Sulpiride augmentation in people with schizophrenia partially responsive to clozapine

1997 ◽  
Vol 171 (6) ◽  
pp. 569-573 ◽  
Author(s):  
Roni Shiloh ◽  
Zvi Zemishlany ◽  
Dov Aizenberg ◽  
Marguerite Radwan ◽  
Bruria Schwartz ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Clinical Status ◽  
Chronic Schizophrenia ◽  
Current Treatment ◽  
Psychotic Symptoms ◽  
Double Blind ◽  
Clozapine Treatment ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

BackgroundWe hypothesised that a combined regimen of clozapine, a relatively weak D2-dopaminergic antagonist, and sulpiride, a selective D2 blocker, would demonstrate a greater antipsychotic efficacy by enhancing the D2 blockade of clozapine.MethodTwenty-eight people with schizophrenia, previously unresponsive to typical antipsychotics and only partially responsive to current treatment with clozapine, received, double-blind, 600 mg/day sulpiride or placebo, in addition to an ongoing clozapine treatment. The clinical status was evaluated before, during, and at the end of 10 weeks of sulpiride addition using the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms, and Hamilton Rating Scale for Depression.ResultsThe clozapine–sulpiride group exhibited substantially greater and significant improvements in positive and negative psychotic symptoms. About half of them, characterised by a younger age and lower baseline SAPS scores, had a mean reduction of 42.4 and 50.4% in their BPRS and SAPS scores, respectively.ConclusionsA subgroup of patients with chronic schizophrenia may substantially benefit from sulpiride addition to clozapine.

Propranolol in Chronic Schizophrenia: A Controlled Study in Neuroleptic-Treated Patients

1980 ◽  
Vol 137 (2) ◽  
pp. 126-130 ◽  
Author(s):  
Leif H. Lindström ◽  
Eva Persson
Keyword(s):  
Rating Scale ◽  
Chronic Schizophrenia ◽  
Placebo Treatment ◽  
Controlled Study ◽  
Psychotic Symptoms ◽  
Double Blind ◽  
Schizophrenic Patients ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
High Doses

The effect of propranolol at a dose level of 1,280–1,920 mg per day was studied with a double-blind crossover design in twelve chronic schizophrenics with persistent psychotic symptoms despite maintenance treatment with a depot neuroleptic. By use of a psychiatric rating scale (CPRS), an improvement was seen during the two week period of propranolol compared to placebo treatment in six patients, whereas three patients were unchanged and three deteriorated. The effect on total symptom scores for the whole group was significantly better after propranolol. The data indicate that propranolol in high doses has an antipsychotic effect in some schizophrenic patients when receiving neuroleptics.

Dexamethasone suppression test in chronic schizophrenia

1988 ◽  
Vol 3 (3) ◽  
pp. 189-194 ◽  
Author(s):  
S.D. Soni ◽  
A. Mallik ◽  
V. Harris ◽  
J. Shrimanker ◽  
J. McMurray
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Chronic Schizophrenia ◽  
Neuroleptic Treatment ◽  
Brief Psychiatric Rating Scale ◽  
Structural Abnormalities ◽  
Psychiatric Rating ◽  
Suppression Test ◽  
Psychiatric Rating Scale ◽  
Anxiety Depression

SummaryDexamethasone suppresson test (DST) was administered to 26 chronic schizophrenic inpatients who were on stable doses of neuroleptics for over 3 months. Clinical assessments were made on the Brief Psychiatric Rating Scale (BPRS), the Manchester Scale (KGV) and the Scale for the Assessment of Negative Symptoms (SANS). Patients’ neuroleptic treatment was then stopped for 4 weeks and the clinical assessements and the DST repeated. Thirty two percent of the patients showed DST non-suppression which was mostly stable over the 4-week period of the study and was unaffected by the neuroleptic treatment. Contrary to some reports in the literature, the clinical rating scores (including those for depression and negative symptoms), in our patients, showed no relationship with the DST status. We suggest that the DST abnormality in chronic schizophrenies may result from two quite different mechanisms: one due to stress assoeiated with transient psychopathology such as agitation, anxiety, depression or psychotic perturbation which is transient, the other resulting from structural abnormalities in the brain and which remains stable over time.

scholarly journals Symptom Profile of Psychiatric Patients With Psychosis or Psychotic Mood Disorder in Prison

