Burtrum C. Schiele

Chlorimipramine: a double-blind comparison of intravenous versus oral administration in depressed patients.

A double-blind study was carried out in 30 patients to compare the results of chlorimipramine given orally and intravenously.The speed of onset of action and the overall improvement were excellent for both treatment modalities. No significant differences were found favoring either way of administration. As a consequence, our results do not support previous reports that suggest advantages and rationale for the intravenous usage of chlorimipramine.

A Double-Blind Study of Amantadine Hydrochloride versus Benztropine Mesylate in Drug-Induced Parkinsonism

A double-blind cross-over comparison of the relative efficacies of amantadine hydrochloride and benztropine mesylate was performed on a sample of patients showing parkinson-like side-effects secondary

Treatment of hospitalized schizophrenics with trifluoperazine plus tranylcypromine: A double-blind controlled study

Summary This study investigated the efficacy of adding a nonhydrazine MAO inhibitor to a phenothiazine in treating depressed schizophrenic patients. In a ten-week double-blind study, comparisons were made between a group given trifluoperazine plus tranylcypromine (T + T) and a group given trifluoperazine plus placebo (T + P). Assessments were made on the basis of ward behavior, psychologic testing, and clinical evaluation. For an initial two-week period, all patients were given trifluoperazine alone, in increasing dosage. For the remaining eight weeks of the study, one group received T + T, the other T + P, in a flexible dosage range of 5 to 50 mg. for trifluoperazine and 10 to 60 mg. for tranylcypromine. The placebo tablets and tranylcypromine were identical in appearance. In general, the differences between the T + T and T + P groups were few. These differences, although all in the direction of favoring T + T, reached only low levels of significance. However, both groups showed a substantial reduction in symptoms during the ten-week period from pretreatment to the final evaluation. Apparently, tranylcypromine does not contribute much to the benefits provided by trifluoperazine alone in the treatment of depressed schizophrenics. The results of this study do not indicate that tranylcypromine should be added routinely to a phenothiazine for treating withdrawn or regressed chizophrenies. Our advice to the practicing psychiatrist would be to treat such a patient wit trifluoperazine alone, adding tranylcypromine later if progress is unsatisfactory.

A sequential comparison of amitriptyline, perphenazine and the amitriptyline-perphenazine combination in recently admitted anergic schizophrenics.

INTRODUCTION • Schizophrenic patients who show pronounced features of withdrawal and apathy, or who show symptoms of depression, frequently fail to respond to treatment with neuroleptic agents alone. Such patients, often called anergic schizophrenics, occur in fairly large numbers and represent a difficult treatment challenge for psychiatry. It is for this reason that combinations of antipsychotic or neuroleptic agents with antidepressant drugs have been used in psychiatric practice. Many physicians have the impression that for the group of anergic schizophrenics, such combinations have an advantage over either type of drug used alone. One commonly used combination is that of perphenazine (Trilafon) and amitriptyline (Elavil). Perphenazine is a potent and effective antipsychotic drug1 while amitriptyline, a widely used tricyclic antidepressant agent, is possibly one of the most effective of the antidepressants • Much of the psychiatric literature on combination drugs reports the results of uncontrolled open trials. This may be because controlled or double-blind studies of combination

A COMPARATIVE STUDY OF THIORIDAZINE AND CARPHENAZINE USING SEQUENTIAL ANALYSIS.

Introduction General. The techniques of sequential analysis are ordinarily recommended in situations where data are collected serially rather than all at once and where there are compellhlg reasons for arriving at a practical decision between two alternatives with as few experimental subjects as possible. I t is well-documented that fewer subjects are ordinarily needed to arrive at a decision using these methods than with equivalent nonsequential procedures. This is of special importance in the evaluation of new drugs because of the ethical considerations involved in the use of compounds of unknown safety and effectiveness in preference to other available treatments of better known but limited safety and effectiveness. The study reported here was carried out primarily as a pilot application of a method of sequential analysis. Our aim was to explore the efficiency of this method in providing a rational basis upon which an investigator may decide whether a particular new drug merits further investigation and/or clinical use. The advantages, disadvantages, modifications, and limitations of sequential analysis in medical applications are excellently summarized in a recent book (A~MITAGE 1960). In the use of conventional, nonsequential, statistical procedures, the investigator decides, in advance of his experiments, how many subjects will be studied under each experimental condition. At the conclusion of the experiment he then uses statistical tests to determine the probability that any differences he has observed might be attributable to the vagaries of sampling or other random features of his experiment. In the use of sequential analysis, all of the statistical computations are carried out in advance of data collection and are represented on a sequential graph similar to that shown in Fig. 1. The experimenter

