Chronic Schizophrenic Inpatients Research Articles

Effects of risperidone on gonadal axis hormones in schizophrenia.

To investigate the effects of risperidone on the hypothalamo-pituitary-gonadal (HPG) axis of chronic schizophrenic male inpatients medicated regularly. Subjects included six inpatients who were diagnosed according to the Diagnostic and Statistical Manual, Fourth Edition, criteria for schizophrenia, and were termed treatment-refractory. Each patient gave informed consent for the research involved in this study. The neuroendocrine studies were done before and during risperidone administration. Patients took a mean dose of risperidone 9.5 mg/d for a mean period of 64.2 days. Psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). Prolactin (PRL) increased significantly during risperidone administration. However, luteinizing hormone, follicle-stimulating hormone, and testosterone did not show significant difference between blood concentrations before and during risperidone administration. Scores of the BPRS total, thought disturbance factor, and tension decreased significantly during risperidone administration. Throughout the study, none of the patients experienced clinically significant problems associated with elevated PRL concentrations including gynecomastia and/or sexual dysfunction. Addition of risperidone produced significant improvement of psychotic symptoms in treatment-resistant schizophrenic patients, and an increase in basal blood PRL concentrations, but not in basal blood HPG axis hormone concentrations. This preliminary result warrants further double-blind evaluation with a larger sample.

Propranolol as an effective agent for the treatment of agitation, aggression and violent behaviour in two inpatients with chronic schizophrenic inpatients

Propranolol as an effective agent for the treatment of agitation, aggression and violent behaviour in two inpatients with chronic schizophrenic inpatients

Auditory distraction and thought disorder in chronic schizophrenic inpatients: Evidence for separate contributions by incapacity and poor allocation and a subsyndrome related to the allocation deficit

This study investigated auditory attentional processes associated with schizophrenic thought disorder. Thirty-five chronically schizophrenic, state hospital inpatients were assessed for thought disorder using the Thought, Language, and Communication Disorders Scale (TLC) and tested in an attentional task. Two measures of attention were derived from the Digit Span Distraction Test (DSDT) (Oltmannns, T.F., Neale, J.M., 1975. Schizophrenic performance when distractors are present: attentional deficit or differential task difficulty. J. Abnorm. Psychol. 84, 205–209), a digit recall task in which distractor digits were interspersed with target digits. The two measures were Distractibility — the overall inaccuracy of recall — which measured attentional incapacity, and Distractible Intrusion — the number of irrelevant digits recalled — which was developed in this study to separately measure the inability to allocate attentional resources. These two measures predicted thought disorder strongly and independently. Distractibility did not significantly correlate with any TLC subscale. In contrast, Distractible Intrusions correlated with the TLC subscales Distractible Speech, Incoherence, Loss of Goal, and Word Approximations. The present findings suggest that these subtypes may comprise a distinct subsyndrome of thought disorder, characterized by a dysfunctionally low threshold for selecting appropriate speech information, and that an attentional allocation deficit is related to this language dysfunction.

Effects of Social Skill Training on the Interpersonal Relationship, Assertiveness and Quality of Life in Chronic Schizophrenic Inpatients

Effects of Social Skill Training on the Interpersonal Relationship, Assertiveness and Quality of Life in Chronic Schizophrenic Inpatients

Effects of Group Art Therapy Program on Self-Esteem and Mental Health Status in Chronic Schizophrenic Inpatients

【The purpose of the study was to determine the effects of the 8-week, 15-session group art therapy program on self-esteem and mental health status in chronic schizophrenic inpatients. The sample consisted of two groups of chronic schizophrenic inpatients: 10 patients with an average of total disease duration of 8.90 years who participated in a 8-week group art therapy program, and 8 comparison subjects with an average of total disease duration of 8.25 years who did not participate in the program. A pretest-posttest quasiexperimental design was used to assess self-esteem and mental health status at the beginning and at the end of the 8-week, 15-session group art therapy program. The time points for obtaining data were matched for both groups. The effectiveness of the 8-week group art therapy program was assessed by Rosenberg's Self-esteem Scale(Rosenberg, 1965) and SCL-90- R(Derogatis et al., 1973). SPSSWIN 8.0 was utilized for data entry and analysis employing Mann-Whitney U test. The findings of the study indicated the followings : (a) No significant differences were found between two groups in self-esteem and (b) The experimental group showed significantly lower scores in obsessive-compulsive symptom dimension and interpersonal sensitivity symptom dimension on the SCL-90-R than the comparison group after participating in the group art therapy program. In conclusion, the findings showed the possibility of applying group art therapy as an effective nursing intervention for patients with lack of verbal communication skills and social interaction to improve their interpersonal relationship.】

