The DSM‐III diagnostic criteria were applied to school refusal cases, and the possibility of a subclassification of school refusal through the DSM‐III was studied. The subjects were 50 cases diagnosed as school refusal following the criteria defined by Sumi and Tatara.
As for the Axis I diagnoses, the subjects fell under the separation anxiety disorder (7 cases), avoidance disorder (13 cases), overanxious disorder (8 cases), identity disorder (5 cases), adjustment disorder (11 cases) and others. On Axis II, no case was diagnosed as having the personality disorder, but 14 cases showed pathological personality traits. On Axis III, nine cases showed some physical disorders or conditions. Among the five major diagnostic groups, there were some definite differences concerning the onset age, clinical course, psychosocial stress, response to therapy and prognosis of disorders.
These results suggest the availability of a subclassification of school refusal by means of the DSM‐III criteria.
The relationship between the serum carbamazepine levels and dosage is obscure. The present study dealt with the daily fluctuation and the dosedependency of serum carbamazepine levels in epileptic patients under a long-term treatment with carbamazepine. The blood was taken by venous puncture at intervals of three hours from 0O:OO to 2 1 : 00 from 17 inpatients, and also taken from 17 outpatients at 1O:OO and from 35 outpatients at 15:OO. The serum carbamazepine levels were determined by the enzymemultiplied immunoassay.The results obtained were as follows: 1. The mean daily fluctuation of serum carbamazepine levels was the lowest at 06:OO and the highest at 15:OO in 17 in-patients.2. The serum carbamazepine levels ( n = 52) at 15:OO showed a linear relationship to the oral dosage (p < 0.001 1, but the levels (n = 34) at 1O:OO did not.The levels in patients with generalized epilepsy were lower than those with partial epilepsy when the daily dosage increased over 10.05 mg/kg ( p < 0.05).These data suggested that the serum carbamazepine levels in the afternoon showed dosedependency, and that the therapeutic range should be determined by monitoring the serum carbamazepine levels in the morning which showed the lowest levels and the toxic range should be in the afternoon which showed the highest.
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