Ulf Malm

Schizophrenic relapse after drug withdrawal is predictable

Abstract— Thirty‐two patients in remission were followed by regular ratings during a prospective neuroleptic withdrawal study. They were outpatients who fulfilled the DSM‐III criteria of schizophrenia and who were motivated for drug withdrawal. The relapse rate was 81 %. The results from the rating scales confirm the hypothesis that a symptom increase occurs before psychotic relapse. In the order statistical differences occurred, the factors predicting relapse were those concerned with positive psychopathology, motor dysfunction, impaired affects and sleep disturbances. The corresponding symptoms and signs were mainly concerned with thought disorders, paranoid ideation, overactivity, depression and insomnia middle, all of nonpsychotic degree of severity. If prodromes appear, the patient should resume his neuroleptic treatment, or other preventive measures should be taken. By such therapeutic interactions, psychotic relapse may be prevented, or can be dealt with in an outpatient setting.

Do schizophrenics well adapted in the community need neuroleptics? A depot neuroleptic withdrawal study.

Two depot neuroleptics (flupenthixol palmitate and clopemthixol de canoate) used for at least 15 months were withdrawn in 32 schizephrenic outpatients belonging to the most symptom‐free and social cohort of a total patient population. They all had only slight schizophrenic symptoms, were well adapted in the community, and had been free from relapse for at least 2 years before the study. They were assessed by means of rating scales every month during the first six months and then after 9 and 12 months.

Resource Group Assertive Community Treatment (RACT) as a Tool of Empowerment for Clients with Severe Mental Illness: A Meta-Analysis

The aim of the current meta-analysis was to explore the effectiveness of the method here labeled Resource Group Assertive Community Treatment (RACT) for clients with psychiatric diagnoses as compared to standard care during the period 2001 – 2011. Included in the meta-analysis were 17 studies comprising a total of 2263 clients, 1291 men and 972 women, with a weighted mean age of 45.44 years. The diagnoses of 86 % of the clients were within the psychotic spectrum while 14 % had other psychiatric diagnoses. There were six randomized controlled trials and eleven observational studies. The studies spanned between 12 and 60 months, and 10 of them lasted 24 months. The results indicated a large effect-size for the ”grand total measure” (Cohen´s d = 0.80). The study comprised three outcome variables: Symptoms, Functioning, and Well-being. With regard to Symptoms, a medium effect for both randomized controlled trials and non-randomized studies was found, whereas Functioning showed large effects for both types of design. Concerning Well-being both large and medium effects were evident. The conclusions of the meta-analysis were that the treatment of clients with Resource Group Assertive Community Treatment yields positive effects for clients with psychoses and that the method may be of use for clients within the entire psychiatric spectrum.

High doses of fluphenazine enanthate in schizophrenia: A CONTROLLED STUDY

The results from this controlled study of 12 schizophrenics refractory to ordinary doses of neuroleptics indicate that treatment with fluphenazine enanthate in higher doses than normal (10–20 times higher) might give reduction in psychopathology beyond what can be obtained with normal doses. In four patients the symptom reduction on high doses was pronounced. Moreover, we found that the high fluphenazine plasma levels demonstrated did not increase extrapyramidal and general side effects. The results presented also speak in favour of certain “non‐responding” patients needing a higher plasma level of a neuroleptic drug than the average patient.

Clopenthixol and flupenthixol depot preparations in outpatient schizophrenics. I. A one year double-blind study of clopenthixol decanoate and flupenthixol palmitate.

Clopenthixol decanoate and flupenthixol palmitate, both depot neuroleptics belonging to the thioxanthene group, were studied during double‐blind conditions for 12 months using four week intervals between injections. The 60 patients included in the study were chronic schizophrenics and treated as outpatients after earlier admission to hospital and rehabilitation training periods. They had all been treated with depot neuroleptics in the last three years and they had been free from relapse for at least 15 months. The main aim with this trial was to study the two depot drugs during maintenance treatment conditions in an outpatient setting.