A Kinetic Model for Simultaneous Fit of Clozapine and Norclozapine Concentrations in Chronic Schizophrenic Patients during Long-Term Treatment

The pharmacokinetic profiles of clozapine and its main metabolite, norclozapine, were investigated in 18 chronic schizophrenic inpatients during long-term treatment. Patients received stable daily doses (between 300 and 900mg) for at least 1 month. Plasma drug concentrations were determined by high performance liquid chromatography. The pharmacokinetic parameters were calculated from both noncompartmental and compartmental approaches with zero-order input rate using a kinetic model for simultaneous fit of clozapine and norclozapine (active metabolite) concentrations. Large interpatient variations in pharmacokinetic parameters of the two drugs were observed. Plasma clozapine concentration peaked on average at 2 hours. The mean elimination rate constants from compartments 1 (k(10)) and 2 (k(20 ), elimination rate constant of norclozapine) were 0.087 and 0.156h(-1), respectively. The rate of formation of norclozapine, k(12), averaged 1.25h(-1). The mean fraction of the administered dose converted to norclozapine was estimated to be 66%. The apparent clearance of clozapine (CL/F) averaged 44.7 L/h and the volume of distribution (V(c)/F) was 7.00 L/kg. The pharmacokinetics of clozapine after multiple doses were linear over the range of clozapine plasma concentrations of 145 to 1411 microg/L. This is the first study assessing the pharmacokinetic profile of clozapine plus norclozapine in plasma during long-term treatment. This pharmacokinetic model can be used to determine the population pharmacokinetic parameters of clozapine and norclozapine in order to optimise individual dosage regimens using a Bayesian methodology.

Procedural Learning in Schizophrenia: Evidence from Serial Reaction Time

Although schizophrenic patients, as a group, show deficits on measures of explicit learning, it is unclear whether they also have deficits on measures of implicit learning. The current study assessed procedural learning in a sample of 48 chronic schizophrenic inpatients and 23 normal controls using the serial reaction time test (SRT). In addition, we examined the clinical correlates of procedural learning. The SRT yields indices of total motor learning and two subcomponents: reaction time learning, and sequence learning. Although patients performed comparably to normal controls on total motor learning, they showed significantly less sequence learning (P <.03) than controls. Reaction time learning did not differ between the two groups. None of the symptom or clinical variables was correlated with the indices of learning. Chronic schizophrenic inpatients showed normal levels of procedural learning on the SRT. However, their learning was qualitatively different than that of controls (i.e. patients showed deficits in sequence learning, but not reaction time learning). Reduced sequence learning could reflect dysfunctional cortico-cerebellar circuits.

Improvement patterns in schizophrenic “nonresponders” treated with clozapine: A Systematic Study Over 1 Year

Forty-four chronic schizophrenic inpatients with unsatisfactory response to conventional neuroleptics were switched to clozapine in flexible dosage and followed up systematically for up to 1 year with the Positive and Negative Syndrome Scale (PANSS), Nurses Observation Scale for Inpatient Evaluation (NOSIE), Clinical Global Impressions (CGI), and the UKU side effect rating scale. Thirty-nine patients were evaluable; 35 completed 6 months, and 25 completed 1 year. There was a highly significant reduction in PANSS, NOSIE, and CGI scores already after 3 weeks. After 6 months there was a mean reduction of total PANSS score of about 50%, and about half of the patients obtained at least 50% reduction. Positive symptoms showed a significantly greater improvement than negative ones. Least improvement was seen in cognitive disturbance. Depression and guilt feeling were favourable prognostic factors, whereas cognitive disturbances were unfavourable predictors of overall improvement. The side effect spectrum was dom...

