petechia, purpura. sedimentation rate increased, sod thrombocythemia.
Metailotic Spd Nuytbon-Froquent:
weight kiss; Infrequent: generalized
edema. hypoglycemia, penpheral edema, and weight gain; Rare: dehydration,
Qout hypercholesterenila, hyperglycemia, hyperlipenila, hypoglycemic riscton, hypokabemla, hyponatremla, and Iron deficiency anemia.
Muscutpskeletal v.pj,ffl-Infrequent:
arthritis, bone pain, bursitis,
tenosynovitis, and twitching; flare: bone neCrOSIS, chondrodystrophy, muscle
hemorrhage. myositis. osteoporosis, pathological fracture, and rheumatoid
arthritis.
,jystetn-Frequent:
abnormal dreams and agitation; Infrequent:
abnormal gat, acute brain syndrome, aitattilsia. amnesia. apathy, stains, butcoglossal syndrome, CNS stimulation, convulsion, delusions, depersonalizalion, emotional lability, euphoria, hallucinations, hostility, hyperkinesia,
hypesthesia, incoordmnation, libido increased, manic reaction, neuralgia, netsropathy, paranoid reaction, psychosis, and vertigo; Rare: abnormal electronscephalogram, antisocial reaction, chronic brain syndrome, circumoral
paresthesia, OilS depression, coma, dysarthria, dystorila, extrapyramidal syndrome, hypertorila, hysteria, myodonus, nystagmus, paralysis, reflexes
decreased, stupor. andtorhcollis.
jj,pira.torJystsn-Frequent:
bronchitis, rhmnitis, and yawn; Infrequent:
asthma, epistasss, hiccup, hyperventilation, and pneumonia; Rare: apses,
hemoptysis, hypoxia, larynx edema, lung edema, lung fibrosis/alveolitis, and
pleural effusion.
g.,ppeodaos-Infrequent:
acne, alopecia, contact dermatitis, dry
skin, herpes simplex maculopapular rash, and urticaria; Rare: eczema, erythema multiforme, fungal dermatitis, herpes zoster, hirsutism, psoriasis, perpuric rash, pustular rash, sebontiea, skin discoloration, skin hypertrophy,
subcutaneous nodule, and vesicubobubous rash.
,peciaISens-Infrequent:
amblyopia, conjunctivitis, ear pain, eye pain,
mydnasis, photophobia, and tinnitus; Rare: blepharitis, cataract, corneal
lesion, deafness, diplopia, eye hemorrhage, glaucoma, ribs, ptosis, strabismus, and taste kiss.
Qjjy-Infrequent:
abnormal e(aculation, amenorrhea. breast
pain, cystltis, dysuna, fibrocystic breast. impotence, leukorrhea, menopause,
menorrhagia. ovarian disordet urinary incontinence, urinary retention, urinary
urgency, urination impaired, and vaginitis; Rare: abortion, albuminuria, breast
enlargement, dyspareunia, epididymitis, female lactation, hematuria, hypeminorities, kidney calculus, metrorrhatma, orchitis, polyurla, pyelonephrlds,
pytiria, salpingitis, urethral pain, urethritis, urinary tract disorder, urolithiasis,
uterinehemorrtiage, uterine spasm, and vagesal hemorrhage.
Mastintmductkjn Reports -Voluntary reports of adverse events temporally
associated with Prozac that have been received since market introduction and
which may have no causal relationship with the drug include the following:
vagInal bleeding after drug withdrawal, hyperprolactinemia, and throm-
2.8
1%olMazac4e*dpadei99weiictidsd.
‘
-Sindencahenflial
1%.
Prozac#{176}(fiuoxetine
hydrochloride, Dista)
onrequesl
from
1.0
Dleta Products
Company
Division
of Eli Ully and Company
Indiana 46285
______________Indianapolis,
Prozac#{149}(fluoxetine
hydrochloride, Dista)
BOYER
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1990
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will be allowed
to enjoy
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December
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HOLLADAY
PARK MEDICAL CENTER
1225 N.E. 2nd Ave., Portland, OR 97232
(by
EXECUTIVE DIRECI’OR
ADULT
PRIVATE
ROBBIE
PSYCHIATRIST
CENTRAL
PRACTICE
CONNECTICUT
KINGSTON,
MEDICAL
MSW
DIRECIOR
ROBERTJONES,J.D.,
CLINICAL
MD,
DIRECI’OR
NILES MEDDERS
CLINICAL
Does
general
consider
the challenge
of a private
adult
psychiatry
appeal
fee-for-.ervice
to you?
practice
If so, then
plea.e
JAINIE BLJENAVEN1TRA, M.D.. ROCKVILLE, MARYlAND
FERNANDO CESARMAN, M.D., MEXICO CITY, MEXICO
RENA11’A (ADDINI DE BENEDE1TI, M.D., ROME, ITALY
HEITOR F.B. DE PAOLA, M.D., RiO DEJANEIRO, BRAZIL
DIETER EICKE, M.D., KASSEL, GERMANY
RLID()LPII EKSTEIN, PH.D., LOS ANGELES, CALIFORNIA
ABRAM EKSTERMAN, M.D., RIO DEJANEIRO, BRAZ1L
PETER L. GIO4CCHINI,
M.D., CHICAGO, ILLINOIS
the following
Our client,
a progressive
240 bed
community
hospital
located
in a highly
desirable
suburb
outside
Hartford,
Connecticutia
actively seekingaBoard
Certified/Board
Prepared
Psychiatrist
to join an independent,
private fee-for-service
practice.
Additional
highlights
include:
..
Establlihed
26 bed inpatient
unit;
strong
interdiaciplinary
team
. Modern,
fully
staffed
outpatient
counseling
center
with (35) clinical
and support
staff
. Full
of psychiatric
spectrum
. Ca_il sharing
and
coll
CONSULTANTS
L BRYCE BOYER, M.D., BERKELEY, CAUFORNIA
in
LEON GRINBERG. M.D., MADRID, SPAIN
JAMES GRO1’STEIN, M.D., LOS ANGELES, CALIFORNIA
JOHN G. GUNDERSON, M.D., BOSTON, MASSACHUSETFS
S’EIN HAL)GSGJERD, M.D., OSLO, NOR’AAY
BARRY K. IIERMAN, M.D., AUSTIN, TEXAS
JANE HEWITt’, D.M.H., BERKELE
CALIFORNIA
ALLEN KANNER, PH.D., PALO ALTO, CALIFORNIA
diagnoses
support
Preferred
candidates
should
have interest
in a communitybased
practice
and
demonstrate
versatile
skill.
in general
adult
psychiatry.
Attractive
income
potential
for qualified
ThEODORE
LIDZ, M.D., NEW HAVEN, CONNECI1CLrF
ThOMAS OGDEN, M.D., SAN FRANCISCO, CALIFORNIA
RAYMOND G. POGGI, M.D., BERKELEY, CALIFORNIA
CANS REAGAN, M.D., WASHINGTON, D.C.
DAVID ROSENFELD, M.D., BUENOS AIRES, ARGENTINA
candidates.
For further
detaila and immediate
consideration,
please
call: Cheryl
Freedman
at (215) 363-5600;
or remit
credentiala
to John Downing
Associates,
Inc.,
P.O. Box 452, Lionville,
PA 19353, FAX (215) 363-5658.
JOSE SCHECHTMANN, M.D., BUENOS AIRES, ARGENTINA
HANS STEINER, M.D., PALO ALTO, CALIFORNIA
ENDRE UGELSTAD, M.D.. OSLO. NORWAY
\AMIK I). VOLKAN, M.D., CHARLO’Il’ESVILLE, VIRGINIA
DAVID ZIMMERMAN, M.D., PORTO ALEGRE, BRAZIL
John
Thming
Ph
Lionvilk
Ceasmoas,
In
Aiates,
BOYER MARIN
Seaivh
170
P.O.
Bo,
452.
tissiviete,
PA 19353
San GeronimoValley
LODGE
Road, Woodacre,
(1-415-488-4340)
CA 94973
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“IT FEELS GOOD
FEEL USEFUL
AGAIN”
TO
For
the
chronic
schizophrenic
patient,
work performance
smoother
social
help
path
improve
a better
towards
the
attitude
ability
toward
recovery.
can
and a
Navane
may
Navane
mean more competent
to concentrate
and promote
work
and co-workers.’3
27%
output compared
to baseline
switched
to Navane2”
rIse In work
shown In patients
20
IMPROVEMENT
4IXENEGRP
DETERIORATION
Anticholinergic4
and
cardiovascular5’6
patients
treated
with
infrequently.
Should
occur,
they
usually
side
effects
in
0
be controlled.
(Adapted
@1989,
Pfizer Inc.
3
4
OF STUDY
from DiMascio
and Demirgian3)
Forty-two psychotic mate and female patients under age 55 were
entered in this study on a nonblind basis, and randomly assigned to
their regular medication or switched to thiothixene.
Patients were
evaluated at baseline and on a daily basis, and periodically
rated on
the Global Improvement
and Brief Psychiatric
Rating Scales.
In schizophrenia,
Please see brief summary
of
NAVANE
(thiothixene/thiothixene
prescribing information on
adjacent page.
2
MONTHS
Navane
are reported
extrapyramidal
symptoms
can
GURUETIONGMOUP
1
HCI)
liothixene
HC)
CaPsu/
1mg
20mg
(thiothixene)
(thiothixene
HCI)
Itfrels
useful
good
again
to feel
References: 1 Bressler B. Friedel RO: A comparison between chiorpromazine and thiothixene in a Veterans
Administration hospital population. Psychosomafics 1971 12:275-277 2. OiMascio A, Demirgian E: Study
of the activating operhes
of thiethixene. Psychosomatics 1972:13:105-108. 3. DiMaSCIO A, Demirgian E:
Joti training in the rehabilitation of the chronic schizophrenic. Presented as a Scientific Exhibit at The Amercan Psychiatric Association. Washington, DC, May 3-6, 1971. 4. Goldstein B, Weiner D, Banas F: Clinical
evaluation of thiothixene in chronic ambulatory schizophrenic patients. in Lehmann HE, Ban TA (ads): The
Thioxanthenes:
Morn
Problems ofPharmacq,sych,atry
Basal. Switzerland, S. Karger, 1969, vol 2, pp
45-52. 5 Ditenkoffer RI, Gallant DM, George RB, et at: Electrocardiographic
evaluation of schizophrenic
patients: A double-blind comparison. Presented as a Scientific Exhibit at The 125th Annual Meeting of the
American Psychiatric Association, Dallas, May 1-4, 1972. 6. Data available on request from Roerig.
BRIEF SUMMARY OF PRESCRIBING INFORMATiON
Navau.
(lMxeee)
Capsades: 1 tag. 2 tag, 5 tag, 10 mg, 20mg
(thlethlzeoe bydrochride)
Couiceatrate: 5 mg/mI, kd,amvscvlar
2 mg/mI, 5 mg/mI
Indlcitlees:
Navane is effective in the management of manifestations of psychotic disorders. Navane has
not been evaluated in the management of behaveral complications in patients with mental retardation.
Contraladlcatlons:
Contraindicated in patients with circulatory collapse, comatose states, central nervous
system depression dueto any cause, and blood dyscrasias. Contraindicated in individuals who have shown
hypersensitivityto
the drug. It is not known whetherthere is a cross-sensitivity
between the thioxanthenes
and the phenothiazine derivatives, butthe possibility should be considered.
Warnings: Tardive Oyskinessa.-Tardive
dyskinesia, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with neuroleptic (antipsychotic)
drugs.
Although the prevalence of the syndrome appears to be highestamongtheelderly,
especiailyeldertywomen,
itis impossibieto rely upon prevalenceestimatesto
predict, atthe inception ofneuroleptictreatment,
which
patients are likely to develop the syndrome. Whether neuroleptic drug products ditier in their potential to
cause tardive dyskinesia is unknown.
Both the risk of developing the syndrome and the likelihood that it will become irreversible are believed
to increase as the duration oftreatment and the total cumulative dose of neuroleptic drugs administered to
the patent increase. However, the syndrome can develop, although much isss commonly, after relatively
brieftreatment penods at low doses.
There is no known treatment for established ses of tardive dyskinesia, although the syndrome may
remit, partially or compistely, if neuroleptictreatment
is withdrawn. Neuroieptictreatment,
itself, however,
may suppress (or partially suppress) the signs and symptoms of the syndrome and thereby may possibly
mask the underlying disease process. The effect that symptomatic suppression has upon the long-term
course of the syndrome is unknown.
Given these considerations, neuroleptics should be prescribed in a mannerthat is most likely to minimize
the occurrence of tardive dyskinesia. Chronic neuroleptic treatment should generally be reserved for paDents who sufferfrom a chronic illness that, 1) is known to respond to rieuroleptic drugs, and, 2) for whom
alternative, equally effective, butpotentialty less harmfultreatments
are notavailable or appropriate. In patients who do require chronictreatment, the smallestdose and the shortestduration oftreatment producing
a satisfactory clinical response should be sought. The need for continued treatment should be reassessed
periodically.
It signs and symptoms of tardive dyskinesia appear in a patient on neuroleptics, drug discontinuation
should be considered. However, some patients may require treatment despite the presence of the
syndrome.
(For further information about the description of tardive dyskinesia and its clinical detection, please refer
to Information for Patients in the Precautions section, and to the Adverse Reactions section.)
Netiro.’eptic Malignant Syndrome (NMS)-A
potentially fatal symptom complex sometimes referred to
as Neuroleptic Malignant Syndrome (NMS) has been reported in association with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythimas)
The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is
importantto identity cases where the clinical presentation includes both serious medical illness(e.g. , pneumonia, systemic infection, etc.) and untreated or inadequatelytreated extrapyramidal signs arid symptoms
(EPS) Other important considerations in the differential diagnosis include central anticholinergic toxicity,
heat stroke, drug fever and primary central nervous system (CP4S) pathology.
The management of NMS should include 1 immediate discontinuation of antipsychotic drugs and other
drugs notessentialto concurrenttherapy, 2) intensive symptomatictreatmentand
medical monitouing, and
3) treatment of any concomitant
serious medical problemsforwhich
specific treatmentsareavailable.
There
is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS.
It a patient requires antipsychotic drug treatment after recovery from NMS. the potential reintroduction
of drug therapy should be carefully considered. The patient thoid be carefully monitored, since recurrences of NMS have been reported.
Usage in Phegnancy-Safe
use of Navane during pregnancy has not been established. Therefore, this
drug should be given to pregnant patients onlywhen, in thejudgment of the physician, the expected benefits
from the treatment exceed the possible risks to mother and fetus. Animal reproduction studies and clinical
experience to date have not demonstrated any teratogenic effects.
In the animal reproduction studies with Navane, there was some decrease in conception rate and litter
size, and an increase in resorption rate in rats and rabbits, changes which have been similarly reported with
other psychotropic agents. After repeated oral administration of Navane to rats (5 to 15 mg/kg/day), rabbits
(3 to 50 mg/kg/day),
and monkeys (1 to 3 mg/kg/day) before and during gestation, no teratogenic effects
were seen. (See Precautions.)
Usage in Chi!dren-The
use of Navane in children under 12 years of age is not recommended because
safety and efficacy in the pediatnc age group have not been established.
As is true with many CNS drugs, Navane may impair the mental and/or physical abilities required br the
performance of potentially hazardous tasks such as driving a car or operating machinery, especially during
the first few days of therapy. Therefore, the patient should be cautioned accordingly.
As in the case ofother CNS-acting drugs, patients receiving Navane should be cautioned aboutthe p05sible additive effects (which may include hypotension) with CNS depressants and with alcohol.
Precavtlons: An antiemetic effect was observed in animal studies with Navane; since this effect may also
occur in man, it is possible that Navane may mask signs of overdosage of toxic drugs and may obscure
conditions such as intestinal obstruction and brain tumor.
In consideration of the known capability of Navane and certain other psychotropic drugs to precipitate
convulsions, extreme caution should be used in patients with a history of convulsie disorders or those in
a state of alcohol withdrawal since it may lower the convulsive threshold. Although Navane potentiates the
actions of the barbiturates,
the dosage of the anticonvulsant
therapy should not be reduced when Navane
is administered concurrently.
CautKin as weilas careful adtustmentofthe dosage is indicated when Navane is used in conjunction with
other CNS depressants other than anticonvulsant drugs.
Though exhibiting rather weak anticholinergic properties, Navane should be used with caution in patients
who are known or suspected to have glaucoma, or who might be exposed to extreme heat, or who are
receiving atropine or related drugs.
Use with caution in patients with cardiovascular disease.
