Am J Psychiatry /36:12, December /979 BOOK REVIEWS

dynamic theory but seems to use it as a flexible guide, not as graph. Villeneuve attempts to define the various forms of
an armor against pragmatic and humanistic practice. physiological and pathological anxiety. stating that drug
In my own current fields ofspecial interest, family therapy treatment should be reserved for the latter. He also points up
and marital therapy, I found Bentovims and Dominians some of the problems in classification of psychotropic drugs
chapters to be most lucid and sensible statements. Each of- and suggests that a new term, anxioleptic, should be used
fers good clinical illustrations that reveal the vitality of those instead of tranquilizer to designate specifically a class of
modalities. Dr. Blochs presentation of group therapy, al- drugs whose primary clinical action is anxiolytic, preferably
ways an extremely difficult thing to do, could not be done without inducing sedation: i.e. , without notable effect on
better in a brief presentation. Bancrofts and Gelders papers psychomotor activity and/or vigilance.
about behavior therapy and sex therapy are areas about Villeneuve also emphasizes that the majority of tests used
which I am least familiar, but I found the writing clean and to screen potential psychotropic agents in animals have little
the ideas sensible. Although the range of papers implies cc- or no relationship to the value ofthese drugs in humans. He
lecticism, the brand is a substantial one. The authors reflect points out that anxiolysis is not an exclusive pharmaco-
their essentially English origins through uncomplicated and logic property and can be produced without drugs. This fact
lucid use oftechnical language. Although I am not an Anglo- can make the clinical evaluation of the efficacy of tranquil-
phile, I must admit I was impressed. izers more difficult. Villeneuve feels that there is a definite
qualitative and quantitative difference between the sedative
SAUL L. BROWN, M.D. and anxiolytic action of many psychotropic agents, although
Los Angeles. Calif. this difference is not easy to establish.
Janke and his coworkers review the research in the dif-
ferential psychopharmacology of tranquilizing and sedating
Downs Syndrome: The Psychology of Mongolism, by David agents. These authors are well aware of the importance of
Gibson. New York, N. Y. , Cambridge University Press, individual variation among patients and its effect on the ad-
1978, 360 pp. , $42.50. ministration of psychotropic drugs. They arc also cognizant
of the shortcomings of their review in that it deals only with
Professor Gibson provides an integrated study of the most single dose administration in normal subjects, although the
recent biological and psychological research on the nature authors refer throughout the paper to results with patients
and management of Downs syndrome. Eighteen of his pa- receiving pharmacotherapy. Nevertheless, their analysis of
pers are listed in the extensive bibliography, testifying to his the nondrug factors influencing results with drug treatment is
broad research interest in the field. exhaustive and excellent. The chapter suffers slightly from
The introduction underlines the magnitude ofthe problem, using an outline format, which adds little to the presentation,
which affects approximately I in 600 children born and costs and from an overabundance of detailed charts and figures
the United States between $1 and $2 billion annually. The that are, at times, unnecessary and confusing. The bibliogra-
authors intention is to identify links between biological and phy, however. is extensive and useful.
psychological phenomena, which arc elaborated in chapters Simon and Soubnie review the animal literature on at-
covering early psychological development and dimensions tempts to differentiate between the anxiolytic and sedative
and foundations of intelligence, including studies connecting activity oftranquilizing drugs. They conclude that it is often
karyotypes and IQ. The author concludes that the sources but not always possible to separate sedative and anti-anxiety
of the variability of intelligence remain undetermined and effects. After their extensive review of the animal literature
that IQ and development can only partly be based on cyto- these conclusions leave one with a feeling of mild dis-
genetic data. appointment.
The chapters on personality, socialization, learning, and In a departure from the subject matter of the title of the
language provide a basis for the section on behavior manage- book, Valzelli reports on the effects of sedatives and anx-
ment. The stereotyped fear that Downs syndrome consti- iolytics on aggressivity in animals. The ability to control cx-
tutes an unalterable state exercises an inhibiting influence on cessive or pathological aggression is a subject of increasing
the approach to management. Dr. Gibson stresses that the importance and considerable clinical significance. Valzelli
syndrome is not defined at birth and proposes useful and examines the effects on aggressive behavior in animals of
maturationally specific programs of early intervention. It is two major categories of drugs: I ) sedative drugs. which in-
my hope that this important reference book will help to dude antihistamines, barbiturates, phenothiazines, buty-
correct psychiatrys disinterest in an important aspect of rophenones, and reserpine derivatives, and 2) anxiolytic
mental retardation. drugs, which include meprobamate and benzodiazcpines. He
points out the complicating factors ofgroup behavior and the
PHILIPPE F. CHANEL. M.D. importance of certain types of aggressive action in self-pre-
Washington. D.C. servative and mating activities.
One of Valzellis most interesting observations is that al-
most all drugs that have some anti-aggressive properties are
Modern Problems of Pharmacopsychiatry, Vol. 14: Dif- also capable of increasing aggressive behavior in both labo-
ferential Psychopharmacology of Anxiolytics and Sedatives, natory animals and man. These aggressogenic effects usu-
edited by J.-R. Boissier. Basel, S;titzerland, S. Karger, ally occur at much lower doses than those used to control or
1979, /73 pp., $35.25. ameliorate anti-aggressive effects.
The final chapter, by Schallek and Schlosser, reviews the
This volume attempts to determine whether the anxiolytic neuropharmacology of sedatives and anxiolytics. Although
properties of tranquilizers can be separated from their seda- not ofimmediate use to the clinician, its value to researchers
tive effects. The clinical value of minimizing or eliminating regarding the possible sites ofaction ofthese drugs is consid-
annoying side effects from a drug while still maintaining its erable. Animal experiments indicate that barbiturates induce
calming effects is obvious. Five papers comprise this mono- their sedative effects by depressing the reticular activating

