Paul C. Bermanzohn

Bromocriptine for “negative” schizophrenia

The hypothesis that the pathophysiology of negative symptoms in schizophrenia may involve relative hypoactivity of central dopaminergic neurotransmission prompts the exploration of dopamine agonist strategies in the treatment of this condition. Although the use of dopamine agonists in otherwise unmedicated schizophrenic patients often leads to the exacerbation of psychosis, trials of dopamine agonists in combination with neuroleptic agents warrant investigation. We therefore report on open clinical experience involving six patients with chronic negative symptoms of schizophrenia, maintained on neuroleptic medication, who appeared to have favorable responses to the addition of moderate doses of bromocriptine (10 to 20 mg/d orally in divided doses). One particular factor that makes these trials potentially informative is that five of the six patients had failed to respond to standard treatments with anticholinergic antiparkinsonian medication before the bromocriptine trial, making it unlikely that the bromocriptine had its effect purely by counteracting neuroleptic-induced akinesia. A trial of bromocriptine under these circumstances has never been reported. A second unique feature of this report concerns the lengthy period of follow-up. Adjunctive bromocriptine was continued for a total of 27 patient-years in the six individuals, with maintenance of favorable course and minimal incidence of psychotic exacerbation.

Adjunctive imipramine for a broader group of post-psychotic depressions in schizophrenia

As an expansion of work examining the usefulness of adjunctive imipramine added to fluphenazine decanoate and benztropine in the treatment of post-psychotic depression, a previously successful and informative protocol was extended to a larger and more heterogeneous cohort of clinic and day-treatment patients. Although the benefit of the adjunctive antidepressant strategy was still observable in the total sample, as calculated by the prospectively intended data analysis, the findings were weaker than those obtained for the initial cohort. Owing to the possibility that differences between the later and earlier cohorts might account for the muted nature of the benefit, a post-hoc analysis was undertaken. This revealed that the later cohort was sicker in general and more psychotic in particular. The later cohort was also treated with lower doses of neuroleptic medication while remaining out of hospital longer, consistent with more recent treatment trends. It was also possible that the later cohort was subtly selected for more refractoriness of depression, since treatment of post-psychotic depression with adjunctive antidepressants had become more commonplace, and patients responding to this in general practice would not have gone on to be referred to the study. Thus a benefit from adjunctive antidepressant medication persists, but more remains to be learned about its character and likelihood in specific situations.

Antidepressant for substance-abusing schizophrenic patients: A minireview

1. Substance abuse and post-psychotic depression are both frequently encountered concomitants of schizophrenia. 2. Substance abuse may be associated with depression-like symptomatology in the course of schizophrenia, and patients may attempt to self-medicate these symptoms with substances of abuse. 3. Antidepressant medication has been found to be a useful adjunct to treatment in at least some cases of substance abuse and some cases of post-psychotic depression. 4. Preliminary evidence exists suggesting that adjunctive antidepressant medication, added to a neuroleptic, may be useful for at least some stable dysphoric substance-abusing schizophrenic patients. 5. It is important to attempt to rule out even subtle neuroleptic-induced akinesia in such patients with a vigorous trial of antiparkinsonian medication.

A profile of obsessive compulsive symptoms in schizophrenia

(n == 226) of male schizophrenics and a group of healthy male controls (n = 142) equivalent in parental education and socioeconomic status. The mean height of the patients (177.0 em) was significantly shorter (p<0.OO5) than the mean height of the controls (179.4 em). Within the patient group, those in the lower quartile of height compared to the upper quartile had significantly poorer premorbid function as measured by: I) social relationships (t = 2.46, p<0.007); 2) school performance measured by grades (t= 1.81 p<0.036) and need for special education (t= 1.78, p<0.002); and 3) estimate of pre-morbid VIQ using the NART (t==2.2, p<0.02). In addition, when the whole patient sample was analyzed these measures of premorbid function, as well as a measure of motor development (age at which child first walked), correlated significantly with height. These findings provide additional support for the hypothes is that schizophrenia may occur as a consequence of neurodevelopmental factors. Furthermore, this is manifested as a global deficit in growth and function resulting in smaller stature, slower motor development, poorer social skills and deficit in cognitive abilities. ..~ A PROFILE OF OBSESSIVE COMPULSIVE SYMPTOMS IN SCHIZOPHRENIA

Treatment of Obsessive-Compulsive Syndromes in Schizophrenia

While obsessive-compulsive (OC) symptoms in schizophrenia have been reported for many years, they have achieved only limited recognition and, perhaps for this reason, few studies their pharmacological treatment have been carried out. One suggested treatment approach is the use of different agents for different symptoms. In this article, we review the small number of published studies and case reports regarding this multi-pharmacological method of treatment for OC symptoms in schizophrenia. While each study used a somewhat different patient population and provided varying and limited information concerning patient sample, study design, and results, some tentative conclusions and treatment recommendations may be drawn from their findings.

Adjunctive imipramine for dysphoric schizophrenic patients with past histories op cannabis abuse

1. Twenty-one schizophrenic or schizoaffective patients with histories of cannabis abuse and operationally-defined syndromes of post-psychotic depression completed a double-blind trial of adjunctive imipramine added to their on-going medication regimen of fluphenazine decanoate and benztropine. 2. The imipramine-treated patients had superior global outcome. 3. Subscales suggested that specific improvement occurred in imipramine-treated patients in the domain of depression-like features. 4. Psychotic symptomatology was not found to be exacerbated by the imipramine.

Cognitive behavioral treatment of panic attacks in chronic schizophrenia

Although panic attacks have been described as relatively common in schizophrenia, few studies have examined treatments for this problem. Because cognitive-behavioral therapy (CBT) has demonstrated efficacy for panic disorder without schizophrenia, the authors conducted an open clinical trial of CBT for the treatment of panic attacks in schizophrenic patients. Eight patients meeting DSM-III-R criteria for schizophrenia and panic disorder were given a 16-week clinical trial of CBT. Ratings after treatment demonstrated both a statistically significant reduction in panic symptoms and a diminution in the number of panic attacks compared with baseline ratings. These results suggest use of CBT in the integrated treatment of patients with a diagnosis of schizophrenia and panic disorder is a promising approach that merits further investigation.