Also, careful observation should be made for pigmentary retinopathy, and lenticular pigmentation (fine
lenticular pigmentation has been noted in a small number of patients treated with Navane for prolonged
)
Concentrate
5 mg/mI
penods). Blood dyscrasias (agranulocytosis,
pancytopema, thrombocytopenic
purpura), and liver damage
(jaundice, biliary stasis) have been reported with related druQs.
Undue exposure to sunlight should be avoided. Photosensitive reactions have been reported in patients
on Navane (thiothixene).
lntramuscularAdministratjon-As
with all intramuscular preparations, Navane Intramuscular should be
injected well within the body of a relatively large muscle. The preferred sites are the upper outer quadrant
of the buttock (i.e. gluteus maximus) and the mid-lateral thigh.
The deltoid area should be used only if well developed, such as in certain adults and older children, and
then only with caution to avold radial nerve inlury. Intramuscular inctions
should not be made into the
lower and mid-thirds of the upper arm. As with all intramuscular infections, aspiration is necessary to help
avoid inadvertent injection into a blood vessel.
Neuroleptic drugs elevate prolactin levels: the elevation persists during chronic administration. Tissue
culture experiments indicate that approximately one third of human breast cancers are prolactin-dependent
in vitro, a factor of potential importance it the prescription ofthese drugs is contemplated in a patient with
a previously detected breast cancer. Although disturbances such as galactorrhea, amenorrhea, gynecomastia, and impotence have been reported, the dinical significance of elevated serum prolactin levels is
unknown for most patients. An increase in mammary neoplasms has been found in rodents after chronic
administration of neuroleptic drugs. Neither dinical studies nor epalemiologic studies conducted to date,
howeve have shown an associahon between chronic administration ofthese drugs and mammary tumorgenesis; the available evidence is considered too limited to be conclusive at this tune.
Information forPatients-Given
the likelihoodthatsome patients exposed chronicallyto neurolepticswill
develop tardive dyskinesia, it is advised that all patients in whom chronic use is contemplated be given, it
possible, full information about this risk. The decision to inform patients and/or their guardians must obviously take into account the dinical drcumstances and the competency of the patient to understand the
information provided.
Adverse Reactlona: Note: Not all of the following adverse reactions have been reported with Navane
(thiothixene). However, since Navane has certain chemical and pharmacoloqic similarities to the phenothiazines, all of the known side effects and toxicity associated with phenothiazine therapy should be borne in
mind when Navane is used.
Cardiovascular effects: Tachycardia, hypotension, lightheadedness, and syncope. In the event hypotension occurs, epinephrine should notbe used asa pressoragentsince a paradoxicalfurther lowering of blood
pressure may result. Nonspecific EKG changes have been observed in some patients receiving Navane
(thiothixene). These changes are usually reversible and frequently disappear on continued Navane therapy.
The incidence of these changes is lower than that observed with some phenothiazines. The clinical significance ofthese changes is not known.
CNS effects: Drowsiness, usually mild, may occur although it usually subsides with continuation of
Navane therapy. The incidence of sedation appears similar to that ofthe piperazinegroup of phenothiazines,
butlessthan that otcertain aliphatic phenothiazines. Restlessness, agitation and insomnia have been noted
with Navane. Seizures and paradoxical exacerbation of psychotic symptoms have occurred with Navane
infrequently.
Hyperreftexia has been reported in infants delivered from mothers having received structurally related
drugs.
In addition, phenothiazine derivatives have been associated with cerebral edema and cerebrospinal fluid
abnormalities.
Extrapyramidal symptoms, such as pseudo-parkinsonism, akathisia, and dystonia have been reported
Management of these extrapyramidal symptoms depends upon the type and severity. Rapid relief of acute
symptoms may requirethe use of an injectable antiparkinson agent. More slowly emerging symptoms may
be managed by reducing the dosage of Navane and/or administenng an oral antiparkinson agent
Persistent Tardive Dyskinesia: As with all antipsychotic agents tardive dyskinesia may appear in some
patents on long-term therapy or may occur after drug therapy has been discontinued. The syndrome is
characterized by rhythmical involuntary movements ofthe tongue, face, mouth
aw (e.g. , protrusion of
tongue, puffing of cheeks, puckering of mouth, chewing movements). Sometimes these may be accompanied by involuntary movements of extremities.
Since early detection of tardive dyskinesia is important, patients should be monitored on an ongoing hasis. It has been reported thatfine vermicular movementofthetorigue
may bean early sign ofthe syndrome
If this any other presentation of the syndrome is observed, the clinician should consider possible discoi-tinuation of neuroleptic medication. (See Warnin9s section.)
Hepatic Effects: Elevations of serum transaminase and alkaline phosphatase, usually transient, ha
been infrequently observed in some patients No clinically confirmed cases of laundice attributable to
Navane have been reported.
Hematologic Effects: As is true with certain other psychotropic drugs, leukopenia and eukocytosis,
which are usually transient, can occur occasionally with Navane. Other antipsychotic drugs have been associated with agranulocytosis,
eosinophilia, hemolytic anemia, thrombocytopenia and pancytopenia.
Ailergic Reactions: Rash, prurifus, urticana, photosensitivity and rare cases of anaphylaxis have been
reported with Navane. Undue exposure to sunliqht should be avoided. Although not experienced with
Navane, exfoliative dermatitis and contact dermatitis (in nursing personnel) have been reported with certain
phenothiazines.
Endocrine Disorders: Lactation, moderate breast enlargementand
amenorrhea have occurred in a small
percentage of females receiving Navane. If persistent, this may necessitate a reduction in dosage or the
discontinuation of therapy. Phenothiazines have been associated with false positive pregnancy tests, gynecomastia, hypoglycemia, hyperglycemia, and gfycosuna.
Autonomic Effects: Dry mouth, blurred vision, nasal congestion, constipation, increased sweating, increased salivation, and impotence have occurred infrequently with Navane therapy. Phenothiazines have
been associated with miosis, mydriasis, and adynamic dens
Other Adverse Reactions: Hyperpyrexia, anorexia, nausea, vomiting, diarrhea, increase in appetite and
weight, weakness or fatigue, pofydipsia and peripheral edema.
Although not reported with Navane, evidence indicates there is a relationship between phenothiazine
therapy and the occurrence of a systemic lupus erythematosus-like syndrome.
Neuroleptic Malignant Syndrome (NMS): Please refer to the text regarding NMS in the WARNINGS
section.
NOTE: Sudden deaths have occasionally been reported in patients who have received certain phenothiazine derivatives. In some cases the cause of death was apparently cardiac arrest or asphyxia due to failure
ofthe cough reflex. In others, the cause could not be determined nor cotud it be established that death was
due to phenothiazine administration.
Dosage: Dosage of Navane should be individually adjusted depending on the chronicity and severity of the
condition. See full prescribing information.
Overdesage: For information on signs and symptoms, and treatment of overdosage, see full prescribing
information.
RORIG
A division of Pfizer Pharmaceuticals
New York, New York 10017
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Box 7205, Oakville,
Ontario,
Canada
L6J 6L5, 416-257-0184.
1989
Vol.
Health
Athens.
CMHR,
Contact
58 Notara
Athens
106
Greece;
83,
L.
and
VanStreet,
telephone,
82-38-332.
November
29-December
sign,
on
health
Marriott’s
2, 2nd sym-
care
interior
de-
Orlando
World
Cen-
ter, Orlando,
Florida.
Contact
National
Symposium
on Health
Care
Interior
Design,
4550
Alhambra
Way,
Marti-
94533,
4 15-370-0345.
December
December
226.
November
12-15, workshop
on improving
the interactions
of the juslice and mental health systems, spon-
November
Mental
Research,
dorou,
Avenue,
Connecticut
203-852-0500,
Medical
CenDar Es Salaam,
November
16-17,
seminar
on personnel management
for rehabilitation facilities,
sponsored
by the Na-
nez, California
10-12,
mental
Dr.
of
Tanzania.
November
and
con-
psychia-
Tanzania.
Contact
Head, Department
Muhimbili
Box 65293,
posium
atric
international
rehabilitation
G. P. Kilonzo,
New
York
City. Contact
NYU
Medical
Center,
Postgraduate
Medical
School,
5 50 First Avenue,
New York,
New
York 10016, 212-340-5295.
06856,
November
2-5, 23rd annual
conference, Association
for Advancement
of Behavior
Therapy,
Washington,
D.C. Contact
Program
Chair, AABT,
15 West 36th Street, New York, New
York 10018, 212-279-7970.
Neuropsychiatry
ence,
40
No.
11
1 1-15, international
conference
on general
hospital
psychiatry,
Cerromar
Beach,
Puerto
Rico.
Contact E. Perez, M.D., do Joan Bradden, Department
of Psychiatry,
Ottawa
Civic Hospital,
1053 Carling Ayenue,
4E9,
Ottawa,
Ontario,
613-725-4787.
Canada
K1Y
December
18-19,
annual
conference,
Society
for Psychosomatic
Research,
Royal College
of Physicians,
London.
Contact
Dr. Michael
Murphy,
Department of Psychological
Medicine,
Kings
College
Hospital,
Denmark
Hill, London SE5 9RS, England,
01-326-3014.
(continued
Hospital
and
Community
on page
1137)
Psychiatry
)
T7T7?i
/1
NEW
kT
r_Id
:)\4
(BURRORON
HOD
helps clear
depression
with
few life-style
disruptions.
See brief summary
of full prescribing
on last pages of this advertisement.
information
Chemically
unique WELLBUTRIN
tricyclics/tetracyclics,
monoamine
or other known antidepressants.
is unrelated
to
oxidase inhibitors,
WELLBUTRIN
relieves
depression
as effectively
as amitriptyline.
Clinical
Global
lmprovement*
1
very
much
2
much
3
minimally
improved
\
improved
-
improved
U)
0)
C
‘-<_
Wellbutrin
(n=62)t
‘I-.
Amitriptyhne
($g)t
minimally
5
Drug
I
*
0
Adapted
tDosages
75
worse
Day
I
I
I
8
15
22
from Mendels
were
I
300 to 450
to 1 50 mg/day
I
29
et al.1
mg/day
43
64
92
for WELLBUTRIN,
for amitriptyline.
Please
review IMPORTANT
CONSIDERATIONS
BEFORE
PRESCRIBING
WELLBUTRIN
on page 6 and brief summary on the
last pages of this advertisement
before prescribing
WELLBUTRIN.
(
WELLBUTRIN
relieves depression
with no clinically
significant
effect
on cardiac conduction.
Average Change in EKG Parameters
from Baseline Values During Treatmentt
j!,
a)
C
0
U
Wellbutrin
(n=23)
C
0
*
0
1.0
Placebo
baseline
Adapted
Amitriptyline
(n=23)
from
“By contrast,
Wenger
2.0
3.0
4.0
Milliseconds
et al.2
the present results with bupropion
support the
in vitro data demonstrating
that this antidepressant
lacks
these undesirable
electro-physiologic
properties,
and imply
that bupropion
has a substantially
wider margin of safety in
man than amitriptyline
with regard to cardiac conduction.”2
j
/1
WELLBUTRIN
relieves
depression
with no
clinically
significant
orthostatic
hypotension.
Orthostatic
Blood
Pressure
Wellbutrin
Change
Placebo
0
LJJ
Hg)t
I,
Tricyclics
I
133W
U
(mm
+1
1
-6.5
-10
-
01
E
-
i1)
>
0-c,)
2C-30
-32.4
-40
*
Adapted
from
Farid
et al.3
butri n#{174}
(BURRORON
Helps
clear
depression
with
HOD
few
life-style
disruptions.
See brief summary
of full prescribing
on last pages of this advertisement.
information
WELLBUTRIN
relieves
depression
with few
anticholinergic
side effects.
Percent
Relative
Difference
in Anticholinergic
to Placebot
Effects
Wellbutrin
27.6
26.0
(n=323)
#{149}
U)
C
a)
18.4
0
17.3
0
14.6
C
a)
0
10.3
a)
1.9
Dry
Constipation
Blurred
vision
mouth
*
Data
on file, Burroughs
Weilcome
2.2
Urinary
retention
Co.’
sq
WELLBUTRIN
relieves
depression
with little or
no weight gain.
Change
-
in Body Weight
(percent
of patients;
n=341)t
-
62.8%
60
50
-
40
-
-
No weight
-
V
-
..
change
4
C
27.8%
a)
ea 30
-
0
Lost
20
6 lb
-
9-4%
-
10
Gained
6 lb
L’.’
\4
-
90.6% gained
*
Data
on file, Burroughs
\
no weight
Wellcome
4.
Co.’
I
Fr]
.---‘
*L/J
(I
/
WELLBUTRIN
relieves
depression
with little or
no daytime
drowsiness.
Percent of Patients
Treatment-Related
50
Reporting
Drowsinesst
-
U)
C
a)
(13
0
0
C
20
15.3%
a)
a-
0
*
Data
Wellbutrin
Amitriptyline
(n=98)
(n=49)
on file, Burroughs
Wellcome
.,
I
Co.4
In placebo-controlled
clinical trials, the incidence of drowsinesst
treated with WELLBUTRIN
was 1 9.8%, versus 1 9.5% for those
for patients
receiving placebo.
Agitation and Insomnia:
A substantial
proportion
of patients treated with
WELLBUTRIN
experience
some degree of increased
restlessness,
agitation,
anxiety, and insomnia, especially shortly after initiation of treatment.
In
clinical studies, these symptoms
were sometimes
of sufficient magnitude
to require treatment
with sedative/hypnotic
drugs. In approximately
2% of
patients, symptoms
were sufficiently
severe to require discontinuation
of
WELLBUTRIN
treatment.
‘As with all drugs in this category,
perform tasks requiring judgment
patients
should
be cautioned
that the ability
NEW
l-i’
(RURRORON
Helps
clear
to
or motor and cognitive skills may be impaired.
depression
with
few
F
;i-1#{128}
HOD
life-style
disruptions.
See brief summary
on last pages
of full prescribing
of this advertisement.
information
/‘
Wellbutrin#{174}
helps clear depression
Important
prescribing
considerations
Weilbutrin.
before
Treatment
Day
Patient
Selection
Criteria
WELLBUTRIN
is contraindicated
in patients
. with a seizure
disorder
. with a current
or prior diagnosis of bulimia or
anorexia nervosa
. on monoamine
oxidase (MAO) inhibitor therapy
. who are allergic
to it
(See CONTRAINDICATIONS
section of full prescribing
information.)
WELLBUTRIN
should be administered
with extreme
caution to patients
. with a history
of seizure, cranial trauma,
or other factors that predispose
toward seizure
. taking
other agents or other treatment
regimens
that
may lower seizure threshold
(See WARNINGS
section of full prescribing
information.)
Overdosage
In 1 3 cases of overdose
involving WELLBUTRIN,
were no deaths or lasting sequelae.
with few life-style
disruptions.
Dosing Regimen
1-3
4
Total
T Tablet
Daily Dose Strength
200
mg
300mg
100
mg
100mg
Number of Tablets
Morning Midday
Evening
1
1
0
1
1
1
An increase in dosage,
up to a maximum
of 450 mg/
day, given in divided doses of not more than 1 50 mg
each, may be considered
for patients in whom no
clinical improvement
is noted after several weeks of
treatment
at 300 mg/day.
Increases
in dose should not
exceed 1 00 mg/day in a three-day
period. WELLBUTRIN
is available
in both 75 mg and 1 00 mg tablets.
Important:
No single dose of WELLBUTRIN
should
exceed
150 mg because
a higher incidence
of
seizures
has been observed
in patients
receiving
higher individual
doses of WELLBUTRIN.
For this
reason,
too, patients
should be reminded
that they
should not double up on any dose because
they
missed
a previous
one. Dosage
should not exceed
450 mg per day (see WARNINGS).
there
Seizures
A wide range of seizure rates have been reported with
antidepressant
therapy with some reports as low as 0.1 %.
The incidence
of seizures with WELLBUTRIN
is approximately 0.4%, which may be as much as fourfold higher
than some other antidepressants,
although no direct
comparative
studies have been conducted.
Dosage
and Administration
The recommended
starting dose of WELLBUTRIN
is 200
mg/day given as 100 mg b.i.d. Based on clinical response,
this dose may be increased
to 300 mg/day given as 100
mg t.i.d. no sooner than three days after beginning
therapy.
