Barringer D. Marshall

Risperidone vs. haloperidol on reaction time, manual dexterity, and motor learning in treatment-resistant schizophrenia patients

BACKGROUND The present study compared the effects of risperidone vs. haloperidol on reaction time, manual dexterity, and two types of motor learning in a sample of treatment-resistant schizophrenia patients. METHODS Fifty-six DSM-III-R diagnosed schizophrenia inpatients participated in a randomized, double-blind comparison of risperidone vs. haloperidol. Measures of reaction time, manual dexterity, motor sequence learning, and gross motor learning were administered at baseline, after 4 weeks of fixed-dose medication, and after 4 weeks of flexible-dose medication. RESULTS The results indicated that patients receiving risperidone showed greater improvement in reaction time and manual dexterity than patients receiving haloperidol. After covarying symptom changes and movement disorder ratings, the results remained significant. The two treatment groups did not differ on either measure of motor learning. CONCLUSIONS The differences in performance in reaction time and manual dexterity may be due to a specific beneficial effect of risperidone, as opposed to a general reduction in extrapyramidal symptom liability, compared to haloperidol.

The effects of risperidone vs haloperidol on cognitive functioning in treatment-resistant schizophrenia: The trail making test

In this article, data are presented from Parts A and B of the Trail Making Test, which examined the effects of haloperidol vs risperidone on cognitive function in treatment-resistant scxhizophrenic patients. This report focuses on findings from the Trail Making Test. Overall, risperidone had a positive effect on Trail Making Part B performance following 4 weeks of treatment. These effects were due, at least in part, to the direct effects of risperidone. The possibility that an antipsychotic agent can enhance executive functioning through direct mechanisms, perhaps mediated by frontal cortex neurochemistry, indicates that the evaluation of antipsychotic medications in the treatment of schizophrenia should be expanded to include cognition.

Simultaneous determination of plasma haloperidol and its metabolite reduced haloperidol by liquid chromatography with electrochemical detection Plasma levels in schizophrenic patients treated with oral or intramuscular depot haloperidol

A simple and highly sensitive liquid chromatographic method with electrochemical detection for the simultaneous determination of haloperidol and its metabolite reduced haloperidol in human plasma has been developed. The sample preparation for the analysis involves a simple one-step extraction procedure with 10% methylene chloride in pentane. The compounds were separated on a cyano column maintained at a temperature of 40 degrees C and were detected electrochemically by a flow-through analytical cell kept at +0.95 V. The standard curve is linear over the range of 0.1 to 15 ng/ml and the lower limit of quantitation is 0.1 ng/ml for haloperidol and 0.25 ng/ml for reduced haloperidol which is equivalent to approximately 40 pg on column when 1 ml of plasma was used for the analysis. The lower limit of quantitation for reduced haloperidol can be extended to 0.1 ng/ml if 2 ml of plasma is used in the analysis. The coefficient of variation of the determination of plasma levels by this method over the standard curve concentration range was less than 10%. Commonly co-administered drugs and other neuroleptics used in conjunction with haloperidol did not interfere in the determination of either haloperidol or reduced haloperidol. This method has been successfully used for the determination of haloperidol and reduced haloperidol in plasma and their levels in patients treated with various doses oral haloperidol or intramuscular haloperidol decanoate are reported.

Maintaining Nursing Staff Performance on an Intensive Behavior Therapy Unit.

Abstract The establishment and maintenance of high quality behavioral programs within a hospital setting are complex and time consuming tasks. Suggestions for maintaining nursing staff performance in such a setting are provided based on the experiences of the authors. The central thesis is that such intensive programs require a combination of factors including high staff morale, consistency of effort, teamwork, staff training and reinforcement. The procedures responsible for the successful 12 year maintenance of the Camarillo State Hospital/UCLA Clinical Research Unit (CRU) include standard patient treatment programs; observation and data collection procedures; a flexible credit economy system; a cohesive, interdisciplinary professional staff; and attentiveness to political currents