Comparison of butaperazine and perphenazine: A double-blind controlled study

SummaryFifty-three chronically ill institutionalized psychotic patients were placed on a double-blind study, using a newer phenothiazine, butaperazine, unmarketed in the United States, and a well-known and widely marketed compound, perphenazine. Matched patients received medication for a period of 8 weeks. Dosage of butaperazine was increased from 20 to 100 mg daily, and of perphenazine from 16 to 80 mg daily.Butaperazine was found to be better than perphenazine in 8 pairs and equal to it in 5 pairs. Perphenazine was better than butaperazine in 12 pairs. Of the butaperazine patients, 1 showed moderate improvement, 9 were slightly improved, and 6 were slightly worse. In the perphenazine group, 7 were much improved, 10 slightly improved, and 3 slightly worse. The chief side effects in both groups were extrapyramidal phenomena, which responded to benztropine methanesulfonate.These results indicate that in this chronic psychotic population, butaperazine does not seem to be a more effective compound than perphenazine, and has more side effects in the nature of extrapyramidal phenomena.

Antidepressants: comparison of clinical effects in anergic schizophrenia and the depressed states.

New antidepressant drugs are often first evaluated in the chronic anergic schizophrenic population of state institutions. These patients have the following advantages as a test group: ( 1 ) chronic anergic schizophrenics are available in reasonably large numbers; (2 ) since chronic schizophrenia is protracted in course, any significant improvement is usually attributed to the drug and not to the natural remissions which frequently occur in “purer” depressed patients. Consequently, increased activity, alertness, and verbalization in drug-treated schizophrenics suggests that the compound may have useful antidepressant properties; ( 3 ) the stabilized condition of anergic schizophrenics also allows significant crossover studies of comparative drug actions. The purpose of the present paper is to answer, insofar as possible from available studies, the following question: Is it valid to test a drug intended for use in depressed states in a different type of patient (anergic schizophrenics)? This question is particularly pertinent in view of the fact that so many anergic schizophrenics are unresponsive and difficult to evaluate.

Panel discussion on tranquilizing drugs in the clinical management of mental disease in geriatric patients.

Moderator: FRANK J. AYD, JR., M.D., Chief of Psychiatry, Franklin Square Hospital, Baltimore, Maryland. Panelists: DOUGLAS GOLDMAN, M.D., Assistant Clinical Professor of Psychiatry, Universityof Cincinnati College of Medicine; and Clinical Director, Longview State Hospital, Cincinnati, Ohio; NATHAN S. KLINE, M.D., Director of Research, Rockland State Hospital, Orangeburg, N. Y., and Assistant Clinical Professor of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, N. Y.; ERNEST H. PARSONS, M.D., Assistant Clinical Professor of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; and BURTRUM C. SCHIELE, M.D., Professor of Psychiatry, University of Minnesota Medical School, and Director, Adult Psychiatric Service, University Hospitals, Minneapolis, Minnesota.

A double-blind comparison of trifluperidol and trifluoperazine in acute schizophrenic patients

Abstract Trifluperidol and trifluoperazine were compared in a double-blind study involving 30 acute schizophrenics. The patients treated with trifluoperazine showed greater improvement and fewer side effects than patients treated with trifluperidol. These results agree with the results of an earlier study with chronic schizophrenics.

The Treatment of Anxiety with a Polyfluorinated Benzodiazepine Derivative

Following 4 weeks of treatment with ORF-8063 a polyfluorinated benzodiazepine derivative, 8 hospitalized patients manifesting a primary pathology of anxiety showed marked general improvement. 2 other persons were treated, but for shorter periods: 9 and 14 days. Both are included in the pre-post analysis. Mean optimal dosage was 66.5 mg. The five instruments used to measure therapeutic effect showed pre- to posttreatment change with high level of statistical significance in serveral of the pathological factors. When measures of change are considered, patients showed more improvement related to psychic than somatic components of anxiety. Change data also indicates more patients improvement in anxiety than depression. Side effects reported more were dizziness, faintness and insomnia; these were reported in 8 patients. 6 patients noted drowsiness, and 4 noted excitement. 5 persons tolerated optimum dosages with no extreme reactions; 5 others (including the 2 subjects who terminated treatment early) were unable to maintain optimum dosages because of side effects.