Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-22T17:43:37.757Z Has data issue: false hasContentIssue false
  • English
  • Français

Timing of Acute Clinical Response to Fluphenazine

Published online by Cambridge University Press:  02 January 2018

Douglas F. Levinson ,
Hardeep Singh  and
George M. Simpson
Douglas F. Levinson*
Affiliation:
Department of Psychiatry, Medical College of Pennsylvania at Eastern Pennsylvania Psychiatric Institute, 3200 Henry Avenue, Philadelphia, PA 19129, USA
Hardeep Singh
Affiliation:
Department of Psychiatry, Medical College of Pennsylvania at Eastern Pennsylvania Psychiatric Institute, 3200 Henry Avenue, Philadelphia, PA 19129, USA
George M. Simpson
Affiliation:
Department of Psychiatry, Medical College of Pennsylvania at Eastern Pennsylvania Psychiatric Institute, 3200 Henry Avenue, Philadelphia, PA 19129, USA
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Abstract

The time course of clinical improvement was studied in 41 schizophrenic and schizoaffective acute in-patients treated for 28 days with 10, 20 or 30 mg/day of oral fluphenazine hydrochloride in a double-blind, randomised study. Significant improvement was seen in the four BPRS factors: thinking disturbance, hostile-suspiciousness, withdrawal–retardation and anxious depression. The first two of these factors were improved by day 5. Significant improvement was seen up to day 22 for three of the four factors, but without significant improvement during the last week (although scores continued to drop). The half of the sample showing greater overall improvement did not improve faster than the sample as a whole. These more improved subjects did not differ significantly from the less improved subjects in the thinking disturbance factor until day 15, suggesting that at least a two-week neuroleptic trial would be necessary to begin to differentiate more and less responsive patients. The longer-term course of improvement cannot be determined from these data. The withdrawal–retardation and anxious depression factors showed their greatest improvement later than the ‘positive’ symptom factors, suggesting that the former may improve as a result of change in the latter.

