Changes in the health state of schizophrenic patients in neuroleptic therapy

The state of health of 135 schizophrenic patients was examined during therapy with a nigrostriatal (Haloperidol) and a mesolimbic (Clozapin) neuroplegic drug, and compared with the situation during treatment without neuroplegics. Among the methods used was the state of health scale of von Zerssen; the neuroleptic threshold was tested using Haase's handwriting test. There was evidence that the patient's health was primarily affected, but individual differential treatment with neuroplegics produced a significant improvement in this important respect. Contrary to Haase, we noticed nothing to convince us of a link between the antipsychotic efficacy of the neuroplegics under investigation and the neuroleptic threshold.     

An analysis of 17 catatonic patients diagnosed with neuroleptic malignant syndrome

This study was conducted to show that catatonia is a predisposing factor for neuroleptic malignant syndrome (NMS) and to review the nosological relationship between catatonia and NMS. Seventeen consecutive cases of NMS were analyzed prospectively with reference to clinical and investigative findings before and after exposure to a neuroleptic. The series comprised eight males and nine females, ranging in age from 18 years to 65 years. Prior to neuroleptic exposure, all patients exhibited features compatible with criteria for catatonia (mutism/excitement) according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, (DSM-III-R). Following neuroleptic administration (single dose in nine cases), patients deteriorated into a febrile, rigid, and obtunded state accompanied by autonomic dysfunction and raised creatine phosphokinase levels. These features were consistent with a diagnosis of NMS. Neuroleptics were discontinued and supportive medical treatment instituted. Benzodiazepines were beneficial in eight cases in relieving stupor, but bromocriptine and dantrolene were generally ineffective. In all patients diagnosed with NMS in the authors' series, catatonia was an invariable prodromal state. It appears that the administration of a neuroleptic intensified the preexisting catatonic state and precipitated a malignant variant of the disorder, which is currently recognized as NMS. The authors, therefore, challenge the separate nosological status of NMS and catatonia and suggest that these syndromes are part of a unitary pathophysiological disorder.     

Results of long-term treatment with depot neuroleptics in schizophrenic patients

An examination was instituted to determine the effectiveness of maintenance therapy involving depot neuroplegics in out-patient after-care during an average follow-up of six years. At the time of examination, 172 patients treated with Depot-Lyogen showed statistically significant lower relapse and rehospitalisation rates, a reduction of the productive schizophrenic symptoms, and improved chance of rehabilitation, compared with 55 patients without treatment. In 22% of the 270 patients on Depot-Lyogen, there were early extrapyramidal side-effects, in 4.7% late dyskinesis, and in 4.3% depressive symptoms relating to medication. 35% of the patients did not receive consistent maintenance therapy. The improvement of after-care is discussed.     

Depressive syndromes within the scope of schizophrenic diseases

The results of a standardized examination of 135 schizophrenics shows that the "depressive factor" is less pronounced during differential neuroleptic therapy (Clozapin, Haloperidol) and in the control group of schizophrenics receiving no drug treatment. This suggests that the depressive syndrome among schizophrenics is not manifested as a result of pharmaceutical action. The author proposes that neuroleptic therapy tailored to the patient can ameliorate the depressive syndrome observed in schizophrenics. Both psychoreactive and disease specific factors may play a role in the pathogenesis of depression among patients with this disease.     

Value of neuroleptic therapy in the self assessment of schizophrenic patients

On the basis of clinical self-assessment scales (von Zerssen) and the Frankfurt questionnaire of complaints, it is demonstrated by the comparison of three groups of schizophrenic patients with one control group which is not undergoing therapy with neuroplegics that within the "genuine" groups the psychopathological factors investigated recede, sometimes quite significantly. Cross-over design treatment involving the control group has not revealed any significance. We conclude that when treating schizophrenic psychoses, psychosocial measures must accompany biological measures.     

Is Lorazepam a treatment for neuroleptic malignant syndrome?

The authors assessed the ability of lorazepam and other benzodiazepines to affect the course of neuroleptic malignant syndrome (NMS). Records of inpatients who met both stringent research criteria and criteria under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) (n=11) or DSM-IV criteria alone (n=5) for NMS were identified. All received lorazepam or related benzodiazepines within 24 hours of NMS onset or hospital admission. The records were reviewed for resolution of clinical signs of NMS. Rigidity and fever abated within 24-48 hours, while secondary features of NMS were relieved within 64 hours. These results compared favorably with prior reports of 5-day to 10-day recovery periods. Benzodiazepine administration appeared to be well tolerated. Lorazepam and related benzodiazepines may reduce recovery time in NMS.     

EEG performance spectral mapping during drug therapy in a patient with schizophrenic psychosis

In a paranoid-hallucinatoric patient with chronic course and acute exacerbation a EEG mapping study during neuroleptic treatment was carried out. The typical changes of the alpha power spectra in schizophrenic psychoses as well the normalization after neuroleptic treatment could be found in the alpha map. The changes were in correlation to the clinical state.     

