Prediction of response to haloperidol dose reduction by Span of Apprehension measures for treatment-refractory schizophrenic patients.

Thirteen treatment-refractory schizophrenic patients participated in a haloperidol reduction study. Two of the subjects were unable to tolerate medication reduction. These subjects were comparable to the other patients in terms of initial clinical variables but were outliers on baseline accuracy and reaction time measures from the Span of Apprehension. The results suggest that aspects of basic visual processing and motor response speed may identify patients who require higher neuroleptic doses.

Optimal drug and behavior therapy for treatment-refractory schizophrenic patients.

Thirteen treatment-refractory schizophrenic patients (10 men and three women) who were receiving more than 50 mg/day of haloperidol and who had been hospitalized for more than 1 year successfully tolerated a mean dose reduction of 63% with consequent improvement in psychopathology and side effects. The addition of intensive behavior therapy to the optimal dose of haloperidol yielded further improvements in functional behavior, such as self-care and social interaction.

Schizophrenic individuals' cognitive functioning and performance in interpersonal interactions and skills training procedures.

The purpose of this research was to determine the relationship between schizophrenic individuals' cognitive functioning and their performance in interpersonal interactions and skills training procedures. Thirty schizophrenic individuals and 15 non-mentally ill individuals were administered two versions of the Continuous Performance Test, the Span of Apprehension Test, the Digit Span Distractibility Test, the Assessment of Interpersonal Problem Solving Skills, and three elemental skills training tasks. Vigilance level as measured by the Continuous Performance Test was substantially correlated with performance in both roleplayed interactions and skills training tasks, while recall memory as measured by the Digit Span Distractibility Test was correlated with performance in the skills training tasks independently of vigilance level. Thus, the results indicated that the cognitive dysfunctions of schizophrenia are associated with poorer social functioning and with reduced performance in the elemental procedures that constitute efforts to improve that functioning.

Optimal drug and behavior therapy for treatment-refractory institutionalized schizophrenics.

Institutionalized persons with a deteriorating form of schizophrenia that was refractory to neuroleptic medication were titrated downward in their haloperidol dose. Based on ratings of their clinical status, an optimal dose was reached that was an average 66 percent reduction from their initial levels. Patients then participated in a personalized, intensive behavior therapy program to remediate their extreme, persisting deficits and disturbances in behavior.

Training chronic mental patients to independently practice personal grooming skills.

Schizophrenic patients typically have poor grooming and self-care skills, which hinder their social relationships and their chances of successful adaptation in the community. A practical and inexpensive program for teaching grooming skills to hospitalized chronic mental patients has been developed in a California state hospital. Patients are also taught to evaluate their grooming behavior and to carry out grooming activities independently. Grooming deficits and improvements are rated on an 11-category performance checklist. Two small-scale pilot studies showed that the program is efficacious and that nursing staff can effectively apply the procedures; in another study, the program was implemented on a large psychiatric unit with minimal staffing and resources.

Systematic dosage reduction in treatment-resistant schizophrenic patients.

Thirteen treatment-resistant, chronically institutionalized schizophrenic patients on high-dose neuroleptic (the equivalent of at least 50 mg of haloperidol (HPL) daily) were transferred to a special research ward for a trial of systematic dosage reduction. In these 13 patients, it was possible to reduce the dose of HPL from 63.1 mg/day (SD +/- 12.5, range = 50-80 mg/day) to 23.1 mg/day (SD +/- 16.3, range = 0-65 mg/day) over a mean period of 32 weeks (SD +/- 9.6, range = 15-46 weeks). Their total Brief Psychiatric Rating Scale (BPRS) scores were improved (p = .04), they definitely experienced fewer extrapyramidal side effects (p = .01), and 6 of the patients showed global improvement. On several behavioral rating scales there was, if anything, an improvement in negativistic behavior. The substantial dosage reduction was paralleled by a comparable drop in plasma levels. HPL plasma levels at baseline were 38.8 ng/mL (SD +/- 17.8, range = 21.5-69.5 ng/mL) and at the lowest effective dose were 12.4 ng/mL (SD +/- 10.3, range = 0-43.4 ng/mL).