Paul R McHugh

Johns Hopkins Medicine | JHUSOM · Department of Psychiatry and Behavioral Sciences

Conversations in Critical Psychiatry’ was an interview series led by Awais Aftab for Psychiatric Times from 2019 to 2022, exploring critical and philosophical perspectives in psychiatry and engaging with prominent commentators within and outside the profession who had made meaningful criticisms of the status quo. The series was well received and ge...

This chapter introduces and compares three prominent systems for the classification of mental illness, recognizing that no one system is ideal for all purposes and that there is a complicated historical context for each. The Diagnostic and Statistical Manual of Mental Disorders arose in response to a troubling lack of consistent and reliable diagno...

This lecture, given to celebrate the centennial of the founding of the Henry Phipps Psychiatric Service at Johns Hopkins, addresses the career and contributions to psychiatry and neurology of Adolf Meyer, the first Phipps Professor. It reviews his achievements historically describing the bleak clinical situation of psychiatry when he began as a neu...

In this companion volume to their widely acclaimed Perspectives of Psychiatry, Phillip R. Slavney, M.D., and Paul R. McHugh, M.D., argue that the discontinuity of brain and mind is the source of much of psychiatry's discord, for it leads psychiatrists to think about their discipline in terms of polar opposites: conscious or unconscious; explanation...

Current efforts to improve the mental and behavioral well-being of the public confront an awkward but conspicuous problem. Although contemporary psychiatric epidemiologic research indicates that some kind of mental disorder afflicts more than 50% of the American people at some time in their lives, it fails to suggest any pathways for either prevent...

In its fifth edition, the Diagnostic and Statistical Manual of Mental Disorders should correct a categorization scheme based on clinical appearance, which offers no way of making sense of mental disorders and fosters a diagnostic method reliant on symptom checklists.

Psychiatry has long struggled with the nature of its diagnoses. This resource brings together established experts in the wide range of disciplines that have an interest in psychiatric nosology.

Throughout his long career, Jerome Frank devoted himself to teaching as well as research. In chapter 8 of Persuasion and Healing (Frank and Frank 1991), he spelled out some implications of his ideas for the training of psychotherapists of many disciplines. This opened up new vistas for the psychiatrists, psychologists, and other therapists who foll...

Research findings have fuelled debate on the construct validity of post-traumatic stress disorder (PTSD). Accompanying these issues are competing suggestions to redefine PTSD's criteria, including a recent proposal by DSM-V committee members. We review various approaches to revising the PTSD diagnosis and conclude that proposed changes should be pl...

Since an automobile accident in 2005, patient FL has reported difficulty retaining information from one day to the next. During the course of any given day, she describes her memory as normal. However, memory for each day disappears during a night of sleep. She reports good memory for events that occurred before the accident. Although this pattern...

"Sybil" is a story of a young woman who has developed sixteen "personalities" that was written by both journalist Flora Rhea Schreiber and psychiatrist Cornelia Wilbur. In each of its distinct alternative personalities, the woman have different behaviors with sometimes being an aggressive male, a defenseless child and an intellectual woman. These s...

Significant issues challenge the diagnosis of post-traumatic stress disorder (PTSD). Yet, applications of the PTSD 'model' have been extended to an increasing array of events and human reactions across diverse cultures. These issues have implications for clinical practice and for those who revise criteria in the DSM-V.

Despite increased professional attention to the mental health aspects of disaster medicine in recent years, advances in clinical assessment of survivors of mass casualty incidents have been few. Contemporary assessment methods often yield little more than check lists of symptoms that, while they may lead to reliable DSM-IV diagnoses, provide no sen...

Since the publication of Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, posttraumatic stress disorder (PTSD) has become a remarkably dominant theme in mental health discourse and diagnostic practice. This development has been encouraged by the diagnosis being officially presumed to exist in acute, chronic, delayed, complex, subdro...

Because most psychiatric illnesses are complex phenomena, no single method or approach is sufficient to explain them or the experiences of persons who suffer from them. In The Concepts of Psychiatry S. Nassir Ghaemi, M.D. argues that the discipline of psychiatry can therefore be understood best from a pluralistic perspective. Grounding his approach...

Psychiatrists are reconsidering how to classify the conditions they treat. What they decide will affect who receives psychiatric services and what those services will be––matters surely of interest and concern to all physicians and health care workers. But the American Psychiatric Association has delayed a new revision of its classificatory manual...

In following families who reported to the False Memory Foundation between 1992 and 2001 that a member had charged them with incest, a survey questionnaire (with a 42% return rate) was sent to some 4,400 families. These data demonstrate that 99% of these accusers were white, 93% were female, 77% were graduates, 86% were in psychotherapy, and 82% acc...