2018 ◽  
Vol 62 (13) ◽  
pp. 4158-4173 ◽  
Author(s):  
J. van Beek ◽  
P. J. Vuijk ◽  
J. M. Harte ◽  
E. J. A. Scherder
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Psychiatric Patients ◽  
Violent Behavior ◽  
Psychotic Symptoms ◽  
Psychiatric Ward ◽  
Symptom Profile ◽  
Patient Groups ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

There is evidence that psychiatric patients with psychotic or manic disorders who are incarcerated suffer from the same symptoms as psychiatric patients who are treated in the community. There are also indications that their symptoms might be more severe. The aim of this study was to examine the severity of psychotic and manic symptoms, as well as to collect information about the emotional functioning of patients admitted to a prison psychiatric ward. Incarcerated patients with a diagnosis of psychotic or a manic disorder were examined with the Brief Psychiatric Rating Scale–Expanded (BPRS-E). With the scores of 140 assessments, a symptom profile was created using the domains of the BPRS-E. This profile was compared with the clinical profile of three nonincarcerated patient groups described in literature with a diagnosis in the same spectrum. We found high scores on positive and manic psychotic symptoms and hostility, and low scores on guilt, depression, and negative symptoms. High scores on manic and psychotic symptoms are often accompanied by violent behavior. Low scores on guilt, depression, and negative symptoms could be indicative of externalizing coping skills. These characteristics could complicate treatment in the community and warrant further research along with clinical consideration.

Idazoxan and Response to Typical Neuroleptics in Treatment-Resistant Schizophrenia

1996 ◽  
Vol 168 (5) ◽  
pp. 571-579 ◽  
Author(s):  
Robert E. Litman ◽  
Tung-Ping Su ◽  
William Z. Potter ◽  
Walter W. Hong ◽  
David Pickar
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Random Order ◽  
Symptom Improvement ◽  
Treatment Resistant ◽  
Neuroleptic Treatment ◽  
Double Blind ◽  
Clozapine Treatment ◽  
Psychiatric Rating Scale ◽  
Typical Neuroleptics

BackgroundWe investigated whether antagonism of α2adrenergic receptors would augment treatment response in schizophrenia, by administering idazoxan, an α2antagonist drug, to treatment-resistant patients on typical neuroleptics.MethodSeventeen hospitalised treatment-resistant patients with DSM–III–R schizophrenia or schizoaffective disorder were studied on typical neuroleptic treatment, on treatment with idazoxan plus typical neuroleptic, and after discontinuation of idazoxan, in fixed, non-random order, and under double-blind, placebo-controlled conditions.ResultsThe addition of idazoxan to fluphenazine treatment resulted in significant reductions of global psychosis and total, positive and negative symptoms on the Brief Psychiatric Rating Scale, compared to neuroleptic treatment alone. Symptom improvement significantly correlated with idazoxan-induced changes in indices of noradrenergic function. In a subgroup of patients, idazoxan plus typical neuroleptic treatment compared favourably with clozapine treatment, when both were compared to typical neuroleptic treatment alone.ConclusionsThe antagonism of α2receptors augmented therapeutic response to typical neuroleptic treatment in treatment-resistant patients with schizophrenia. This antagonism may contribute to clozapine's superior antipsychotic effects.

Adjunctive memantine for schizophrenia: a meta-analysis of randomized, double-blind, placebo-controlled trials

2017 ◽  
Vol 48 (1) ◽  
pp. 72-81 ◽  
Author(s):  
W. Zheng ◽  
X-H. Li ◽  
X-H. Yang ◽  
D-B. Cai ◽  
G. S. Ungvari ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Neurocognitive Performance ◽  
Double Blind ◽  
Significant Difference ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Mean Differences

