Faculty Bibliography

This study explored the relationships between plasma levels and the clinical effects of haloperidol in 176 acutely exacerbated schizophrenic or schizoaffective patients. After a single-blind placebo period of 1 week (period 1), they entered the double-blind period 2 randomly assigned to one of three plasma levels of haloperidol: low (2 to 13 ng/mL), medium (13.1 to 24 ng/mL), or high (24.1 to 35 ng/mL). Patients whose conditions did not improve in period 2 continued on one of the three haloperidol levels (period 3). Periods 2 and 3 lasted 6 weeks each. Only minor differences in clinical responses were noted among the three levels of haloperidol. These results imply that low or moderate doses of neuroleptics are appropriate for many acutely psychotic patients

Replies to comments of L. A. Graham et al (see record 1991-04614-001) on the M. I. Krakowski et al (see record 1989-36627-001) study on the prediction of violent behavior. Graham et al miss the point of the distinction between low and high violence; the emphasis was not on the seriousness of incidents. Frequency of assaults is also an important dimension. Also, various assaultive behaviors seemed to have the same neurological underpinnings. Data showing greater neurological impairment in a high violence group of patients suggest an association between high violence and more severe schizophrenia.

This study relates violent behavior of schizophrenic inpatients to demographic, historical, EEG, neurological, and neuropsychological variables. Patients were classified into high (N = 28), low (N = 27), or no (N = 34) violence groups. There were no significant differences among the groups on demographic or historical variables, except for prevalence of violent crime, which was higher in both violent groups than in nonviolent patients. Neurological and neuropsychological abnormalities differentiated the groups, with the high violence group evidencing more abnormalities than the other two groups in the area of integrative sensory and motor functions. The authors suggest that violence as well as neurological and neuropsychological deficits may characterize a more severe form of schizophrenia

This study compared patients who showed persistent violence, transient violence and no violence. The presence of neurological abnormalities was found to be the factor that differentiated most clearly among the three groups. The persistently violent patients, in addition to showing significantly more neurological abnormalities, also evidenced a more disturbed family background. Both violent groups had a higher incidence of violent crime prior to hospitalization than the nonviolent controls. A logistic regression model simultaneously relating the effects of six factors on violent behavior was developed and used to predict violent group membership

Extensive work in the field has indicated a state-dependent hyperactivity of the hypothalamic-pituitary-adrenocortical (HYPAC) functions and unresponsiveness to dexamethasone suppression in at least 50% of patients suffering from endogenous depression. In this study, elderly outpatients, 60-85 years of age, suffering from major depressive illness according to research diagnostic criteria (RDC) were studied with the dexamethasone suppression test (DST). Careful diagnostic evaluation included RDC, the Newcastle index, and clinical interviews focusing on 'endogenomorphic features.' The great majority (83.3%) of patients diagnosed as endogenous depressives were nonsuppressors (abnormal DST) as compared to 16.7% nonsuppressors amongst nonendogenous patients. In addition, DST tended to normalize the clinical recovery. The research and clinical implications of our findings in this population are further discussed

Elderly depressed patients who met the research diagnostic criteria (RDC) for major depressive illness, resistant to other types of treatment, were treated with phenelzine, a nonselective monoamine oxidase (MAO) inhibitor, for a period of 2 to 7 weeks, following 2 weeks of placebo washout period. Dosage ranged from 15-75 mg daily. Clinical status of patients as well as vital signs, EKG, and platelet MAO inhibition were measured weekly. All responders at the end of this period were followed for 1 to 2 years. Analysis of the results showed a 65% response rate as measured by Hamilton, Global, and Self-rating Scales. No significant drug effect in cognitive functioning, as measured by objective cognitive tests, was observed. Clinical improvement was sustained for all participants throughout the follow-up period with no side effects. A direct relationship between platelet MAO inhibition and clinical response was found. The majority of the responders (70%) had achieved high platelet MAO inhibition values (greater than 80%), while most of the nonresponders had platelet MAO inhibition values of less than 80%. These findings have potential clinical and research implications for treating geriatric depression, especially the ones resistant to other forms of treatment