Gerry Smith had been a fellow in the Neuropsychiatry Division at the Walter Reed Army Institute of Research. There, he and Paul McHugh first worked together. This is the story of the formation of their two companion careers in physiology and behavior and the issues they confronted at this early stage.

Health care reform has posed special challenges for departments of psychiatry in academic medical centers. This report describes one department's strategic responses to a marketplace with high penetration by managed care and provides examples of the kinds of faculty concerns that can arise when major departmental reorganizations are attempted. The...

A demand was made in psychiatry to change the fourth addition of the American Phychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The psychiatric association rejected the proposal by emphasizing that the mental illness are linked to brain disorders. The association further emphasized that, any distressing mental state o...

From a sample of 239 patients diagnosed paranoid state and hospitalized between 1913 and 1940 at the Phipps Clinic, we particularly studied a group of 60 patients without previous hospitalizations, consisting of 57 patients with follow-ups of 5 or more years, and 3 patients who killed themselves (the ultimate follow-up) less than 1 year after disch...

We examined the relationships between gastric volume and duodenal glucose load in the regulation of gastric emptying in adult male rhesus monkeys. Intragastric glucose loads (0.125 g/ml) of volumes ranging from 150 to 375 ml empty from the stomach at the same rate from 20 to 120 min. However, to achieve these equivalent emptying rates, progressivel...

We examined the relationships between gastric volume and duodenal glucose load in the regulation of gastric emptying in adult male rhesus monkeys. Intragastric glucose loads (0.125 g/ml) of volumes ranging from 150 to 375 ml empty from the stomach at the same rate from 20 to 120 min. However, to achieve these equivalent emptying rates, progressivel...

From a sample of 1357 schizophrenic patients hospitalized between 1913 and 1940 at the Phipps Clinic, we have follow-up data on 1212 (89%) cases, with a mean length of follow-up of 11 years. Of these 1212 patients, 28 (2%) are known to have committed suicide. Suicide was significantly correlated with 1) previous suicide attempts, 2) depressive symp...

From a sample of 1357 schizophrenic patients hospitalized between 1913 and 1940 at the Phipps Clinic, we particularly studied 484 patients with follow-ups of 5 or more years. Of the sample of 1357 patients, 28 (10%) committed suicide. None of the suicides were included in the sample of 484, which also eliminated all patients with any previous psych...

Substantially revised to include a wealth of new material, the 2nd edition of this book provides a concise, coherent introduction that brings structure to an increasingly fragmented and amorphous discipline. The authors offer an approach that emphasizes psychiatry's unifying concepts while accommodating its diversity. Recognizing that there may nev...

At graduation, many medical students recite oaths vague in precept and betraying a self-solicitude inimical to professional maturity.

Evidence suggests that the neuropathology of Huntington's disease, a neuropsychiatric disorder due to a mutation on chromosome 4, results from excessive activation of glutamate-gated ion channels, which kills neurons by oxidative stress. Therefore, the authors hypothesized that alpha-tocopherol, which reduces oxyradical damage to cell membranes, mi...

Contemporary psychiatric misdirections derived primarily from standard medical errors of oversimplification, misplaced emphasis, and invention are reviewed. These particular errors, however, were in part prompted and sustained by the sociocultural fads and fashions of the day. The results have been disastrous for everyone--patients, families, the p...

The author discusses major issues of faculty promotion in medical schools by describing the decision-making processes of the Professorial Promotion Committee (PPC) at The Johns Hopkins School of Medicine, a committee he chaired for several years. Perhaps the major dilemma of medical school promotion committees is how to define standards that encomp...

This exploratory study compares the prevalence of personality disorders and traits in people over and under 55 years of age. The comorbidity between personality and other psychiatric disorders is also examined. Psychiatrists examined 810 subjects in a two-stage community survey. The semi-structured Standardized Psychiatric Examination was used to d...

Peripheral administration of the brain/gut peptide cholecystokinin (CCK) has been demonstrated to inhibit food intake in a variety of species, and administration of the specific type A CCK receptor antagonist devazepide increases food intake in a variety of experimental paradigms. The potency of CCK to inhibit intake depends upon a variety of facto...

To identify the transduction mechanisms underlying gastric vagal afferent responses to gastric loads and cholecystokinin (CCK), we investigated the ability of specific CCK antagonists, acute pylorectomy, and cholinergic blockade to effect these vagal afferent responses. The CCK-B antagonist L-365,260 (10 pmol-1 nmol) failed to block the gastric vag...

The aims of this study were to estimate the prevalence and investigate the comorbidity and potential consequences of DSM-III personality disorders in the community. A total of 810 adults were examined in the second stage of the Eastern Baltimore Mental Health Survey in 1981, part of the National Institute of Mental Health Epidemiologic Catchment Ar...

