Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenic outpatients: clinical outcome at one year.

Abstract

A study was conducted to investigate a novel approach to the prophylaxis of schizophrenic relapse. The treatment strategy comprised brief intermittent courses of neuroleptic agents begun as soon as non-psychotic symptoms believed to be early signs of relapse appeared. Fifty four stable, remitted outpatients meeting the American Psychiatric Association's DSM-III criteria for schizophrenia were randomised double blind to receive brief intermittent treatment with either active or placebo depot neuroleptic injections. Only three patients given placebo injections and two controls were admitted to hospital during one year of follow up. Eight (30%) of the patients given placebo injections and only 2 (7%) ofthe controls, however, had a recurrence of schizophrenic symptoms. Patients given placebo injections experienced fewer extrapyramidal side effects and showed a trend towards a reduction in tardive dyskinesia. Dysphoric and neurotic symptoms were identified before eight out of 11 relapses, and these symptoms were more frequent in patients given placebo depot injections.These results suggest a viable but not necessarily better alternative to continuous oral or depot treatment for less ill, chronic, stabilised schizophrenics based on the early treatment of putative prodromal symptoms of relapse.

The Self-screen-Prodrome as a short screening tool for pre-psychotic states

“…In previous research the SCL-90-R was successfully used for detecting a disposition to psychosis (Henquet, et al, 2005) and as valid indicator of prodromal episodes (Jolley et al, 1989). The PSYC and PAR scales have been used previously for assessing psychotic experiences in a general population sample (van der Werf et al, 2007) and as predictor of subsequent psychotic states (Wilson et al, 1985).…”

Methylphenidate Response, Psychopathology and Tardive Dyskinesia as Predictors of Relapse in Schizophrenia

“…The targeted in termittent maintenance treatment strategy was believed to be viable for the long term management of patients. Because of recent studies (Jolley et al 1989;Carpenter et al 1990;Herz et al 1991;Schooler et al 1993), it is now clear that continuous antipsychotic drug main tenance is the preferred mode of treatment for multiepi sode, chronic, schizophrenic patients. Because medi cation discontinuation is rarely indicated in the long term management of schizophrenic patients, the main practical implementation of provocative tests with psy chostimulant drugs will be in identifying candidates for dose reduction, or for patients who insist on discon tinuing medication.…”

“…{Neuropsychopharmacology 11:107-118, 1994J ever, it is apparent that signifIcant numbers of patients still relapse while taking medication, whereas others taking PBO do not. In addition, studies have demon strated that many patients can be successfully treated with "low doses" of neuroleptics (less than 25% of the standard dose range) (Kane et al 1983;Marder et al 1987;Hogarty et al 1988) whereas targeted/intermit tent neuroleptic treatment strategies (Pietzcker et al 1986;Jolley et al 1989;Carpenter et al 1990;Herz et al 1991) may be employed in patients who refuse con tinuous maintenance treatment. These studies have demonstrated that the increased risk of relapse as sociated with low dose and targeted treatment may be offset by fewer behaviorally manifest extrapyramidal side effects (e.g., akinesia, akathisia) and improved so cial functioning (Kane et al 1985;Marder et al 1987;Carpenter et al 1990;Herz et al 1991).…”

Prodromal Symptoms and Early Detection of Schizophrenia

“…Meanwhile, intraindividual stability is presumed in clinical practice, and on that basis educational interventions are being offered particularly in relapse-oriented targeted and crisis-intervention therapy [74,[106][107][108][109].…”