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On the ability of schizophrenic patients to learn control of inter-hemispheric slow potential negativity
203
XVIII. Late Submissions THE PRIMARY CARE SCHIZOPHRENIA
OF PATIENTS
WITH
T. Burns, T. Kendrick, A. C o h e n St George's Hospital Medical School. Cranmer Terrace, London SWI7. UK
The proportion of patients with schizophrenia who lose contact with the specialist services is between 25% and 40%. It is the General Practitioner that remains the most likely health professional to be in contact with such patients. A consensus group of 14 members met on four occasions to review the literature and to develop good practice guidelines for the management of schizophrenia in primary care. The group consisted of clinical and academic psychiatrists, clinical and academic general practitioners, CPN, practice nurse facilitator, and a health economist. The group developed 'standard' guidelines--guidelines appropriate to the average general practitioner working in an average practice in five areas: establishing a register and organizing regular reviews, comprehensive assessments, information and advice for patients and carers, indications for involving specialist services, and crisis management. The guidelines have been published and are being disseminated through the educational network of primary care, targeting in particular the primary care clinical tutors, chairs of primary care audit groups, and practice nurse facilitators.
OLANZAPINE VERSUS FLUPHENAZINE-6 WEEKS TREATMENT OF ANXIETY SYMPTOMS DURING ACUTE SCHIZOPHRENIA M. D o s s e n b a c h ~, M. Jakovljevic 2, V. Folnegovic 2, B. Uglesic z, G. D o d i g 2, P. FriedeP, L. Hotujac 2 ~Lilly Area Medical Centre Vienna, Bariehgasse 40-42. A-1030 Vienna, Austria 2hn'estigators, Croatia Background: The new atypical antipsychotic olanzapine has shown improvement similar to anxiolytic agents in the conflict schedule animal model. As olanzapine has no interaction with the GABA receptors other effects like the broad interaction with the serotonergic receptors may explain this finding. It was the aim of this project to see if olanzapine has an anxiolytic effect in humans. Methods: Patients began with a washout period of 2-9 days and were then treated either with olanzapine (5 20 rag/day) or fluphenazine (6 21 mg/day) for a period of 6 weeks followed by a double blind extension phase. Evaluations were made at weekly intervals; the instrument used to measure the anxiety effect was the HAMA. Other efficacy and safety measurements used were the PANSS, CGI, SAS, HAS, AIMS and UKU rating scales. Data from these evaluations are reported elsewhere.
Results: Sixty patients entered the study, fifty-four ( 27 olanzapine, 27 fluphenazine) were evaluable for the efficacy analysis. The mean age was 34.6 years and 44% were male. Mean compared to baseline differed statistically significantly on HAMA total score (Olz--9.8, Flu 5.8, p<0.05) and on the HAMA somatic score ( O 1 ~ 3 . 6 , Flu-- 1.6, p<0.05). Concomitant use of benzodiazepines (diazepam equivalents-Olz 1.05mg/day, Flu 3.7mg/day, p<0.05) was statistically significantly higher in the fluphenazine group. Conclusion: In this study olanzapine has proven to be an effective therapy in the treatment of anxiety symptoms during acute Schizophrenia with a statistically significantly better efficacy compared to fluphenazine.
ON THE ABILITY OF SCHIZOPHRENIC PATIENTS TO LEARN CONTROL OF INTER-HEMISPHERIC SLOW POTENTIAL NEGATIVITY J o h n Gruzelier, Jennifer Wild, Elinor H a r d m a n , Rashid Z a h m a n , Steven Hirsch Charing Cross Hospital, London. UK
With neuroleptic treatment and withdrawal of treatment reversals in directions of functional asymmetry have been found in schizophrenia with measures of hemi-inattention, flash evoked potentials, lower motoneuron excitability, eye movements and recognition memory, some of which were doserelated (Gruzelier, 1998), Animal research has shown that striatal dopamine is under reciprocal hemispheric control. These considerations along with substantive and long standing evidence of functional and structural lateral anomalies in schizophrenia led us to investigate whether schizophrenic patients could learn to shift the balance of cortical negativity interhemispherically. 25 DSM IV schizophrenic patients agreed to participate in the study and were rated on syndromes known to be associated with functional asymmetry. Eight did not comply with testing, 7 of whom had high withdrawn syndrome ratings. The remainder participated in ten half-hour sessions. They were trained to shift negativity recorded from lateral central placements (C3 and C4) in a leftward or rightward direction. Feedback was given in the form of an on-screen rocket ship which rose or fell. Control was learned by both active (P<0.03) and withdrawn/mixed ( P < 0.002 ) syndromes. Active syndrome patients were better able to shift negativity rightward and withdrawn syndrome patients leftward. As in each syndrome these are the directions associated with drug reversal of functional asymmetry and symptom recovery. This suggests that neurofeedback regimens may have therapeutic potential. This is the first successful demonstration of slow potential feedback training in schizophrenia. The support of NARSAD and the Saugstad Fund is gratefully acknowledged. Gruzelier, J. (1998) Functional asymmetry in schizophrenia: A review and reconsideration of the neuro-psychophysiological evidence. Schizophrenia Bulletin, in press.