Type
Papers
Information
The British Journal of Psychiatry , Volume 160 , Issue 3 , March 1992 , pp. 365 - 371
Copyright
Copyright © Royal College of Psychiatrists, 1992 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abse, D. W., Dahlstrom, W. G. & Tolley, A. G. (1960) Evaluation of tranquilizing drugs in the management of acute mental disturbance. American Journal of Psychiatry, 116, 973–980.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Baldessarini, R. J., Cohen, B. M. & Teicher, M. H. (1988) Significance of neuroleptic dose and plasma level in the pharmacological treatment of psychoses. Archives of General Psychiatry, 45, 79–91.Google Scholar
Bowers, M. B. Jr, Swigar, M. E., Jatlow, P. I., et al (1984) Plasma catecholamine metabolites and early response to haloperidol. Journal of Clinical Psychiatry, 45, 248–251.Google ScholarPubMed
Bunney, B. S. (1988) Effects of acute and chronic neuroleptic treatment on the activity of midbrain dopamine neurons. Annals of the New York Academy of Science, 537, 77–85.Google Scholar
Casey, J. F., Lasky, J. J., Klett, C. J., et al (1960) Treatment of schizophrenic reactions with phenothiazinc derivatives; a comparative study of chlorpromazine, triflupromazine, mepazine, prochlorperazine, perphenazine, and phenobarbital. American Journal of Psychiatry, 117, 97–105.Google Scholar
Clark, M. L., Ramsey, H. R., Ragland, R. E., et al (1970) Chlorpromazine in chronic schizophrenia: behavioral dose-response relationships. Psychopharmacologia, 18, 260–270.CrossRefGoogle ScholarPubMed
Cole, J. O. & Davis, J. M. (1969) Antipsychotic drugs. In The Schizophrenic Syndrome (eds Bellak, L. & Loeb, L.), pp. 478–568. New York: Grune and Stratton.Google Scholar
Crow, T. J. (1985) The two-syndrome concept: origins and current status. Schizophrenia Bulletin, 11, 471–486.CrossRefGoogle ScholarPubMed
Davidson, M., Giordani, A. B., Mohs, R. C., et al (1987) Short-term haloperidol administration acutely elevates human plasma homovanillic acid concentration. Archives of General Psychiatry, 44, 189–190.Google Scholar
Davila, R., Manero, E., Zumarraga, M., et al (1988) Plasma homovanillic acid as a predictor of response to neuroleptics. Archives of General Psychiatry, 45, 564–567.Google Scholar
Davis, K. L., Davidson, M., Mohs, R. C., et al (1985) Plasma homovanillic acid concentration and the severity of schizophrenic illness. Science, 227, 1601–1602.Google Scholar
Endicott, J., Spitzer, R. L., Fleiss, J. L., et al (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33, 766–771.Google Scholar
Endicott, J. & Spitzer, R. L. (1978) A diagnostic interview: The schedule for affective disorders and schizophrenia. Archives of General Psychiatry, 35, 837–844.Google Scholar
Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology (ADM 76–338). Washington, DC: Department of Health, Education and Welfare.Google Scholar
Johnstone, E. C., Crow, T. J., Frith, C. D., et al (1978) Mechanisms of the antipsychotic effect in the treatment of acute schizophrenia. Lancet, i, 848–851.Google Scholar
Kane, J. M. (1986) Somatic therapy. In American Psychiatric Association Annual Review, Vol. 5 (eds Frances, A. J. & Hales, R. E.), pp. 78–95. Washington, DC: American Psychiatric Press.Google Scholar
Kane, J. M., Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment-resistant schizophrenic; a double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789–796.Google Scholar
Keck, P. E. Jr, Cohen, B. M., Baldessarini, R. J., et al (1989) Time course of antipsychotic effects of neuroleptic drugs. American Journal of Psychiatry, 146, 1289–1292.Google Scholar
Lerner, Y., Lwow, E., Levithin, A., et al (1979) Acute high-dose parenteral haloperidol treatment of psychosis. American Journal of Psychiatry, 136, 1061–1064.Google Scholar
Levinson, D. F., Simpson, G. M., Singh, H., et al (1988) Neuroleptic plasma level may predict response in patients who meet a criterion for improvement. Archives of General Psychiatry, 45, 878–879.Google Scholar
Levinson, D. F., Simpson, G. M., Singh, H., et al (1990) Fluphenazine dose, clinical response and extrapyramidal symptoms during acute treatment. Archives of General Psychiatry, 47, 761–768.CrossRefGoogle ScholarPubMed
Meltzer, H. Y., Bastani, B., Kwon, K. Y., et al (1989) A prospective study of clozapine in treatment-resistant schizophrenic patients; I. Preliminary report. Psychopharmacology (Berlin), 99 (suppl.), S68 S72.Google Scholar
National Institute of Mental Health Psychopharmacology Research Branch Collaborative Study Group (1967) Differences in clinical effects of three phenothiazines in “acute” schizophrenia. Diseases of the Nervous System, 28, 369–383.Google Scholar
Overall, J. E. (1974) The brief psychiatric rating scale in psychopharmacology research. In Modern Problems in Psychopharmacology, Vol. 7 (eds Pichot, P. & Olivier-Martin, R.), pp. 67–78. Basel: Karger.Google Scholar
Overall, J. E. & Gorham, D. P. (1962) The brief psychiatric rating scale (BPRS). Psychological Reports, 10, 799–812.Google Scholar
Pickar, D., Labarca, R., Doran, A. R., et al (1986) Longitudinal measurement of plasma homovanillic acid levels in schizophrenic patients; correlation with psychosis and response to neuroleptic treatment. Archives of General Psychiatry, 43, 669–676.Google Scholar
Reschke, R. W. (1974) Parenteral haloperidol for rapid control of severe, disruptive symptoms of acute schizophrenia. Diseases of the Nervous System, 35, 112–115.Google Scholar
Rifkin, A. (1986) Neuroleptic dosage strategies in schizophrenia. International Drug Therapy Newsletter, 21, 17–20.Google Scholar
Rosen, W. G., Mohs, R. C., Johns, C. A., et al (1984) Positive and negative symptoms in schizophrenia. Psychiatry Research, 13, 277–284.Google Scholar
Schooler, N. R., Sakalis, G., Chan, T. L., et al (1976) Chlorpromazine metabolism and clinical response in acute schizophrenia: a preliminary report. In Pharmacokinetics of Psychoactive Drugs: Blood Levels and Clinical Response (eds Gottschalk, L. A. & Merlis, S.), pp. 199–219. New York: Spectrum.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1981) Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders. New York: New York State Psychiatric Institute, Biometrics Research.Google Scholar
Strauss, J. S., Hafez, H., Lieberman, P., et al (1985) The course of psychiatric disorder, III: longitudinal principles. American Journal of Psychiatry, 142, 289–296.Google Scholar
van Kammen, D. P., Hommer, D. W. & Malas, K. L. (1987) Effect of pimozide on positive and negative symptoms in schizophrenic patients: are negative symptoms state dependent? Neuropsychobiology, 18, 113–117.Google Scholar
Wilkinson, L. (1988) SYSTAT: The System for Statistics. Evanston, IL: Systat, Inc.Google Scholar
Wode-Helgodt, B., Borg, S., Fyro, B., et al (1978) Clinical effects and drug concentrations in plasma and cerebrospinal fluid in psychotic patients treated with fixed doses of chlorpromazine. Acta Psychiatrica Scandinavica, 58, 149–173.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.