Clinical trials involving more than 7,000 depressed
patients and over 200 investigators
demonstrated
that
WELLBUTRIN
relieves
depression
in a wide range
of patients:
- with no clinically
significant
effects on cardiac
conduction
- with no clinically
significant
orthostatic
hypotension
- with few anticholinergic
side effects
- with little or no weight
gain
- with little or no daytime
drowsiness
NEW
WeHbutrin
(BURRORON
See brief summary of
on last pages
/pab1?31
HO)
full prescribing
of this advertisement.
information
WELLBUTRIN#{174}(BUPROPION
HYDROCHLORIDE)
Tablets
Before prescribing, please consult complete product information, a summary of which
follows:
Use in Patients with Systemic Illness: There is no clinical experience establishing the satety of Wellbutrin in patients with a recent history of myocardial infarction or unstable heart
INDICATIONS AND USAGE: Vllbutrin
is indicated forthe treatment of depression. A physiclan considering the initiation of Wellbutrin should be aware that the drug may cause
generalized seizures with an approximate incidence of 0.4% (4/1000). This incidence may
exceed that of other antidepressants as much as fourfold. This relative risk is only an ap-
disease. Therefore, care should be exercised if it is used in these groups. Wellbutrin was
tolerated in Patients who had previously developed orthostatic hypotension while receiving tricyclic antidepressants.
bupropion HCI and s metabolitesarealmost completelyexcretedthnugh the kidney
proximation
and metabolites are likelyto undergo conjugation inthe liver priorto urinary excretion, treatment of patients with renal or hepatic impairment should be initiated at reduced dosage
as bupropion and its metabolites may accumulate in such patients beyond concentrations
expected in patients without renal or hepatic impairment. The patient should be closely
monitoredforpossibletoxiceffectsofelevated
bloodandtissuelevelsofdrugandmetaboles.
Information for Patients:
since no direct comparative
studies have been conducted.
CONTRAINDICATIONS: Wellbutrin is contraindicated in patients: with a seizure disorder;
with a current or prior diagnosis of bulimia or anorexia nervosa, because of a higher incidence of seizures
noted in such patients;
who have shown an allergic response to it; or
who are currently being treated with an MAO inhibitor. At least 14 days should elapse between discontinuation of an MAO inhibitor and initiation of treatment with Wellbutrin.
WARNINGS:
SEIZURES: Wellbutnn is associated with seizures In approximately 04% (4/1000) of patients treated at doses up to 450 mg/day. This incidence of seizures may exceed that of
other marketed antidepressants by as much as fourfold. This relative risk is only an approximate estimate because no direct comparative
studies have been conducted. The
estimated seizure incidence forWellbutrin
increases almosttenfold between 450 and 600
mg/day, which is twice the usually required daily dose (300 mg) and one and one-third
the maximum recommended daily dose (450 mg). Given the wide variability among individuals and their capacity to metabolize and eliminate drugs, this disproportionate increase in seizure incidence with dose incrementation calls for caution in dosing.
Duringthe pro-approval evaluation period, 25 among approximately 2400 patients treated
with Weilbutrin
experienced
seizures. Atthetimeofseizure, 7 patients were receivIng datly doses of4SO mg rn below, foran incidence of033% (3/1000) withinthe recommended
dose range. Twelve (12) patients experienced seizures at600 mg perday (23% incidence);
6 additIonal patients had seizures at daily doses between 600 and 900 mg (28% Incidence).
Aseparate, prospective studywas conductedto determinethe incidence ofseizure during
an8weektreatmentexposureinapproximately3200addftionalpatientswhoreceiveddaily doses of up to 450 mg. Patients were permitted to continue treatment beyond 8 weeks
if clinically indicated. Eight (8) seIzures occurred during the Initial 8 weektreatment
period
and 5 seizures were reported in patients continuing treatment beyond 8 weeks, resuffing
in a total seizure incidence of 0.4%.
The risk of seizure appears to be strongly associated with dose and the presence of
predisposlng
factors. Asignificant
predisposing
factor (e.g., history of head trauma
prior
seizure, CNStunw, concomitant medationsthater
seizurethreshold,
etc.)was present
in approximately one-half ofthe patients experiencing a seizure. Sudden and large increments in dose may contribute to increased risk. While many seizures occurred early
in the course of treatment, some seizures did occur after several weeks at fixed dose.
Recommendations
for reducing the risk otseizure: Retrospective analysis of clinical experience gained during the development ofWeflbutrin suggests thatthe risk of seizure may
be minimized if (1) the total daily dose ofWellbutrin does notexceed 450 mg, (2) the daily
dose is administered t.i.d. , with each single dose notto exceed 150 mg to avoid high peak
concentrations of bupropion and/or its metaboiltes, and (3) the rate of incrementation of
dose is very gradual. Extreme caution should be used when Wellbutrin is (1) administered
to patients with a historyofseizure, cranialtrauma,
orother predisposition(s)
toward seizure,
or (2) prescrIbed with other agents
(e.g., antipsychotics, other antidepressants, etc.) or
treatment
regimens (e.g. , abrupt discontinuation ofa benzodlazepine)that
lower seizure
threshold.
Potential for I’lepatotoxicity: In rats receiving large doses of bupropion chronically, there
was an increase in incidence of hepatic hyperplastic nodulesand hepatocellular hypertrophy.
In dogs receiving large doses of bupropion chronically, various histologic changes were
seen inthe liver, and laboratorytests suggesting mild hepatocellular injury were noted. Although scattered abnormalities in liverfunctiontests
were detected in patients participating
in clinicaltrials, there is noclinicalevidencethatbupropion
actsasa hepatotoxin in humans.
PRECAUTIONS:
General:
Agitation and Insomnia: A substantial proportion of patients treated with Wellbutrin expenence some degree ofincreased restlessness, agitation, anxiety, and insomnia, especially
shortly after initiation of treatment. In clinical studies, these symptoms were sometimes
ofsufficientmagnitudeto
requiretreatmentwith
sedative/hypnotic drugs. In approximately
2% of patients, symptoms were sufficiently severeto require discontinuation ofWellbutrin
‘eatment.
p. vchosis,
Confusion, and Other Neuropsychiatric
Phenomena:
Patients treated with
Wt Ibutrjn have been reported to show a variety of neuropsychiatric signs and symptoms
inck ding delusions, hallucinations. psychotic episodes, confusion, and paranoia. Because
ofthe uncontrolled nature of many studies, it is impossible to provide a precise estimate
of the extent of risk imposed by treatment with Wellbutrin. In several cases, neuropsychiatric
phenomena abated upon dose reduction and/or withdrawal of treatment.
Activation ofPsychosisand/orMania:
Antidepressants can precipitate manic episodes in
Bipolar Manic Depressive patients during the depressed phase oftheir illness and may activate latent psychosis in other susceptible patients. Wellbutrin is expected to pose similar
risks.
AlteredAppetite
and Weight: A weight loss of greater than 5 pounds occurred in 28% of
Wellbutrin patients. This incidence is approximately double that seen in comparable patients treated with tricyclics or placebo. Furthermore, while 34.5% of patients receiving
tricyclicantidepressantsgainedweight,
only9.4% of patientstreated with Wellbutrin did.
Consequently, if weight loss is a major presenting sign of a patient’s depressive illness,
the anorectic and/or weight reducing potential of Wellbutrin should be considered.
Suicide:The possibilityofa suicideattempt
is inherent in depression and may persist until
significant remission occurs. Accordingly, prescriptions for Wellbutrin should be written
for the smallest number of tablets consistent with good patient management.
Patients should be instructed to takeWellbutrin in equally divided doses three or fourtimes
a day to minimize the risk of seizure.
patients should be told that any CNS-active drug like Wellbutrin may impair their ability to
perform tasks requiring judgment or motor and cognitive skills. Consequently,
until they
are reasonably certain that Wellbutrin does not adversely affect their performancethey should
refrain from driving an automobile or operating complex, hazardous machinery.
Patients should be told that the use and cessation of use of alcohol may alter the seizure
threshold, and, therefore, thatthe consumption of alcohol should be minimized, and, if possible, avoided completely
tients
should be advised to inform their physician if they are taking or plan to take any
prescription or over-the-counter drugs.
patients should be advised to notify their physician if they become pregnant or intend to
become pregnant during therapy
Drug Interactions: No systematic data have been collected on the consequences of the concomitant administration of Wellbutrin and other drugs.
However, animal data suggestthat Wellbutrin may be an inducer of drug metabolizing enzymes.
This may be of potential
clinical
importance
because
the blood levels of co-
administered drugs may be altered.
Alternatively, because bupropion is extensively metabolized, the co-administration of 0ther drugs may affect its clinical activity. In particular, care should be exercised when administering drugs known to affect hepatic drug metabolizing enzyme systems (e.g ., carbamazepine, cimetidine, phenobarbital, phenytoin).
Studies in animals demonstrate that the acutetoxicity of bupropion is enhanced by the MAO
inhibitor phenelzine (see CONTRAINDICATIONS).
Limited clinical data suggesta higher incidence ofadverse experiences in patients receiving concurrentadministration ofWellbutrin and L-dopa. Administration ofWellbutrinto patients receiving L-dopa concurrently should be undertaken with caution, using small initial
doses and small gradual dose increases.
Concurrent
administration
of Wellbutrin
and agents which lower seizure threshold should
be undertaken only with extreme caution (see WARNINGS) .Low initial dosing and small
gradual dose increases should be employed.
Carcinogenesis,
Mutagenesis, Impairment of FertIlity: Lifetime carcinogenicity studies were
performed in rats and mice at doses up to 300 and 150 mg/kg/day, respectively. In the
rat study there was an increase in nodular proliferative lesions of the liver at doses of 100
to 300 mg/kg/day;
lower doses were not tested. The question of whether or not such le-
sions may be precursors of neoplasms ofthe liver is currently unresolved. Similar liver lesions were not seen in the mouse study, and no increase in malignant tumors of the liver
and other organs was seen in either study.
Bupropion produced a borderline positive response (2-3 times control mutation rate) in some
strains in the Ames bacterial mutagenicity test, and a high oral dose (300, but not 100 or
200 mg/kg) produced a low incidence of chromosomal aberrations in rats. The relevance
ofthese results in estimatingthe risk ofhuman exposuretotherapeutic
doses is unknown.
Afertility study was performed in rats; no evidence ofimpairmentoffertilitywas
encountered
at oral doses up to 300 mg/kg/day.
Pregnancy: Teratogenic Effects: Pregnancy Category B: Reproduction studies have been
pertormed in rabbits and rats at doses up to 15-45 times the human daily dose and have
revealed no definitive evidence of impaired fertility or harm tothe fetus due to bupropion.
(In rabbits, a slightly increased incidence offetal abnormalities was seen in two studies,
but there was no increase in any specific abnormality). There are no adequate and wellcontrolled studies in pregnant women. Because animal reproduction studies are not always
predictive of human response, this drug should be used during pregnancy only if clearly
needed.
lJbor and Delivery: The effect of Wellbutrin on labor and delivery in humans is unknown.
Nursing Mothers: Because ofthe potentialfor serious adverse reactions in nursing infants
from Wellbutrin, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pediatric Use: The safety and effectiveness ofWellbutrin in individuals under 18 years old
have not been established.
Use in the Elderly: Wellbutrin has not been systematically evaluated in older patients.
ADVERSE REACTIONS: (See also WARNINGS and PRECAUTIONS) Adverse events cornmonly encountered in patientstreated with Wellbutrin are agitation, dry mouth, insomnia,
headache/migraine, nausea/vomiting, constipation, and tremor.
Adverse events were sufficientlytroublesometo
cause discontinuation ofWellbutrin treatment in approximately ten percent of the 2400 patients and volunteers who participated
inthe product’s pre-approvalclinicaltnals. The morecommoneventscausing discontinuation
include neuropsychiatric disturbances (3.0%), primarilyagitation and abnormalities in mental status; gastrointestinal disturbances (2.1%), primarily nauseaand vomiting; neurological
disturbances
(1 .7%),
primarily
seizures,
headaches,
and sleep disturbances;
and der-
matologic problems (1 .4%), primarily rashes. It is important to note, however, that many
of these events occurred at doses that exceed the recommended daily dose.
The table below is presented solely to indicate the relative frequency of adverse events
reported in representative controlled clinical studies conducted to evaluate the safety and
efficacy of fllbutrin
under relatively similar conditions of daily dosage (300-600 mg), setting, and duration (3-4 weeks). The figures cited cannot be used to predict precisely the
incidence of untoward events in the course of usual medical practice where patient
characteristics and other factors must differ from those which prevailed in the clinical trials.
These incidence figures also cannot be compared with those obtained from other clinical
studies involving related drug products as each group of drug trials is conducted under
a different set of conditions.
Finally, it is important to emphasize that the tabulation does not reflect the relative severity
and/or clinical importance ofthe events. A better perspective on the serious adverse events
associated with the use of Wellbutrin is provided in the WARNINGS and PRECAUTIONS
sections.
EMERGENT ADVERSE EXPERIENCE INCIDENCE
IN PLACEBO-CONTROLLED CUNICAL InIALs’
(Percent of Patients Reporting)
CARDIOVASCULAR
Cardiac Arrhylhmias
Dizziness
Hypertension
Hypotension
Palpitations
Syncope
l#{228}chycardia
Wsllbuh’In
Patients
(n = 323)
Placebo
Patients
(n = 185)
5.3
22.3
4.3
4.3
16.2
1.6
2.5
2.2
3.7
2.2
1.2
10.8
0.5
8.6
DERMATOLOGIC
Prunlus
Rash
GASTROINTESTiNAL
Anorexia
Appetite increase
Constipalion
Diarrhea
Dyspepsia
Nausea/\Aimiting
ightGain
WeighlLoss
2.2
0.0
8.0
6.5
18.3
18.4
3.7
26.0
2.2
17.3
6.8
3.1
22.9
13.6
23.2
8.6
2.2
18.9
22.7
23.2
3.4
4.7
2.5
1.9
3.1
1.1
2.2
2.2
GENiTOUR1NARY
impolence
Menstrual Complaints
Urinary rrequency
Urinary Retention
3.1
2.7
Akathisia
1.5
1.1
Akinesia/Bradykinesia
8.0
8.6
1.9
1.6
Cutaneous bnperatureDisturbance
Excessive SweaIing
Headache/Migraine
impaired Sleep Ouaiity
increased Salivary Flow
insomnia
Muscie Spasms
Pseudoparkinsonism
Sedation
Sensory Disturbance
Tremor
Welbutrin
Placebo
PafteMs
Patients
(n = 323) (n = 185)
27.6
22.3
18.4
14.6
25.7
22.2
4.0
3.4
18.6
1.9
1.5
19.8
4.0
21.1
1.6
3.8
15.7
3.2
1.6
19.5
3.2
7.6
NEUROPSYCHiATRIC
Agitation
Anxiety
31.9
3.1
22.2
1.1
Confusion
DecreasedLibido
Delusions
8.4
3.1
1.2
4.9
1.6
Disturbed Concentration
Euphoria
3.1
1.1
3.8
1.2
5.6
0.5
3.8
Fatigue
5.0
8.6
Fever/Chiiis
1.2
0.5
Hostility
NONSPECIFIC
and 300 mg of tranylcypromine
and recovered
further
5.0
11.4
SPECIALSENSES
Auditory Disturbance
Blurred Vision
5.3
14.6
3.2
10.3
Gustatory Disturbance
3.1
1.1
during the entire pro-approval evaluation of Wellbutrln: During its
pre-approval assessment, Wellbutrin was evaluated in almost 2400 subjects. The condiOther events observed
tions and duration of exposureto Wellbutrin varied greatly and a substantial proportion of
the experience was gained in open and uncontrolled clinical settings. Duringthis experience,
numerous adverse events were reported; however, without appropriate controls, it is rnpossibleto determine with certainty which events were or were not caused by Wellbutrin.
The following enumeration is organized by organ system and describes events in terms of
their relative frequency of reporting in the data base. Events of major clinical importance
are also described in the WARNINGS and PRECAUTIONS sections of the labeling.
The following definitions of frequency are used: Frequent adverse events are defined as
those occurring in at least 1/100 patients. Infrequent adverse events are those occurring
in 1/100 to 1/1000 patients, while rare events are those occurring in less than 1/1000
patients.
Cardiovascular:
Frequent was edema; infrequent were chest pain, EKG abnormalities
(premature beats and nonspecific SiT changes), and shortness of breath/dyspnea; and
rare were pallor and phlebitis.
Dermatologic:Frequent were nonspecific rashes; infrequent were alopecia and dry skin;
rare were change in hair color and hirsutism.
Endocilne:
Infrequent was gynecomastia; rare were glycosuria and hormone level change.
Gastrointestinal:
Infrequent were dysphagia, thirst disturbance, and liver damage/jauncolitis, G.I. bleeding,
and intestinal
without
experienced
a grand mal seizure
sequelae.
DOSAGE AND ADMINISTRATION:
General Dosing Considerations:
It is particularly important to administer Wellbutrin in a manner most likely to minimize the risk of seizure (see WARNINGS).
