William Guy

Flexible System Criteria in chronic schizophrenia

Abstract In a multinational study of chronic hospitalized schizophrenia, the 12 items of the Flexible System Criteria were employed in addition to clinical diagnosis for admission. Comparisons with the more acutely ill patients of the International Pilot Study of Schizophrenia (IPSS) suggest a possible shift to a greater percent of chronic patients having negative symptoms.

The prevalence of abnormal involuntary movements among chronic schizophrenics.

In an international survey of chronic schizophrenia, data were collected on the Abnormal Involuntary Movements Scale (AIMS) to ascertain the prevalence of tardive dyskinesia. Abnormal movements were found to present in 28% of the sample of 739 patients. Using the more stringent Research Criteria for Tardive Dyskinesia (RD-TD) the prevalence rate was found to be 13.6%. Statistically significant differences were obtained between patients meeting RD-TD criteria and patients with abnormal movement who did not meet RD-TD criteria on total score, global severity, degree of incapacity and patient awareness--all reflecting greater severity in the RD-TD group. A much lower rate of moderate/severe tardive dyskinesia than that reported in the literature was obtained in this sample. Using the Leonhard classification of chronic schizophrenia, it was found that patients with prominent negative symptomatology had a high prevalence of tardive dyskinesia--confirming the previous reported relationship between these variables. Prevalence differences, possibly related to specific psychopathological syndromes, were also obtained.

An international survey of tardive dyskinesia.

As part of an international study of chronic schizophrenia, data on tardive dyskinesia were collected by clinical judgment and a standard rating scale, on over 700 patients. The frequently-reported positive correlation between age and prevalence rate was confirmed in this sample. While not statistically significant, high prevalence rates were associated with higher dosage levels and length of hospitalization. Positive relationships were also found to exist among prevalence rates and schizophrenic subtypes--particularly among those with high degrees of negative symptomatology.

Pharmacotherapy of Chronic Hospitalized Schizophrenics: Prescription Practices

Prescription practices were examined as part of a multinational study of chronic hospitalized schizophrenic patients. The study included a total of 768 patients from 8 countries. All patients had a diagnosis (ICD-9) of schizophrenia and met defined criteria for chronic hospitalization. The patients were treated with psychotropic drugs from 6 categories, i.e., neuroleptics, antidepressants, lithium salts, anxiolytics, anticonvulsants, and antiparkinsonian medications, as well as with a variety of nonpsychotropic drugs. The majority of the patients received concurrently more than 1 neuroleptic, medications from 2 or more categories, and neuroleptics combined with other agents. Polypharmacy appeared to be universal in this population.

Patient assessment in clinical trials

Abstract 1. Appropriate clinical assessment procedures are critical for the successful execution of a psychotropic drug trial and essential for the proper documentation of results. 2. Clinical instruments may be classified in four general areas: demography, efficacy, safety, administration. 3. Since questions concerning the precise characteristics of the research sample are among the first to be raised, the detailed assessment of sample characteristics is mandatory and should include demographic, historical and diagnostic data. 4. Instruments for the assessment of efficacy are, for the most part, rating scales which provide measures of initial psychopathology and subsequent change. This area of assessment has been the focus of much research over the past two decades and, for many diagnostic populations, reliable and sensitive standard instruments are available. 5. The assessment of safety, in contrast to efficacy, is less well defined. The earlier checklist approach is being replaced by newer, more sophisticated instruments but, as yet, standardized procedures for the assessment of safety are not in general use. 6. Lastly are the administrative documents which record the events of trial, e.g., dosage, concomitant medication, intercurrent events, disposition. Regarded as “bookkeeping” chores, these instruments are frequently neglected—often to the detriment of the exposition and interpretation of results.

Neuroleptic-induced skin pigmentation in chronic hospitalized schizophrenic patients.

In the framework of a multi-national collaborative study carried out in eight countries, 768 chronic hospitalized schizophrenic patients were surveyed. Skin pigmentation was found to be present in 13 patients (1.7%), that is, within the same range (1–2.9%) of the initial reports. While the mean age and mean duration of hospitalization in the skin-pigmented population was slightly higher and larger than in the total population of our survey, no definitive relationships between sex, diagnosis, drugs and dosage of medication were revealed.