BackgroundDysfunction of N-methyl-D-aspartate receptor (NMDAR) is involved in the pathophysiology of schizophrenia. A meta-analysis of randomized controlled trials (RCTs) was conducted to examine the efficacy and safety of memantine, a non-competitive NMDAR antagonist, in the treatment of schizophrenia.MethodsStandardized/weighted mean differences (SMDs/WMDs), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed.ResultsIncluded in the meta-analysis were eight RCTs (n = 452) of 11.5 ± 2.6 weeks duration, with 229 patients on memantine (20 mg/day) and 223 patients on placebo. Adjunctive memantine outperformed placebo in the measures of Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale negative symptoms [SMD: −0.63 (95% CI −1.10 to −0.16), p = 0.009, I2 = 77%], but not in the total, positive and general symptoms [SMD: −0.46 to −0.08 (95% CI −0.93 to 0.22), p = 0.06–0.60, I2 = 0–74%] or the Clinical Global Impression Severity Scale [WMD: 0.04 (95% CI −0.24 to 0.32), p = 0.78]. The negative symptoms remained significant after excluding one outlying RCT [SMD: −0.41 (95% CI −0.72 to −0.11), p = 0.008, I2 = 47%]. Compared with the placebo group, adjunctive memantine was associated with significant improvement in neurocognitive function using the Mini-Mental State Examination (MMSE) [WMD: 3.09, (95% CI 1.77–4.42), p < 0.00001, I2 = 22%]. There was no significant difference in the discontinuation rate [RR: 1.34 (95% CI 0.76–2.37), p = 0.31, I2 = 0%] and adverse drug reactions between the two groups.ConclusionsThis meta-analysis showed that adjunctive memantine appears to be an efficacious and safe treatment for improving negative symptoms and neurocognitive performance in schizophrenia. Higher quality RCTs with larger samples are warranted to confirm these findings.

Effects of Neuroleptic Reduction in Schizophrenic Outpatients Receiving High Doses

1994 ◽  
Vol 39 (4) ◽  
pp. 223-229 ◽  
Author(s):  
Gérard Leblanc ◽  
Hugues Cormier ◽  
Marie-Andrée Gagné ◽  
Sylvie Vaillancourt
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
High Dose ◽  
Clinical Effects ◽  
Relative Paucity ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
High Doses ◽  
Schizophrenic Outpatients

This paper presents an open study which evaluated the clinical effects of a partial and progressive reduction in neuroleptic medication in 32 outpatients suffering from schizophrenia who were receiving high doses (equivalent of ≥ 18 mg of oral haloperidol per day; EHL). After an observation period of twelve weeks, each subject's dose of neuroleptics was reduced by 50% at the rate of 10% every four weeks. Patients were receiving a mean of 62 mg per day EHL at the beginning of the study and 30 mg per day EHL at the completion of the study. After the reduction, the following was observed: 1. a significant but modest change in psychopathology: a decrease in negative symptoms and in the total score on Brief Psychiatric Rating Scale; and 2. a significant increase in tardive dyskinesia symptoms. Six subjects relapsed but five of them recovered without increasing their reduced medication. Results of this study are discussed in the context of trying to find a minimal maintenance dose in the treatment of schizophrenia. The relative paucity of change despite a large reduction in medication argues for réévaluation of dosage in patients on high or very high doses of neuroleptics. The results suggest that many patients taking high doses could be maintained on significantly lower doses of neuroleptics. With gradual reduction of medication it would seem that many patients who are receiving a high dose of neuroleptic can achieve a lower dose than their current maintenance level.

The Efficacy of Electroconvulsive Therapy in the Treatment of Schizophrenia

1987 ◽  
Vol 151 (2) ◽  
pp. 152-155 ◽  
Author(s):  
K. R. Abraham ◽  
P. Kulhara
Keyword(s):  
Electroconvulsive Therapy ◽  
Rating Scale ◽  
Double Blind Trial ◽  
Double Blind ◽  
Blind Trial ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
To Receive

The efficacy of ECT was investigated in a double-blind trial. Twenty-two patients with schizophrenia received trifluoperazine and were randomly allocated to receive eight real or eight simulated ECTs. In the first eight weeks, the group receiving real ECTs showed significantly more improvement as measured on the Brief Psychiatric Rating Scale. However, the groups showed no significant differences from the twelfth week onwards. The superiority of real ECT was not confirmed at the end of six months.

scholarly journals Staff perception on reduction of medication in patients with chronic schizophrenia

1997 ◽  
Vol 21 (11) ◽  
pp. 692-694 ◽  
Author(s):  
A. Thomas ◽  
G. Katsabouris ◽  
N. Bouras
Keyword(s):  
Rating Scale ◽  
Clinical Symptoms ◽  
Chronic Schizophrenia ◽  
Staff Perceptions ◽  
Average Decrease ◽  
Brief Psychiatric Rating Scale ◽  
Medication Plan ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Stay Hospital

This exploratory study assessed staff perceptions to the reduction of maintenance neuroleptic medication in patients with chronic schizophrenia living in a long-stay hospital. Ten in-patients were assessed at regular times over six months. In addition to the Brief Psychiatric Rating Scale (BPRS), data were obtained from nursing staff on patients' ward behaviour (Ward Behaviour Interview Schedule, WBIS), clinical global opinion (CGI) and staff reaction (SR) to the reduction of medication plan. The average decrease of BPRS and WBIS was not related to keyworker's clinical global impression. The SR increased against the reduction of medication over the study period (P<0.05). Staff perceptions in the treatment of patients with chronic schizophrenia and their possible influence on prescribed closes should be taken into consideration in addition to psychopathology and clinical symptoms.

