Very high dose fluphenazine decanoate: a controlled trial in chronic schizophrenia.

In a double-blind trial of six months' duration, a very high dose (VHD) regimen of fluphenazine decanoate (250 mg weekly) was compared with a standard dose (SD) regimen (12.5 mg weekly) in 50 chronic schizophrenic patients. The rating scales used included the Brief Psychiatric Rating Scale and the Wing Ward Behavior Scale. Both treatment groups improved during the trial, but there was no significant difference between them. The VHD regimen, however, exerted better control of the psychosis in that it had fewer patient dropouts and fewer "additional treatments" prescribed. Some of the patients receiving standard doses were probably not receiving adequate antipsychotic drug dosage. No predictors of clinical response could be defined. Extrapyramidal side effects were not significantly higher in the VHD group.

A comparison of high- and low-dose lorazepam with amylobarbitone in patients with anxiety states.

A double-blind crossover trial comparing lorazepam at two dosage levels with amylobarbitone supported previous reports of the effective anxiolytic action of the drug. Evaluation of the patients' responses during each week of treatment was based on a physician's weekly rating and on daily self-rating by patients. The results were analyzed by sequential and nonsequential analyses. The main side effect of the drug was drowsiness, which occurred to a clinically significant degree among the high-dose group of patients. The authors emphasize the value of two dosage trials, particularly in devising subsequent flexible individual treatment regimens.

The evaluation of an ultrasound detector (UD) in the measurement of oro-facial dyskinesia.

An ultrasound detector (UD) was compared with a clinical rating (CR) scale in the assessment of oro-facial movements in 23 chronic schizophrenic patients and 23 normal subjects over a period of 4 weeks. The apparatus distinguished well between normal volunteers and dyskinetic patients. There were also highly significant correlations between UD scores and clinical ratings. The results thus confirm both the construct and concurrent validity of the technique. Nevertheless, there was significant variation in the UD scores for some patients between assessments. A technical problem was the inability of some patients to cooperate for more than 30 seconds. The scores of the normal subjects were consistent. With further development and repeated 30-second assessments the technique might be of value in the ascertainment of early dyskinesia in patients at risk and also in measuring drug effects.

A clinical comparison of nomifensine and amitriptyline.

1. The study consists of a double-blind evaluation of nomifensine and amitriptyline in a group of 37 patients with primary depressive illness. 2. The patients were referred by their family doctors on the basis that they would ordinarily have been prescribed a tricyclic antidepressant drug. Random allocation to the treatment groups took place. Assessment took place at weekly intervals over a 4-week period using the Visual Analogue Scale for depression and anxiety, and a side-effects check-list. Patients were also assessed on the Hamilton Depression Scale before the onset and at the end of the trial. 3. No significant difference was found between the two groups as regards relief from depression and anxiety, although marginal differences were found in favour of the amitriptyline group. 4. The overall frequency of side-effects was similar in the nomifensine and amitriptyline patients, But the development of severe side-effects was significantly more common in the amitriptyline group.

Trazodone. A comparative clinical and predictive study.

The clinical efficacy and tolerability of trazodone and amitriptyline were compared in 74 hospital patients suffering from depressive illness. The daily doses of trazodone and amitriptyline were 150-300 mg and 75-225 mg, respectively, with half-strength capsules for patients over the age of 65 years. Twenty-five and 29 patients receiving trazodone and amitriptyline, respectively, completed the 6 week treatment period. Antidepressant activity was measured using the Hamilton Depression Rating Scale (HDRS), the Zung Scale of Depression, visual analogue scales and a Global Assessment Scale. Trazodone and amitriptyline were both effective but not statistically different from each other in terms of antidepressant action. Moreover, patients with neurotic or endogenous depression responded equally well on either treatment. Trazodone was less troublesome in respect of the persistent dry mouth and severe adverse psychiatric reactions which occurred with amitriptyline. Patients should be advised to take trazodone after meals.