Increases in dose should
not exceed 100 mg/day in a 3 day period. Gradual escalation in dosage is also important
if agitation, motor restlessness, and insomnia, often seen during the initial days of treatment, areto be minimized. Ifnecessary, these effects may be managed bytemporary reduc-
tion of dose or the short-term administration of an intermediate to long-acting sedative hypnotic. A sedative hypnotic usually is not required beyond the first week of treatment. Insomnia may also be minimized byavoiding bedtime doses. Ifdistressing, untoward effects
supervene, dose escalation should be stopped.
No single dose offIlbutrfn
should exceed 150 mg. Wellbutnn should beadministered lid.,
preferably with at least 6 hours between successive doses.
Usual Dosage for Adults: The usual adult dose is 300 mg/day, given t.i.d. Dosing should
begin at 200 mg/day, given as 100 mg bid. Based on clinical response, this dose may
be increased to 300 mg/day, given as 100 mg t.i.d. , no soonerthan 3 days after beginning
therapy (see table below).
Dosing Regimen
Treatment
Total
Tablet
Number of Tablets
Day
Daily Dose
1
‘Events reported by at least 1% of Weiibutnn patients are inciuded.
dice; rare were rectal complaints,
embolism.
9000 mg of Wellbutrin
RESPiRATORY
Complaints
and pulmonary
ofWellbutrin.
Thirteen overdoses occurred during clinical trials. Twelve patients ingested
850 to4200 mg and recovered without significant sequelae. Another patient who ingested
Upper Respiratory
MUSCUWSKELETAL
Arthritis
NEUROLOGICAL
Adverse Experience
Dry Mouth
Pneumonia
Respiratory:
OVERDOSAGE:
Human overdose experience: There has been limited clinical experience with overdosage
TREATMENT
AdverseExperlence
Nonspecffic: Frequent were flu-like symptoms; infrequent was nonspecific pain; rare were
body odor, surgically related pain, infection, medication reaction and overdose.
Past-Approval Reports: The following additional events were rarely observed (less than
1/1000 patients) post-approval.
Cardiovascular:
Flushing and myocardial infarction.
Dermatologic: Acne.
Gastrointestinal: Stomach ulcer.
Hematologic/Oncologic:
Anemia and pancytopenia.
Neurological:
Aphasia.
Musculoskeletal: Musculoskeletal chest pain.
200mg
300mg
4
Strength
Morning
Midday
Evening
100mg
100mg
1
1
0
1
1
Increasing the Dosage Above 300 mg/Day:
As with other antidepressants,
the full an-
tidepressant
effect of Wellbutrin may not be evident until 4 weeks of treatment or longer.
An increase in dosage, uptoa maximum of450 mg/day, given in divided doses of not more
than 150 mg each, may be considered for patients in whom no clinical improvement is noted
after several weeks of treatment at 300 mg/day. Dosing above 300 mg/day may be accomplished using the 75 or 100 mg tablets. The 100 mg tablet must beadministered q.i.d.
with at least 4 hours between successive doses, in order notto exceed the limit of 150 mg
in a single dose. Wellbutrin should be discontinued in patients who do not demonstrate an
adequate response after an appropriate period of treatment at 450 mg/day.
Elderly Patients: In general, older patients are knownto metabolize drugs more slowly and
to be more sensitivetothe anticholinergic, sedative, and cardiovascular side effects of antidepressant
drugs.
References: 1. Mendels J, Amin MM, Chouinard G, et al,
A comparative
study of bupropion
and amitriptyline
in depressed
outpatients,
J Clin Psychiatry.
1983;44(5,
sec 2):1 18-120.
2. Wenger
TL, Cohn JB, Bustrack
J. Comparison
of the effects
of bupropion
and amitriptyline
on cardiac
conduction
in depressed
patients,
J Clin Psychiatry.
1983;44(5,
sec 2):1 74-1 75. 3. Farid FE, Wenger
TL,
Tsai SY, et al, Use of bupropion
in patients
who exhibit orthostatic
hypotension
on tricyclic
antidepressants.
J Clin Psychiatry.
1983:44
(5, sec 2):1 70-173,
4. Data on file, Burroughs
Wellcome
Co.
perforation.
Genitounnary:
Frequent was nocturia; infrequent were vaginal irritation, testicular swelling, urinary tract infection, painful erection, and retarded ejaculation; rare were dysuria,
enuresis, urinary incontinence, menopause, ovarian disorder, pelvic infection, cystitis,
dyspareunia, and painful ejaculation.
Hematologic/Oncologic:
Rare was lymphadenopathy.
Neunisogical:
(see WARNINGS) Frequent were ataxia/incoordination, seizure, myoclonus,
dyskinesia, and dystonia; infrequentwere mydriasis, vertigo, and dysarthria; and rare were
EEG abnormality, abnormal neurological exam, impaired attention, and sciatica.
(see PRECAUTIONS) Frequent were mania/hypomania,
increased libido,
hallucinations, decrease in sexualfunction, and depression; infrequentwere memory impairment, depersonalization,
psychosis, dysphoria, mood instability, paranoia, formal
thought disorder, and frigidity; rare was suicidal ideation.
Oral Complaints:
Frequent was stomatitis; infrequent were toothache, bruxism, gum irritation, and oral edema; rare was glossitis.
Resp#{252}atoiy:
Infrequentwere bronchitisand shortnessofbreath/dyspnea;
rarewereepistaxis
and rate or rhythm disorder.
Special Senses: Infrequent was visual disturbance; rare was diplopia.
‘dUelibutrin
hi
NEW
(RURRORON
Newopsychiatiic:
Copr
-
1989
Burroughs
Welicome
Co
Au r,ghts
rese,ved
W-141
Burroughs
Wellcome
Weilcome Co.
Research Triangle Park, NC 27709
HO)
(continuedfrom
page 1128)
Box 365,
Greenbelt,
Maryland
Contact
20770,
301-345-3534.
January
January
5-7, seminar
on therapeutic touch,
sponsored
by University
of California,
Los Angeles,
Extension,
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Hotel,
Marina
del
Rey, California.
Contact
Extension’s
Health Sciences Department,
P.O. Box
24901, Los Angeles,
California
90024,
2 1 3-825-670
1.
February
15-16,
regional
congress,
World
Federation
of Societies
in
Biological
Psychiatry,
Casablanca,
Morocco. Contact Dr. M. Moussaoui,
Moroccan Association
of Biological
Psychiatry,
Centre
sitaire,
February
American
vancement
Hilton,
January
1 1-14,
annual
meeting,
American
Association
of Directors
of Psychiatric
Residency
Training,
Inc., Royal Sonesta
Hotel,
New Orleans. Contact Peter M. Zeman,
M.D.,
Executive
Secretary,
AADPRT,
400
Washington
Street, Hartford, Connecticut 06106,
203-241-6856.
21-24,
57th annual
meetNational
Association
of PriPsychiatric
Hospitals,
MarriOtt’s
Camelback
Inn, Scottsdale,
Anzona. Contact NAPPH,
1319 F Street,
N.W.,
No.
1000,
Washington,
D.C.
20004,
202-393-6700.
January
ing,
vate
Psychiatnique
Casablanca,
Univer-
Morocco.
15-20,
annual
meeting,
Association
for the Adof Science,
New Orleans
New
Orleans.
ings
Office,
AAAS,
N.W.,
Washington,
Contact
Meet-
1333 H Street,
D.C. 20005,
202-
326-6448.
February
17-19,
annual
meeting,
American
Association
for Geriatric
Psychiatry,
Le Menidien
Hotel
on
Coronado
Island, San Diego.
Contact
George
T. Grossbeng,
M.D.,
President, AAGP,
P.O. Box 376A, Greenbelt, Maryland
20770,
301-220-0952.
February
20-24,
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meeting,
American
Group
Therapy
Associa-
tion,
Place,
Inc.,
Westin
Hotel-Copley
Boston.
Contact
Marsha
Block,
Chief
AGPA,
Executive
New
York,
New
York
S.
6th Floor,
10010,
2 12-
February
477-2677.
February
February
21-24,
fourth
national
forum on AIDS and chemical
dependency,
sponsored
by the American
2-3,
conference
on
sui-
cide, sponsored
by Cambridge
Hospital
and Harvard
Medical
School,
Boston.
Contact
Judy Reiner
Plait,
Ed.D., Director,
Continuing
Education
Division,
Department
of Psychiatry,
Cambridge
Hospital,
1493
Street,
Cambridge,
02139,
617-864-6165.
Cambridge
Suite
225,
Rochester,
14624, 716-235-6910.
New
York
33612,
3rd
813-974-4500.
February
14-18,
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meeting,
American
College
of Psychiatrists,
Wyndham
Hotel,
Palm Springs,
California.
Contact
Alice
Conde
Martinez, Executive
Director,
ACP,
P.O.
Hospital
and
ference
Travel
on
Alcoholism
and
Drug
Dependencies,
Hotel,
Miami. Contact
Coordinator,
Services,
Hyatt
Con-
Meeting
Community
Psychiatry
Linda
Hotel,
Fort
Tuchman,
Service,
VA Medical
Kingsbnidge
Road,
10468,
212-584-9000,
March
1-3, annual
can Psychopathological
Lauderdale.
Neurology
Center,
130 West
Bronx,
New
York
ext.
1885.
meeting,
AmenAssociation,
March
6-9, 8th annual
symposium
on forensic
psychiatry,
Desert
Inn
Country
Club and Spa, Las Vegas.
Vol.
annual
meeting,
AssoAcademic
Psychiatry,
Seattle.
Contact
Department
of Psychiatry,
Mount Auburn Hospital,
Cambridge,
Massachusetts
02238, 617-4923500, ext. 4314.
March 9-10, conference
on treating
the addictions,
sponsored
by Cambridge
Hospital
and Harvard
Medical School,
Boston.
Contact
Judy Reiner Plait, Ed.D., Director,
Continuing
Education
chiatry,
Division,
Department
Cambridge
of Psy-
Hospital,
1493
bridge
Street,
Cambridge,
setts 02139,
617-864-6165.
March
16-19,
annual
Cam-
Massachu-
meeting,
Amen-
McDonough,
Ed.D.,
ton, AACD,
Alexandria,
Executive
Direc-
5999 Stevenson
Virginia
22304,
Avenue,
703-823-
9800.
March 21-23,
can Medical
Hyatt
annual meeting,
AmenStudent
Association,
Regency
Crystal
City,
ton, Virginia.
Contact
Executive
Director,
Preston
ginia
Arling-
Paul R. Wright,
AMSA,
1890
White
Drive,
Reston,
22091, 703-620-6600.
Vir-
40
No.
Plaza,
Boston.
Contact
K. Degnon,
Executive
6728
McLean
Old
McLean,
George
Director,
APS,
Village
Virginia
22101,
Drive,
703-556-
9222.
March
23-28,
annual
meeting,
Amencan Society
of Clinical
Hypnosis,
Sheraton World Resort, Orlando,
Ronida.
Jr.,
Contact
Executive
2250
East
Des
Plaines,
William
F.
Vice-President,
Devon
Illinois
Avenue,
60018,
Hoffmann,
ASCH,
Suite
336,
312-297-
3317.
St. Moritz,
New
York
City.
Contact
Nancy
C. Andreasen,
M.D.,
Ph.D.,
Department
of Psychiatry,
University
of Iowa
College
of Medicine,
500
Newton
Road, Iowa City, Iowa 52242,
3 19-356-1 5 53.
1989
7-10,
for
Stouffer
Madison,
Mary O’Loughlin,
pley
Marina
November
March
ciation
March
22-24, annual meeting,
Amencan Psychosomatic
Society,
Inc., Co-
March 1-3, symposium
on nonepileptic seizures,
sponsored
by the Amencan Epilepsy
Society
and the Epilepsy Foundation
of America,
Marniott
of Foren-
and
404-458-3382.
March
Contact
annual
research
conference,
sponsored
by Research
and Training
Center
for Children’s
Mental
Health
of the Florida
Mental Health
Institute,
Tampa,
Florida.
Contact
Bob
Friedman,
Director,
RTCCMH,
FMHI,
13301
Bruce
B.
Downs
Boulevard,
Tampa,
Florida
12-14,
Society
Other
Regency
Massachusetts
February
4-7, annual
meeting,
Amencan Association
of Psychiatric
Services
for Children,
San Diego
Hilton, San Diego.
Contact
Sydney
Koret,
Ph.D.,
Executive
Director,
AAPSC,
1200-C
Scottsville
Road,
February
Medical
College
can Association
for Counseling
and
Development,
Cincinnati
Convention
Center,
Cincinnati.
Contact
Patrick J.
Officer,
22 East 21st Street,
American
sic Psychiatry,
26701
Quail
Creek,
No.
295,
Laguna
Hills,
California
92656, 714-831-0236.
11
March 28-April
1, 18th annual
meeting, American
Society
for Psychosomatic
Obstetrics
and Gynecology,
Waldorf
Astoria
Hotel,
New
York.
Contact
Patricia Stahn, Administrator,
Liaison
Activities,
American
College
of Obstetricians
and Gynecologists,
409
12th
D.C.
20024,
Street,
S.W.,
Washington,
202-863-2514.
1137
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& Wilkins,
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Journal
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Include
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JM, Yudofsky
SC, Kogan
M, et al:
Elevation
of thioridazine
plasma 1evels by propranolol.
American
Journal
of Psychiatry
143: 1290-1292,
1986
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E: Clinical Neuropsychology,
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Science
and psychiatry,
in CompreNovember
1989
Vol.
40
No.
11
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& Allied
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Health
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cal Abstracts,
Social
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Science
dex, and other indexes
The journal publishes
in December.
Index
Literature,
Hos-
Medicus,
PsychologiCitation
In-
and data bases.
an annual index
1139
Q
FIEALTHCARE
UALITY
“Step
Forward
RESOURCES.
Improve
...
Quality
of Care
INC.
with
a
can
QHR”
A defense
cancer
be cooked
up
in your
Q uality
Joint
Healthcare
Commission
maximize
the
We
care
Resources,
on Accreditation
value
of your
understand
the
providers.
assistance
And,
quality
unique
a not-for-profit
Organizations,
improvement
activities.
of psychiatric
individualized
substance
and
programs
.
Alcohol/drug
dependence
services
Community
mental
health
centers
Child/adolescent
psychiatric
services
Adult
psychiatric
services
Services
for the mentally
retarded/
developmentally
disabled
Forensic
facilities
.
.
WE PROVIDE
further
abuse
technical
hospitals
WE
_
help
for:
Psychiatric
.
For
and
.
.
can
educational
CAN
information,
Quality
875
A DIFFERENCE’
complete
the attached
Healthcare
North
Michigan
Suite 2207
Chicago,
Illinois
or, call
SOLUTIONS!
MAKE
Resources,
form
and
send
it to:
flrcra
cancer.
Foods
high in fats,
salt- or nitrite-cured
food,ssuch
as ham,
and fish and types of
smoked
by traditional
should
be eaten in
Avenue
60611
us at:
_______
firtt’
Address
_________
City/State/Zip
Telephone
Number
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11/89
Note: QHR’s
tion activities.
advantage
retained
are entirely separate
of QHR services should
services
consultation
Any requestor
nor receive
QHR.
sausages
methods
moderation.
Be moderate
in consumption
of alcohol
also.
A good rule of thumb
is cut
down
on fat and don’t be fat.
Weight
reduction
may lower
cancer
risk. Our 12-year
study of nearly
a
million
Americans
uncovered
high
cancer
risks panicularly among
people
40% or more overweight.
Now, more
than ever, we
know
you can cook up your
own defense
against
cancer.
So
eat healthy
and
healthy.
-
_______
rti 7:
There
is evidence
that diet and cancer
are related,
Some
foods
may promote
cancer,while
others
may.
protect
you from it.
Foods
related
to lowening the risk of cancer
of the larynx
and esophagus all have high
amounts
ofcarotene,
a
form of Vitamin
A
which
is in cantaloupes,
peaches,
broccoli, spinach,
all dark
green
leafy vegetables, sweet
potatoes,
carrots,
pumpkin,
winter
squash,
and
tomatoes,
citrus
fruits and
brussels
sprouts.
Foods
that may help reduce
the
risk ofga.strointestinal
and respiratory tract cancer
are cabbage,
broccoli,
brussels
sprouts,
kohlrabi, cauliflower,
Fruits,
vegetables
and whole;p-. ?grain cereals
such as oatmeal, bran and wheat
may help lower
the
risk of colorectal
Inc.
312/642-9193
Name
Title
kitchen.
of the
them.
tailors
.
subsidiary
of Healthcare
needs
we provide
to fulfill
Q HR
Inc.,
any special
treatment
from
understand
in the accreditation
Joint
Commission
it will
process
derive
because
accredita-
no special
No
it had
one
cancer
q
RIC4N
faces
alone.