XVIII. Late Submissions THE PRIMARY CARE SCHIZOPHRENIA
OF PATIENTS
WITH
T. Burns, T. Kendrick, A. C o h e n St George's Hospital Medical School. Cranmer Terrace, London SWI7. UK
The proportion of patients with schizophrenia who lose contact with the specialist services is between 25% and 40%. It is the General Practitioner that remains the most likely health professional to be in contact with such patients. A consensus group of 14 members met on four occasions to review the literature and to develop good practice guidelines for the management of schizophrenia in primary care. The group consisted of clinical and academic psychiatrists, clinical and academic general practitioners, CPN, practice nurse facilitator, and a health economist. The group developed 'standard' guidelines--guidelines appropriate to the average general practitioner working in an average practice in five areas: establishing a register and organizing regular reviews, comprehensive assessments, information and advice for patients and carers, indications for involving specialist services, and crisis management. The guidelines have been published and are being disseminated through the educational network of primary care, targeting in particular the primary care clinical tutors, chairs of primary care audit groups, and practice nurse facilitators.
OLANZAPINE VERSUS FLUPHENAZINE-6 WEEKS TREATMENT OF ANXIETY SYMPTOMS DURING ACUTE SCHIZOPHRENIA M. D o s s e n b a c h ~, M. Jakovljevic 2, V. Folnegovic 2, B. Uglesic z, G. D o d i g 2, P. FriedeP, L. Hotujac 2 ~Lilly Area Medical Centre Vienna, Bariehgasse 40-42. A-1030 Vienna, Austria 2hn'estigators, Croatia Background: The new atypical antipsychotic olanzapine has shown improvement similar to anxiolytic agents in the conflict schedule animal model. As olanzapine has no interaction with the GABA receptors other effects like the broad interaction with the serotonergic receptors may explain this finding. It was the aim of this project to see if olanzapine has an anxiolytic effect in humans. Methods: Patients began with a washout period of 2-9 days and were then treated either with olanzapine (5 20 rag/day) or fluphenazine (6 21 mg/day) for a period of 6 weeks followed by a double blind extension phase. Evaluations were made at weekly intervals; the instrument used to measure the anxiety effect was the HAMA. Other efficacy and safety measurements used were the PANSS, CGI, SAS, HAS, AIMS and UKU rating scales. Data from these evaluations are reported elsewhere.
Results: Sixty patients entered the study, fifty-four ( 27 olanzapine, 27 fluphenazine) were evaluable for the efficacy analysis. The mean age was 34.6 years and 44% were male. Mean compared to baseline differed statistically significantly on HAMA total score (Olz--9.8, Flu 5.8, p<0.05) and on the HAMA somatic score ( O 1 ~ 3 . 6 , Flu-- 1.6, p<0.05). Concomitant use of benzodiazepines (diazepam equivalents-Olz 1.05mg/day, Flu 3.7mg/day, p<0.05) was statistically significantly higher in the fluphenazine group. Conclusion: In this study olanzapine has proven to be an effective therapy in the treatment of anxiety symptoms during acute Schizophrenia with a statistically significantly better efficacy compared to fluphenazine.
ON THE ABILITY OF SCHIZOPHRENIC PATIENTS TO LEARN CONTROL OF INTER-HEMISPHERIC SLOW POTENTIAL NEGATIVITY J o h n Gruzelier, Jennifer Wild, Elinor H a r d m a n , Rashid Z a h m a n , Steven Hirsch Charing Cross Hospital, London. UK
With neuroleptic treatment and withdrawal of treatment reversals in directions of functional asymmetry have been found in schizophrenia with measures of hemi-inattention, flash evoked potentials, lower motoneuron excitability, eye movements and recognition memory, some of which were doserelated (Gruzelier, 1998), Animal research has shown that striatal dopamine is under reciprocal hemispheric control. These considerations along with substantive and long standing evidence of functional and structural lateral anomalies in schizophrenia led us to investigate whether schizophrenic patients could learn to shift the balance of cortical negativity interhemispherically. 25 DSM IV schizophrenic patients agreed to participate in the study and were rated on syndromes known to be associated with functional asymmetry. Eight did not comply with testing, 7 of whom had high withdrawn syndrome ratings. The remainder participated in ten half-hour sessions. They were trained to shift negativity recorded from lateral central placements (C3 and C4) in a leftward or rightward direction. Feedback was given in the form of an on-screen rocket ship which rose or fell. Control was learned by both active (P<0.03) and withdrawn/mixed ( P < 0.002 ) syndromes. Active syndrome patients were better able to shift negativity rightward and withdrawn syndrome patients leftward. As in each syndrome these are the directions associated with drug reversal of functional asymmetry and symptom recovery. This suggests that neurofeedback regimens may have therapeutic potential. This is the first successful demonstration of slow potential feedback training in schizophrenia. The support of NARSAD and the Saugstad Fund is gratefully acknowledged. Gruzelier, J. (1998) Functional asymmetry in schizophrenia: A review and reconsideration of the neuro-psychophysiological evidence. Schizophrenia Bulletin, in press.