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The mechanisms underlying the frequent association of nausea and vomiting with elevations of plasma vasopressin(PAVP) were studied in man and rat. After oral water loads (N = 16), plasma osmolality fell in all human subjects and was associated with a decline in PAVP in 14 asymptomatic human subjects. In 2 human subjects, nausea occurred and was associated with increases in PAVP, without changes in blood pressure. During ethanol infusion (N = 28), PAVP was suppressed unless nausea supervened. In 4 nauseated human subjects, PAVP escaped from ethanol inhibition and rose to levels 10 times basal, despite the absence of hemodynamic changes. Apomorphine, a potent dopamine agonist and emetic agent, was administered to human volunteers in doses of 7 to 24 microgram/kg. There was no increase in PAVP in 3 human subjects who remained asymptomatic (7 to 16 microgram/kg). Ten human subjects experienced nausea after 16 microgram/kg, which was followed shortly by marked increases in PAVP. Emesis occurred in 5 human subjects given 16 to 24 microgram/kg, and was followed by PAVP levels similar to those seen with nausea alone. In 7 human subjects from the nausea group, the repeat study (16 microgram/kg) after pretreatment with dopamine antagonist (haloperidol, N = 4; fluphenazine, N = 3) resulted in complete blockage of apomorphine-induced AVP release. In rats, which lack an emetic reflex, apomorphine doses of 200 microgram/kg induced only slight increases in PAVP when compared to the response to 16 microgram/kg in man. These studies indicate that stimulation of the emetic reflex results in AVP-release in man. Nausea-mediated AVP release supervenes over concomitant osmolar or pharmacologic (ethanol) inhibition.

It is clear to those involved in psychosocial rehabilitation that consumers inherently have the ability to effectively communicate with each other and to be supportive of those who have experienced life in psychiatric hospitals. This article will describe an innovative model for consumers providing into-hospital reach-out and will discuss why participants in self-help clubhouse programs are ideally suited for involvement in the hospital discharge process.This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 20 Psychosocial Rehabilitation Journal disrupting problem, and bringing about desired social and/or personal change. (Gartner & Reissman, 1982)The Virginia Alliance for the Mentally Ill (the support and advocacy organization for Virginia's relatives of the mentally ill, affiliated with the National Alliance for the Mentally Ill) and the Commonwealth Clubhouse Association (consisting of mental health service consumers) are good examples of mental health self-help organizations in Virginia. Elsewhere, the Community Network Development Project at the Florida Mental Health Institute demonstrates the efficacy of a mutual aid network within a state hospital (Gartner & Reissman, 1982).Support for the premise of using self-help as a method of reducing hospital recidivism is also mentioned by Fraser, Fraser, and Delewski (1985) is a study on how club members in Salt Lake City had expanded social networks and greater community support as a result of their participation in the clubhouse program. The study further suggested that the role of the clubhouse staff had a direct relationship to reduced rehospitalization. The authors felt that "staff and clients developed qualitatively different ties in clubhouse program. . .these ties appear to be more informal and normative than those established in clinical outpatient programs. In comparison to the kind of ties developed in clinical settings, such ties may actually be more influential in affecting client behavior and may account for the marked success of clubhouse treatment programs" (p. 41).The attitudes that clubhouse staff have are fundamental to the success and expansion of this model. Their willingness to engage with and view the strengths rather than the pathology of the club members cannot be overemphasized. "Most critical to client involvement is the practitioners' commitment to the goal of client involvement and their belief that rehabilitation is done with clients and not to clients" (Anthony, Cohen, & Farkas, 1982, p.87). Another example in Florida of a self-help group, which also focuses on staff and client collaboration, is Project Return (PR).

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