ABSTRACT
Schizophrenic patients who showed greater neuropsychological deficits on the Luria-Nebraska Pathognomonic subscale (PATH) and Trail-Making Test showed less improvement during treatment with neuroleptic drugs than patients with lower scores on these neuropsychological tests. Other neuropsychological test scores we used were not consistently related to the patients' degree of clinical improvement during neuroleptic treatment. Only a few patients evidenced severe scores on either the PATH or TM tests, suggesting that more subtle neuropsychological deficits may identify a subgroup of schizophrenics who will show a relatively poor response to treatment with standard neuroleptic drugs.
Subject(s)
Antipsychotic Agents/therapeutic use , Neuropsychological Tests , Schizophrenia/diagnosis , Adult , Antipsychotic Agents/administration & dosage , Female , Hospitalization , Humans , Luria-Nebraska Neuropsychological Battery , Male , Patient Compliance , Psychiatric Status Rating Scales , Schizophrenia/drug therapy , Trail Making TestABSTRACT
The relationship between clinical response to neuroleptics and brain morphology as revealed by CT scans was evaluated in a sample of 39 patients with schizophrenia and schizoaffective psychosis. Four measures of brain morphology previously shown to differ between schizophrenics and patients with headaches - white matter density, asymmetry in brain white matter density, sulcal width and global cortical atrophy - did not correlate with clinical improvement after 3 weeks treatment with constant doses of neuroleptics. These brain morphology measures also did not correlate with baseline psychopathology scores. The same results were found with scales or subscales reflecting primarily positive symptoms of schizophrenia as well as those reflecting primarily social withdrawal.
Subject(s)
Antipsychotic Agents/therapeutic use , Cerebral Cortex/pathology , Schizophrenia/pathology , Adult , Atrophy , Female , Haloperidol/therapeutic use , Humans , Male , Middle Aged , Prognosis , Psychiatric Status Rating Scales , Psychopathology , Psychotic Disorders/pathology , Schizophrenia/drug therapy , Schizophrenic Psychology , Thioridazine/therapeutic use , Tomography, X-Ray ComputedABSTRACT
The relationship between enlargement of the lateral ventricles in the brains of schizophrenic patients and clinical response to neuroleptic treatment, as assessed by the ventricle-brain ratio (VBR) and psychopathology scores, was studied in a sample of 39 patients with schizophrenia or schizoaffective psychosis during a drug-free washout and after 3 1/2 weeks of treatment with either haloperidol or thioridazine. There was a weak, but statistically significant positive relationship between VBR and improvement on BPRS Psychosis factor scores after 3 1/2 weeks of treatment, and a negative correlation between VBR and baseline (washout) scores on the BPRS Anergia factor. Patients with enlarged VBRs, as defined by two criteria, also tended to show a better response to neuroleptics than patients below these criterion values.
Subject(s)
Cerebral Ventricles/pathology , Haloperidol/therapeutic use , Schizophrenia/drug therapy , Schizophrenic Psychology , Thioridazine/therapeutic use , Brain/pathology , Humans , Hypertrophy , Psychiatric Status Rating Scales , Schizophrenia/pathology , Tomography, X-Ray ComputedABSTRACT
The relative utility of steady-state (SS), plasma (Pl), and red blood cell (RBC) haloperidol levels for predicting clinical response was evaluated in a fixed-dose study in schizophrenic inpatients. There were significant curvilinear relationships between the decrease in BPRS Psychosis Factor Scores by day 24 of haloperidol treatment and both Pl (R2 = 0.34) and RBC (R2 = 0.38) haloperidol levels. Although SS RBC haloperidol levels consistently showed a slightly stronger relationship to clinical response than Pl levels in several comparisons, the differences in R2s between Pl and RBC haloperidol were not statistically significant. Ninety percent confidence intervals for the blood level ranges associated with optimal clinical response in our sample of patients were: 6.5-16.5 ng/ml Pl haloperidol and 2.2-6.8 ng/ml RBC haloperidol.
Subject(s)
Haloperidol/therapeutic use , Psychotic Disorders/drug therapy , Schizophrenia/drug therapy , Adult , Brief Psychiatric Rating Scale , Erythrocytes/analysis , Haloperidol/blood , Humans , Psychiatric Status Rating Scales , Regression Analysis , Thioridazine/therapeutic useABSTRACT
The relationship of plasma and red blood cell (RBC) levels of thioridazine to clinical response in schizophrenia was evaluated in a fixed-dose study. Steady-state plasma and RBC levels of thioridazine, mesoridazine, and sum of thioridazine and mesoridazine, determined by gas-liquid chromatography, were not significantly correlated with clinical response as measured by improvement on the Brief Psychiatric Rating Scale. RBC thioridazine levels were not substantially more strongly correlated with clinical response than plasma levels.
Subject(s)
Schizophrenia/drug therapy , Thioridazine/blood , Adult , Dose-Response Relationship, Drug , Erythrocytes/analysis , Humans , Mesoridazine/blood , Plasma/analysis , Psychiatric Status Rating Scales , Psychotic Disorders/blood , Psychotic Disorders/drug therapy , Schizophrenia/blood , Thioridazine/therapeutic useABSTRACT
Quantitative and qualitative measures of brain morphology were derived through CT scans using computer-assisted methodology in patients with schizophrenia or schizo-affective psychosis and headache controls. Schizophrenics had significantly higher density of white matter, together with greater right vs. left asymmetry in density of white matter than controls. Schizophrenics tended to have larger widths of cortical sulci than headache patients. In our sample of schizophrenics, however, no significant differences were found on measures of lateral ventricle (LV) width, LV area, VBR, or other measures of ventricular size compared to headache controls. There were no differences between CT scan measures taken in patients with schizophrenia vs. schizo-affective psychosis.
Subject(s)
Brain/pathology , Neurocognitive Disorders/pathology , Schizophrenia/pathology , Tomography, X-Ray Computed , Adult , Age Factors , Atrophy , Cerebral Cortex/pathology , Cerebral Ventricles/pathology , Chronic Disease , Female , Humans , Male , Psychotic Disorders/pathology , Sex FactorsABSTRACT
Nuclear magnetic resonance (NMR) scans were performed in nine patients with schizophrenia and five control subjects. NMR scans allowed multiple-plane views of the brains of schizophrenic patients and demonstrated much greater detail of morphological structure than computed tomographic (CT) scans. This small sample of subjects, however, showed no significant differences in several quantitative measurements between schizophrenic patients and control subjects. Problems in the interpretation of image intensity measures of NMR scans are discussed.
Subject(s)
Magnetic Resonance Spectroscopy , Schizophrenia/diagnosis , Adult , Humans , Tomography, X-Ray ComputedABSTRACT
Serum prolactin and blood levels of haloperidol were assessed in schizophrenic patients after single acute oral doses of haloperidol and during fixed dose treatment with this medication. Although significant intrapatient correlations between prolactin responses to different doses of haloperidol were found, no statistically significant interpatient relationship between haloperidol dose and prolactin response emerged. There were statistically significant relationships between steady-state plasma and red cell haloperidol levels (measured by radioreceptor or gas liquid chromatographic techniques) and serum prolactin response, but not between blood levels after the acute haloperidol dose and prolactin response.
