An innovative approach to clinical communication in schizophrenia: the approaches to schizophrenia communication checklists.

Side effects from antipsychotic medications can have a profound effect on patients' lives and may adversely affect their willingness to comply with treatment. Identification of side effects through improved communication between psychiatrists, other members of the healthcare team, and their patients might increase treatment compliance. The Approaches to Schizophrenia Communication (ASC) Steering Group developed two simple, practical checklists for use in the busy clinical setting. The ASC-Self-Report (ASC-SR) checklist is completed by the patient and comprises a list of the more common or clinically important side effects of antipsychotic treatment. The ASC-Clinic (ASC-C) checklist is completed by both clinician and patient together, being used as the basis for a semi-structured interview. In a multicenter pilot study set up to evaluate the utility of checklists, 86% of patients responding considered the ASC-SR to be useful in communicating their problems to psychiatrists and other members of the healthcare team. All healthcare team respondents found both checklists to be helpful when discussing side effect problems with their patients. Moreover, 41% and 47% of healthcare team respondents reported that the ASC-SR and ASC-C, respectively, had assisted them in identifying side-effect problems not previously acknowledged. Preliminary evaluation of the ASC-SR and ASC-C in this multicenter pilot study suggests that both tools were user-friendly, encouraged communication between patients and healthcare professionals about antipsychotic drug side effects, and could readily integrated into everyday clinical practice.

Adverse cutaneous reactions to antidepressants.

The authors review the literature on adverse cutaneous reactions to antidepressant medications. The prevalence of rashes ranges from approximately 2% to 4% but is higher for certain antidepressants such as maprotiline and carbamazepine. Antidepressant drug reactions result in a variety of cutaneous morphologic patterns, but the majority of eruptions are exanthematous. The patterns of these reactions are similar whether the pathogenesis is mediated by immunologic or nonimmunologic mechanisms. The management of patients with adverse cutaneous reactions to antidepressants is discussed, and various recommendations are given.

Aphasia in senile dementia of the Alzheimer type.

We assessed language function, using a brief clinical Aphasia Battery and psychometric measures, in 150 subjects with senile dementia of the Alzheimer type (SDAT) and 83 elderly controls. Aphasia occurred only in demented subjects, and its prevalence increased with severity of dementia. Aphasia in mildly demented subjects was associated with both an earlier age of onset and more rapid progression of SDAT than in similarly demented nonaphasics. Language dysfunction in SDAT subjects was characterized by early decline in measures of comprehension and written expression, whereas other components, including oral naming, were less profoundly affected. Performance on the verbal psychometric measures, the Sentence Repetition and the Token tests, correlated strongly with Aphasia Battery scores and declined only minimally in nonaphasics, despite increasing dementia. We conclude that aphasia is a common feature of SDAT subjects and identifies a subgroup with more rapid progression of dementia. Furthermore, it represents language-specific dysfunction beyond the global cognitive impairment of SDAT.

Predictive value of the Boston Naming Test in mild senile dementia of the Alzheimer type.

The prognostic implications of anomia were examined in a group of subjects with mild senile dementia of the Alzheimer type. Anomia was found to correlate with a more rapidly progressive course of illness. A subject's age did not account for the degree of anomia. Duration of illness was not correlated with the degree of anomia or with severity of dementia. The presence of anomia in a subject with mild senile dementia of the Alzheimer type appears to indicate a more rapidly progressive course.

Performance of normal elderly on the Boston Naming Test.

The Boston Naming Test has enjoyed increasing use in many research studies since its introduction. However, there is little normative data on the age group above 60 years of age. This study presents data from a sample of 58 well-defined healthy elderly males and females between the ages of 60 and 85. In comparison with published normative data, our sample has higher means, smaller standard deviations, and narrower ranges. These results suggest that aging alone does not significantly alter recognition-cued word-finding ability as defined by the Boston Naming Test. Also there is remarkably consistent performance throughout our age range.

Aphasia, family history, and the longitudinal course of senile dementia of the Alzheimer type.

Aphasia, was present in a majority of subjects in a longitudinal study of 43 subjects with senile dementia of the Alzheimer type. Aphasic subjects had a more rapidly progressive course but a lower prevalence of familial cases than the study group, other study groups, or the nonaphasic subjects. Conversely, the lack of aphasia was associated with a higher prevalence of familial cases and a slower rate of progression. It is concluded that senile dementia of the Alzheimer type is a heterogeneous disorder in which the presence of aphasia early in the course signifies a nonfamilial, rapidly progressive variety of illness.

