Linda Bowen

Conversational skills training with schizophrenic inpatients: A study of generalization across settings and conversants

Three male schizophrenic inpatients were taught appropriate conversational behavior using social skills training (SST). Subjects were taught verbal skills in an office and those behaviors were monitored in that setting as well as covertly assessed in the ward dayhall and courtyard during encounters with unit staff and strangers. SST produced large and consistent increases in responding in the training setting; however, generalization across settings and conversants varied greatly depending on the subject, skill, and conversant. When an intervention consisting of homework assignments plus intermittent prompts and consequences was applied in the dayhall, responding rose substantially in that setting. Follow-up assessments conducted 3 months after the completion of training showed that the verbal skills were maintained. Social validity ratings given by stranger confederates directly after treatment revealed improvements for 2 of the 3 subjects on several measures of social competence and attractiveness.

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 This dosage level was maintained until fenfluramine was withdrawn by stepwise decrements, so that the duration of fenfluramine treatment did not exceed 12 weeks.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.