[Subjective and objective evaluation of treating schizophrenia with classic or atypical drugs]. / Subiektywna i obiektywna ocena leczenia schizofrenii lekami klasycznymi i atypowymi.

Subjective and objective evaluation of pharmacological treatment was made in 105 schizophrenic in-patients. PANSS and Calgary scale as well as Van Putten scale were used. Fifty-four percent of subjects received classic neuroleptics and 46%--new atypical drugs for an average period of 8 weeks. The severity of schizophrenic symptoms during treatment as well as subjective evaluation of first effects of the drug did not differ among subjects treated with classic or atypical drugs. Depressive symptoms decreased significantly during treatment with atypicals but not with classic drugs. Also a significant decrease of depression was found under olanzapine treatment. The severity of neuroleptic-induced side-effects did not differ in both groups. Neurological side effects were more prominent in subjects after 4 weeks of therapy with risperidone, in comparison to patients receiving olanzapine. Forty-seven per-cent of patients showed a dysphoric reaction to the first dose of medication. After treatment with atypical drugs, better subjective evaluation of pharmacotherapy correlated with less severe general and depressive schizophrenia symptoms. Patients' better evaluation of olanzapine treatment correlated with less severe schizophrenic general symptomatology. The subjective evaluation of treatment was better in patients with less severe neurological side-effects of atypical drugs (including olanzapine but not risperidone) and less severe autonomic side-effects of classic drugs. The evaluation of pharmacotherapy made by patients' family members did not correlate with subjects' opinions after distribution of the first dose of the drugs, but correlated significantly with patients' opinion after 8-weeks of treatment. The treatment received by the patients was judged better by the family members if less severe neurological side-effects were present.

[Clozapine treatment: possibilities and limitations]. / Klozapina: mozliwosci i ograniczenia stosowania.

The purpose of this article--based on the recent years literature--is discussing the principles of the use of clozapine in schizophrenia, with the special attention to treatment-resistance as a main indication, dose selection and duration of the trial. In spite of dynamic development of pharmacotherapy of schizophrenia, clozapine, registered in Europe 25 years ago, still remains a drug of choice in treatment-resistant schizophrenia, that is in 5-25% of patients, bringing a substantial clinical improvement in 30-50% of the group. The main factor limiting the possibility of the use of clozapine is the increased risk of neutropenia and agranulocytosis, what demands the WBC monitoring. Old age and female sex are considered to be potential risk factors. In both classical neuroleptics and clozapine, no clear linear correlation was noticed between the dose and clinical effect. It seems, however, that only in case of clozapine a noticeable correlation exists between the plasma level and clinical improvement. Many authors try to define a threshold level sufficient/necessary to achieve improvement. Suggested amounts are between 250-420 ng/ml. With fixed doses used, extremely different levels of clozapine are observed (from a few, to thousands ng/ml), so measuring plasma level is suggested as a routine procedure in cases of clozapine-resistance. The duration of the trial creates real controversy. Most authors agree that six weeks time, sufficient to diagnose treatment resistance in case of typical neuroleptics, may be too short for clozapine. At the same time, the postulated prolongation of the trial to a few months or even one year, explained by the presence of late improvements, is not well and generally accepted. It seems that time of 2-4 months is in most cases sufficient to notice the potential advantage. The problem of clozapine-resistance still remains open. Many strategies are being proposed (augmentation with lithium, valproate, sulpiride and benzodiazepines), but they demand further examination.

[Clozapine withdrawal. A review]. / Odstawienie klozapiny. Przeglad pismiennictwa.

