Patrick T. Donlon

Comparison of depot fluphenazines: duration of action and incidence of side effects.

LUPHENAZINE ENANTHATE (FE) and fluphenazine deconoate (FD) are two long-acting injectable neuroleptics. Their outstanding advantage traditionally has been with chronic ambulatory psychotic patients who take their oral neuroleptics irregularly. More recently, the effectiveness of FE for acute psychosis has been demonstrated by Chien and Cole, who conclude that the therapeutic efficacy of FE is greater than that of moderate dose chlorpromazine.’ Comparison data on the differences in clinical effectiveness, duration of action, and incidence of extrapyramidal symptoms (EPS) between FE and FD have been less well documented. These data nonetheless are important clinically so that one particular agent can be selected more precisely. Numerous investigators contend that FD has a longer duration of action and fewer EPS.2*3 However, with the exception of one study with acute psychotic patients that supported this clinical impression, other studies tend to be poorly controlled or without a double-blind technique, thus weakening these conclusions. At the Sacramento Medical Center we have developed a rapid neuroleptization (“digitalization”) method for administering both oral and long-acting depot neuroleptics to decompensated schizophrenic patients.5 The method allows for administering initial high doses to promote the patient’s rapid improvement. In our hospital practice, long-acting depot neuroleptics are administered predominantly to psychotic patients who are irregular about taking medication immediately following discharge. Using depot neuroleptics we find that we can promote continuity of outpatient care following hospital discharge. Guidelines for dosage adjustments for the rapid neuroleptization method are the emergence of side effects, especially sedation and pseudoparkinsonism, and clinical remission. Our standard parenteral injection for both FE and FD is 50 mg given two to three times weekly until reintegration occurs. Furthermore, doses are made dependent on drug history, age, body weight, and severity of symptoms. Subsequent injections are withheld until reappearance of decompensation symptoms which include increased anxiety, dream and sleep disturbances, dysphoria, increased cognitive disorganization, perceptual distortions, and idiosyncratic thought.6

Emotional stress as a factor in ventricular arrhythmias

Abstract Clinical evidence suggests that in some cases psychologic stress may be a more potent factor than exercise in precipitating pathologic cardiac effects. An experiment designed to test this hypothesis with one patient is described. The data suggest the importance of a more careful evaluation of the differential cardiac effects of emotional factors and physical exercise when outlining a treatment plan for coronary patients.

Clobazam Versus Placebo for Anxiety and Tension in Psychoneurotic Outpatients. A Multicenter Collaborative Study

Clobazam, a 1,5-benzodiazepine, was compared with placebo in 190 psychoneurotic outpatients with prominent symptoms of anxiety and tension of at least two weeks of duration. The design was one of double-blind parallel groups treated for one week. Clobazam subjects began on 40 mg daily in divided dosage, which was increased to 80 mg daily be day 3 if the drug was well tolerated. Two patients receiving clobazam had laboratory chemistry abnormalities which were possibly drug related. Adverse effects occurred more frequently in the clobazam group and were typical of those of marketed benzodiazepines. This study indicates that clobazam is an effective anxiolytic agent demonstrating its clinical effects during the first week of treatment.

Issues in developing quality aftercare clinics for the chronic mentally III

Two large aftercare clinics were established to provide treatment and rehabilitative care for a chronic mentally ill population requiring neuroleptic drugs. The clinics have evolved rapidly and expanded their service over the past 3 years but have required constant monitoring and modification in order to provide quality as well as quantity care in the community setting. These modifications are described and the importance of further community-based investigation in the rehabilitation and treatment of the chronic mentally ill is stressed.

Differential diagnosis of the schizophrenias and affective disorders circa 1979

Abstract The differential diagnosis of the schizophrenias and affective disorders normally is not difficult once it is recognized that much data has to be collected over time before a definitive diagnosis can be established. Diagnostic guidelines are summarized in Table 6. They include a psychiatric evaluation with mental status, physical examination, and indicated laboratory and psychological tests. Longitudinal and family histories are essential, as well as a drug history listing agents, dosage, and response. Unless treatment is indicated to relieve the distressing symptoms immediately, it is helpful to have a several-day observation period free of medication. The initial diagnosis should be tentative. And the physician should not be reluctant to change the final diagnosis if such a change is suggested by additional data. Finally, with continuing advancement in psychobiology, it may someday be possible to subdivide patients in the two syndromes into highly homogeneous subpopulations. Until then, greater precision in clinical diagnosis may be obtained by following the guidelines outlined in this review.

An experimental test of two opposing theories of the perception deficit in schizophrenia.

Devised the experiment to test two alternate theories of the etiology of the perceptual defect in schizophrenia: The theory supported by Searles and Hartmann that it is a secondary recation to defense and that proposed by McGhie that it is a primary defecrt. Two groups (N = 32) of schizophrenic patients were compared, one of which was administered low doses and the other hight doses of fluphenazine HCL. Both groups were given before medication and 7 days after medication a batery of five-digit span tests. The tests differed in that they were accompanied by orally presented distracting words presented with varying combinations of emotional and neutral content and affect or with no distracting stimuli. Results indicated that patients administered high as compared to patients administered low doswages of medication performed significantly better on two-digit span tests, the test comprised of words with emotional content presented. with neutral affect, and the test with no-distracting stimuli. Because the higher dosage did not produced greater improvement on the test that utilized emotional-distracting stimuli than on the test accompanied by no distracting stimuli, the results are interpreted as supporting the theory of McGhie.