Assessment of patient satisfaction with psychiatric care. Development and clinical evaluation of a brief consumer satisfaction rating scale (UKU-ConSat)

Quality management and quality control of health services has become increasingly important. Central to the concept of quality of care is the patients (the health care consumers) own view of the care provided and the treatment outcome. UKU (Udvalg for Kliniske Undersøgelser; that is, Committee for Clinical Trials), a working group within the Scandinavian Society for Psychopharmacology (SSP), has designed a brief consumer satisfaction rating scale, the UKU-ConSat. Based on an extensive literature review, a number of principles related to content, assessment, interview techniques, documentation and standardisation steered the design of the rating scale. UKU-ConSat consists of six items related to the structure and process of treatment care, and two items related to outcome and well-being. A manual accompanies the rating scale with guidelines for how to solicit information from the patient and how to rate each item. A first field trial of the rating scale in 135 inpatients at multiple clinical sites in Finland and Sweden showed that it could be applied to several relevant patient categories (psychotic, affective, neurotic, organic and alcohol and substance abuse disorders). According to both patients and staff the rating scale promises to become useful both for research and for improvement of routine psychiatric services.

A CONTROLLED ONE‐YEAR STUDY OF PIPOTIAZINE PALMITATE AND FLUPHENAZINE DECANOATE IN CHRONIC SCHIZOPHRENIC SYNDROMES: Evaluation of results at 6 and 12 months' trial

Earlier open studies on two new depot neuroleptics, pipotiazine palmitate (PP) and fluphenazine decanoate (FD) had indicated their usefulness in treatment of schizophrenia (Kristjansen et al. (1971), Lambert (1970)). The AIM OF THIS STUDY was to evaluate the effects and side-effects of the two drugs in maintenance therapy of chronic schizophrenic syndromes. .Another purpose was to ascertain whether the drugs could be given once every -1. weeks. In addition, special attention was given to the occurrence of depression, extrapyramidal side-effects, and the importance of life events.

INTRAMUSCULAR LONG‐ACTING FLUPHENAZINE IN THE TREATMENT OF SCHIZOPHRENIA

Previous reports by Bursa & Saunders (1965), Ravaris et al. (1965), Kinross-Wright & Charalampous (1965) and Rimon & Stenbiick (1966) of a longacting major tranquillizer, fluphenazine enanthate, indicated the value of this phenothiazine in the management of schizophrenia. A single intramuscular injection lasts approximately 2-3 weeks. The aim of this study was to compare previous treatment on oral psychotropic drugs with fluphenazine enanthate in so far as it concerns control of the symptoms and the social function of chronic schizophrenia.

Durability of the Efficacy of Integrated Care in Schizophrenia: A Five-Year Randomized Controlled Study

OBJECTIVE The aim of the study was to evaluate the durability of efficacy of the Integrated Care (IC) program in a Swedish context. The IC program is a person-centered flexible assertive community treatment approach delivered through a novel mechanism: a resource group clinical microsystem for each patient. METHODS All patients with schizophrenia in a Gothenburg urban-sector catchment area were randomly assigned to either the IC or the Rational Rehabilitation (RR) programs. Sixty-six patients were interviewed and assessed by independent interviewers before treatment, after treatment (24 months), and at follow-up (five years). Analysis was by intention to treat. RESULTS At the five-year follow-up, significant improvements were noted in social functioning and consumer satisfaction in the IC group (N=35) compared with the RR group (N=31). No patients were lost to services in either program. CONCLUSIONS The major finding was the durability of efficacy of the IC program.

Self-reported consumer satisfaction in mental health services: Validation of a self-rating version of the UKU-Consumer Satisfaction Rating Scale

The UKU-Consumer Satisfaction Rating Scale (UKU-ConSat) for the evaluation of consumer satisfaction in mental health services was constructed for assessments by independent professional interviewers. In the present study, a patient self-reported version of the scale is validated against the original version. The Spearmans rank correlation between single items, subscores and the total of the original scale and the self-assessment version was found to be good. Another main finding was an acceptable unidimensionality of the self-rating version of the UKU-Consumer Satisfaction rating scale, evaluated by a Mokken analysis. Furthermore, the internal consistency by Cronbachs alpha was found to be satisfactory. The results show that the patient self-rating version is psychometrically sound and therefore suitable for use in ordinary clinical practice. Being a part of a concept for continuous quality control and development in mental health services, the self-rating version of the UKU-ConSat promotes an open collaborative dialogue between professionals and users. A further advantage is that it saves professional time.