Medication side effects in anxious patients: negative placebo responses?

The purpose of the present study was to detect any problems among anxious patients in switching from alprazolam to extended release alprazolam. Fifty-four patients with an anxiety disorder, stabilized on alprazolam, entered the study. During the first 2 weeks, all patients took alprazolam as usual. During the second 2 weeks, they all took the same dosage of the extended release formulation. They were evaluated weekly with standard clinical measures and were asked to report any adverse medical events. The clinical measures showed modest, steady improvement over the course of the study. Patients reporting adverse medical events increased from 26% of the sample to 60% after the switch of dosage forms. Most of these events were anxiety-like (48%) or sedative (37%). Patients who developed sedative events took slightly higher mean doses of alprazolam. Patients who developed anxiety-like events had higher baseline scores on the Somatization, Anxiety and Phobia clusters of the SCL-90. The results suggest that more anxious patients confronted with a change of regimen commonly generate anxiety symptoms that they attribute to the medication, i.e., negative placebo responses, perhaps especially if they have a tendency toward somatization. A study designed to sort out pharmacological and psychological effects and further explore the mechanisms at work is indicated.

Long-term outcome of major psychoses. II. Schizoaffective disorder compared with schizophrenia, affective disorders, and a surgical control group.

Eighty-five patients with both schizophrenic and affective features at the time of admission to the University of Iowa Psychiatric Hospital between 1934 and 1944 were selected for a 30- to 40-year outcome study. Comparison groups were 200 schizophrenic and 325 affective disorder patients, selected by the Feighner et at criteria, and 160 psychiatric symptom-free surgical patients. We assessed marital, residential, occupational, and psychiatric status to evaluate the outcome of these patients at the time of field follow-up. We used multivariate analysis of covariance to analyze the data by taking admission marital and occupational status into consideration. Patients with schizoaffective disorders had a significantly better outcome than those with schizophrenia, but a significantly poorer outcome than those with affective disorders and surgical conditions. Schizoaffective disorder fell somewhere in between the schizophrenia and mania group. Before final conclusions could be made about the nature of schizoaffective disorders, more research should be done.

A family history study of schizo-affective disorder.

All patients with a discharged diagnosis of schizo-affective disorder (53 cases) admitted to the University of Iowa Department of Psychiatry during 1971-73, were selected for the present study. Schizophrenia (chronic psychotic disorders) and affective disorders (episodic remitting disorders with affective symptoms) were diagnosed among parents and sibs on the basis of chart material. The frequency of schizophrenia was 0.9%; the frequency of affective disorders, 11.8%. These results were compared to data for the relatives of cases of schizophrenia and affective disorders. There were no significant differences for the rates of schizophrenia among the relatives. The rate of affective disorder among the relatives of the schizo-affectives was significantly higher than for the relatives of schizophrenics (3.2%), and not significantly different from the relatives of affective disorder cases (8.3%). An analysis of outcome, precipitants, and age of admission also support the view that schizo-affective disorder should not be routinely classified as schizophrenia for research purposes.