The comparative antidepressant value of lofepramine and amitriptyline. Results of a controlled trial with comments on the scales used.

A double-blind controlled trial comparing the antidepressant activity of amitriptyline with lofepramine is reported. Forty-six patients entered the 4-week trial. Analysis of the Hamilton Depression Rating Scale scores at the beginning and end of the trial showed no significant difference between the therapeutic efficacy of lofepramine and amitriptyline. However, patients with endogenous depression responded significantly more rapidly to lofepramine as measured by Visual Analogue Scales and showed a significantly greater degree of clinical improvement after 4 weeks' treatment, as measured by Global Assessment. Adverse effects were similar in the two treatment groups. The use of rating scales in trials of depressive illnesses is discussed. The Visual Analogue Scale for depression was found to be a simple, useful and valid measure.

Metoclopramide and haloperidol in tardive dyskinesia.

The effect of single intravenous doses of metoclopramide (10 mg, 20 mg and 40 mg) and haloperidol (5 mg and 10 mg) have been compared to placebo (saline) in a double blind randomised study in 8 patients with tardive dyskinesia secondary to neuroleptic therapy. Tardive dyskinesia rating scores were improved significantly (P less than 0.01) 6 hours after dosing by metoclopramide 40 mg, and haloperidol 5 mg and 10 mg, when compared to placebo. Single doses of dopamine receptor blocking agents improve tardive dyskinesia. The dose of metochlopramide required to show a beneficial effect was high, and this therefore suggests that it is unlikely to be of therapeutic value as the incidence of adverse reactions would be greatly increased. By monitoring the effects of single doses of dopamine receptor blocking drugs in patients with tardive dyskinesia it is possible to compare the relative potencies of these drugs on dopaminergic systems in vivo in man.

The effect of propranolol and thioridazine on positive and negative symptoms of schizophrenia.

Patients with chronic schizophrenia were treated with either propranolol (640 mg daily) or thioridazine (400 mg daily). In a double-blind study lasting five weeks, propranolol was superior to thioridazine on both psychiatrists' and nurses' ratings. Significant improvements were noted with propranolol in both positive (Type I) and negative (Type II) symptoms.

Facial dyskinesia: a 16-year follow-up study.

The 109 female survivors of a mental hospital population surveyed in 1965 for facial dyskinesia were followed up 16 years later. The 99 survivors with non-organic brain syndromes were analysed. Prevalence of dyskinesia had risen from 18.4% to 46.5% during follow-up and its development was significantly associated with neuroleptic dosage. Enlarged ventricles on brain scans were significantly associated with dyskinesia, cognitive impairment and neuroleptic prescribing.

Mortality and facial dyskinesia.

In 1965 a psychiatric in-patient population was surveyed for the prevalence of facial dyskinesia. The present investigation reports on their survival time. Among male and female patients with functional disorders (mostly schizophrenia) there was a strong association between moderate or severe facial dyskinesia and shortened survival, but no clinical factors were found to explain this. Mild facial dyskinesia in functional disorders was not associated with reduced life expectancy and may be attributable to the general effects of ageing rather than to a specific pathological process. Among patients with primary organic brain syndromes, dyskinesia was not associated with reduced life expectancy.

Study on the effects of tablet colour in the treatment of anxiety states.

Forty-eight patients with anxiety states were treated with oxazepam (Serenid-D), which was administered in tablets of three different colours-red, yellow, and green. Every patient received one week's treatment with each colour, according to a random programme. A latin square design was used to ensure complete balance between the colours and between the weeks. The patients' symptoms were categorized and then assessed by both weekly physicians' ratings and daily self-rating, which showed close agreement. Colour preference was shown on both these scales in that symptoms of anxiety were most improved with green, whereas depressive symptoms appeared to respond best to yellow. Such colour preferences, however, did not reach levels of statistical significance, except for phobias as rated on the physicians' assessment.The results indicate that colour may play a part in the response to a drug.