Herbert E. Spohn

Results of a controlled, experimental, outcome study of nondrug treatments for the control of migraine headaches

Headache variables were examined for 136 subjects who participated for 36 weeks in one of four groups-No Treatment, Autogenic Phrases, Electromyographic (EMG) Biofeedback, and Thermal Biofeedback. All subjects kept daily records of headache activity and medication usage and participated in 22 laboratory sessions during which frontalis electromyographic and handtemperature measurements were taken; those in the three treatment groups practiced at home. There was a substantial reduction in headache variables in all groups. The No-Treatment Group differed significantly from the treatment groups combined, with the least reduction in headache variables. The Thermal Biofeedback Group vs. EMG Biofeedback and Autogenic Phrases Groups showed a suggestive trend toward improvement in the frequency and intensity of total headache.

The Effects Of Phenothiazine Medication On Skin Conductance And Heart Rate In Schizophrenic Patients

The effects of chronically administered phenothiazine medication upon aspects of skin conductance (SC) and heart rate (HR) in 32 schizophrenic patients were assessed in two ways. Skin conductance scores obtained during rest and during the performance of a series of span of apprehension tasks were correlated with a phenothiazine dosage index (PDI), representing chlorpromazine equivalent daily dosage. For 15 schizophrenics withdrawn from medication for 3 months and for nine normal controls pre- and postwithdrawal rest and performance scores were obtained and compared by repeated measurement analyses of variances. Results, congruent with other studies, indicate that phenothiazines reduce SC level, elevate HR and restrict frequency of specific and nonspecific reactivity in SC and range of variability in HR. Moreover, it was shown that several of these effects are linearly related to daily dosage level. The implications of these findings for past and future uses of autonomically mediated psychophysiological variables in the study of phenothiazine-treated schizophrenic disorders are discussed, as well as the applicability of the PDI in controlling statistically drug dosage-contaminated psychophysiological variance.

Medical effects of abrupt neuroleptic withdrawal.

Abstract Abrupt withdrawal of neuroleptics is often associated with symptoms such as headache, insomnia, nausea, and vomiting. Do these symptoms exceed base rates? Are prewithdrawal dosage and type of neuroleptic significant? Are the concurrent administration and/or withdrawal of AP drugs necessary for the production of these withdrawal symptoms? The literature in the area is reviewed to indicate current status of these issues. Also, prewithdrawal and postwithdrawal symptom data are presented from a withdrawal study of 56 chronic schizophrenic patients. Postwithdrawal symptom rates (38%) significantly exceeded base rates for the total group and for subgroups withdrawn from neuroleptics only and from neuroleptics and AP drugs. Other studies2,3,5,8 have found incidences of 60% and higher. A relationship between neuroleptic dosage and withdrawal symptoms was not found, as was also the case in one prior study.3 We did not establish a relationship between neuroleptic type and withdrawal symptoms, but the studies2,3,5,8 showing the highest incidences of withdrawal symptoms used particularly autonomic neuroleptics (especially aliphatics). Although nonautonomic neuroleptics (piperazines and butyrophenones) alone can lead to withdrawal symptoms, they appear to do so mostly when AP drugs are concomitantly being taken and are withdrawn. The clinical implications of these findings are discussed.

A conceptual model for research on required length of psychiatric hospital stay.

Abstract Fifty-four clinicians in a setting that provides a multifaceted network of services geared toward long-term rehabilitative treatment wrote vignettes describing psychiatric patients they considered to be ideally suited to various lengths of hospital stay at the long end of the spectrum. From a content analysis of 545 vignettes, the authors developed a conceptual model for research on factors affecting length of stay. They distinguished among the domains of patient, environmental, and treatment factors; discovered that different factors from these domains pertain to different diagnostic groups; and proposed the concept of “length-of-stay prototype,” based on groups of factors linked to diagnosis, as a model for predicting required length of inpatient stay in the long-term treatment context.

PSYCHOPHYSIOLOGICAL PATTERNS OF RESPONSE IN SCHIZOPHRENIA

Schizophrenic subgroups (paranoid vs. nonparanoid), (acute vs. chronic), (poor vs. good premorbids) did not differ on heart rate (HE,) and skin conductance (SC). Paranoids showed significantly higher muscle tension (EMG) than nonparanoids, and there were no subgroup differences on blood pulse volume (BPV). Under phenothiazine medication patients showed lower SC and higher HR than normals, but after drug withdrawal patients showed both high SC and high HR. Correlations between the four psychophysiological measures provided little evidence for arousal as a unitary concept, and correcting for background variables by stepwise regression analysis did not modify the evidence for arousal. Analysis of coefficients of concordance, based on autonomic lability scores, showed that drugged schizophrenics were physiologically less sensitive to changes in the procedure than normals.