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BOOK REVIEWS Am J Psychiatry /36:12, December 1979

system in the rostral brain stem. Anxiolytic drugs intended tween short-term and long-term patients one and two years
to reduce anxiety at doses that do not cause sedation or sleep after discharge.
(propanediols such as meprobamate) may act by depressing The authors summarize the clinical implications of their
deactivating centers in the caudal brain stem, releasing the study as follows: 1) for most patients with schizophrenia and
activating centers in the rostral brain stem and thus depress- for all patients with neurosis and personality disorder there
ing the thalamic recruiting response, and by depressing the is no clear advantage of a length of stay longer than four
amygdala or hippocampus. These effects may release the re- weeks, 2) schizophrenic patients who have functioned well
ticular formation from inhibition. Recent research has re- before hospitalization tend to drop out of aftercare programs
vealed a specific binding site for benzodiazepines in the brain that provide psychotherapy; one way to encourage patients
of the rat. Barbiturates, in sharp contrast, do not bind to to persist in aftercae is to extend hospitalization beyond two
these sites. to four weeks so that a firm connection to aftercare treat-
This excellent review of present-day research efforts to ment can be established, 3) schizophrenic patients who did
differentiate between the anxiolytic and sedative effects of not function well before they were hospitalized tend to stay
psychotropic drugs substantiates that much has been accom- in treatment after brief hospitalization and should therefore
pushed in attempting to make this differentiation but that the be hospitalized for a short period of time.
ideal anxiolytic has not yet been developed. Much more re- I feel that this study begins to provide some solutions
search must be done before a clinically significant difference to problems that currently face the field of psychiatry
between anxiolytics and sedatives can be established. and need to be answered in the l980s. The authors are to be
congratulated for their important contribution to this goal.
SIDNEY MALITZ, M.D.
Ne%t York, N. Y. GEORGE W. BARTHOLOW, M.D.
Omaha, Neb.