CANCER SOCIETY#{174}
NORTH
CAROUNA
A
of Opportunity
Medical
Opportunities
State
Immediate
Excellent
for
PSYCHIATRISTS
BIBE
A “warm and friendly place to practice,
a great place to live. Commumties exist thmughout
the State, from over 300 miles of beautiful
2IaI)jI:]J©;:\1
beaches,
across
rolling
hills of the Piedmont,
America.
North
Carolina
provides
in Eastern
tivities.
mental
Expanding
ceflified/Board
eligible
services
health
psychiatrists
offer
highest
mountains
recreational
ac-
for Board
health pro-
opportunities
with community
Mental
state supported
psychiatric
approved
grams and withJCAH
Salaries are competitive;
deferred
compensation.
to the
unlimited
hospitals.
excellent
benefit package
including
on-call
and
Many programs
are affiliated
with one of four
psychiathc residency programs
in North
Carolina;
Univessity appointmean available. Full license to practice medicine in North Carolina
a
Vinfen Corporation
is currently recruiting
a Medical
Director
for
a large psychiatric
facility in Southeastern
Mass. Salary negotiable.
The
must.
Also,
positions
available
for
PSYCHOLOGISTS
REGISTERED
NURSES
PHYSICAI
Please send C.V. to: Shirley A.
McKinney,
Vice President,
Professional Services, VINFEN CORPORATION, 28 Travis Street, Boston, MA 02134. (617) 254-7300. An
Equal
Opportunity/Affirmative
Action Employer.
THERAPISTS
OCCUPATIONAL
THERAPISTS
SOCIAL
WORKERS
SPEECH
& lANGUAGE
PATHOLOGISTS
information
Forfurther
Tom Lane, Recmitment
Patsy
ONea1,
please contact:
Director
Recruitment
NC.
Department
Division
of Mental
Coordinator
of Human
Health,
& Substance
Disabilities,
325 N. Salisbuzy
Resources
Developmental
Abuse
Services
St., Raleigh,
(919)
N.C.
27611
733-5668
“VIV c NFEN
0 R P 0 R A T I 0 N
‘
.
CHIEF
OF PROFESSIONAL
SERVICES
Rewarding
opportunity
for an experienced
Board
Certified
Psychiatrist
to direct
treatment
services
in an innovative
public
mental
health
system.
Oversee
all
aspects
of
clinical
services
within
the
disciplines
of
Psychiatry,
Nursing,
Social
Work,
Psycho!ogy,
Rehabilitation,
and
Chaplaincy.
Position
reports
directly
to the
Superintendent
and
is actively
involved
with
Q, UR, peer
review
and
Residency
Training.
Connecticut
Valley
Hospital
is
a
fully
accredited
hospital
with
a 451
bed
inpatient
and
three
community
programs
that
are integral
parts
of regionalized
managed
care
system.
JCAHO
Must
have
four years’
as staffpsychiatrist
hospital
or
clinic,
including
one
administrative
or clinical
supervision,
licensure,
and
Board
cialist
in Psychiatry.
and APA
Administrative
itation
preferred.
in
in
CT
year
certification
as
Academic
Psychiatry
affiliation
accred-
spe-
Athrrnativc
Action/Equal
Comprehensive
Oppoi-tunitv
Employer.
Regional
opportunities
ing
for
and
include
ment
planning
and
in
with
has
work-
a variety
of
Outstanding
and
research
time
fringe
benefit
program.
Medical
Director
and
vitae
to:
Erickson
St. Peter
Regional
100 Freeman
Drive
iii
and
ofapplication
D.
For
the
both
candidate.
William
Peter,
in
a
gen-
programs.
salary
letter
treatutilizing
approach
appointment
to qualified
assessment,
implementation
team
forensic
Academic
Send
clinically
psychiatric
and
multi-disciplinary
able
Center
interested
groups.
Services
eral
Treatment
psychiatrists
administratively
disability
St.
Salary
range
$72,
136
to $90,795
with
libera!
fringe
benefits,
including
possibility
of on-grounds
housing.
Send
resume
to
Raymond
Cioffi,
Personnel
Director,
Connecticut
Valley
Hospital,
Box
351,
Middletown,
CT 06457.
An
PSYCHIATRISTS
Treatment
Mn.,
56082
more
information:
ST.
Center
(507)
PETER
TREATMENT
931-7127
REGIONAL
CENTER
avail-
staff nurses
had annual average
increases
of 7 5 5 percent
and 7 5 3 percent,
respectively;
staff
psychologists
were
earning
an average
of
$42,725
in
1988,
staff
nurses
$27,321.
.
Annual
.
rates ofincrease
tors of nursing
(7.38
for direc-
percent)
and
directors
of psychology
(7.36
percent) outpaced
the rate of increase
for directors
of social
work
(6.45
percent).
In 1988 psychology
directors
earned
an average
salary
of
$57,4 17, nursing
directors
$44,605,
and social work
directors
$37,024.
Staff
social
workers
earned
an
average
of $28,455.
The
gap in
salaries
between
staffnurses
and staff
social
workers
narrowed
over
the
ten-year
period,
which
may reflect
the shortage
ofnurses
and the lack of
problems
hospitals
experience
in
recruiting
social
workers
according
to the author
of the survey
report,
Dan W. Pope,
Ph.D.
,
Medical
directors
in private
hospitals earned
substantially
more than
teaching
staff
in medical
colleges,
whose
salary
averaged
$82,284
in
1988, and medical
directors
of general
hospital
units,
whose
salary
averaged
S I 10,000.
However,
the
average
salary
of private
hospital
medical
directors
fell below than that
ofmedical
school department
chairs,
who
were
paid
an
average
of
$147,IOOin
1988.
Both
administrators
and nursing
directors
were paid lower
salaries
in
private
psychiatric
hospitals
than
their counterparts
in general
hospitals. Salaries
for general
hospital
administrators
climbed
at a higher
annual rate
(9.4 1 percent)
over
the
1979-88
period
and
averaged
$96,400in
1988.
The average
salary ofa director
of
nursing
in a general
hospital
was
$52,300
in 1988 and had increased
at a higher
annual
rate (8.84 percent)
in the
1979-88
period
than
the
average
salary in a private
psychiatric
hospital.
Dr. Pope
said the fact that
private
psychiatric
hospitals
tend to
have fewer beds than general
hospitals may account
for some of the difference
in salary levels.
On the other
hand,
social
work
directors
in private
psychiatric
hos-
Hospital
and Community
Psychiatry
pitals earned
more
than social work
directors
in general
hospitals,
who
were
paid
an average
salary
of
$33,900
in 1988. Dr. Pope said the
higher
salary
in private
psychiatric
hospitals
may reflect
the more direct
role social
work
directors
play in
patient
care in those settings.
News
Briefs
Decade
George
of the
Brain:
President
Bush has signed
a congressional
resolution
declaring
the 1990s
the Decade
ofthe
Brain. The resolution, introduced
in Congress
by Representative
Silvio
0. Conte
(R.Mass.)
and cosponsored
by Senator
Donald
W. Riegle,Jr.
(D.-Mich.),
is
designed
to promote
awareness
of
the
technological
advances
that
have
been made
in the last decade
in the
treatment
ofbrain
injuries
and disorders and to emphasize
the need for
more research
into the brain. Disorders
and diseases
associated
with
brain
dysfunction
include
schizophrenia,
depressive
and
manicdepressive
illnesses,
obsessive-cornpulsive
disorder,
substance
abuse
disorders,
epilepsy,
stroke,
Alzheirner’s
disease,
AIDS
dementia complex,
and Parkinson’s
disease.
The resolution
passed
the House
of
Representatives
last June
29 with
246
cosponsors
and
passed
the
Senate
on July
13 with 56 cosponsors. It was signed
by President
Bush
onjuly
25.
NAMI
training
award:
Departments
of psychiatry,
psychology
social work,
and nursing
that are training students
to work with the chronic
mentally
ill and their families
are invited to apply for the Award
for Excellence
in Training
presented
annually
by the National
Alliance
for
the Mentally
Ill. The deadline
for
applications
is March
1 1 990. For
more
information,
contact
Kayla
Bernheim,
Ph.D.,
Livingston
County Counseling
Services,
Building
1,
,
Stanley
awards:
The
first seven
recipients
ofthe
Stanley
Foundation
Awards
for Research
on Serious
Mental
Diseases
have
been
announced
by the National
Alliance
for the Mentally
Ill. They
areJ.
A.
Girault,
M.D.,
of the College
de
France
in Paris;
S.J. Watson,
Ph.D.,
M.D.,
ofthe
University
of Michigan
in Ann Arbor;J.
G. Knight,
Ph.D.,
of the University
of Otago,
New
Zealand;
C. P. Reynolds,
Ph.D.,
of
Queen’s
Medical
Centre
in Nottingham,
England;
K. L. O’Malley,
Ph.D.,
of Washington
University
SchoolofMedicine
in St. Louis; S.J.
Peroutka,
M.D.,
Ph.D.,
of Stanford
(Calif.)
University
Medical
Center;
and S.J. Lolait, Ph.D.,
ofthe
National Institute
of Mental
Health
in
Rockville,
Maryland.
Twenty
senior
scientists
were also awarded
grants
through
the
Stanley
Scholars
pro-
gram,
which
enables
them
to hire
promising
students
to work
with
them on research
on mental
illness.
The foundation
has pledged
to provide $1 million
annually
to support
research
on the causes
of serious
mental
diseases.
TO ADVERTISERS
INDEX
NOVEMBER
EMPLOYMENT
1115,
HALDOL
McNeil
1989
OPPORTUNITIES
1204, 1208-1215,C3
DECANOATE
Pharmaceutical
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MANAGEMENT
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1108-1115
1123-1124
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1106
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Pharmaceuticals
PROZAC
1110-1112
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County
New York
658-2834.
November
Campus,
14510;
1989
Mount
Morris,
telephone,
Vol.
40
Products/Div.
1129-1136
Burrougha-Welicome
The
11
of Eli Lilly & (k.
WELLBUTRIN
XANAX
716-
No.
Dista
Co.
C3-C4
Upjohn
Company
1207
Clas sified
Rates
and
Advertising
CompHealth
cum
Tenens
Deadlines
staffing)
Rates:
$4.40
per
line
Classified
sionable
box
rates
are
to agencies.
service
number
noncommis-
Absolute
ad
and
copy
changes
for
deadline
for all
cancellations
issues
and
West,
84101.
December
1 for January
Issue
January
2 for February
Issue
February
1 for March
Issue
March
1 for April Issue
Correspondence
Tiawana
Pierce
nationwide
toll
532-1200).
is:
Address
finest
Lophysician
Each
.
Or
#300,
we
Utah
(801)
300
City,
UT
Lake
leader
in
and
Staffing.
a change
are
or just
encourage
you
We currently
have
starting
out
to write
or call us.
openings
in Ohio,
H&CP Classified
Advertising
American
Psychiatric
Association
1400
K Street,
NW.
Washington,
D.C. 20005
Pennsylvania,
Virginia,
sippi,
Illinois,
and
offer
competitive
other
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community
professional
(202)
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ronments,
fulland part-time
openings
and
the opportunity
to establish
a private
practice.
Contact:
ANNASHAE
(FAX)
All advertisers
in this
section
must employ
without
regard
to
race or sex, in accordance
with
law. Readers
are urged to report
any violations
immediately
to
the Editor.
Hospital
Community
Psychiatry
CLINICAL
CHIATRISTS:
Management,
specializing
patient
the
management
facilities,
practice
privately.
the resources
powered
package
of
establish
you need
$100,000;
a private
stream
c.v.
to
referrals,
Director
Dept.
HC,
7601
200,
3589.
1208
You
career:
An
with
income
excess
in excess
are available
offers
RECTORSHIP
POSITIONS
tal-based
inpatient
psychiatric
and provides
the opportunity
to
&
of
of
McLean,
the
practice;
22102;
all
a highfinancial
well
freedom
Rd.,
1-800-368-
in
to
a steady
and
more.
of
Recruitment,
Lewinsville
VA
have
to build
excellent
potential
inDI-
at hospiunits,
for you
will
Send
Suite
Village,
Mississtates.
We
pleasant
Wilson
OH
449-2662.
confidence.
envi-
All
Mills
44 143-
inquiries
THE
PSYCHIATRIC
PLACEMENT
SERVICE
of the American
Psychiatric
Association
currently
has
DIRECTORS-PSYMental
Health
Inc., a nationwide
firm
in
psychiatric
6593
Mayfield
3404;
(216)
are held
in
______________
Nationwide
settings,
CORPORATION,
Rd.,
Florida,
of
1 30 vacancies.
in many
areas
of
Positions
the coun-
thriving
underserved
first
year
ongoing
stipend
sponsibilities.
outpatient
practice
in
community.
Genercompensation
includes
for administrative
reContact
Pam Taylor
at
(800) 327-1585
or (305) 271-9213
Phoenix-FULL-TIME
AND
TIME
PSYCHIATRISTS-needed
for
outpt.
mental
Ambulatory
copa
County
Phoenix,
health
Care
Arizona.
Positions
For
information
Munz,
Ambulatory
dinator,
1400
Fergusson,
Psychiatric
K Street,
20005;
Placement
NW,
Placement
Washington,
$90K.
ticipate
atry Service.
inpatient
CoorService,
DC
(202) 682-6108.
Carroll
44 1 1 5.
85040;
(602)
PSYCHIAOR OUTPA-
multidisciplinary
the
AZ
Fayetteville-STAFF
ThIST-INPATIENT
move
Graeme
available
Arkansas
Unusual
in development
exploring
contact
with
children/acontractor
provided.
contact:
Care,
Phoenix,
at V.A.
in
please
services
for work
with
adults
and/or
dolescents.
Independent
status.
Malpractice
coverage
Broadway,
437-4453.
PART-
Division
of
ManHealth
Department,
to
interested
available,
in
Florida.
TIENT
are
AL
ASSISTANT
MEDICAL
DIRECTOR-Regional
Medical
Center
seeking recently
trained
or experienced
board-eligible/board-certified
psychiatrist to assist in developing
expanding
inpatient
program.
Opportunity
to de-
try for STAFF
PSYCHIATRISTS,
ASSOCIATE
MEDICAL
DIRECTORS
AND
MEDICAL
DIRECTORS.
If you are seeking
a career
and
positions
Proof
and
Behavioral
NeurobiolStation,
Birmingham,
velop
this
ous
is
Healthcare
If you
David
L. Garver,
M.D.,
and Chairman,
Department
Arizona
South
POSITIONSCORPORATION
a recognized
Management
seeking
(in
155
Salt
PSYCHIATRIC
ANNASHAE
to:
free
write
Contact
lessor
Psychiatry
ogy,
UAB
35294.
oldest
and largest
supplier
of temporary psychiatric
staffing services
at: 1800-453-3030
Deadline:
the
CompHealth
Psychiatrist
is carefully
screened
and
referenced
insuring
you
competent,
reliable
coverage.
Have
your
practice
covered
or join
us and
cover
other
practices.
Call
CompHealth
Physician
Group,
America’s
(approximately
36 characters)
$35.20
minimum
$ 12.00 extra for blind
provides
(temporary
Medical
Center.
opportunity
of
unit
new
Outpatient
team,
Salary
to parPsychi-
clinic
25-bed
for acute
with
open
treatment.
Me-
187
beds,
exPsychiatry.
ConM.D.,
Chief
of
orJim
Williams,
dical/Surgical
hospital,
cellent
relations
with
tact
Arthur
Arnold,
Staff(501)
444-5050,
444-5020.
Alabama
Birmingham-CO-DIRECTOR
OF
VA-UAB
DAY
HOSPITAL
PROGRAM-with
academic
affiliation
at
University
of Alabama
at Birmingham
(UAB)
Department
of Psychiatry
and
Behavioral
Neurobiology.
Position
available
immediately
in
pleasant
working
environment
with
cohesive
staff on campus
of major teaching
hospital. Teaching
responsibility
for medical students
and resident
electives.
November
1989
Vol.
40
No.
11
California
Bakersfield-PSYCH
IATRI
MENTAL
HEALTH-Psychiatrist
$95,500
$98,000,
pensation
al benefits
weekly.
diagnostic
patients
Health
Hospital
STI-
board
eligible;
Psychiatrist
IIBoard
Certified.
Total
comexceed
$ 100,000
with liberpackage.
Salaries
paid
biPosition
provides
psychiatric,
and
therapeutic
services
to
of the
Kern
County
Mental
Department.
A valid
and Community
license
Psychiatry
to
practice
medicine
in the State of California is required.