The article describes the symptoms of withdrawal of clozapine and their possible causes as well as research on switching from clozapine to another antipsychotic drug. A computerised search was conducted using MEDLINE (1966-1997) to retrieve reports of clozapine withdrawal. Fifteen case reports and sixteen withdrawal studies (only one of them double-blind and two single-blind) were identified. Clozapine multi-receptors profile seems to be responsible for withdrawal symptoms--several specific mechanisms are suggested: cholinergic supersensitivity, dopaminergic supersensivity, special role of D4 receptors, possibilities of serotonergic, noradrenergic and GABA-ergic involvement. Risk of relapse after withdrawal of clozapine seems to be greater than after withdrawal of classical neuroleptics. Some patients might become de novo neuroleptic resistant for at least several weeks after withdrawal. Therefore, clozapine should be stopped only due to strong clinical indications, and if only possible, the withdrawal should be slow (50 mg/week). To prevent relapse of psychosis some experts advocate starting new antipsychotic drugs in therapeutic dosage before withdrawal of clozapine is completed. In case of emergency, when clozapine (high dosage) must be withdrawn immediately, patient must be hospitalised and cholinergics might be considered to prevent, cholinergic rebound". There are no established guidelines which antipsychotic to choose after withdrawal of clozapine. In general, classical antipsychotics are ineffective. Thioridazine is suggested because of its prominent anticholinergic activity, but there is no clinical evidence of advantage of this treatment in comparison to classical drugs. Risperidon and especially olanzapine are promising possibilities, but initial data are disappointing. Benzamides might be another possibility but clinical data are scarce. These important issues require further studies.

[Therapeutic effect of zuclopenthixol acetate on positive and negative symptoms in schizophrenia]. / Ocena wplywu terapeutycznego octanu zuklopentyksolu na objawy pozytywne i negatywne w schizofrenii.

Fifty schizophrenic in-patients (DSM-IV) were treated in an open study with zuclopenthixol acetate. Mental status, improvement and side-effects were measured before administration of the drug as well as after the 1st, 2nd and 3rd injection. Positive and negative symptoms were evaluated with the use of PANSS. 60% of patients received three injections. Usually the intervals between injections lasted 48 hours. The improvement after the 3rd injection of zuclopenthixol acetate was found in 80% of patients. All positive symptoms improved after the treatment (p < 0.001), among them excitement (54% reduction vs. baseline), hostility (49%) suspiciousness/persecution (45%). The study revealed that parallel to the decrease of positive symptoms, the severity of negative symptoms also decreased, in particular: difficulty in abstract thinking (28%) and stereotyped thinking (27%) (p < 0.001). Passive/apathetic social withdrawal and lack of spontaneity as well as flow of conversation only slightly improved (p < 0.05). 50% of patients experienced side-effects--usually extrapyramidal reactions.

[The evaluation of well-being of schizophrenic or depressed patients with Bradley's questionnaire: a pilot study]. / Badanie dobrego samopoczucia pacjentów z rozpoznaniem schizofrenii lub depresji za pomoca skali Bradley--doniesienie wstepne.

Well-being of 65 in-patients with the diagnosis of schizophrenia or major depression was evaluated with the use of Bradley's well-being questionnaire. The severity of psychopathology as well as clinical improvement after pharmacotherapy were evaluated by doctors using CGI scale. Patients with the diagnosis of depression estimated their well-being lower in comparison to schizophrenics. The groups did not differ in the subscales of depression and energy. Female patients revealed more anxiety than male ones, regardless diagnosis. Physicians' evaluation of disease severity did not correlate with patients' well-being judgement using Bradley's questionnaire. After pharmacotherapy correlation between clinical improvement and several questions from Bradley's questionnaire was found.

[Neuroleptic induced deficit syndrome]. / Poneuroleptyczny zespól ubytkowy.

Increasing interest in subjective aspects of therapy and rehabilitation focused the attention of psychiatrists, psychologists and psychopharmacologists on the mental side effects of neuroleptics. For the drug-related impairment of affective, cognitive and social function the name of neuroleptic-induced deficit syndrome (NIDS) is proposed. Patients with NIDS appear to be indifferent to the environmental stimuli, retarded and apathetic. They complain of feeling drugged and drowsy, weird, they suffer from lack of motivation, feel like "zombies". The paper presents description of NIDS and its differentiation from negative and depressive symptoms in schizophrenia and subjective perceiving of extrapyramidal syndromes.