The universal field hypothesis of catatonia and neuroleptic malignant syndrome

Catatonia and neuroleptic malignant syndrome (NMS) are uncommon disorders that can be life-threatening. Many researchers consider them as clinically divergent entities; however, they share similar and overlapping literature on causative agents, phenomenology, and treatment response. This hypothesis considers both disorders as a single entity that result from variable combinations of the following: 1) gamma-aminobutyric acid (GABA) hypoactivity at the GABAA receptor; 2) dopamine hypoactivity at the D2 receptor; 3) serotonin hyperactivity at the 5-HT1A receptor and hypoactivity at the 5-HT2A receptor; and 4) glutamate hypoactivity at the N-methyl-D-aspartate (NDMA) receptor. In this paper, evidence to support this hypothesis is limited to retrospective human studies of catatonia and NMS. The four components of the hypothesis are: 1) GABAA agonists have been shown to alleviate catatonia and NMS; 2) D2 antagonism is proportional to the relative likelihood of NMS and catatonia; 3) 5-HT1A agonism with 5-HT2A antagonism is implicated in catatonia and NMS; 4) NMDA receptor antagonists, such as phencyclidine and ketamine, reduce glutamate transmission. This hypothesis proposes that it is the interaction of these systems that prediposes, initiates, and maintains the twin syndromes of catatonia and NMS.     

Case study: Use of propranolol to reduce aggressive behavior in a woman who is mentally retarded

Although neuroleptic medications are frequently used to treat the aggressive behavior of persons with mental retardation, little empirical support exists for their efficacy. In the case study reported here, the beta-blocker propranolol was used to treat the aggressive behavior of a 23-year-old woman with severe mental retardation. Initiation of treatment was correlated with a dramatic decrease in aggression and a less pronounced improvement in self-injurious behavior (SIB). An increase in resting heart-rate was associated with a significant increase in aggression, and progressive increases in propranolol dosage were correlated with reductions in heart rate and in significant behavioral improvement. Consideration of propranolol as a less intrusive, and possibly more effective, pharmacologic treatment for the aggressive behavior of persons with mental retardation is discussed.     

Clinical experience with Leponex]

Until now the "neuroleptic threshold" (Haase) was considered to be the efficiency criterion of the antipsychotic effect of a neuroleptic substance and it was thought therefore that the extrapyramidal symptoms were a necessary although undesired side effect. The benodiazepine derivative Leponex developed by Sandox - Basel upsets this view because it has an excellent antipsychotic effect without creating definite extrapyramidal symptoms. It is noted for its quick soporfic effect after only a few minutes, for subdueing psychopathological productivity in a very impressive way, for acting rapidly on the "plus"-symptomatology typical of psychosis, as early as in the first days of treatment, and for its equally visible effect on the "minus"-symptoms, typical of psychosis, in the last third of an average period of treatment lasting 40 days. The clinic using Leponex (Dresden, Halle, Brandenburg-G?rden) belonged to the clinical application programme of the Sandox - Basel firm. The article gives a summary of essential results and particulars about the treatment. A detailed evaluation of the case sheets which are at present being statistically reviewed will be given in the next paper.     

Serotonin syndrome in elderly patients treated for psychotic depression with atypical antipsychotics and antidepressants: two case reports

We report two cases of serotonin syndrome in elderly patients during treatment of psychotic depression with atypical antipsychotics and antidepressants. The first case is a 69-year-old man who was admitted for depression with psychosis and treated with trazodone, risperidone, and sertraline. Subsequently, he developed myoclonus, tremor, cogwheel rigidity, and diaphoresis. The second case is a 72-year-old female initially admitted to a medical inpatient unit for a change in mental status that presented as increased confusion, lethargy, slurred speech, and a fever of 101.5 degrees. She had been on phenelzine and quetiapine. In both cases, all symptoms resolved within 24 hours of the psychotropics being stopped. In both cases, we believe that serotonin syndrome was produced by a combination of an antidepressant and an atypical antipsychotic. There have been several case reports of serotonin syndrome from similar combinations of antidepressant and atypical antipsychotic treatment. Clinicians treating elderly patients with a combination of serotonergic antidepressants and atypical antipsychotics for psychotic depression should be aware of the potential for serotonin syndrome.     

Procedural learning in schizophrenia: further consideration on the deleterious effect of neuroleptics

Deficits in procedural learning remain a controversial issue in schizophrenia. This may be related to the nature of the neuroleptic treatment of schizophrenic patients as conventional neuroleptics may be more deleterious than new atypical neuroleptics. However, there is no comparative study on the effect of specific neuroleptics on procedural learning. In this study, three groups of patients treated with different neuroleptics were compared to normal controls on two procedural learning tasks. In a visuo-motor task, patients and controls showed similar learning rates, although schizophrenic patients showed generally lower performances than normal controls. However, patients treated with a conventional neuroleptic, but not those treated with the atypical neuroleptics, showed many fluctuations during the initial learning phase. In a problem-solving task, all groups were comparable in performance and learning fluctuations, but learning rates were lower in patients treated with the neuroleptic showing the higher incidence of extrapyramidal symptoms. This suggests that procedural learning abilities may be significantly affected by neuroleptics in schizophrenia, although the effect may differ between tasks and the specific neuroleptics. Fluctuations in the initial learning phase of the visuo-motor task probably results from a frontal dysfunction while reduced learning rates, such as those observed in the problem solving task, may be attributed to a striatal dysfunction. This is concordant with the differential pharmacological actions of the conventional and atypical neuroleptics in these two cerebral areas.     