Apply immediately:
Contact
Don Ross, Personnel
Analyst,
Kern County
Personnel
Department,
1120
Golden
CA 93301
State
(805)
Ave.,
Bakersfield,
871-8240.
CENTRAL
NO-Combine
CALIFORNIA-FRESa QUALITY
lifestyle
with
a QUALITY
career
opportunity
as a Staff Psychiatrist.
Central
California and Fresno offer a unique
metropolitan/rural
atmosphere
of cultural,
professional
and leisure activities.
Yosemite National
Park,
Carmel,
San
Francisco,
Los Angeles
are all within
easy reach. Fresno’s
housing
values are
among the best in the state, with both
urban
and rural settings.
Join our multidisciplinary
teams in a variety of inpatient and outpatient
settings.
Contract
salary $100,000
+, CME
time, additional pay for specific assignments
and
malpractice
coverage.
Please send your
Curriculum
Vitae and a copy of your
current
terson,
California
license
to: Paul
Fresno
County
Department
Health,
93775;
P.O.
Box
11867,
Patof
Fresno,
CA
(209) 445-3305.
ARE YOU
WAITING
FOR? You
now have the opportunity
to enjoy an
unencumbered
psychiatric
practice
forty hours
per week in a variety
of
clinical areas: Acute,
Forensics,
Resosonal
Geropsychiatnic,
Skills
world-class
Enjoy
the
Interper-
Development.
location-the
collegiality
Practice
in a
Napa Valley.
and support
of
80+ staff physicians,
80+ CME hours
per year,
psychiatric
residency
program,
extensive
library,
good
salary,
and generous
call. Minimal
fringe
benefits.
No
night
weekend
call. INTERESTED?
To apply, send CV to Jeffrey
Zwenin,
D.O., Medical
Director,
Napa
State
Hospital,
2100
Napa-Vallejo
Highway,
Napa, CA 94558-6293.
OR
CALL
NOW:
(707)
253-5434.
In California 800-42 1-0666.
Equal Opportunity
Employer,
Affirmative
Action,
and
Physicians
psychiatry
enal
residency
psychology
Union.
program
ferred.
and
Duties
will
supervising
include
County.
Send
resume
to:
H.B.
Kahn,
MD,
Medical
Director,
San Mateo
County
General
Hospital,
222
W.
39th Ave., San Mateo,
CA 94403.
Hospital
and
Community
Psychiatry
sev-
Po-
teaching
psychiatry
residents,
psychology
trainees,
dents, consultation
and medical
stuto the organ trans-
plant
service
and
service,
development
clinic and subspecialty
inpatient
pediatric
of an outpatient
clinics,
working
with
the Family
Therapy
PPMC,
and development
liaison
relationsurgical
or medical units,
and teach
and supervise
psychiatry
resident
and medical
students
who rotate on the service.
Time, facilities and funding
are available
for research.
A California
license
is repatient
care,
ships
with
quired.
your
CV
If
you
terian
Medical
San Francisco,
January
accredited,
1,
team.
support
work
with
Time,
facilities,
and
are available
to initi-
ate on continue
research
projects.
Must have, or be eligible for, a California
license.
Send
CV to Robert
E.
Hales,
M.D. , Chairman,
Department
of
Psychiatry,
Medical
Francisco,
Pacific
Presbyterian
Center,
P0 Box
CA 94120-7999.
7999,
(415)
San
923-
3624.
San Francisco-CONSULTATION/LIAISON
PSYCHIATRY
SHIP-Position
available
Presbyterian
Medical
a 34 1-bed
tal
tertiary
located
Center
care
in the
FELLOWat Pacific
(PPMC),
teaching
Pacific
hospi-
Heights
sec-
Box
799,
(4 15)923-
eclectic
ACGME
general
fulltrainee-
psychiatry
at a modern
leading
340-bed
Center,
serving
as both a corn-
program
Medical
munity
hospital
ten with
other
tients
a multi-
Center,
P0
CA 94120;
1990,
in an
competency-based
classes,
to
send
San
Francisco-POSTGRADUATE
YEAR III PSYCHIATRY
RESIDENCY POSITION
available
on or before
skill,
ability
interested,
3297.
psychopathologies,
and
are
and three
references
to
George
E. Becker,
M.D.,
Director,
Consultation
Psychiatry
Division,
Department
of Psychiatry,
Pacific Presby-
oriented,
Clinic
at
of educa-
develop
particular
tional
programs
for
the
community
and medical
center.
Position
requires
leadership,
initiative,
administrative
served
are
and
tions
are
and tertiary
care
GME
programs.
representative
socioeconomic
ethic
Clinical
groups.
coordinated
conferences,
and
sion
to maximize
Strong
professional
among
with
rota-
seminars,
individual
superviin-depth
training.
and teaching
ties
Psychiatry,
nal Medicine,
Social Work
cenPaof all
Neurology,
Clinical
provide
Inter-
Psychology,
and
a well-rounded
interdisciplinary
education.
Competitive stipend
and benefits.
Eligibility
for
California
license
required.
AAIEOE.
Inquiries:
James
R. McCurdy,
M.D.,
Director,
Psychiatry
Residency
Training, or Larraine
Decker,
Training
Coordinator,
Department
Pacific
Presbyterian
P.O. Box 7999,
94120-7999;
of
Psychiatry,
Medical
Center,
San Francisco,
CA
(415) 923-3510.
tion of San Francisco.
This is an new
fellowship
to begin July 1, 1990. Stipend
is at the
PGY
V level
with
oppor-
tunities
Colorado
lowships
Denver-PSYCHIATRIST-Innovative team working
with older
adults.
Medical
evaluations,
consultations.
Some
supervision.
$78K
to $ 104K
to augment
funding.
PPMC
is
a major teaching
center with residency
programs
in psychiatry,
medicine,
pathology,
and ophthalmology,
and felin cardiology,
pulmonary
ical
care,
gastroenterology,
mology
subspecialty
San
Francisco
Bay
Area-INPATIENT
ADULT
PSYCHIATRISTExellent
opportunity
for a creative
inpatient
ad ult psychiatrist
involving
training
and supervision
of Psychiatric
Residents
and working
in a most progressive
and
innovative
community
mental health program
with consultatiye/evaluative
and
treatment
roles.
Competitive
salary with strong benefit
package.
Half-time
to full-time
position available
in culturally
rich, environmentally
beautiful
San
Mateo
and
programs.
training
sition is part-time,
with excellent
salary
and benefits.
Full-time
office
available
for private
practice
and secretarial
support
provided.
Individual
must
be
Board
eligible.
Board
certified
pre-
disciplinary
financial
Napa-PSYCHIATRISTS-WHAT
cialization,
San Francisco-CHILD
PSYCHIATRIST-Position
available
on or before January
1, 1990 at Pacific Presbytenian Medical
(PPMC)
a 34 1 bed tentiary
care referral
center
located
in the
Pacific Heights
section
of San Francisco. The Department
of Psychiatry
is
expanding
the
number
of core faculty
members.
It has a four year approved
transplant.
The
areas,
hospital
ing site for various
and
is also
surgical
ties (orthopedics,
others)
and other
cnitophthal-
plus
liver
a train-
subspecial-
general
medical
benefits
for
full-time.
Part-time
also available.
National
Institute
Behavior
Change,
(303)296-2244.
Ask for Lois Munson.
for
surgery
and
disciplines.
PPMC is noted for its pioneering
work
in performing
kidney,
liver, bone marrow, and heart transplants.
The hospital has a major commitment
to oncology, kidney
dialysis,
and cardiac
rehabihitation.
New
and
expanded
Jacksonville-PSYCHIATRIST-A
comprehensive
community
programs
license.
Excellent
benefits.
Alberto
Director,
Center,
Please
respond
with CV to:
de ha Tome,
M.D.,
Medical
Mental
Health
Resource
Inc., P.O. Box 19249,
JackFL
32245-9249.
EOE.
in OB/GYN
and
pediatrics
have recently
Consultation
multidisciplinary
been
established.
The
Fellow would serve on a
Consultation
Psychi-
atry
staffed
Service
psychologists,
cialists.
November
and
He/she
1989
by
psychiatrists,
clinical
would
Vol.
nurse
provide
40
spe-
direct
No.
11
Florida
health
he/certified
sonville,
M/F/H/V.
center
is seeking
psychiatrist
with
salary
mental
a board-eligiba Florida
plus
other
1209.
Commonwealth
Indiana
Logansport-STAFF
TRIST-Logansport
has
immediate
PSYCHIAState
Hospital
opening
for Staff Psystart-
chiatnist.
Extremely
ing salaries
and ranges
are negotiabhe
experience
and training.
Ex-
based
of Kentucky.
Inquir-
fessionals
Vitae
be sub-
12-bed
mitted
to Vice President
for Resource
Development,
Comprehensive
Care
Centers
of Northern
Kentucky,
P.O.
Box
1260,
Covington,
KY 41012.
EOE.
CMH.
ies and
on
competitive
cellent
fringe
for on-grounds
benefits
housing.
with
potential
This
hospital
Curriculum
Michigan
is based
upon a medical
provides
an atmosphere
sional
growth.
Indiana
completion
of approved
model
and
for profeslicense
and
psychiatric
residency
required.
Contact
W.
Edward Smith, Human
Resources
Director, Logansport
State Hospital,
Logansport,
IN 46947.
(219) 722-4141.
Equal
Opportunity
Employer.
Male/Fernale.
Alpena-STAFF
Four
county
Health
Clinic
time
PSYCHIATRISTCommunity
Mental
on Lake Huron
has full-
vacancy
in well-established
Clinical
supervision
and staff on outpatient
27-bed
tal.
sional
inpatient
matehy
tating
$102,000,
on-call;
and
Charles
dependency
Central
program,
an ex-
to work
ty and
in a peaceful,
get
that
Knoxville
just
counseling
center,
services.
If you want
hometown
feeling,
then
for you, located
from
Des Moines,
include
attractive
re-
minutes
Benefits
tirement
tion,
communi-
is the place
45
Iowa.
rustic
plan,
fifteen
thirty
days
sick
and
mulate),
health
practice
coverage.
days
paid
vaca-
leave
(can
accu-
life insurance,
Competitive
malsalary
and bonus
depending
upon quahifications. Require
hicensure
in any state.
Equal
opportunity
Chief of Staff
Center,
15 15
employer.
Contact
(1 1), D. V.
West
Pleasant
A. Medical
St. , Knox-
ville, IA 50138;
(515) 842-3101,
ext.
6006.
Kentucky
Covington-CHILD
LESCENT
and
AND
ADO-
PSYCHIATRIST-Varied
stimulating
serving
full
seriously
chemically
time,
dependent
olescents
joint
and/or
children
at a large JCAHO
Community
position
disturbed
Mental
Health
and
ad-
accredited
Center
and
bed private,
non-profit
child and adolescent
psychiatnic hospital.
Progressive
multi disciit’s
associated
phinary
phasis
tialed
salary.
within
fifty-one
atmosphere
with
strong
maintaining
convenient
to a wide
highly
variety
of cultur-
al, educational,
and
suits. Candidates
fled or eligible,
must
be Board
and licensable
1210
em-
credenprofessional
staff. Competitive
Located
in Northern
Kentucky
the
Greater
Cincinnati
area
on
recreational
puncertiin the
A. White,
leave;
Director,
MenAve., Al-
Community
49707;
State
(517)
356-2161.
CHILD
PSYCHIA-
TRY SERVICES-Fellowship
trained
Child Psychiatrist
needed
for inpatient/outpatient
practice.
Area hospital
has
15 bed adult
unit
and
18 bed child
unit. Second
Child Psychiatrist
sought
to assist on DRG
exempt
program.
Excellent
guarantee
and benefits.
Community
mental
health
center
attached
to hospital.
Large liberal
arts
and business
university
in town. Short
driving
distance
to
Lansing
and
De-
troit.
Send curriculum
vitae or call:
Durham
Medical
Search,
Inc., 6300
Transit
Rd., P.O. Box 478, Depew,
NY 14043,
1-800-633-7724
(National), 1-800-367-2356
(NYS).
Minnesota
Fergus
Falls-PSYCHIATRISTPosition
available
for psychiatrist
in
the beautiful
lakes area of Minnesota
with numerous
cultural,
educational,
and recreational
opportunities.
Work
with multidisciplinary
team to provide
outpatient
services
to varied clientele.
Opportunity
for clinical
faculty
appointment.
Salary
to $1 15,000.00.
Excellent
fringe
benefits,
including
paid
malpractice
insurance.
Please
call
(218) 736-6987,
or send CV to Clinical Director,
Lakeland
Mental
Health
Center,
Inc.,
126 East Alcott
Ave.,
Fergus Falls, MN 56537.
Winona-PSYCHIATRIST-A
established
community
system
seeks
mental
a board
well
health
certified-board
eligible
psychiatrist.
Opportunity
offers outpatient
practice
at a Mental
Health
Center
with a staff of 45 pro-
November
1989
Vol.
40
along
beautiful
miles
south
practice
mental
A community
on a
health
unity
of26,000
Mississippi
of
Numerous
opportunities
at
located
River,
Minneapolis/St.
educational
110
Paul.
and
cultural
are provided
by an expanding
University
with graduate
programs
and private
liberal
arts college.
Excellent
compensation
and benefit
package.
Send
CV in confidence
or
contact Rand Gettler,
Community
Memorial
Hospital,
855 Mankato
Ave.,
Winona,
MN,
55987.
Call
collect
(507)
457-4302.
No.
Jefferson
An
E.E.O.
11
City-CLINICAL
NURSE
SPECIALIST-Exciting,
new position
for RN to coordinate
nursing
function
of adult psychiatric
unit. Responsibihities include:
standard
of care, patient
care delivery
system,
staff development, education.
BSN required;
minimum of two years recent acute mental
health experience
preferred.
Colleges
and
from
Michigan-ASSOCIATE
OF
inpatient
Missouri
ro-
vacation/sick
1 13 South
DIRECTOR
tended
alcohol rehabilitation
program,
a transitional
care unit, a day treatment
center,
a clinical
and consultation
tal Health,
pena, MI
EOE.
includes
leave,
disability,
life,
malpractice
insurance.
Michigan
and
certified
hospi-
for profesto approxi-
which
paid
Contact
Northeast
in general
opportunity
Salary: Up
Knoxville-CHIEF,
PSYCHIATRY
SERVICE-Knoxville
Veterans
Administration
Medical
Center
is actively
recruiting
for a Chief, Psychiatry
Service. Our medical center has four acute
general
psychiatry
units,
an alcohol
Iowa
clinic.
of agency
clients
basis; access to
unit
Excellent
growth.
educational
health,
treatment
may
universities
beautiful
nearby;
Lake
of
45
minutes
St. Marys
Health
the Ozarks.
Competitive
salary and benefits.
Equal
Opportunity
Employer.
Submit
resume to: Kathy
DeForest,
Manager/Mental
Health,
ten, 100 St. Marys Medical
ferson City, MO 65101.
Kansas
Cen-
Plaza,
Jef-
City-STAFF
PSYCHIAexists for a fulltime staff psychiatrist
to serve in a new
outpatient
post-traumatic
stress treatment program
at this medical
center.
This is an opportunity
to participate
in
the development
of an innovative
treatment
program;
playing
an important role in shaping
the program
and
the position.
Involvement
in a variety
of treatment,
research,
educational,
and administrative
activities
are possibhe, according
to the incumbent’s
interests.
The Medical
Center
is a 470bed general
medical/surgical/psychiaTRIST-A
tnic
vacancy
facility
affiliated
with
the
University
of Kansas
Medical
school
and a number
of other
professional
schools.
Applicants
will be eligible
for
an academic
appointment
to the University of Kansas
Department
of Psychiatry.
The Kansas
City area offers
both one of the highest
qualities
of life
and
one
of the
lowest
cost
of housing
and living of any major
metropolitan
area. Top flight
recreational
activities
of all varieties
are available,
including
theater,
symphony,
the arts, professional and collegiate
sports,
and many
parks and outdoor
recreational
areas.
Inquiries
should be made to the Directon, PCT,
VAMC,
4801
Linwood
Blvd.,
Kansas
City,
MO
64128;
(816)861-4700
extension
371, or FF5
754-1
37 1 Smoke-free
facility.
EOE.
.
Hospital
and
Community
Psychiatry
Nevada-PSYC
RECTOR
AND
H I ATRIST-DISTAFF-JCAHO-ac-
New
credited
mental
health
center
located
in scenic
southwest
Missouri
seeks
apphicants
for a clinical
director
and a
staff psychiatrist
position.
Our
center
provides
both inpatient
and outpatient
services
in adult psychiatry.
