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Nadolol treat aggression and psychiatric symptomatology in chronic psychiatric inpatients
49
VI.B.6.1.
BETA-BLOCKERS
IN SCHIZOPHRENIA:
A REVIEW
OF THE LITERATURE
J Ratey, M Daehler, C O’Driscoll, P Sorgi and B Rosenfeld Department of Mental Health, Medfeld State Hospital, 4S Hospital Rd., Medfeld.
Massachusetts
02052, U.S.A
We conducted a literature review of 34 clinical studies assessing beta-blockers in the treatment of schizophrenia. 11 controlled studies assessed primary and secondary symptoms of schizophrenia as outcome measures. These studies were entered into a discriminant analysis by finding, with seven studies being coded positive and four negative. The most significant discriminations of the two groups were ‘number of patients in the study to receive beta-blockers’ and ‘duration of illness’. Positive studies had significantly larger subjects per group than negative studies. ‘Number of subjects on beta-blocker’ alone assigned 10 out of 11 studies to their correct group, suggesting that statistical power is a critical determinant of these studies’ findings. Subjects in positive studies had a mean duration of illness of 10.6 years while subjects in negative studies had a mean duration of illness of 17.0 years, suggesting extreme chronicity may also have played a role in negative studies. Positive studies consistently reported improvement in both thought disorder and non-thought disorder symptoms of schizophrenia, with the most frequently reported improvements in the areas of hostility/aggression and negative symptoms.
VI.B.6.2.
NADOLOL TREAT AGGRESSION PSYCHIATRIC INPATIENTS
AND PSYCHIATRIC
SYMPTOMATOLOGY
J Ratey, P Sorgi, K Lindem, G O’Driscoll and M Daehler et al. Department of Mental Health, Medfield State Hospital, 45 Hospital Rd., Medfeld,
Massachusetts
IN CHRONIC
02052, U.S.A.
Aggression and negative symptomatology are important causes of prolonged institutionalization in the mentally ill. For many, neuroleptic treatment has not helped these symptoms and, in fact, may have exacerbated them. Beta-blockers have been proposed as an alternative or adjunct treatment but conflicting results in studies of low power and issues around the mechanism of action have delayed their acceptance. We conducted a 17 week double-blind placebo-controlled study of the effects of the lipophobic beta-blocker nadolol on aggression and psychiatric symptoms. The drug was chosen because it does not potentiate neuroleptic levels and because of its largely peripheral action. 46 chronic psychiatric patients (mean age 44 years) with at least weekly aggressive behaviors were included. A 1 month placebo lead-in was followed by random assignment to placebo (n = 26) or nadolol 120 mg (n = 20). Nadolol treated subjects also showed a significant decline in frequency of aggressive episodes in psychiatrists ratings of severity of illness and in nurses ratings of behavioral problems on the ward. Compared with controls, nadolol-treated subjects also showed a greater decrease in overall Brief Psychiatric Rating Scale score, and in the subfactors hostility-suspicion, negative symptoms and activation. Significant improvement was apparent within l-2 weeks of nadolol initiation, suggesting a peripheral effect.
VI.B.6.1.
BETA-BLOCKERS
IN SCHIZOPHRENIA:
A REVIEW
OF THE LITERATURE
J Ratey, M Daehler, C O’Driscoll, P Sorgi and B Rosenfeld Department of Mental Health, Medfeld State Hospital, 4S Hospital Rd., Medfeld.
Massachusetts
02052, U.S.A
We conducted a literature review of 34 clinical studies assessing beta-blockers in the treatment of schizophrenia. 11 controlled studies assessed primary and secondary symptoms of schizophrenia as outcome measures. These studies were entered into a discriminant analysis by finding, with seven studies being coded positive and four negative. The most significant discriminations of the two groups were ‘number of patients in the study to receive beta-blockers’ and ‘duration of illness’. Positive studies had significantly larger subjects per group than negative studies. ‘Number of subjects on beta-blocker’ alone assigned 10 out of 11 studies to their correct group, suggesting that statistical power is a critical determinant of these studies’ findings. Subjects in positive studies had a mean duration of illness of 10.6 years while subjects in negative studies had a mean duration of illness of 17.0 years, suggesting extreme chronicity may also have played a role in negative studies. Positive studies consistently reported improvement in both thought disorder and non-thought disorder symptoms of schizophrenia, with the most frequently reported improvements in the areas of hostility/aggression and negative symptoms.
VI.B.6.2.
NADOLOL TREAT AGGRESSION PSYCHIATRIC INPATIENTS
AND PSYCHIATRIC
SYMPTOMATOLOGY
J Ratey, P Sorgi, K Lindem, G O’Driscoll and M Daehler et al. Department of Mental Health, Medfield State Hospital, 45 Hospital Rd., Medfeld,
Massachusetts
IN CHRONIC
02052, U.S.A.
Aggression and negative symptomatology are important causes of prolonged institutionalization in the mentally ill. For many, neuroleptic treatment has not helped these symptoms and, in fact, may have exacerbated them. Beta-blockers have been proposed as an alternative or adjunct treatment but conflicting results in studies of low power and issues around the mechanism of action have delayed their acceptance. We conducted a 17 week double-blind placebo-controlled study of the effects of the lipophobic beta-blocker nadolol on aggression and psychiatric symptoms. The drug was chosen because it does not potentiate neuroleptic levels and because of its largely peripheral action. 46 chronic psychiatric patients (mean age 44 years) with at least weekly aggressive behaviors were included. A 1 month placebo lead-in was followed by random assignment to placebo (n = 26) or nadolol 120 mg (n = 20). Nadolol treated subjects also showed a significant decline in frequency of aggressive episodes in psychiatrists ratings of severity of illness and in nurses ratings of behavioral problems on the ward. Compared with controls, nadolol-treated subjects also showed a greater decrease in overall Brief Psychiatric Rating Scale score, and in the subfactors hostility-suspicion, negative symptoms and activation. Significant improvement was apparent within l-2 weeks of nadolol initiation, suggesting a peripheral effect.