Insight and symptom change in schizophrenia and other disorders.

OBJECTIVE: This study sought to evaluate levels of insight and change in insight in subjects with schizophrenia and other major psychiatric disorders. This study also evaluated the relationship of insight to acute psychopathology. METHOD: One-hundred and eighty-seven subjects consecutively admitted to an acute care psychiatric unit and who met DSM-III-R criteria were evaluated by the Insight and Treatment Attitudes Questionnaire and Brief Psychiatric Rating Scale on admission and discharge. Relationships of insight to diagnosis, involuntary commitment status and change in insight were evaluated with analysis of variance and post hoc Tukey's Standardized Range test. Relationships of change in insight and symptoms were evaluated with analysis of covariance (ANCOVA) and correlation. RESULTS: Insight deficits were more prevalent in schizophrenia, a mixed group of other psychosis and bipolar disorder as compared with major depressive and schizoaffective disorder. Committed patients had lower insight. Insight improved across diagnoses during hospital care in both voluntary and committed patients. Significant relationships between improved symptoms and improved insight were obtained in the bipolar, schizophrenia and major depressive groups. CONCLUSION: Insight deficits are prevalent in schizophrenia and bipolar disorder. Many patients show improved insight as their acute symptoms improve. Some aspects of insight are state related during exacerbation of illness in patients with schizophrenia and bipolar disorder.

Use of clozapine to treat levodopa-induced psychosis in Parkinson's disease: retrospective review.

Levodopa-induced psychosis can complicate the treatment of Parkinson's disease (PD). In this retrospective, uncontrolled report, we describe our experience treating PD-related psychosis with clozapine, emphasizing those patients treated for longer than 1 year. Twenty-seven patients were treated, 14 for longer than 1 year. Most patients showed a rapid improvement from baseline within 1 month using the Clinical Global Impression and Global Psychosis Rating Scores. Five patients discontinued the drug due to side effects, but only two patients reported side effects after 6 months of treatment. Clozapine appears to be effective in treating PD related psychotic symptoms while not interfering with motor function.

Fluoxetine and norfluoxetine serum concentrations and clinical response in weekly versus daily dosing.

This study explored serum concentrations of fluoxetine and norfluoxetine in subjects treated under different dosing regimens. Using a placebo-controlled, randomized, double-blind design, we compared 20 mg fluoxetine daily, 60 mg fluoxetine weekly, and a placebo. All subjects had responded positively to a 7-week open-label trial of 20 mg fluoxetine daily. Consistent with numerous attempts to correlate fluoxetine and norfluoxetine blood levels to clinical response, we found no significant relationships between serum concentrations and Hamilton Rating Scale for Depression (HAM-D) scores. Serum concentrations were significantly different among the three treatment groups. Pairing the fact that the serum concentrations of subjects given 60 mg fluoxetine weekly were significantly lower than those given 20 mg daily with the finding that the 60 mg weekly group had lower HAM-D scores suggests that, for stabilized subjects, this nontraditional dosing strategy is at least as effective in treating depression as the standard 20 mg fluoxetine daily treatment.