Tardive dyskinesia prevalence rates during a ten-year follow-up.

We followed up patients in the State Psychiatric Hospital Mauer-Ohling, Mauer-Ohling, Austria, who had been examined in 1982 to determine the prevalence of tardive dyskinesia (TD). Of the 861 patients examined in 1982, 270 were still in hospital 10 years later. Only these patients were included in our study. The SKAUB (Skala für abnorme unwillkürliche Bewegungen, i.e., The German version of the Abnormal Involuntary Movement Scale) was used to quantify the occurrence of TD. The prevalence rate of TD was 3.7% in 1982 and 12.7% in 1992. The 1992 prevalence rate in patients who had not shown TD symptoms in 1982 was 11.4%. The major risk factor for TD was advanced age.

[Neuroleptic low-dose long-term strategy and intermittent therapy strategy in chronic schizophrenia--a critical review]. / Neuroleptische Niedrigdosis-Langzeitstrategie und intermittierende Behandlungsstrategien bei chronisch Schizophrenen--ein kritischer Uberblick.

Much effort has been devoted during the past decade in finding new therapeutic approaches to cope with the commonly occurring adverse side effects of long-term neuroleptic maintenance treatment of schizophrenics, such as, in particular, akathisia, parkinsonian symptoms and tardive dyskinesia. Both low-dose maintenance (e.g. long-term treatment at dosages reduced to one-fifth or even less of conventional dosage levels in remitted and stable schizophrenics) and intermittent or-target medication strategies (e.g. discontinuation of neuroleptics in remitted stable chronic schizophrenics, aimed at resuming the medication as soon as prodromal signs of a relapse or actual relapses occur) might eventually imply for many schizophrenics a substantial reduction in total long-term neuroleptic dosages. This may lead to a reduction in the incidence of side effects and to an improvement in social integration. A critical review of the results published so far arrives at the following conclusions: 1. low-dose maintenance therapy is just as effective as a standard dose regimen and even superior to intermittent (target) medication. Especially if the dosage is increased in case of exacerbations; 2. these results are representative for a very small group of patients only, since the study populations were highly selective.

Defining treatment refractoriness in schizophrenia.

Addressing the need for research on the nature of refractoriness to antipsychotic drug therapy exhibited by a substantial minority of schizophrenic patients, Philip R.A. May and Sven Jonas Dencker instigated an international study group to discuss this problem, beginning with the International Congress of Neuropsychopharmacology in Göteborg, Sweden, in 1980. The study group subsequently met in Haar, Federal Republic of Germany, in 1985; in Banff, Canada, in 1986; and again in Telfs, Austria, in 1988. The study group set three objectives: (1) to clarify the concept of treatment resistance or refractoriness; (2) to suggest criteria for defining or rating the degree of treatment refractoriness; and (3) to explore the role of psychosocial and drug therapies in increasing the responsiveness of the treatment refractory patient. This position article represents a distillation of the study group's efforts to define treatment refractoriness in schizophrenia.

[Neuroleptic infusion therapy with high-dosed fluphenazine (author's transl)]. / Hochdosierte neuroleptische Infusionsbehandlung mit Fluphenazin.

19 chronic schizophrenics who had previously been resistant to various neuroleptic treatment regimens, were given extemely high doses (ca. 300-500 mg daily) of fluphenazine. 2 infusions were given in the morning and in the afternoon. Therapy results, possible side effects and the transition to oral and i.m. (depot) modes of application are discussed. The above-mentioned extemely high doses of fluphenazine appear to be contra-indicated in depressive states and in cases of latent organic brain changes. Psychiatric state hospitals would be able to carry out this form of treatment in a special unit for "intensive care" in connection with appropriate social rehabilitative methods.

[Fluphenazine dihydrochloride--a multicenter trial on 660 patients (author's transl)]. / Fluphenazindihydrochlorid--eine Verbundstudie bei 660 schizophrenen Patienten.

Selected patients were treated with fluphenazine dihydrochloride. Summarizing the studies 51 investigators from 32 hospitals conducted, permits only a relative statement because, without doubt, also various additional social and psychotherapeutical treatments were employed. The findings, however, emphasize the authors' personal judgements considering fluphenazine dihydrochloride a qualified drug for psychiatric emergency cases and also particularly for the treatment of acute schizophrenic episodes. On account of the broadly disseminated identical findings about fluphenazine dihydrochloride further studies are being planned to which a scientific standard can be applied.