Minimum
qualifications
include
residency
cornphetion
and license
eligibility
with administrative
experience
preferred
for
the director
position.
Salary
is negotia-
ble with
free
legal
liability
coverage
and excellent
fringe
benefits.
Enjoy
a
relaxed
lifestyle
and lower
cost of living near
the scenic
Missouri
Ozarks
region.
Contact
Personnel
Office,
Nevada
State
Hospital,
Nevada,
MO
64772; (417) 667-7833,
ext. 2152.
New
Hampshire
Manchester-Board-certified/boardeligible
PSYCHIATRISTS
for adult
inpatient
unit and a child
and adolescent unit in a community
hospital
that
serves
an area of 240,000.
This
is a
dynamic
and
aggressively
expanding
program
of behavior
medicine
and
psychiatry
in an acute
care setting
located in beautiful
tax-free
New Hampshire!
Only
45 minutes
to Boston,
Seacoast,
lakes,
and mountains
region.
Responsibilities
revolve
primarily
around
the provision
of inpatient
services,
but
the opportunity
exists
for
outpatient
salary/benefits
quire
or
Sharon
80
care
as well.
package
CV
in
send
Dionne,
Into:
multispecialty
going
qualified
group
major
tus,
including
income
ten of
Carol
Group
City
FELLOWSHIP
CHIATRY-Now
IN
the
Fellowship
Columbia
York
& Area
PUBLIC
in its ninth
in Public
University
State
PSYyear,
Psychiatry
and
Psychiatric
the
of
New
Institute
pre-
pares junior
psychiatrists
for successful
management
and clinical
roles
in the
most progressive
aspects
of public
secton psychiatry.
The
training
program
includes
teaching
in strategic
organizational
management,
advanced
practice
in social
psychiatry
and family
therapy,
and the scientific
basis of public
prac-
tice-evaluation
ohogy.
with
research
Didactic
exercises
on-site
field
model
clinical
for six full-time,
will
1989.
Direct
are combined
experience
until
inquiries
M.D.,
722
West
10032;
168th
and
in
December
to
Director,
Street,
R.
FellowBox
1 11,
Institute,
New
York,
(212) 960-2556.
Community
Psychiatry
program.
Send letand CV to Mrs.
Sessa, Slocum-Dickson
PC, 430 Court
St.,
Medical
Utica, NY
North
salary/benefit
package
awaits
board-certified/boardeligible
adult psychiatrist
in large,
progressive
community
mental
health
centen. Staff position
currently
available
offers
opportunity
to work in academics, research,
direct
inpatient
and outpatient
care,
administration,
and program
development.
Rapidly
growing
city of 450,000
with
low unemployment and thriving
economy.
Located
1
hours
from
the
3
mountains,
1/2
hours
from
the beaches,
Charlotte
is
the largest
city in the Carolinas.
Send
C.V.
to: JoAnn
sician
land
its Silver
and
from
school.
major
Our
cludes
Crenshaw,
Recruitment,
Charlotte,
NC
Kaiser
R.N.,
P.O.
Box
a
seeks
PSYCHIATRISTS
and
certified/board-eligible
CHIATRISTS
to
medical
board-
CHILD
PSYjoin
multidis-
mental
health
Durham/Chapel
in
board-cer-
staff
in
Hill,
our
and
Must
have
offices.
psychopharmacology
and
therapy.
Excellent
salary/benefits
including
professional
hiability and medical
coverage,
paid vacation
and
sick
leave,
holidays,
continuing
education,
retirement
plan, and shareholder
opportunity.
CV
to Phyllis
Kline,
Recruitment
Coordinator-
HCP,
Carolina
Permanente
Medical
Group,
P.A., 3 120 Highwoods
Blvd.,
Raleigh, NC 27604-1018;
(800) 277CPMG.
AA/EOE.
twenty
miles
and
medical
package
in-
competitive
salary/benefits
Wilson-PSYCH
prehensive
IATRIST-ComCommunity
Center
Mental
east of Raleigh,
NC,
Health
seeks
the
ofa board
eligible
psychiatrist.
is well funded,
well organized
professional,
congenial
staff.
Our
Medical
Records
manager
has a great
disposition.
City
of Wilson
is family
oriented
with excellent
medical
facihities. Drive
to work
in 1 5 minutes.
Convenient
to beach
tans,
metropolitan
cehlent
benefits
We
are
resorts,
moun-
areas and 1-95. Exwith paid malpractice.
a special
program
seeking
a
special
doctor
to provide
psychiatric
care
and
supervision.
Call
collectJohn White,
Area Director,
(919)
399802
Affirmative
Employer.
1.
portunity
Action/Equal
Op-
Oregon
Pendleton-CHIEF
FICER-This
32861,
28232.
Permanente
ciphinary
Raleigh,
Phy-
Lake;
university
compensation
plan, including
malpractice
insurance.
Please
contact:
Faye Rogers,
Area Director,
Tideland
Mental
Health
Centen, 1308
Highland
Drive,
Washington, NC 27889;
(919)
946-8061.
with
Carolina
Charlotte-Excellent
1/2
to boating,
fishing,
and sailing
Pamhico
Sound
to Ocracoke
Is-
services
Program
13502.
MEDICAL
is an opportunity
OFto lead
an outstanding
team
of clinicians
and
to realize
your vision for rural public
psychiatry.
The Chief
Medical
Officer
must be a creative
and skillful
psychiatnc administrator
who is committed
to
participative
management
and innovation. The Eastern
Oregon
Psychiatric
center
is a state-operated,
sixty-bed
general
psychiatric
inpatient
component of a sixteen-county
rural
mental
health
network.
The
Center
and
its
associated
county
mental
health
pro-
grams
have
a long
history
of close
cooperation
and coordination.
This Iacihity is known
for its teamwork,
cornmitment
to innovation,
and high morale.
It is associated
with
the Oregon
Health
land,
Sciences
and
University
a joint
Department
of
in
Port-
appointment
win
the
Psychiatry
may
be
to the CMO.
EOPC
is located
in a town of 15,000
at the foot of the
Blue
Mountains
and in the center
of
world-class
fishing,
hunting,
wind surfavailable
Washington-PSYCHIATRISTTIDELAND
MENTAL
CENTER,
a comprehensive
ty program
Coastal
serving
Plain
opening
portunities
include
and
clinical
HEALTH
communi-
five
of North
immediate
fled/board-eligible
ices
3 1,
William
in Public
Psychiatry,
York,
State
Psychiatric
NY
Hospital
site
epidemi-
services.
Applications
one-year
positions
be accepted
McFarlane,
ship
New
and
with
proSta-
incentive
cost-accounted
distribution
introduction
short-term
York
currently
underis seeking
a
expansion
ble psychiatrist.
Salaried
position
excellent
corporate
fringe
benefit
gram.
Two
years
to Shareholder
skills
New
MED40-member
board-certified/board-ehigi-
Charlotte
(603) 623-1321.
access
across
State
Utica-SLOCUM-DICKSON
ICAL
GROUP
PC-A
tifled
attractive
is offered.
confidence
do Health
NorthEast,
Rd., Manchester,
NH
Tarrytown
03103;
An
York
counties
Carolina,
in the
has an
for
a board-certipsychiatrist.
direct
patient
supervision
variety
of outpatient
peutic
settings.
and
Op-
serv-
to staff
special
Experience
in a
thera-
with
1989
Vol.
40
No.
skiing,
11
and
mountain
climbing.
Pendleton’s
schools
are excellent,
estate
is exceptionally
affordable,
three
major
metropolitan
areas
within
be
three
and
hours
drive.
a board-eligible
psychiatrist
sub-
stance
abuse
and chronic
mental
illness
a plus.
We are located
in a beautiful
geographical
area
of coastal
rivers,
lakes, and sounds
with headquarters
in
the City ofWashington,
nestled
on the
navigable
Pamhico
River
with
ready
November
ing,
or
with
You
should
board-certified
inpatient
administrative
real
and
are
experience
training
and/or
experience.
Salary to $72,204
with an
excellent
fringe benefits
package.
Contact
Stephen
penintendent,
H.
Feinstein,
Eastern
PH.D.,
Oregon
Su-
Psychi-
atnic Center,
2575
Westgate,
Pendleton, OR 97801; (503) 276-0810.
1211
Salem-STAFF
PSYCHIATRIST-
Are you interested
in living
one hour
from the spectacular
Oregon
coast, the
scenic Cascade
Mountains,
and the cuhtural
pursuits
of Portland?
Oregon
State Hospital
is JCAHO-accredited
with general
adult psychiatry
and these
specialty
areas:
forensic,
geriatric,
child/adolescent,
and correctional
psychiatry.
Several
openings
academic
affiliation
Health
Sciences
have
possible
with
Oregon
University
land. Individuals
ic appointment
may spend one
in Port-
approved
for academin forensic
psychiatry
day a week
doing
tea-
ching/research
with an ongoing
fonensic research
team. Onsite
teaching
and
supervision
is also possible.
Salem is
the state capital and is a small,
familyoriented
city.
Medical
staff
may
choose
inexpensive,
tractive
housing
like
hospital
spacious
located
on the
at-
park-
campus.
Housing
else-
area,
including
rural
are
where
in
housing,
excellent
health
is inexpensive.
including
insurance,
life
tional
and
the
deferred
Benefits
comprehensive
insurance,
compensation
op-
rise
up
Officer
to
$90,800
in July,
of the day duties
1990.
provide
gen-
erous
additional
pay (up to $16,000)
or vacation
time.
Contact Philip Shapiro,
M.D.,
M.P.H.,
Chief
Medical
Officer
at (503)
378-2374,
Oregon
State
Hospital,
2600
Center
St.,
N.E.,
Salem,
OR
are
Department
of
Equal
Opportunity
ployers.
Tennessee
Knoxville-PSYCHIATRIST
to join
three
full-time
and two part-time
psychiatnists
for full- or part-time
position. with private,
non-profit,
compre-
hensive
ten.
97310.
community
Columbia-ACADEMIC
CHILD
PSYCHIATRISTS-Department
Neunopsychiatry
of
and
Behavioral
Sci-
ence,
University
of South
Carolina
School
of Medicine.
Challenging
opportunity
in child psychiatry
programs
including
gram
a psychiatry
at the
fellowship
pro-
S. Hall
Psychiatric
Institute.
Requires
a demonstrated
competence
and strong
interest
in clinical
teaching
and pursuit
of scholarly
activities.
Level
of appointment
and salary
depending
upon
candidates
experience
and
qualifications.
Salaries
can
be supplemented
through
the Department’s
Professional
Practice
plan. Excellent
fringe
benefits
program.
The
Hall
Psychiatric
Institute is located
in beautiful
downtown
Columbia,
only
capital
a few
of South
miles
affiliated
blocks
Carolina.
Carolina
from the University
Approximately
100
Ocean
and
for
write
Don-
M.D.,
the
South
Blue
Ridge
Mountains,
excellent
weekend
trips.
For information,
or call the Chain,
Alexander
G.
aid,
from
William
of
P.O.
Atlantic
Box
202,
SC 29202;
(803)
734-7113.
versity
South
Carolina
1212
of
mental
Negotiable
package
salary
health
and
full
cenbenefit
for board-ehigible/board-certi-
fled
M.D.
AACP/APA
Position
Guidelines.
patient
community
and
inpatient
meets/exceeds
Includes
out-
services
and
and university
hospi-
services
tal on grounds.
Private
practice
permitted.
Outdoor
mountain/water
necreation
abound.
Stable,
quality
cornmunity
practice
in metro
area
of
594,000
with University
of Tennessee
and
Smoky
Mountains.
Contact
Clif
Tennison,
M.D.,
Helen
Ross McNabb
Center,
vilhe,
1 520
TN
Cherokee
37920;
Trail,
(615)
Knox-
637-9711.
Columbia,
The
and
UniSouth
or
of
exceeds
Beaumont-Psychiatrists
highly
developed,
needed
in
JCAHO-
4-county
accredited
CMHC
in process
of expanding
scope
of operations.
Innovative methods
of delivering
services
to
all segments
of
by-line.
Primary
mont
area
250,000)
my, highly
the
population
service
sites
(Tn-City
with
and
Great
commu-
recreational
fresh/salt
fishing
1 hour
from
30 minutes
from
the
hour
drive
to Houston.
GulfCoast.
Flexible
uhe and
the
in our
assignments
and
base
econo-
medical
cultural
residential,
is our
Beau-
population
a well-balanced
developed
many
in
lakes
for
work
load:
tient.
Salary
weeks
inpatient
American
Asso-
Psychiatrists
psychiatric
practice.
Af-
80%
outpatient,
and
fringe
vacation,
20%
inpa-
benefits
one
week
(three
CME/year,
etc.) over $100,000,
depending
sition
and qualifications.
Contact
ent G. Denney,
M.D.,
Medical
ton, P.O. Box 4730,
Tyler,
TX
on po-
Rob-
Dinec75712;
(214)
597-135
1. EOE.
Tyler
is a beautiful
place
to live,
1 00 miles
east of
Dallas
in the Piney
Woods
and Lake
Country.
El
Paso-PSYCHIATRIST-New
position
division
center.
board
in expanding
medical
services
of a community
mental
health
Requires
board
eligibility
on
certification
and Texas
license.
A base
salary
depending
fication.
of
upon
Fringe
plus
$73,300-$95,700
experience
benefit
and certipackage
of
administrative
and
malprac-
tice liability
coverage.
El Paso’s cost of
living
is considered
one of the lowest
in the nation.
Average
three
bedroom
house rents for
average
home
Mountain
$496.00
per month;
sells
for
$65,000.
resorts
with
skiing
and
fish-
two hours
away.
A culturally
diverse
major
metropolitan
area, El
Paso has a population
ofover
500,000.
Our claim is not one of putting
more
money into your life but we do proming
are
ise more
Spanish/English
water
formation,
region,
Personnel
Center,
1-1/2
sched-
all
Community
fihiated
with
University
of Texas
Health
Center
at Tyler,
we provide
psychiatric
rotation
for their
Family
Practice
Residency.
Well-distributed
23%
Texas
opportunities.
Carolina
it meets
ciation
standards
nity,
South
Mental
Em-
and out-
standing
state-paid
retirement,
for a
total
benefits
package
worth
42%
of
annual
salary.
Salary
for a board-centifled psychiatrist
is up to $84,500
and
will
Carolina
Health
79990;
life for your money.
Bilingual
required.
For more incall or write
W. M. Smith,
Director,
Life Management
P.o.
Box
9997,
El Paso,
TX
(915) 594-1069.
outpatient,
Houston-PSYCH!
psychiatric
ATRISTS-
adult
crisis
stabilization
in a
structured
40-bed
residential
facility
and
a 20-bed
chemical
dependency
unit.
Functional
duties
will
include
Lange, multi-program
Psychiatry
Service in major
VA general
hospital
seeks
two certified
or eligible
psychia-
evaluations
in
hospital,
& assessments,
treatment
team
recommendations,
evaluation
and monitoring.
qualifications:
degree
proved
of
medical
3-year.
school
Psychiatry
gram,
Texas
medical
Board
certified
and
ence
preferred.
$ 102,000,
DOE
status;
excellent
Contact
rector,
John
Adult
medication
Minimum
from
an ap-
full-time
and
treatment
leadership
positions
abuse
affiliation
outpatient
programs.
drug
Strong
and completion
residency
benefit
post
pro-
required.
board
Salary
and
expeni-
$80,000-
board
certified
benefits
EOE.
TX,
77701;
package
includes
bonuses
subsidized
30
life
no malpractice
P. Ross, A.C.S.W.,
DiResidential
Programs,
MHMR
of Southest
St., Beaumont,
TX
6203.
for
inpatient
with Baylor
College
of Medicine
ports
opportunities
for teaching
research
as well as clinical
care.
license
and
fringe
tnists
2750
5. 8th
(409)
838-
new hospital
ample
days
and
health
opens
heave,
insurance,
Magnificent
in autumn
of 1990.
Positions
available
January
1990.
Send
CV to William
E. Fann, M.D.
Department
of Psychiatry,
Baylor
College
of
Medicine,
One
TX 77030.
Baylor
Plaza,
Houston,
Houston-PSYCHIATRIST
East
Texas/Tyler-PSYCHIATRIC
POSITIONS
available
to join five other psychiatrists
in a comprehensive
community
CMHC
has
November
mental
health
strong
medical
1989
Vol.
center.
leadership;
40
No.
SERV-
ICES-GENERALIST-CHILD/A-
DOLESCENT-Mental
Mental
Retardation
nis County,
Houston,
ditional
11
and
Full
salary
annual
premiums.
sup-
Hospital
Physician
and
Health
and
Authority
of HanTexas,
seeks adservices.
Community
Two
years
Psychiatry
experience
in a psychiatric
setting.