Awareness of illness moderates self-assessment of psychotic symptoms

2021 ◽  
pp. 000486742110574
Author(s):  
Luis Martinez Agulleiro ◽  
Renato de Filippis ◽  
Stella Rosson ◽  
Bhagyashree Patil ◽  
Lara Prizgint ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Confidence Interval ◽  
Rating Scale ◽  
Psychotic Symptoms ◽  
Schizophrenia Spectrum Disorders ◽  
Brief Psychiatric Rating Scale ◽  
Schizophrenia Spectrum ◽  
Psychiatric Rating ◽  
Spectrum Disorders ◽  
Psychiatric Rating Scale

Objective: Self-reports or patient-reported outcome measures are seldom used in psychosis due to concerns about the ability of patients to accurately report their symptomatology, particularly in cases of low awareness of illness. The aim of this study was to assess the effect of insight on the accuracy of self-reported psychotic symptoms using a computerized adaptive testing tool (CAT-Psychosis). Methods: A secondary analysis of data drawn from the CAT-Psychosis development and validation study was performed. The Brief Psychiatric Rating Scale and the Scale of Unawareness of Mental Disorders were administered by clinicians. Patients completed the self-reported version of the CAT-Psychosis. Patients were median-split regarding their insight level to compare the correlation between the two psychosis severity measures. A subgroup sensitivity analysis was performed only on patients with schizophrenia spectrum disorders. Results: A total of 159 patients with a psychotic disorder who completed both CAT-Psychosis and Scale of Unawareness of Mental Disorders were included. For the whole sample, CAT-Psychosis scores showed convergent validity with Brief Psychiatric Rating Scale ratings ( r = 0.517, 95% confidence interval = [0.392, 0.622], p < 0.001). Insight was found to moderate this correlation (β = –0.511, p = 0.005), yet agreement between both measures remained statistically significant for both high ( r = 0.621, 95% confidence interval = [0.476, 0.733], p < 0.001) and low insight patients ( r = 0.408, 95% confidence interval = [0.187, 0.589], p < 0.001), while psychosis severity was comparable between these groups (for Brief Psychiatric Rating Scale: U = 3057, z = –0.129, p = 0.897; disorganization: U = 2986.5, z = –0.274, p = 0.784 and for CAT-Psychosis: U = 2800.5, z = –1.022, p = 0.307). Subgroup of patients with schizophrenia spectrum disorders showed very similar results. Conclusions: Insight moderates the correlation between self-reported and clinician-rated severity of psychosis, yet CAT-Psychosis remains valid in patients with both high and low awareness of illness.

Treatment of drug-resistant chronic schizophrenics with an association of neuroleptics and the calcium antagonist nimodipine

1992 ◽  
Vol 7 (4) ◽  
pp. 177-182 ◽  
Author(s):  
F Brambilla ◽  
GL Gessa ◽  
A Sciascia ◽  
A Latina ◽  
M Maggioni ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Psychiatric Symptomatology ◽  
Brief Psychiatric Rating Scale ◽  
Chronic Schizophrenics ◽  
Daily Dose ◽  
Effect Of Therapy ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Plasma Mhpg

SummaryNimodipine was administered at the daily dose of 90 mg po, for 30 days, to ten chronic undifferentiated schizophrenics, eight men and two women, aged 31-35 years, maintained on previously longlasting neuroleptic treatments. In five patients, a placebo period of 15 days preceded the administration of the drug. Monitoring of psychiatric symptomatology by the Brief Psychiatric Rating Scale (BPRS) revealed significant nimodipine-induced improvement. However, the Andreasen Rating Scale for Positive Symptoms (SAPS) showed favourable effects only in the five patients who had not received placebo, while in the others both SAPS and the Andreasen Rating Scale for Negative Symptoms (SANS) showed no significant effect of therapy. The Tardive Dyskinesia Scale revealed no improvements of neurological symptoms after either placebo or drug treatment. Measurement of plasma MHPG concentrations revealed no significant changes induced by either placebo or nimodipine, while HVA plasma levels showed a trend toward decrease, and prolactin a trend toward increase, after nimodipine.

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