Pindolol augmentation in aggressive schizophrenic patients: a double-blind crossover randomized study.

Treatment of aggression in schizophrenic patients is a major challenge. We sought to examine the efficacy of augmentation of antipsychotic treatment with pindolol in the amelioration of aggression. Thirty male inpatients meeting DSM-IV criteria for schizophrenia, aged 20-65 years involved in four or more aggressive incidents in the two previous months, were enrolled in a double-blind crossover study. Aggression was evaluated per incident, with the Overt Aggression Scale (OAS). Positive and Negative Syndrome Scale (PANSS) was administered at baseline, crossover and at endpoint. Patients received either pindolol or placebo augmentation 5 mg x three times a day until crossover, then switched. No significant differences were found in the PANSS scores between the placebo and pindolol treatments. OAS scores were significantly reduced for number of aggressive incidents towards objects and other persons during pindolol treatment (0.59 versus 1.46, F = 6.09, P < 0.02; 1.96 versus 3.23, F = 4.17, P < 0.05, respectively). Similar results were obtained for severity of incidents (0.89 versus 3.58, F = 19.42, P < 0.0001; 2.89 versus 6.85, F = 10.11, P < 0.004, respectively). Pindolol, with its dual beta and 5-HT1A blocking effect ameliorated both number and severity of aggressive acts. Influence on severity may be associated with a 5-HT1A antagonistic effect.

Immediate effects of chlorpromazine and perphenazine following neuroleptic washout on word association of schizophrenic patients.

Reaction time and idiosyncrasy of word associations were examined in 30 schizophrenic patients, 2 h after administering a single dose of chlorpromazine, perphenazine or placebo. These patients were in the acute phase of their illness following 72 h cessation of oral neuroleptic treatment administered for 1-2 weeks. There was a statistically significant reduction in reaction times after administering perphenazine as compared to the placebo. Chlorpromazine showed some reduction in reaction times that was not statistically significant. Further study is needed to examine the relationship between such changes and other parameters, such as the patients' symptomatology and their social competence. Since many schizophrenic patients exhibit low or partial compliance, including patterns of intermittent taking of medication with a few days cessation, studies using such a model of a single dose of neuroleptic following several days withdrawal, may have clinical relevance. Another finding was a correlation between reaction time and the number of uncommon word associations produced. This correlation was beyond drug effect. Further study is needed to find out if such a correlation characterizes schizophrenic patients only.

Treatment of resistant akathisia with ECT--a case report.

We present a case of neuroleptic induced akathisia resistant to traditional drug therapy which improved with electroconvulsive therapy. If confirmed in further cases, these findings call for well designed studies on the efficacy of this treatment, especially in nonresponders to traditional therapy or in a subgroup of patients suffering from akathisia and depression.