Must be board-certified
or board-ehigible. If you are interested
in full-time
or
part-time
services,
contact
Catherine
Fine Art,
collegiate
International
Henry,
major
Director,
(713)
Human
3737
683-4012,
D, Houston,
TX
Resources,
Dacoma,
Suite
clinical
Texas.
nestled
a variety
of
evaluations,
supervision,
development
in
a flexible
area
of beautiful
East
Texas,
125
Northeast
of Houston,
175
miles
Southeast
ofDallas,
and 20 miles
South of a 12,000
student
population
State university.
Favorable
cost-of-living area with a base salary of $100,000
plus travel pay of up to $12,000/year
and an additional
$ 1 ,000/week
compensation
if on-call
duty is worked.
Benefits
include
1 3 paid holidays
and
vacation
days/year,
insurance.
candidates
may
call
or
Dr.,
Lufkin,
TX
75901;
package
expenses,
holidays,
and
an
paid
or
send
(804)
23803.
for
a
motivat-
ehigi-
Psychiatry
additional
call
duty.
benefits,
and
Eastern
on-
exists
for
faculty
affiliation
of Washington
The
hospital
is situatfrom Spokane,
in
the
Pacific
Northwest.
a wide range of cultural
opportunities
includ-
civic theater,
two fourtwo community
colleges,
Washington
University.
and
an hour’s
lakes,
drive,
lent skiing,
fishing,
ing. Several
public,
golfing
facilities
are
vicinity.
for
possibility
mountains
less than
ad-
for
continuing
Salary:
$85,740
to have
University
colleges,
retireand
compensation
The
year
insur-
compensation
the heart
of
Spokane
offers
and educational
vaca-
life
within
offer
excel-
sailing,
and huntas well as private
in the immediate
In addition,
relocation
costs
are provided.
Housing
costs
in the
Spokane
area are below
the national
average.
Interested
psychiatrists
should
contact
Al Miller,
M.D.,
col-
Wisconsin
eligible/board
hospital.
with the
Medical
and
attractions
of a
the
Medical
College
of Virginia
with opportunities
for teaching
and research.
Richmond,
“one of the most livable
cities in the country”
is conveniently
located
within an easy two hour drive
to the mountains,
beaches,
historic
‘Williamsburg,
the nation’s capital, and
affords a wide array of cultural,
histonical, and recreational
opportunities.
In
the greater
Richmond
area there
are
opportunities
to enjoy the symphony,
Community
employer.
Ft. Steilacoom-GENERAL
CHIATRIST
(Board
hiking,
ble or board
certified
psychiatrist
to
become
a pant of our staff. Opportunity for practice
with adult and forensic
and
State
Petersburg,
EEO/AA
plus
Nearby
vi-
Central
4030,
deferred
of paid
leave,
Washington
The hospiUniversity
of
School
nearby
with
skiing.
include
chini-
sports.
and
the
The
State
income
CV
plan.
Send
Professional
Hospital,
(206)
Services,
Fort
756-2349.
Medical
insurance,
equivadeferred
to
Director,
State
WA 98494;
STATE
addition
of
cellent
knowledge
of psychopharma-
cology,
the
to
working
in an interdisciplinary
and
relate
well
be
new
setting,
health
recreational
outlets
An excellent
November
40
Vol.
Excellent
include
Door
Winnebago
and LawUniversity.
Low overhead,
exincome
potential.
Specialty
inencouraged.
Call Ken Olson,
Lake
County,
Madison
or write
St., Suite
530,
1531
South
Appleton,
WI
54915.
& Conferences
AMERICAN
GROUP
PSYCHOTHERAPY
ASSOCIATION
ANNUAL
MEETING,
34TH
ANNUAL INSTITUTE,
47TH
ANNUAL
CONFERENCE,
THE
WESTIN
No.
PLACE,
BOS-
interest
11
sections
geared
toward
experiential
learning.
Different
modalities will be represented
by top therapists. In conjunction
the Conference
with
provides
the
Institute,
stimulating
papers,
panels,
demonstrations
and
workshops
designed
to broaden
the
scope of the participant’s
area of expertise.
Topics
to be covered
include:
Hospital
cen-
tens and the community.
1989
nity in the hub ofWisconsin.
cific
comfortable
to mental
primo-oppontu-
TON,
FEBRUARY
20-24,
1990:
The Institute
is devoted
to small group
teaching
and provides
an array of spe-
psychiatrist
positions,
the hospital
has
psychiatric
vacancies
in its adult,
geniatnic,
and
forensic
psychiatric
programs.
Applicants
should
have an exability
hospital-affihiat-
risk,
HOTEL-COPLEY
Lake-EASTERN
to the
private
Low
Meetings
EOE.
Due
practice.
seek
psychiatrist
an
HOSPITAL
is a 362-bed
JCAHO-accredited
facility
serving
Eastern
Wash-
ington.
psychiatrists
inchud-
Western
Steilacoom,
to join thriving
ed
(414) 738-2727,
and
are
is without
estimated
optional
of
or adolescent/child
Seattle-
benefits,
ing hospitalization/medical
retirement,
vacation
hence at 24%,
plus
group
general
theatre,
cool summers
housing
costs
tax. Excellent
Appleton-PSYCHIATRIST-Pro-
gressive
rence
cellent
terest
Additional
symphony,
professional
income
with
the possibility
appointment
with
liabil-
insurance,
cal faculty
appointment
possible.
Located on Puget
Sound,
the area offers
boating
of all sorts,
fishing,
camping,
(409)
board
11
curriculum
do
Box
An
Washington
Area-PSYCH!-
is searching
populations
joint
faculty
their
medical/dental
ment,
ing symphony,
leave,
health
524-7511,
P.O.
certified
(HCFA)
tal is associated
send
Hospital,
sick
professional
Tacoma
area enjoys
temperate
winters;
professionally
fringe
relocation
tax deferred
cornInterested
applicants
plan.
call
to
certified
and with WA State license)-.Salary to $85,74
1. Western
State Hospital is a fully accredited
(JCAHO)
and
ing JCAHO
accredited
psychiatric
hospital
located
on a beautiful
700acre campus twenty-five
miles south of
Richmond
and
ance,
Medical
School.
ed twenty-minutes
certi-
Excellent
consists
sick
holidays,
psychiatrists
with
the
upward
board
including
annual
reasonable
stimulating
Hospital
or eligibility.
and
State
nationally
for
package
tion,
lect, (509) 299-4351,
or P.O. Box A,
Medical
Lake, WA 99022,
for further
information.
Virginia
Richmond
a bonus
benefit
Hospital,
.
ATRIST-Central
both
and ranges
plus
fication
son,
639- 1 14 1 EEO/AAE.
Greater
cities
benefit
ministrative
leave
medical
education.
Rich-
tae’s to: Richard
Elliott,
M.D.,
Ph.D.,
Medical
Director,
(804) 524-7291
or
John P. Kirby,
Recruitment
Supervi-
their resume
to: Mn. Tim Richenson,
Director,
Human
Resources
and Business
Planning,
Deep
East
Texas
MHMR
Services,
4101
South
Medford
linking
The hospital
has an active
medical
education
program
with experience,
VA
from
of
the area provides
many opportunifor continuing
education,
includthe Medical
College
of Virginia.
Salary
is negotiable
commensurate
may
approved
medical
school and completion of an approved
three year psychiatnic residency
required.
Two
years
experience
in a clinical
management
position
following
residency
program
preferred.
Must
have Texas
license
and Board
Certification
preferred.
Qualified
other
pensation
$8,000-
Graduation
closely
ity and life insurance,
paid retirement,
and
$ 1 0,000/year
center
contribution
to
your
retirement
plan, no social secunity taxes
withheld,
paid medical/dental/hife insurance,
and paid professional
liability
Museum
and
ties
ing
paid
miles
12
to
$97,327,
environment
located
in Lufkin,
Lufkin
(population
30,000)
is
in the non-urban
pineywoods-
/lakes
airlines
mond
Mental
Health
Center
to provide
services
including
medical
psychotherapy,
clinical
staff
recognized
and, both professional
and
sporting
events.
Richmond
Airport
is served
by six
and abroad.
continuing
77092.
Lufkin-PSYCHIATRIST-Staff
psychiatrist
for
Community
and
a nationally
Approach.
Accreditation
Settings
AGPA
and
Group-Centered
is accredited
Council
for
by the
Medical
1213
Education
to
cation
also
for
sponsor
credits
continuing
for
meet
the
the American
Physician’s
Events
criteria
for
Medical
Category
Association
Recognition
program
contact:
East
2 1st
Street,
NY
10010.
1
Award.
information
materials
edu-
physicians.
and
For
registration
AGPA,
6th Floor,
Dept.
New
4, 25
York,
Premiering
in the
January
1990 issue, the
Products
and Services
Directory
CALL
FOR PAPERS.
SUICIDE
IN
THE 1990’S. American
Association
of
Suicidology
23rd Annual
Conference,
New
Orleans,
Louisiana,
April
25,
1990.
Contact:
AAS,
2459
5. Ash,
Denver, CO 80222; (303) 692-0985.
Books
& Tapes
HELP
YOURSELF
AND
YOUR
PATIENTS.
Psychiatrist-produced
VHS
tapes
save
you
patient
compliance,
ity by explaining
and
precautions
time,
improve
and
reduce
liabilthe
uses,
side effects
for
Lithium,
Neuro-
leptics,
and the medications
used for
treating
Anxiety
and Depression.
Use
them in the office, hospital,
training,
etc.
Approximately
each.
One
tape-$59;
three-$145;
four-$180.
rency
twenty
or equivalent.
minutes
two-$
100;
U.S.
cur-
Send
check,
ey order,
or Master
Card/Visa,
number
to
2060
P55,
Drive,
Suite
Houston,
TX
1 597
for
Money
A
Space
Park
404,
Department
77058. Call (713)
information
Back
Mental
mon-
AMEX
or
to
D,
335-
order.
Guarantee.
Health
classified
Employers
ad
in
COMMUNITY
HOSPITAL
PSYCHIATRY
&
adds
a new dimension
to your staff recruitment
efforts.
Here’s
why:
1) A classi-
fled
ad in H&CP
takes
into a wide
variety
treatment
settings,
and administrative
country.
2)
ensures
reach
other
3)The
in H&CP
incorporated
ment
that
your
message
psychologists,
health
cost
means
in
program.
your
position
available
issue!
1214
the
psychiatric
nurses,
activity
therapists,
mental
low
across
interdisciplinary
psychiatrists,
administrators,
cial workes,
message
agencies
H&CP’s
readership
will
your
of mental
health
training
programs,
professionals.
of classified
that
your
Plan
openings
soand
advertising
it can
current
now
easily
be
recruit-
to advertise
in
the
next
November
1989
Vol.
40
No.
11
Hospital
and
Community
Psychiatry
..
PSYCHIATRIST
POSITION
FlED
OR BOARD
MUST
BE LICENSABLE
LENT
SALARY
CREDITED
IN INDIANA.
BENEFITS.
AND
FACILITY
INDIANA.
1-2
TOWN
ATMOSPHERE
DRIVING
NITIES
INVESTIGATE
HERE
CENTER,
AT
SEND
LEUERS
THE
AND
PERSONNEL
EQUAL
BOWEN
is the
health
members
board
eligible
certified/board
us keep
up with
Program
rapid
in
growth
Northeastern
multispecialty
group
practice
care
services
to the
In the Cleveland-Akron
more
than
of oven 40 plus
Permanente
a mature,
Kaiser
that
205,000
area.
of experience
makes
years
(25 in
leader
solId,
in the managed
care sector
of the health
care industry.
The rewards
of practice
with us are substantial-excellent salary and benefit
packages,
company-paid
retirement plan,
full malpractice
coverage.
A stimulating,
cine,
Kaiser
environment
in which
Permanente’s
of the
dynamic,
offers
the best
Please
to practice
Ohio Region
resurgent,
ofbig
your
living
resume
mcdl-
may
call
us
in the heart
Midwest.
The
and culture
area
in an
area.
to:
Ronald
G. Potts,
M.D.
Medical
Director
Ohio
Perinanente
Medical
1300
E. 9th Street,
Suite
Cleveland,
OH 44114
EMPLOYER
Is located
industrial
city sophistication
accessible
send
IN 46580
oryou
quality
more...
and
affordable,
BOX 497
OPPORTUNITY
for
Permanente
OPMG
collegial
TO:
Ohio
Permanente
Group,
Inc.
to help
Kaiser
Ohio)
OffICE
WARSAW,
looking
Our wealth
REFERENCE
OF LICENSE
COPY
P.O.
R.
3
are
provides
Kaiser
OPPORTU-
OTIS
RESUME,
the
Medical
the
Ohio.
SPORTING
THE
We’re
we
of
OFFERING
MAJOR
AND
A LEADER
PSYCHIATRISTS
DISTANCE
CITIES
ARTS
TO
THE
and
METROPOLITAN
EVENTS.
IN
IN NORTHERN
HOURS
THEATER,
AC-
REQION
SMALL
WITHIN
JCAIIO
PERMANEN1E
JOIN
EXCEL-
LOCATED
OF LAKES
HEART
OF
KAiSER
FOR BOARD CERTIELIQIBLE PSYCHIATRIST.
AVAILABLE
collect
at
Group,
1100
(216)
Inc.
623-8780.
BINGHAMTON
g!!c
;51v,i
fttiiiicic
PSVCHIATRC
CENTER
Child
Psychiatrist
M[LICAI
CERTiFIED
BOARD
DIRECTOR
PSYCHIATRIST
OF A 48.BED
MEDICAL
D1RECTOR
AND
MEDICAL
HEALTH
UNIT
SERVICES
POSITION
AS MEDICAL
COMPREHENSIVE
WITHIN
TO
THE
OF
MEDICATION
OF
PROVIDED
ASSURES
AND
REGULA11ONS
BOARD
OVERSEES
APPROPRIATENESS
CENTER,
AGENCY
BY
MENTAL
AS
IN
PROVIDES
MANAGERIAL
A
DIRECTiON
AND
TO
THE
HAVE
AN
ALL LAWS.
THE
SERVES
THE
AS ADVI-
DIRECTOR,
CENTER’S
CONSULTANT
TO
MENTAL
WITH
CUNICAL
RELATION
THE
INDIRECT
REPRESENTS
COMMUNITY
MEDICAL
ASSURES
AND
COMMUNITY
COMPUANCE
DIRECTOR.
DIRECTORS
SERVES
CUNIC,
DIRECT
REQUIREMENTS;
MEDICAL
EXECUTIVE
ALL
GARY
MEDICAL
FUNDING
THE
SERVICES;
MUST
INPATIENT
FILL
TO
PHYSICIANS
AND
MEDICAL
THERAPISTS;
AND
CUNI-
DIRECTOR.
BE BOARD
CERTIFIED.
COMPE1ThVE
SALARY
SEND
OF APPUCATION
LFflER
LaNITA
HUMAN
GARY
(219)
AND
MUST
FRINGE
BENEFIT
AND
VITAE
INDIANA
PROGRAM
UCENSE
OFFERED.
TO:
M. JAMES
We
are
COMMUNITY
core
position as a Child Psychiatrist
Psychiatric Center.
a 535 bed JCAHO
accredited
awaits you at the
New
York
State
Hospital.
We have a 15 bed Adolescent
Unit consisting of adolescents ages 13-18 drawn from a 5 county catchment
area.
The Adolescent
Service provides a full range of psychiatric
services and is closely networked
with community
agencies
and school systems. We are currently
in the planning
stages for a major capital expansion.
Binghamton,
New York is nestled
in a valley of the
Appalachian
Foothills,
an area of outstanding
natural
beauty which is centrally located and easily accesses New
York City, Syracuse, etc., the Fingerlakes
and Poconos.
The Metropolitan
area boasts a population
of 250,000
with excellent school systems and a major university
and
many other cultural associations.
We are seeking the right individual
who is board certified
in child psychiatry and is a dynamic leader, a team oriented individual
and one who will guide our Adolescent
Unit
with vision as we continue to expand.
Who Care” and grow
with
us.
DEPARTMENT
MENTAL
6th AVENUE
INDIANA
who
Come and join the “People
RESOURCES
I 00 WEST
GARY,
A fulfilling
Binghamton
Psychiatric
QUAUTY
CAL
TO
FACIUTY.
HEALTh
SOR
I
PopIe
HEALTH
CENTER,
INC.
Contact:
Mr. Russell Jordan
Director
of Human
(607)
46402
Resources
773-4012
881-2456
EOE/M/F
, EW
STATE
Equal HEALTH
0punI/AffirmatIve
FFICEYORK
OF MENTAL
ActIon
Employer