A total of 810 adults were examined by psychiatrists in the second stage of the Eastern Baltimore Mental Health Survey. A semistructured examination, the Standard Psychiatric Examination, was used. The relationships between obsessions and compulsions and personal characteristics, childhood behaviors, family history, and other psychopathology were e...

To identify genes responsible for the susceptibility for schizophrenia, and to test the hypothesis that schizophrenia is etiologically heterogeneous, we have studied 39 multiplex families from a systematic sample of schizophrenic patients. Using a complex autosomal dominant model, which considers only those with a diagnosis of schizophrenia or schi...

The object of this study is to assess the internal validity of DSM-III personality constructs and to explore whether the constituent elements are better explained by an alternate internally coherent classification. A two-stage stratified random sample of subjects identified at the Baltimore site of the Epidemiologic Catchment Area (ECA) program wer...

To ascertain the prevalence and type of psychiatric morbidity present in HIV infected patients presenting for the first time to a specialty HIV medical clinic. Also, to develop a way of screening for psychiatric cases in this setting using established self-report questionnaires. Fifty patients who presented consecutively for medical care at the Joh...

Both gastric preloads and exogenous cholecystokinin (CCK) administration inhibit food intake, and combinations of preloads and CCK suppress feeding to a greater degree than either stimulus delivered alone. A role for the vagus nerve in mediating CCK's inhibition of food intake has been proposed, and gastric vagal afferent fibers respond to both gas...

The exogenous administration of the brain/gut peptide cholecystokinin (CCK) inhibits food intake in a variety of species, including subhuman primates and humans. To determine the role of endogenously released CCK in the control of food intake in rhesus monkeys, we examined the ability of the selective type A and type B CCK antagonists devazepide an...

A role for the brain/gut peptide cholecystokinin (CCK) in the control of gastric emptying has been proposed. In the present studies, we have used a potent type A CCK-receptor antagonist (devazepide) to examine the quantitative contribution of endogenously released CCK in the control of liquid gastric emptying of 100 ml lipid, protein, and carbohydr...

This article reviews the literature on the classification and treatment of psychiatric morbidity associated with infection from the human immunodeficiency virus (HIV). The psychiatric disorders seen in HIV-infected patients are formulated by using one of the following four perspectives as treatment guides: 1) the syndromal or disease perspective, 2...

Pages R630–R637: G. J. Schwartz, G. Berkow, P. R. McHugh, and T. H. Moran. “Gastric branch vagotomy blocks nutrient and cholecystokinin-induced suppression of gastric emptying.” Page R361: An incorrect formula was used to calculate the volume remaining. The correct formula appears below. V = (C s /C i ){[5/(1 – C o /C s )] – 5} where C s , is the c...

A role for the vagus nerve in the emptying of intragastric nutrients and the gastric inhibitory actions of the brain-gut peptide cholecystokinin (CCK) has been proposed. To directly assess the role of the gastric vagal branches in these actions, we compared the emptying of 5-ml nutrient and nonnutrient gastric loads in male rats in which both branc...

In a chart review at a hospital's infectious disease AIDS clinic, manic syndromes affected 8% of patients who had AIDS. Of the 14 patients with manic episodes, those without a family or personal history of mood disorder presented later in the course of HIV infection and had a higher prevalence of comorbid dementia.

Pages R630–R637: G. J. Schwartz, G. Berkow, P. R. McHugh, and T. H. Moran. “Gastric branch vagotomy blocks nutrient and cholecystokinin-induced suppression of gastric emptying.” Page R361: An incorrect formula was used to calculate the volume remaining. The correct formula appears below. V = (C s /C i ){[5/(1 – C o /C s )] – 5} where C s , is the c...

The aim of this study was to assess the relationships between specific personality disorders and DSM-III axis I conditions in a community sample. A total of 810 subjects were examined by psychiatrists in the second stage of the Eastern Baltimore Mental Health Survey, part of the Epidemiological Catchment Area Program of the National Institute of Me...

Cholecystokinin (CCK) is found in high concentrations in mammalian brain where it appears to act as a neurotransmitter. CCK has been implicated in a number of important physiological processes and disease states, including feeding and feeding disorders, nociception, schizophrenia, movement disorders, anxiety, and panic disorder. The recent increase...

Synopsis Psychiatrists used a semi-structured Standardized Psychiatric Examination method to examine 810 adults drawn from a probability sample of eastern Baltimore residents in 1981. Of the population, 5·9% was found to be significantly depressed. DSM-III major depression (MD) had a prevalence of 1·1% and ‘non-major depression’ (nMD), our collecti...