Psychiatric Hospital Treatment for the 1980s: A Controlled

Study of Short Versus Long Hospitalization, by Ira D. Glick Growing Up to Be Violent: A Longitudinal Study of the Devel-
and William,, A . Hargreaves; ttit/z the collaboration of Joan opment of Aggression, by Monroe M. Lefkowitz, Ph.D.,
Drues ii,ic/ Jonathan S/to itstack . Lexington . Mass . . Lexing- Leonard D. Eron. Ph.D. , Leopold 0. Walder, Ph.D. , and L.
ton Books (D.C. Heath and Co.), /979, 140 pp. , $16.95. Rowe/I Hues,nann, Ph.D. Elmsford, N. Y. , Pergamon Press,
1977, 224 pp. , $14.00; $8.00 (paper).
The study reported in this book begins to give some factu-
al data on which psychiatric hospital treatment for the future This book incorporates the strengths and weaknesses of
can be based. Many questions need to be answered, not only social science research methodology when applied to a com-
for psychiatrists but for health planners, insurers, and politi- plicated, hard-to-define subject, namely, violence and ag-
cians. There has been much heated debate on such issues as gression. The authors attempted an ambitious longitudinal
hospital utilization, short-stay versus long-stay, aftercare, study of 875 third-grade children in Columbia County, New
and the revolving
door syndrome, but few facts on which York. They interviewed the children and most of their par-
a rational treatment policy could be based have been avail- ents in 1960, then followed up with 427 interviews in 1970.
able to date. Through a combination of self-report, peer ratings, psycho-
To address these issues the authors present a controlled logical tests (MMPI), and objective measures like arrest re-
comparison of the effects of brief hospitalization, defined as ports, the authors attempted to measure the aggressiveness
three to four weeks, with the effects of hospitalization rang- of the sample and to find connections between a number of
ing from three to four months in duration. A total of 235 pa- variables that they conceptualized as independent and
tients were involved in the study: I 17 were in the short-stay various measures of aggression.
group and I 18 were in the long-stay group. The diagnostic The authors independent variables were classified as fol-
categories represented by these patients were schizophrenia, lows: 1) instigators (parental rejection, parental disharmony,
affective disorder, neuroses, personality disorders, and hys- lack of nurturance of the child by the parents, and IQ), 2)
terical personality. The patients with hysterical personality contingent responses to aggression (such as the use of pun-
were analyzed separately because they were expected to be ishment), 3) identification (identification with a parent, sex
the most refractory to current treatment approaches. The role identification, and television preferences), and 4) socio-
groups were analyzed at four weeks of hospitalization, at cultural factors (status offathers occupation, education 1ev-
discharge, and one year and two years after discharge. At- els of mother and father, mobility, and aspirations).
tempts were made to make the treatment experiences of all Using a number of statistical techniques, primarily regres-
of the hospitalized patients as similar as possible in such sion analysis, the investigators made a number of general
areas as medication and staff attitudes. and specific findings. They concluded that instigator van-
The authors found that short-term schizophrenic patients ables exerted their greatest effects during childhood and that
were functioning better at four weeks than the long-term the effects of these variables were not prolonged into adult-
schizophrenic patients. Specific symptoms of subjective dis- hood. Identification variables and, particularly, sociocultural
tress and withdrawal were significantly improved at four variables tended to be better predictors of violence and ag-
weeks in the short-term schizophrenic patients. Long-term gression at age 19 than other variables. Specifically, the au-
schizophrenic patients had less symptomatology at dis- thors concluded that I ) aggression appeared to be more pre-
change. The long-term hospital treatment had a major effect dominant as a trait in males than females, 2) fathers aspira-
on schizophrenic patients participation in aftercare pro- tions for socioeconomic status appeared to be related to
grams, and this effect lasted into the second year. For the higher levels of aggression in boys, 3) there was a strong
patients with diagnoses other than schizophrenia, the au- relationship between preferences for violent television pro-
thors found that short-term patients functioned better at four grams and higher aggression levels in boys (both at age 8 and
weeks and that there were no significant differences be- age 19), 4) cultural and sex role factors appeared to influence

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