THE MADISON DOCTRINE a web site by Ralph Ankenman MD.

(Not peer reviewed)

The material in this web page is intended to present the special treatment techniques of the practice of Ralph Ankenman, M.D., derived from 15 years of psychiatric care for the developmentally disabled and brain injured in the in-patient and out-patient departments of Madison County Community Hospital Special Psychiatric Unit in London, Ohio. Since this is a unique population, consisting of profoundly to mildly retarded individuals of all age groups, unique medication treatment plans have been derived which are not standard for other psychiatric facilities. Many of the treatment regimes are not known elsewhere and they are not proven by scientific clinic trials. Users of this web page must be aware that the material presented is of one facility's clinical experience only. The material on this web site is given to provide information about specialized treatment regimes. The author cannot provide responses to inquiries about the use of this material in individual cases. However, Madison County Community Hospital has had extensive experience and success dealing with this population. It is probable that some of these regimes represent major breakthroughs in the treatment of psychiatric conditions.

Since the material covers many aspects of a wide field of psychiatric practice, it is not possible to present this material in a uniform manner. It is not expected that the basic web page will be complete until the end of 2002.

There are 3 types of documents on this site:
Madison topics-Fairly comprehensive descriptions of a main subject.
Madison notes-Brief descriptions of one, limited subject.
Madison memos-Short, incomplete information generally listed in chronological order.

Unique techniques developed at Madison County Special Psychiatric Unit:

1. Treatment and cure for most cases of Tardive Dyskinesia and Tardive Dystonia.

2. Identification of a special form of Tardive Dyskinesia involving a gait disturbance with a parkinsonian step gait or stutter step which often causes falling, but which is not manifested at all times.

3. Identification of a variety of Impulse Control Disorder called Giddy Disinhibition Disorder (Odie Syndrome) and its treatment with naltrexone.

4. Distinction in rage reactions. The distinction between Fright Rage (beta-adrenergic) and Predator Rage (Alpha-adrenergic): their clinical differences, their neurohumoral and neuroanatomical correlates, and the implication for medication treatment. And the implication for treatment with beta-blocking medications such as propranolol and alpha-adrenergic blocking medications such as betoxalol.

5. Use of the neurotransmitter-depleting medications in psychiatric states—especially dissociative rage and similar states. (reserpine, metyrosine, methyldopa)

6. Use of trazodone and/or buspirone for obsessive-compulsion in individuals who become activated on SSRI’s.

7. The "broad-spectrum" socialization treatment benefits of atypical antipsychotics.

8. The understanding of the dissociative-like phenomena underlying the major psychotic disease states such as Schizophrenia, Bipolar Disorder and Autism and the implication for treatment.

9. Understanding and treatment of rage and other aggression derived from dissociation/altered personality states.

10. The prevalence of dissociative-like phenomena (including multiple personality) as a cause of many aggressive, "psychotic" and other erratic behavioral reactions in the developmentally disabled.

11. The rational of multiple medication use (Polypharmacy) to provide general stabilizing for dysfunctional states which are not commonly identified

12. The rational of very early drug intervention in treatment of Autism

13. “Dual Mode” for treatment of Autism—general stabilizing medications plus atypical antipsychotics and SSRI anti-obsessionals.

14. The relation of excess alpha-adrenaline activity to the clinical problems of hypertension and hypotension.