The Effect Of Chlorpromazine On Visual Information Processing In Normal Subjects

The hypothesis that chlorpromazine (CPZ) has the effect in visual information processing of protecting the short term memory visual trace by serving to filter or habituate stimuli following an initial stimulus was tested in 40 normal college students. The method involved the tachistoscopic presentation of paired, successive 3 x 2 consonant arrays, separated by a 200-millisecond interval, with instructions to report either the first or the second array, in a double blind repeated measurement design in which Ss served as their own placebo controls and a single dose of 50 milligrams of CPZ was administered. Under the particular conditions obtaining in this investigation, the results do not support the hypothesis, but suggest that when ipsimodal, isomorphic distraction follows an initial relevant stimulus, CPZ tends to reduce STM span. The results do afford partial support for the hypothesis that CPZ has the effect of delaying the processing (coding) of visual information. A CPZ mechanism of action on response criteria in deciding the relevance of stimuli is advanced and related to clinical effects of CPZ in acute schizophrenics.

A strategy for the study of behavioral mechanisms of antipsychotic drug action in schizophrenia

The basic strategy being proposed is one of studying the time-course of antipsychotic drug effects upon performance measures in parallel with the timecourse of drug effects upon the symptoms of schizophrenia, general morbidity and ward behavior. Critical for the productivity of this strategy is the inclusion of performance measures that reflect functioning in psychological processes—e.g., attention, perception etc., in which schizophrenic-specific deficit or deviance has been demonstrated and which may be presumed to mediate symptom formation. Promising candidates for inclusion in a battery of performance measures under these criteria are those reflecting functioning in the information-processing sequence, i. e., in sensory-attentional-perceptual-cognitive processes. Given this approach, the examination of relationships between patterns of change at the level of deficit performance and of symptomatology, has the potentiality of disclosing both mechanisms of drug action and critical mediating mechanisms of schizophrenic disorder.

How long does chlorpromazine last

How long does chlorpromazine last? This question regarding the persistence of chlorpromazine (CPZ) in chronically medicated schizophrenic patients after drug discontinuation led to wide ranging preliminary answers. These varied from a few to several days for blood studies up to many months for urinary and clinical studies. At least two implications of the question need to be considered: a) the pharmacological persistence of active drug and/or metabolites after drug discontinuation; and b) the persistence of the therapeutic effects regardless of whether or not active drug and/or metabolites are pharmacologically present. For example, a patients behavior may improve while on CPZ and this improvement may persist after the active drug and/or metabolites cease to be present in the patients body. These two areas of inquiry were examined by looking at blood, urinary, and clinical data. Although blood studies undoubtedly give the most definitive data, they are greatly complicated by the lack of definitive information regarding the active moiety (moieties) and crucial sites of action, the large number of metabolites (up to 150 or so), the minute quantities involved (ng/ml), the wide inter- and intrapatient variations, and the newness and lack of complete comparability of the quantitative methodologies. Within these limitations, there are a number of studies that are fairly consistent in showing a half-life of disappearance from the plasma of CPZ and/or metabolites in the range of a few to several hours. This would usually mean that most of the drug and metabolites are cleared from the plasma in a few days after drug discontinuation. Urinary studies are related less directly than blood studies to desired clinical effects. Under steady-state conditions in various studies, 43 to 63 per cent of a daily therapeutic dose of CPZ can be recovered in the urine in 24 hours. After drug discontinuation, urinary drug and/or metabolites in most studies last from about 3 to 18 days, with sometimes minimal or trace amounts after this. The clinical studies show a continuation of therapeutic benefits for up to 6 months and longer in some studies, but there are a number of studies showing placebo (withdrawn) groups deteriorating significantly more than continued drug groups much before this, even as early as 1 to 2 weeks off drug. This examination of the literature tends toward a duration of substantial pharmacological (therapeutic) action of CPZ of no more than a few days after drug discontinuation. For a small number of patients, clinical deterioration begins about the same time, whereas in many others, clinical improvement lasts weeks or months. Some of this latter continuation of improvement is likely not due to CPZ and/or metabolites currently active. There do remain many unanswered questions regarding the persistence of minute amounts of CPZ and/or metabolites in storage and possibly at active sites, and whether or not in some patients this makes a significant contribution.