Symptom stability in geriatric chronic schizophrenic inpatients: A one-year follow-up study

The results of previous studies of symptom stability in schizophrenia suggest that negative symptoms manifest traitlike characteristics while positive symptoms fluctuate over time. Various prospective studies of chronic schizophrenic patients have found consistent results, regardless of the follow-up period, yet there is little research addressing symptomatology in geriatric schizophrenic patients. Since these patients have a very poor outcome and more severe negative symptoms, their symptoms might differ from younger patients. This study examined the course of symptomatology in 178 geriatric schizophrenic inpatients who were assessed twice at a 1-year interval with the Positive and Negative Syndrome Scale (PANSS). Intraclass correlations revealed that the distribution of negative symptoms was considerably more stable than that of positive symptoms over the interval, and subtypes based on negative symptoms were the only ones that manifested consistent stability over time. There was also a significant increase in negative symptom severity for the sample, with a slight decrease in positive symptom severity. Thus, even in chronic inpatients, with a very extended illness, positive symptom severity is not particularly stable within patients. These data indicate that the characteristics of negative and positive schizophrenic symptoms are similar in younger and geriatric schizophrenic patients, suggesting a continuity of the illness process. Tentative evidence for increasing severity of negative symptoms over a brief follow-up period suggests the possibility of a steady worsening of clinical state in very elderly patients who remained hospitalized.

Cyproheptadine augmentation of haloperidol in chronic schizophrenic patients

A 6 week double-blind placebo-controlled trial of cyproheptadine augmentation of ongoing haloperidol treatment was conducted in 40 chronic schizophrenic in-patients. Cyproheptadine augmentation, compared to administration of haloperidol with placebo, did not produce a statistically significant improvement in psychotic symptoms. Cyproheptadine augmentation caused significant reduction in the extrapyramidal symptoms, which supports the atypical profile of antipsychotics. As to the neuroendocrinological effect, cyproheptadine augmentation did not reduce the plasma prolactin level but did induce a decrease in the plasma cortisol level. Although long-term follow-up studies are needed to confirm the results, this study suggests that cyproheptadine augmentation may be effective in treating chronic schizophrenic patients who are intolerant of extrapyramidal side effects of conventional antipsychotics.

Possible inhibitory effect of lithium on peripheral conversion of thyroxine to triiodothyronine

The effect of lithium on thyroid function was studied in 18 neuroleptic-treated male chronic schizophrenic in-patients. Lithium carbonate was administered for 8 weeks at a dosage giving a mean serum level of 0.79 mmol/l. Blood was obtained just before and after 8 weeks of lithium administration to determine the serum free thyroxine (free T4) levels, free triiodothyronine (free T3) levels and thyrotropin (TSH) levels. Overall, free T4 and TSH levels significantly increased whereas free T3 levels did not change. Two (11%) patients had abnormally increased free T4 levels and abnormally decreased free T3 levels after 8 weeks of lithium administration. These findings suggest that lithium may inhibit the peripheral conversion of free T4 to free T3 in some susceptible patients.

Fluvoxamine augmentation in chronic schizophrenia: An open exploratory study

AbstractThe effect of augmenting standard antipsychotic treatment with the specific serotonergic reuptake inhibitor (SSRI) fluvoxamine was examined in severely disabled chronic schizophrenic inpatients using an open, naturalistic protocol. Fluvoxamine in doses ranging from 25 to 200 mg was added to the antipsychotic medication which was kept constant. Patients were followed for the duration of treatment (to date up to 7·5 months). Assessment included BPRS SANS SAPS and CGI scales (CGI only in the most severely disturbed), and global impressions of occupational and social functioning. Fourteen (74%) of the 19 patients studied showed improvement using 15 per cent change in SANS score or CGI improvement score &gt; = 1 as criterion. The symptom constellation appeared to influence the rate and timing of response. Ten patients experienced exacerbations, some within 2 months of starting treatment, others after 5–6 months. The findings suggest that SSRI augmentation may be effective in severely disabled schizophrenics.

Investigation of gestural and pantomime performance in chronic schizophrenic inpatients.

