Prediction of relapse in schizophrenia.

Despite the proven efficacy of neuroleptic drugs in the acute and maintenance pharmacotherapy of schizophrenia, practical methods for identifying patients who require neuroleptic treatment to prevent relapse are lacking. This study evaluated the use of a methylphenidate challenge test to predict the outcome in 34 stable outpatients with schizophrenia receiving neuroleptic treatment. Patients received two infusions, one of methylphenidate and one of placebo, in randomized order one week apart while receiving neuroleptic treatment and again three weeks after drug withdrawal. Behavioral, cardiovascular, and neurologic responses were evaluated before and after infusion under double-blind conditions. Patients were then followed up without medication for 52 weeks or until symptom recurrence. The results indicate that specific measures, including behavioral response to methylphenidate, presence of tardive dyskinesia, and, under specific pharmacologic conditions, tardive dyskinesia, blink-rate, and pulse-rate responses to methylphenidate, are associated with time and propensity to relapse following neuroleptic withdrawal. These measures may be potentially useful in the identification of candidates for neuroleptic withdrawal and/or dosage-reduction treatment strategies.

Depot neuroleptics: a comparative review of standard, intermediate, and low-dose regimens.

New research in maintenance drug therapy has been influenced by a need to clarify risk-benefit ratios and determine minimum effective dosages. This research employing controlled study designs and new methods of data analysis has increased our ability to apply findings to specific patients, families, and treatment settings. Results from studies using depot neuroleptics indicate that this methodology may clarify the correlation between dose and blood levels and thus lead to the establishment of generalizable dosage guidelines. Lack of knowledge of maintenance requirements with long-acting injectable drugs may have led to the use of higher doses than necessary and an increased incidence of side effects. Recent studies suggest that with careful clinical observation, substantial reduction of maintenance doses can, for many patients, lead to improvement in some areas of subjective and objective well-being and to a diminution of adverse effects.

Dexamethasone suppression tests in patients with obsessive-compulsive disorder.

Obsessive-compulsive disorder and major depressive disorder are associated by several lines of evidence. To explore the possible relationship between the two disorders, the authors administered 1-mg dexamethasone suppression tests to 18 patients with obsessive-compulsive disorder and 51 patients with major depressive disorder. None of the obsessive-compulsive patients were classified as nonsuppressors on the basis of a 4:00 p.m. serum cortisol level, whereas 37% of the depressed patients were nonsuppressors. The mean cortisol levels of the two groups differed significantly. Factors that may influence hypothalamic-pituitary-adrenal function, such as age, depressive symptoms, and severity of illness, are discussed in light of these results.

Is loxapine more effective than chlorpromazine in paranoid schizophrenia?

The authors compared loxapine with chlorpromazine in inpatients with paranoid schizophrenia and found no difference in clinical efficacy. Thus a previous finding, based on retrospective analyses, that loxapine was superior to other neuroleptics in the treatment of paranoid schizophrenia was not verified in this prospective study.

Low-dose neuroleptic treatment of outpatient schizophrenics. I. Preliminary results for relapse rates.

In an attempt to begin to establish minimum effective dosage requirements for the maintenance treatment of schizophrenia, we undertook a double-blind comparison of low-dose fluphenazine decanoate (1.25 to 5.0 mg/2 wk) with the standard-dose regimen (12.5 to 50.0 mg/2 wk) in outpatient schizophrenics. For the first 126 patients studied, cumulative relapse rates at one year for the low dose were 56% and for the standard dose 7%, a significant difference. Despite the fact that very little dyskinetic symptomatology developed in the sample as a whole, the low-dose treatment appeared to have a significant advantage in producing fewer early signs of tardive dyskinesia. Severity of relapse and total cumulative dosage were also considered.

Safety and efficacy of bupropion in elderly patients: preliminary observations.

The efficacy and safety of bupropion, an atypical antidepressant, were assessed in depressed patients aged 55 and above. Data were analyzed for 38 patients who completed 4 weeks of double-blind treatment with bupropion in maximum doses of 150 or 450 mg/day; imipramine, up to 200 mg/day; or placebo. Preliminary results suggest that bupropion does have antidepressant activity and is well tolerated in this population. A particular advantage is suggested in terms of cardiovascular side effects.

Hamilton Depression Rating Scale. Extracted from Regular and Change Versions of the Schedule for Affective Disorders and Schizophrenia.

Investigators who wish to use new procedures usually wish to relate their results to those already in the literature. This often results in the use of both old and new measures. The Schedule for Affective Disorders and Schizophrenia Regular and Change Versions (SADS and SADS-C) have advantages over the widely used Hamilton Depression Rating Scale (HDRS). A procedure was developed to extract the HDRS score from the SADS and SADS-C. The comparative reliability and the validity of the extracted HDRS score as a substitute for a real HDRS score was established. The SADS-C and the HDRS were completed by the raters for 48 subjects. The correlation between the extracted and real HDRS scores was positive and large.