The AMDP-System in chronic hospitalized schizophrenics

Abstract The English edition of the Manual for the Assessment and Documentation of Psychopathology (AMDP)-System was published in 1982. 1 As part of our ongoing research, we have been employing one part of the system, i.e., the Psychopathological Symptoms (PS) form to assess the incidence of different psychopathological symptoms in chronic hospitalized schizophrenics. The data were collected by employing a specially devised 176 item instrument, the Psychopathological Symptom Profile (PSP), which includes the items of the PS of the AMDP. The importance of research on the chronic population is evidenced by reports indicating that there are approximately 200,000 hospitalized schizophrenic patients in the United States. 2 There is evidence to suggest that 15% of patients who are now diagnosed as schizophrenic become part of the “new long-term” hospitalized population. 3 Almost 50% of all schizophrenic patients may need long-term treatment 4 and it is anticipated that 30% to 60% of all new long-term patients will be diagnosed as schizophrenic. 4–6,11 In spite of these figures, to our knowledge, no adequate information on the PSP of chronic hospitalized schizophrenic patients is available. Such information could bring to attention shortcomings of existing treatment modalities and focus efforts to more effective procedures. The data to be presented was collected as part of an ongoing multinational study; therefore, a comprehensive discussion of the transcultural aspects of this data will be presented in future papers.

Viloxazine in the treatment of endogenous depression. A standard (amitriptyline) controlled clinical study.

In a double-blind clinical trial with 20 patients suffering from endogenous depression statistically significant changes (improvement) were present in the scores of all assessment instruments. Although no statistically significant differences occurred between the groups, significant improvement on the HAM-D occurred earlier for amitriptyline and significant improvement occurred earlier on HAM-A for viloxazine. 2 patients were discontinued due to adverse reactions; one for nausea and vomiting while receiving viloxazine and one for paroxysmal atrial tachycardia while receiving amitriptyline. The same number of TES occurred for each group with seven unique to viloxazine (numbness, tingling, palpitation, ejaculation difficulty, nausea/vomiting, diarrhea, epigastric pain and gustatory disturbances) and seven unique to amitriptyline (insomnia, irritability, syncope, tremor, nasal congestion, orthostatic hypertension and paroxysmal atrial tachycardia). Other than for 1 patient who developed syncope and orthostatic hypotension and the patient who developed paroxysmal atrial tachycardia, there were no clinically significant changes in pulse rate, blood pressure and weight. There were no clinical laboratory findings with either drug that were judged to be pathological.

Organizing and Conducting Clinical Trials

Of the three stages of clinical trial, i.e. design, data collection, analysis, the second stage is the most neglected. The literature abounds with discussions on design and analysis, but there is a dearth of information on the organization and execution of the trial itself. Easily the most time-consuming aspect of a trial, data collection is frequently carried out by individuals who have not designed the study and who will not perform the analysis of results. With different individuals involved in each of the stages, intercommunication on substantive and procedural issues is essential for the successful culmination of the clinical project.

The AGP System

ion, impaired 55, PS40 Acalulia 76, PS129 Accommodation, visual 91, SS21 Actions, compulsive 56, PS48 Admission, number of 42, PH28 -, reason for 40, DD24 -, type of 40, DD23 Affect, blunted 65, PS77 Affective lability 68, PS93 incontinence 68, PS94 rigidity 68, PS95 Age 33,DD2 Aggressiveness 80, PP152 Agnosia 73, PSlJO -, visual 75, PS120 Agraphia 76, PS128 Akathisia 96, SS55 Akinesia 95, SS54 Alexia 76, PS127 Ambivalence 68, PS91 Anamnesis, source of 33, DD1 Anxiety 66, PS81 Anosognosia 76, PS125 Aphasia 73, PSJ09 -, amnestic 77, PS133 -, conduction 76, PS126 -, motor 74, PS1l6 -, nominal 77, PS133 -, sensory 77, PS134 Apperception 49, PS10 Appersonalization 64, PS70 Appetite, decreased 92, SS27 -, excessive 92, SS26 Apraxia 73, PS111 -, facial 74, PS1l3 -, frontal 74, PS1l2 -, ideational 76, PS131 -, ideomotor 76, PS130 -, constructive 77, PS132 -, motor 74, PSlJ6 Ataxia, pointing 96, SS59 -, postural 96, SS60 -, gait 96, SS6J Attention, disorders of 49, PSlO-26 Bedridden 82, PS173 Blocking, thought 54, PS36 Blunted affect 65, PS77 Blurred vision 91, SS21 Breathing difficulties 87, SS6 Bulbar disorders 98, SS67-68 Cerebral seizures 98, SS69-75 Chewing disturbance 82, P S 172 Children, number of 34, DD5 -, presently living 34, DD5 Chills 91, SS23 Chronic pain 90, SS19 Circadian disturbances 78, PS135-139 -, better p.m. 78, PS137 -, worse a.m. 78, PS135 -, worse p.m. 78, PS136 -, nighttime exacerbation 78, PS138 -, symptom alternation 78, PS139