The present study compared the performance on apraxia tests and additional motor tasks between medicated chronic schizophrenic inpatients (n = 21) and healthy subjects (n = 21). Praxis testing did not reveal a clear-cut apractic syndrome in the patient group. The most striking difference between patients and healthy controls was the more frequent use of body parts as object (BPO) by schizophrenic patients (P < 0.0003). There was no significant difference in psychopathology between subgroups classified according to their BPO performance, although a tendency towards a difference in duration of illness and the actual hospitalization period existed between BPO subgroups. Schizophrenic patients performed more poorly than controls in frontal motor tasks: sequencing, including oral sequential movements, and reciprocal innervation. Frontal motor task performance tended to be related to the negative dimension of schizophrenia in accordance with previous studies. The data do not support the assumption that BPO performance is part of a multidimensional concrete attitude in schizophrenic patients. Nevertheless, this peculiarity in motor behaviour might be a link between neurophysiology and psychopathological phenomenology in schizophrenia. We therefore suggest further investigation focusing the performance of object-related pantomime movements in schizophrenic patients.

Comparison of Standard Locked-Ward Treatment Versus Open-Ward Rehabilitation Treatment for Chronic Schizophrenic Patients

A priority for psychiatric rehabilitation workers in China is to develop less-restrictive methods for managing the estimated 2500 chronically institutionalised patients who are symptomatically stable and have adequate psychosocial functioning but have no family members who are able or willing to take them home. We transferred 45 chronic schizophrenic male in-patients to an open-door rehabilitation ward where they were given as much freedom as possible and encouraged to take part in occupational, social, and recreational activities. The Nurses Observation Scale for Inpatient Evaluation (NOSIE) was used to compare the psychosocial functioning of the 43 patients who completed the year-long trial with that of 43 similar patients who received standard in-patient treatment on a locked ward. Over the year, the experimental group showed a significant improvement in overall functioning, whereas the control group showed no improvement. These findings suggest that open-door rehabilitation wards situated within the hospital can mobilise latent psychosocial functioning and may be a good method for re-introducing chronic schizophrenic patients in China back into the community.

A Behavioural Training Programme for Chronic Schizophrenic Patients

This paper discusses the effectiveness of an in-patient rehabilitation programme administered by nurses that combines life skills training, active encouragement, and a token economy. Fifty-two chronic schizophrenic patients with prominent negative symptoms who had been continuously in hospital for at least a year were randomly assigned to the experimental or control group. The training and associated reinforcement schedule were administered daily to experimental subjects by two specially trained rehabilitation nurses. Control subjects did not receive training or reinforcement but were individually asked to perform the same daily tasks and participate in the same activities as the experimental-group subjects. Patients in both groups received their previous dosage of medication throughout the trial. After three months the severity of negative symptoms, as assessed by blind evaluators, decreased in both groups of subjects, but the improvement in the experimental group was much greater than that in the control group. These findings demonstrate the efficacy of behavioural interventions for chronic schizophrenic in-patients in China and highlight the importance of changing the role of Chinese psychiatric nurses from that of custodians who control patients' behaviour to that of therapists who provide psychological and behavioural treatment.

L-dopa helps positive but not negative features of neuroleptic-insensitive chronic schizophrenia

L-dopa (Sinemet-110 in a final dose equivalent to - 4 g per day) added to maintenance chlorpromazine, produced a small antipsychotic effect in a group of eight severely impaired male chronic schizophrenic in-patients. Negative symptoms were unaffected by L-dopa, although the improvement in psychotic behaviour and positive symptoms was restricted to the four patients with the most severe negative symptoms measured during the control treatment period. These L-dopa responders also tended to improve slightly when the dose of chlorpromazine was halved, an indication of their poor, or even counter-therapeutic response to conventional neuroleptic medication given in relatively high dosage. Signs of increased dopaminergic activity (raised eye blink rate and reduced plasma prolactin) were not observed in subjects showing an antipsychotic response to L-dopa. This raises the possibility that L-dopa may exert an antipsychotic effect in neuroleptic-insensitive subjects by altering noradrenergic activity in the brain.

