Haloperidol blood levels and clinical effects.

This study explored the relationships between plasma levels and the clinical effects of haloperidol in 176 acutely exacerbated schizophrenic or schizoaffective patients. After a single-blind placebo period of 1 week (period 1), they entered the double-blind period 2 randomly assigned to one of three plasma levels of haloperidol: low (2 to 13 ng/mL), medium (13.1 to 24 ng/mL), or high (24.1 to 35 ng/mL). Patients whose conditions did not improve in period 2 continued on one of the three haloperidol levels (period 3). Periods 2 and 3 lasted 6 weeks each. Only minor differences in clinical responses were noted among the three levels of haloperidol. These results imply that low or moderate doses of neuroleptics are appropriate for many acutely psychotic patients.

Tryptophan treatment of aggressive psychiatric inpatients.

This double-blind, placebo-controlled study tested the effectiveness of tryptophan (TRP) in the treatment of aggressive psychiatric inpatients. After a baseline observation period of 1 month, patients were randomly assigned to treatment either with TRP (up to 6 g/day) or with placebo. There were 10 subjects in each treatment group. These treatments were administered for 25-35 days, after which the patients were observed for 1 month. Throughout this study, patients were receiving other medications. Injections of antipsychotics and sedatives were administered as needed to control agitated or violent behavior. Blood levels of TRP and other large neutral amino acids were obtained repeatedly, and ratios between TRP and other amino acids were computed. These analyses confirmed significant increases of TRP ratios in TRP-treated patients. TRP treatment had no effect on the number of violent incidents, but it significantly reduced the need for injections of antipsychotics and sedatives. The study thus provided indirect support for beneficial effects of TRP in aggressive psychiatric inpatients.

Typology of patient-patient assaults detected by videocameras.

OBJECTIVE: Previous studies of inpatient assault have relied on reports by ward staff, data from which are often incomplete. The authors observed patient-patient assaults with videocameras, obtaining previously unavailable data. In this article they report a systematic method for assault description and classification. METHOD: Assault was defined by behaviors such as hitting, kicking, and choking, with physical contact. Raters reviewed videotapes to make a global judgment of assailant intent to hurt; assault class was based on this judgment. At the same time the raters chose descriptors to better define classes. For external validation, the authors compared classes for resulting injuries, detection by incident reports, and patients' accounts of their motivations. RESULTS: Of 155 assaults detected, 21 were classified as least serious, 57 were in an intermediate group, and 76 were classified as most potentially hurtful. One assault could not be classified. Descriptor variables each made independent significant contributions to assault classification. Almost all assaults detected by incident report or resulting in injuries were in the most serious class. Assailants' claims that they were playing were significantly associated with the least serious class. CONCLUSIONS: With videocameras a variety of interactions between patients involving hitting, slapping, etc., were detected and documented. Some events seemed playful, others seemed intended to hurt, and some were of an intermediate type. This basic, descriptive work can lead to advances in the study of assault predictors.

Videotape recording of inpatient assaults: a pilot study.

Inpatient assaults were videotaped and then characterized by tape reviewers as showing high or low hostility. Over a 2-month period, the videotape reviewers documented more than twice as many high-hostility assaults as were documented by other methods of reporting.

Postnatal development of a cholinergic influence on neuroleptic-induced catalepsy.

The development of cholinergic influence on neuroleptic-induced catalepsy was investigated in 10-, 15- and 20-day-old rat pups. It was found that the antimuscarinic atropine was ineffective in decreasing the catalepsy produced by spiroperidol treatment at 10 and 15 days. By day 20, however, atropine attenuated cataleptic behavior in a dose-dependent manner. Atropine alone was shown paradoxically to elicit mild to moderate cataleptic responses in 10- and 15-day-olds, but not at day 20. Clozapine by itself produced the same age dependent pattern of catalepsy response as the spiroperidol and atropine combination treatment. These results suggest that cholinergic mechanisms which interact antagonistically with the dopamine systems underlying cataleptic behavior are not functionally mature until after day 15 in the rat.

Psychiatric patients' explanations for assaults.

Using videocameras, the authors detected 134 assaults by 40 of 113 patients treated over a 23-month period on a 14-bed intensive ward for violent psychiatric patients. After assailants were approached by an interviewer to obtain their explanations for the assaults, investigators analyzed the content of their responses by assigning up to four themes to each response. Most frequently the patient refused to be interviewed. Assailants who cooperated often claimed to have been playing with the victim, complained of verbal abuse, or said they wanted to stop objectionable behaviors by the victim. The results suggest that assailants may perceive some behaviors by victims as provocations.

Akathisia and violence.

Akathisia is a common side effect of neuroleptic drugs that may present with behavioral disturbances. There have been preliminary reports on the association between violence and akathisia. We report the first observational study of this relationship. Patients studied were from a special unit for violent patients. A closed-circuit television camera was installed in each of the corners in its dayroom. Incidents of assault plus the 5 minutes preceding each assault were recorded on videotape. Participants and bystanders were rated for the motor component of akathisia. For each of nine incidents, we compared the akathisia scores for participants and for bystanders. Both victims and assailants were akathisic before about half of all incidents; bystanders rarely were. The classification of the movements we rated and the implications for further studies are discussed.