Effects of Fenfluramine on Neuropsychological and: Communicative Functioning in Treatment-Refractory

Reported behavioral improvement among autistic patients following feufluramine treatment and a high serotonin level among certain chronic schizophrenic patients suggested that fenfluramine treatment might be beneficial with such schizophrenic patients, especially within the realm of neuropsychological and communicative functioning. A brief neuropsychological battery was administered to eight chronic schizophrenic subjects before, during, and after fenfluramine treatment. Conversations in controlled settings were audiotaped before and during fenfluramine treatment for seven of these subjects and one additional subject. These language samples were analyzed for communicative competence and evidence of thought disorder. Overall, neuropsychological and communicative functioning was worse under the fenfluramine condition, even though blood serotonin levels were about half those at baseline conditions. The results suggest that it is not the higher levels of blood serotonin by themselves that are related to depressed neuropsychological, communicative, and other functioning. In fact, the higher levels of serotonin may well be related to adaptations for maximal level of functioning. These results suggest caution in the use of fenfluramine for other schizophrenic populations.

Pharmacokinetics of Fenfluramine and Neuroleptics in the Treatment of Refractory Schizophrenia

SummaryThis study was designed to investigate whether the addition of fenfluramine to neuroleptic therapy could produce an improvement in chronic schizophrenics who were limited responders to neuroleptics. Initially, each of 9 inpatients received at least 6 weeks’ treatment with placebo fenfluramine for baseline data collection. Thereafter, active fenfluramine therapy commenced at 60 mg/day with increments of 20 mg/day implemented every 2 weeks until a maximum daily dose of 120mg of fenfluramine was attained. This dosage level was maintained until fenfluramine was withdrawn by stepwise decrements, so that the duration of fenfluramine treatment did not exceed 12 weeks. The patients then continued to receive placebo fenfluramine for a minimum of 4 weeks for further evaluation and data collection. Throughout the study each patient was maintained on a constant dose of a neuroleptic drug.The stepwise addition of fenfluramine revealed significant correlations between dose and plasma concentrations for both isomers of fenfluramine and its pharmacologically active metabolite, nor-fenfluramine. Dose proportionality with the plasma concentrations of the isomers of parent and metabolite was also maintained during dose tapering. The plasma concentrations of the l-isomers of both fenfluramine and norfenfluramine were significantly higher than those of the corresponding d-isomers. Moreover, the l: d optical isomer ratios were constant at 1.9 for fenfluramine and 1.4 for norfenfluramine. Thus, it would appear that the enantioselective aspects of fenfluramine and its metabolite norfenfluramine were not affected by changes in the dose of fenfluramine. The presence of fenfluramine had no consistent effects on the steady-state plasma concentrations of either the neuroleptic drugs or metabolites.

ASSESSING PSYCHIATRIC PATIENTS' COMPLIANCE IN TAKING MEDICATION

HOSPITAL & COMMUNITY PSYCHIATRY The group functions as a conjoint team. It reviews outreach referrals and collaborates on services to patients in residence. The function of the conjoint team is explained to the patients, and they are asked to sign release-of-information forms before they are discussed in the group. The meetings have resulted in many new neferrals to Midtown center and its satellites. Communication between the various services has improved, and referrals are much more appropriate. During 1977 a total of 63 patients lived in Salvation Army residential facilities; they stayed an average of 33 days. Twenty-six returned to independent living, three moved to other types of residential facilities, and two returned to the hospital. Contact was lost with 26 patients, and eight had other dispositions. In addition to work with these patients, the conjoint team provided consultation on 135 other cases. The emergency residential service has helped meet the needs of chronic patients who have no support systern. It has expedited discharge for patients with dispositional problems and no resources. It has temporarily helped patients meet basic needs while disability benefits, employment or job training, and living quantens were being arranged. The program was begun on a voluntary basis by professionals who were concerned about these unmet needs. It started with a verbal agreement and with the question “What can be done about this problem?” The emergency residential service is one answer, and the resuIts have been gratifying.