Predictive features in mild senile dementia of the Alzheimer type.

Forty-three subjects with mild senile dementia of the Alzheimer type, diagnosed and staged by clinical research criteria, were studied with clinical, psychometric, EEG, visual evoked potential, and CT measures. During the 12 months following entry into the study, 21 subjects progressed to moderate or severe dementia, 21 remained mild, and one was lost to follow-up. Many of the clinical and psychometric measures of impairment were predictive of the progression to moderate or severe dementia. Electrophysiologic and CT measures were not. In a discriminant function analysis, the scores on two measures (the digit symbol subtest of the Wechsler Adult Intelligence Scale and an Aphasia Battery) correctly predicted the stage of dementia 1 year later in 95% of the subjects.

Six-year follow-up of patients with carefully diagnosed good- and poor-prognosis schizophrenia.

Forty-nine probands, diagnosed according to objective diagnostic criteria as having good- or poor-prognosis schizophrenia, were interviewed 6 years after being diagnosed to assess outcome measured by the Strauss-Carpenter outcome scale, global ratings made by experienced clinicians, and Feighner criteria. The majority of poor-prognosis probands were doing poorly, had a higher than expected number of suicides or probable suicides, and had evidence of organic impairment. The authors conclude that poor prognosis can be accurately predicted when longitudinal factors are embedded in the diagnostic criteria and that clinicians should be aware of the substantial risk of suicide and organic impairment with schizophrenia.

Preliminary report on affective symptoms in the early stages of senile dementia of the Alzheimer type.

The authors rated 30 probands with senile dementia of the Alzheimer type and 30 healthy controls for depression at the beginning of a longitudinal study and 1 year later. Significant degrees of depression were not found in either group at either time.

Birth order and maternal age effect in dementia of the Alzheimer type.

Birth order and maternal age were unrelated to dementia of the Alzheimer type (DAT) in a study of 42 probands with clinically diagnosed DAT and 42 age-matched control subjects. Mean birth order in both groups did not differ significantly from the general population. The mean maternal age for the DAT probands was neither significantly different from that for the controls nor from that for the 1920 U.S. Caucasian population. Since the diagnostic criteria for the DAT group were only clinical, an additional 14 probands with DAT confirmed by autopsy were studied. Mean maternal age did not differ significantly in this group from the controls, the general population, or the clinically diagnosed DAT group. It was concluded that maternal age and birth order bear no special relationship to DAT in this sample.

Mild senile dementia of Alzheimer type: research diagnostic criteria, recruitment, and description of a study population.

Clinical investigations of senile dementia of the Alzheimer type require establishment of explicit clinical diagnostic criteria before histological confirmation is possible. Criteria for selection of mildly impaired subjects with senile dementia of Alzheimer type, free of other major disease, are proposed. Problems of recruitment of this select population for a longitudinal study are discussed. A study population with matched healthy control subjects has been enrolled and described. Short term follow-up has provided preliminary support for the diagnostic criteria.

Validity of the Hamilton Rating Scale for depression.

In 26 depressed patients, a high correlation (0-89) was found between the Hamilton score and a psychiatrist's global rating and between the change (0-68) in these ratings during treatment. The Hamilton scale was able to differentiate at the o-01 level four degrees of severity based on the global rating. Limiting the range of severity measured was found to lower significantly the correlation between the ratings. A prospective examination of a six-item sub-scale of the Hamilton scale developed by Beck and associates failed to confirm its claimed improvement in sensitivity or validity.

Sampling time, dosage schedule, and nortriptyline plasma levels.

Steady-state nortriptyline plasma levels were determined in eight patients at 9 AM, 12 PM, 3 PM, and 6 PM during treatment with nortriptyline hydrochloride administered as a single daily bedtime (hs) dose at 10 PM and repeated after changing the dosage schedule to three times a day (tid) with divided doses at 10 AM, 4 PM, and 10 PM. Overall, the mean levels were stable during the sampling period and comparable on the two schedules. As expected, the plasma level decreased at the later sampling times on the hs schedule and increased on the tid schedule. In seven of the eight patients, the differences on the two dosage schedules were less than 30 ng/ml, which is not considered clinically significant. One patient had a higher plasma nortriptyline level on the tid schedule, which was clinically significant. Standardization of sampling time is of importance when comparing plasma levels and therapeutic response in treatment studies.