The cell membranes of the acinar cells in the parotid gland contain both α-adrenergic receptors (which regulate the volume of saliva and the release of potassium ions) and β-adrenergic receptors (which regulate the secretion of amylase). We used parotid salivary volume and amylase secretion as indicators of adrenergic functioning in 11 young male patients with Tourette's syndrome (TS). Parotid saliva was collected for 1 hour before and 4 hours following placebo or a single dose of clonidine (0.05–0.15 mg) in five drug-free TS patients and in six TS patients who had shown good therapeutic responses to long-term clonidine treatment. Following placebo, drug-free patients showed increased salivary volume and total amylase secretion over a 4-hour collection period. Clonidine produced decreased salivary volume for both the drug-free (-63% decrease) and chronically treated patients (-56%). Also, following a single dose of clonidine, 5/6 of the chronically treated patients and 1/3 of the drug-free patients showed decreased salivary amylase concentration; all showed decreased total secretion of amylase. Untreated TS patients may experience nor-adrenergic hyper-reactivity to stressful situations. Clonidine inhibits noradrenergic functioning in TS patients even after treatment for up to 4 years.

This paper deals with the techniques of integrating a child psychiatrist into a pediatric-surgical service. The use of executive meetings between the heads of both departments and the psychiatrist allowed for immediate clarification of misunderstandings and the formalization of decisions into administrative procedures. The special technique whereby the surgeon, on the basis of psychiatric information, acts as the spokesman for the joint psychiatric-surgical decision is discussed. The conceptualization of severe physical illness with rapid hospitalization as a crisis, allowed us to apply the crisis intervention theory as the basis for remedial intervention.

The accuracy of initial diagnostic decision-making under conditions of uncertainty may depend on the ease with which diagnostic hypotheses come to a physician's mind (their “availability”), as well as on physician judgments of their probability and seriousness. This study investigated the above factors as to their effect on physicians' diagnostic performance on simulated clinical cases. In addition, physician judgments of the probability of diagnostic hypotheses were compared to their objective probabilities as determined from hospital records. It was found that the availability order of diagnostic hypotheses was highly related to physicians' judgments of their probability, but not to their judgments of seriousness. The implication is that availability may distort physicians' diagnostic judgments more than does seriousness. Variation was found in physicians' awareness of objective hospital probabilities from simulated case to case. The effect of awareness of objective probabilities on diagnostic accuracy remains to be further investigated.

A new approach to teaching Normal Growth and Development to preclinical medical students is described. By using specially constructed multidisciplinary clinical simulations as training and evaluation devices, students were gradually and simultaneously exposed to: (1) subject matter; (2) the concept of multidisciplinary health care delivery; and (3) the objectives, strategies, and techniques of problem solving and diagnostic reasoning that characterize experienced physicians. The course, designed by a child psychiatrist and medical educators, was taught by a multidisciplinary teaching team drawn from faculty and health care representatives. Student evaluations of the course were favorable.