Prevalence and correlates of stable negative symptom subtypes in geriatric chronic schizophrenic inpatients

Although negative symptoms of schizcbphrenia have been studied in detail over the past 20 years, with substantial attention paid to the correlates of those symptoms, less attention has been paid to the stability characteristics of those symptoms, in the studies that have been conducted on the subtype, it has been reported that patients with stable deficit symptoms have specific cognitive and functional impairments. These studies have largely been conducted on relatively young patients, with less attention paid to geriatric patients with a long-term course of continu. ous hospitalization. In order to address the issue of the stability of negative subtypes in chronically institutionalized patients, a sample of 149 geriatric schizophrenic inpatients were examined with ratings of clinical symptoms (the Positive and Negative Syndrome Scale; PANSS) and a cognitive assessment battery at two assessments one year apart. Patients were characterized on the basis of their symptom presentation at the two assessments into groups who had stable negative subtypes (n=95; 64%), negative subtypes at one assessment only (n=31; 21%), or non-negative subtypes at both assessments (n-23; 15%). Patients with stable negative subtypes had significantly lower MiniMental State Scores at the 2nd as. sessment than the patients with mixed or non-negative subtypes (m! 3. I vs. 21.6 vs. 24.4). Similar findings were found for the entire cognitive battery, including verbal learning, delayed recall, praxis, and naming per. formance. Although the stable negative patients had lower premorbid education (m-8.9 vs 10.0 vs. 10.5) than the other two groups of patients, this difference did not account for the other differences in cognitive perform. ante. These data suggest that a majority of the patients in long-term inpa. tient care have stable negative symptoms and that this presentation is associated with substantial cognitive impairments. The presence of any negative symptoms, even unstable ones, was associated with reductions in cognitive functioning and reduced educational attainment, suggesting an intrinsic relationship between negative symptoms and intellectual functions in geriatric schizophrenic patients.

Ventricular enlargement, neuropsychological status, and premorbid function in schizophrenia

Ventricular enlargement is one of the most consistently documented neurobiological abnormalities in schizophrenia. The timing of the development of this abnormality in the course of schizophrenic illness and its relationship to neuropsychological dysfunction and premorbid adjustment is, however, unclear. To address these questions, we examined the relationship between ventricle-brain ration (VBR), premorbid adjustment, and neuropsychological function, in 23 acutely exacerbated chronic schizophrenic inpatients. We obserged that larger ventricles were associated with better current neuropsychological test performance, better premorbid cognitive ability, greater cognitive deterioration, better childhood premorbid social function, and greater decline in social function from premorbid levels. These data suggest that at least two developmental processes may operate in the genesis of cognitive and social dysfunction in schizophrenia: (1) childhood onset associated with poor premorbid childhood function, low educational achievement, lower intelligence quotient (IQ) and variably with VBR; and (2) adolescent onset associated with relatively normal childhood social function, higher academic achievement and IQ and increased VBR. Ventricular enlargement may reflect a late developmental or degenerative pathological process in schizophrenia.

The Efficacy of Vitamin E in the Treatment of Tardive Dyskinesia: A Double-Blind Placebo Controlled Study

DOI: http://dx.doi.org/10.5915/26-2-16367 Our aim in this study was to investigate the efficacy of vitamin E in the treatment of tardive dyskinesia in a group of chronic schizophrenic patients. Thirty-eight chronic schizophrenic inpatients with tardive dyskinesia were selected for a double-blind trial of Vitamin E versus placebo (Vitamin E: N=18). Tardive dyskinesia was rated by a blind-trained rater using the Abnormal Involuntary Movement Scale (AIMS) at baseline and after treatment. The AIMS scores in the Vitamin E cohort decreased significantly after treatment while the AJMS scores in the placebo cohort were not different after placebo. The results replicate the short-term effectiveness of Vitamin E in the treatment of tardive dyskinesia in a larger group of chronic schizophrenic patients.

The clinical relevance of an auditory attention task (PAT) in a longitudinal study of chronic schizophrenia, with placebo substitution for chlorpromazine

A new auditory attention task (PAT) is described. The test comprises four different subtest combinations (diotic/dichotic, slow/fast) each of 5 min duration. Omission and commission errors are combined by an index of errors ( I E). The PAT was given fortnightly to 20 chronic schizophrenic inpatients for more than one year. Independent psychiatrists rated the patients according to the Brief Psychiatric Rating Scale and a Global Rating Scale. All measures yielded significant test-retest reliabilities. The patients were stabilized on individualized doses of chlorpromazine (CPZ) and randomized to two groups. Placebo was substituted for CPZ during 10 weeks, according to a double-blind cross-over design. Significant deterioration under placebo was detected by all three methods, but the PAT was the most sensitive to change. The PAT mean score (M I E) was correlated with both rating scales. Unlike the rating scales, it also correctly ordered the twenty patients along a dimension which measured the severity of illness and ‘predicted” hospital discharge.