Observations on switching patients with schizophrenia to risperidone treatment. Risperidone Switching Study Group.

This study examined one possible strategy for switching patients to treatment with risperidone involving immediate cessation of current neuroleptics and gradual withdrawal of anticholinergic treatments. All patients received risperidone monotherapy for at least 4 weeks. Side-effects and symptoms were rated and successful switching was defined as completion of the study with no consistent worsening in any rating scales. Of the 41 patients entered, five withdrew for reasons unconnected with the study. Of the remaining 36 patients, 64% (23 patients) were switched successfully. Overall, the rating scales showed significant improvements (mean score on Krawiecka scale, 11.0 to 6.6, P < 0.001), and side-effects decreased (mean score on Simpson & Angus scale, 5.1 to 2.9, P = 0.004). The strategy appeared to be successful for most patients, especially those who had previously received depot medication. However, more gradual withdrawal of previous treatments, including anticholinergics, may be advisable in some cases.

Monospot and VP1 tests in chronic fatigue syndrome and major depression.

Thirty-four patients with chronic fatigue syndrome (CFS) were compared with controls with DSM-III-R major depression on the Monospot and VP1 antigen tests. There was no significant difference in the numbers initially VP1 positive in the groups (11/34 and 7/34 positive in the chronic fatigue and major depression group respectively). Four CFS but no depressed patients were Monospot positive initially. No patient was both Monospot and VP1 positive. Patients positive on the tests were offered a repeat 6 months later. Eight of the 11 VP1 positive patients in the CFS group were retested and four remained positive, but none of the four depressed patients retested remained positive. No patient retested remained Monospot positive. The Monospot and VP1 tests appear to have little discriminating ability between these groups as screening tests and their predictive validity is unclear.

Lithium in the treatment of aggression in mentally handicapped patients. A double-blind trial.

In a double-blind trial lasting 4 months in 42 mentally handicapped patients, the effect of lithium on aggression was assessed in comparison with placebo. In the lithium-treated group, 73% of patients showed a reduction in aggression during treatment. There were significant differences in mean weekly aggression scores and in the frequency of aggressive episodes between the lithium and placebo groups. Side-effects were noted in 36% of the lithium group (and 20% of the placebo group), but were mainly transitory. There were no episodes of toxicity, and no patients had to be withdrawn from the trial. Lithium appears to be worth a 2-month trial in such patients, where repeated aggression has not been relieved by more appropriate placement, occupation or company.

Effect of propranolol on the airway response to prostaglandin E2 in normal man.

1 The airway response to inhaled prostaglandin E2 (PGE2) and the effect of oral propranolol on this response was studied in eight normal subjects in a double-blind randomised trial. The airway response was measured as specific airway conductance (sGaw). 2 Inhalation of PGE2 caused retrosternal soreness, coughing and an awareness of mucus production. Despite this, PGE2 caused bronchodilatation and reproducible dose-response curves were obtained, with a maximum increase in sGaw of 53%. 3 Inhalation of the diluent of PGE2, an ethanol/saline mixture, did not cause irritation nor did it alter sGaw. 4 Prior administration of propranolol 80 mg did not alter baseline sGAW, nor the response to PGE2, indicating that the action of PGE2 in vivo is unaffected by bronchial beta-adrenoceptor blockade. 5 This technique should be of value in studying bronchodilator prostaglandins and their interaction with other drugs.