The Present State Examination Change Rating Scale.

The development and use of a new psychiatric symptom change scale based on the Present State Examination (PSE)--the PSE Change Rating Scale--is described. The advantages of the PSE are retained (the extensive glossary, the diagnostic facility and the standardised interview technique) while improving its sensitivity to change and decreasing its administration time. The scale has been designed to prevent feedback of results and 'halo' effects: it has proved highly reliable in use across raters with different backgrounds and experience. The scale has been used to monitor drug effects on clinical state across a variety of diagnoses and examples of its use are given.

The response of untreated chronic schizophrenics to haloperidol and haloperidol decanoate.

A group of 13 untreated schizophrenic patients was collected over two and a half years. They were prescribed a standard regime of oral haloperidol, and where possible were transferred to haloperidol decanoate depot injections when their clinical condition stabilised. The progress of their symptoms was monitored weekly with a modification of the Present State Examination called the PSE Change Rating Scale. The ratings demonstrated a surprisingly good response to neuroleptic treatment in these chronic patients. Ten out of the 13 reached an arbitrary criterion of improvement with respect to psychotic symptoms, and in six patients these disappeared entirely. The reasons why the patients remained untreated for so long are considered, and include vagrancy, living with high Expressed Emotion relatives, and neglect in the community.

Tactile-evoked potentials in schizophrenia. Interhemispheric transfer and drug effects.

EEG potentials evoked by tactile stimulation of the forearm (tactile-evoked potentials or TEPs) were recorded simultaneously from both cerebral hemispheres in a group of schizophrenics and a group of healthy control subjects. Differences between the groups were found for the early waves of the TEPs: in the control subjects the first two positive waves (P25 and P50) and the first negative wave (N35) recorded from the hemisphere on the same side as the stimulation were slower (i.e. had longer latency) than those recorded from the hemisphere contralateral to the stimulation. This 'lateralization effect' was not seen in the schizophrenic subjects. It was concluded that the TEPs recorded from the hemisphere ipsilateral to the stimulus were not being transmitted from the other hemisphere via the corpus callosum and must therefore have been transmitted via direct ipsilateral pathways from the periphery. In a second experiment the drug pindolol was administered to schizophrenic subjects but differences in P50 latency between ipsilateral and contralateral hemispheres were found equally in both drug and placebo groups. We also found slight evidence to suggest that the more severely ill the patient the more similar the TEP latencies recorded from the contralateral and the ipsilateral hemispheres.

Cardiovascular, respiratory and temperature responses to intravenous heroin (diamorphine) in dependent and non-dependent humans.

1 Intravenous heroin (diamorphine) was administered to volunteers, in doses of 2.5 and 5 mg to non-dependent and doses of 1/6, 1/3 and 1/2 of their prescribed daily dose of opiates to dependent subjects, and heart and respiration rates, blood pressure, body and skin temperature and skin conductance were measured before and for 2 h after injection. 2 Heart rate fell and continued to fall after injection in both groups of subjects although the time course was different in the two groups. This was thought to be a non-specific effect of heroin. 3 Respiration rate fell after injection in both groups. The dependent group showed a faster recovery of pre-drug respiration rate. This was interpreted as being due to tolerance in the dependent group. 4 Systolic blood pressure fell only in the dependent group and diastolic blood pressure only fell after injection of the largest dose of heroin in both groups. 5 Body temperature fell after injection of heroin in a similar way in both groups while neither skin temperature nor skin conductance changed. This was interpreted as a drug-induced alteration in thermo-regulatory mechanisms. 6 Placebo had no effect on any of these measures. There were no differences between the responses of the high and low dose dependent subjects to different doses of heroin nor did prior ingestion of methadone affect any of the measures.

Interocular transfer of movement after-effects in schizophrenia.

A group of 16 chronic schizophrenic subjects were compared with 15 age-matched control subjects for interocular transfer of movement after-effects. Contrary to the hypothesis that schizophrenic subjects would show a deficit on this measure schizophrenics showed increased transfer compared to the controls. This effect is not due to response perseveration and is not correlated with length of hospitalization, age or dose of antipsychotic drugs. It is suggested that the effect reflects a deficit in 'inhibitory processes' in schizophrenia.

Pupil responses to intravenous heroin (diamorphine) in dependent and non-dependent humans.

1. Intravenous heroin was administered to volunteers, in doses of 2.5 and 5 mg to non-dependent subjects and does of 1/6, 1/3 and 1/2 of their prescribed daily does of opiates to dependent subjects, and pupillary responses measured before and three times during the 2 h after injection. 2. Tolerance to the miotic effects of heroin in the dependent subjects was demonstrated--larger doses of heroin were needed to produce the same pupil response in dependent subjects than in non-dependent subjects and the duration of action was shorter in the former group. 3. The effect of concurrent oral methadone medication on pupil response to heroin was demonstrated. Subjects prescribed both methadone and heroin showed smaller control pupil diameters and a reduced dose effect to heroin than did subjects prescribed heroin alone.