Neuroleptic malignant syndrome: diagnostic and therapeutic dilemmas

Neuroleptic malignant syndrome (NMS) is a life threatening medical state complicating the use of antipsychotic medications and other drugs that affect the dopaminergic system on administration or withdrawal. The condition was recognised nearly half a century ago, shortly after the discovery of antipsychotic medications. However, there are still no systematic studies about NMS. There are no definitive guidelines on its treatment. Although early recognition is emphasised and usually possible, delayed diagnosis is not rare. We here report on a case of NMS complicated by renal failure, and possibly respiratory failure. The report underscores the seriousness of delayed diagnosis and puts forward a comprehensive management recommendation based on our experience and the existing literature.     

Relation of neuroleptic and anticholinergic medication to cognitive functions in schizophrenia

In this article, we review research designed to examine the influence of neuroleptic and anticholinergic drugs on cognitive processes in schizophrenia. The review is motivated by the recognition that pharmacotherapy is an important factor in psychological research on schizophrenia, given that the great majority of patients studied in investigations of cognition receive both of these drugs. We find that neuroleptic treatment is associated with limited normalization on many psychological measures, whereas anticholinergics appear to disrupt some aspects of memory. Subject selection criteria, research designs, and drug measurement methods important in the evaluation of possible drug effects in psychological studies are discussed.     

Decreasing Neuroleptic Doses in Older Adults with Schizophrenia

This prospective study of 27 older adults, residing in long-term care facilities, examined the effects of reducing neuroleptic medications to the point of controlling symptoms and reducing side effects. Schizophrenia is a challenging health care condition that leads to delusions, hallucinations, disorganized speech, and a host of other symptoms. Unfortunately, medications control many of the symptoms but cause unwanted side effects unless monitored closely and regulated to each person's needs. This study addresses six research questions related to the reduction of neuroleptic medications. Study findings related to neuroleptic medication dose reduction were encouraging. Additionally, the findings strongly suggest that health care providers working with older adults with the diagnosis of schizophrenia would benefit from planned educational programs about behavior, observations, and medications.     

Schizophrenically disordered time perception and its modification by neuroleptics

The authors deal with the question as to whether the target symptom "disturbed time perception" is to be considered a basic schizophrenic symptom and whether therapeutical (neuroleptic) control possibilities exist. 135 schizophreniacs have given statistical evidence (intensity quotient, Wilcoxon comparison, Hotelling-Pabst test, exact probability test according to Fisher/Yates) that the disturbed time perception of schizophreniacs is accessible by a differentiated neuroleptic therapy but is not a basic schizophrenic disturbance.     

Neuroleptic modification of basic schizophrenic disorders

After a short review of the German literature dealing with basal schizophrenic disturbances, the authors present the results of their own studies involving 135 schizophrenics. A large inventory of statistical methods is used to present the findings gained during differential neuroleptic therapy by means of the Frankfurt complaints questionnaire and the structured psychopathic assessment system (SPES-A). The studies indicate that basal schizophrenic disturbances are accessible to (differential) neuroleptic influence.     

发挥中药在肿瘤症状处理中的作用——兼谈结直肠癌的中医“病证结合辨治”

改善症状是中医治疗晚期恶性肿瘤的优势,但简单的对症治疗显然体现不了中医的特色;辨证论治虽然是中医治疗的核心,但在对癌病本质的把握上缺乏理论和实践的支撑;单一的辨病论治强调以毒攻毒,却不能改善症状及预后。本文作者以对结直肠癌的治疗为例,认为抓主症,将病证与辨治相结合,有望较好地解决“症”“证”“病”三者的关系,在改善症状...     

The Assessment and Treatment of Post-Abortion Syndrome: A Systematic Case Study From Southern Africa

This article reports a clinical case study of “Grace”, a black Zimbabwean woman with post-abortion syndrome (PAS), a form of post-traumatic stress disorder precipitated by aborting an unwanted pregnancy. She was treated by a middle class white South African trainee Clinical Psychologist. The case narrative documents the assessment and the course of treatment which was guided by ongoing case formulation based on current evidence-based models. Factors that made her vulnerable to developing PTSD included active suppression of the memory of the event and lack of social support. An understanding of these factors was used to guide an effective intervention. In spite of the differences in culture and background between client and therapist, there was considerable commonality in their experience as young women and students who each had to balance personal and occupational priorities. The narrative also highlights the commonalities of Grace's experiences with those reported in the literature on post-abortion syndrome, which is mostly from the U. S. A. and Europe.