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Relapse after lithium withdrawal in schizoaffective psychoses
212
tic threshold dosage. To avoid the first-pass-effect and physical-chemical interactions, nowadays depot neuroleptics for high dosage treatment.
a lot of are used
It seem urgent to collect data from individual trials of untraditional treatments and to try to determine what was effective and what was ineffective. Special TRS units are suggested to be established, linked to a central registry. 1.
Dencker, Refractory
2.
P.R.A., Dencker, S-J., Hubbard, J.W., Midha, K.K., May, Liberman, R.P. In: Dencker, S.J., Bender, W., Kulhanek, F. teds) Treatment Refractory Schizophrenia. Braunschweig: Vieweg, 1988
3.
Platz, W., Fiinfgeld, E-W., Kulhanek, F. In: Hinterhuber, H., Schubert, H., Kulhanek, F. teds) Seiteneffekte und Stdrwirkungen der Psychopharmaka. Stuttgart-New York: Schattauer, 1986, pp 137-150
RELAPSE
AFTER
S.J., Bender, Schizophrenia.
LITHIUM
G. Lenz, A. Lovrek, Wancata and R. Wolf
Psychiatric Clinic, Vienna, Austria
WITHDRAWAL K.
Thau,
University
W., Kulhanek, F. teds) Treatment Braunschweig: Vieweg, 1988
IN SCHIZOAFFECTIVE A.
Topitz,
of Vienna,
E.
Denk,
PSYCHOSES C.
Wahringergurtel
Simhandl,
18-20,
J.
1090
In an attempt to validate subtypes of schizoaffective disorder (bipolar type and depressive type, diagnosed by RDC and DSM-III-R) by means of therapy response to lithium, a double-blind placebo-controlled withdrawal study was undertaken with 20 bipolar type patients and 10 depressive type patients. In a crossover design patients received lithium for four months and placebo for four months. Every two weeks patients were rated using the Beth-Rafaelson scale for mania and melancholia, BPRS and GAS. After six patients (all bipolar type, 5 male and 1 female, mean age 47.5k9.9 years, mean age of onset of illness 21f3'years, mean duration of lithium therapy 11.522.3 years, mean lithium plasma level 0.7?0.01 mval/l) had entered the trial, severe manic relapses occurred in five patients, so that the trial had to be stopped because of ethical reasons. All relapses occurred during the placebo period within ten days to six weeks. One patient, a rapid cycler, entered the study in a subdepressive state which improved and worsened during the lithium period as well as during the placebo period (severe depression after six weeks on placebo). The high rate of early relapse on placebo suggests the existence of a when lithium is withdrawn suddenly in patients rebound phenomenon, with schizoaffective disorder.
213
TABLE 1. Six patients with schizoaffective R simultaneously) withdrawn from lithium Pat. No. and initials
l(KW)
Sex/age now Age at first episode No. of schizophr. adm. No. of schizoaff. adm. No. of manic adm. No. of depressive adm. Interval since last illness (years) Neuroleptic med. Antidepressive med. Time on lithium (yrs) Serum-lithium before withdrawal (mval/l) Time on placebo before relapse
LOW DOSE FLUPHENAZINE OUTPATIENTS
F/44 20 1 2 6 2 6 no yes 12 0.7 6 wk
DECANOATE
2(GW) M/50 21 2 1 1 rapid cycles yes no 3 0.6 after 6 wk max of depression
disorder
I
4(QN) M/64 24 1 2
M/43 21 1 1 3
(RDC and DSM-III5(RE)
6(RW)
M/36 M/43 16 24 3 1 1 3 6 1 1 1 chron. subdepr. yes yes no yes 11 11
10
9
no no 10
no no 14
0.6
0.7
0.6
0.8
10 d
4 wk
3 wk
6 wk
AND SKILLS TRAINING
Stephen R. Marder, M.D. and Robert P. Liberman,
IN SCHIZOPHRENIC
M.D.
West Los Angeles Veterans Administration Medical Center, Brentwood Division, and the UCLA Department of Psychiatry, Los Angeles, CA, USA Two promising biobehavior treatment strategies for patients with chronic schizophrenia are being evaluated in a controlled clinical trial: (1) low dose fluphenazine decanoate maintenance therapy supplemented by either placebo or additional fluphenazine at the times when patients demonstrate early signs (or prodromal signs) of relapse; and (2) behavioral training of patients in a number of selfmanagement skills. Self-management skills are presented in four modules: medication self-management, symptom self-management, recreation for leisure, and social problem solving. Medication and symptom self-management are presented during the first year since skills in the managing of the illness itself are viewed as the basic foundation upon which other skills may be added. The study was designed to maximize the interactions between psychosocial and pharmacological interventions. For example, patients in the selfmanagement groups are taught to recognize the earliest signs of schizophrenic and to take effective remedial action. We relapse predict that self-management skills will yield the greatest therapeutic impact with patients who receive active drug when they demonstrate prodromal symptoms. Preliminary data are presented for the 25 patients who have entered the first year of the study on the feasibility of involving therapy and on the generalized.
schizophrenic patients degree to which the
in structural behavioral skills are acquired and
tic threshold dosage. To avoid the first-pass-effect and physical-chemical interactions, nowadays depot neuroleptics for high dosage treatment.
a lot of are used
It seem urgent to collect data from individual trials of untraditional treatments and to try to determine what was effective and what was ineffective. Special TRS units are suggested to be established, linked to a central registry. 1.
Dencker, Refractory
2.
P.R.A., Dencker, S-J., Hubbard, J.W., Midha, K.K., May, Liberman, R.P. In: Dencker, S.J., Bender, W., Kulhanek, F. teds) Treatment Refractory Schizophrenia. Braunschweig: Vieweg, 1988
3.
Platz, W., Fiinfgeld, E-W., Kulhanek, F. In: Hinterhuber, H., Schubert, H., Kulhanek, F. teds) Seiteneffekte und Stdrwirkungen der Psychopharmaka. Stuttgart-New York: Schattauer, 1986, pp 137-150
RELAPSE
AFTER
S.J., Bender, Schizophrenia.
LITHIUM
G. Lenz, A. Lovrek, Wancata and R. Wolf
Psychiatric Clinic, Vienna, Austria
WITHDRAWAL K.
Thau,
University
W., Kulhanek, F. teds) Treatment Braunschweig: Vieweg, 1988
IN SCHIZOAFFECTIVE A.
Topitz,
of Vienna,
E.
Denk,
PSYCHOSES C.
Wahringergurtel
Simhandl,
18-20,
J.
1090
In an attempt to validate subtypes of schizoaffective disorder (bipolar type and depressive type, diagnosed by RDC and DSM-III-R) by means of therapy response to lithium, a double-blind placebo-controlled withdrawal study was undertaken with 20 bipolar type patients and 10 depressive type patients. In a crossover design patients received lithium for four months and placebo for four months. Every two weeks patients were rated using the Beth-Rafaelson scale for mania and melancholia, BPRS and GAS. After six patients (all bipolar type, 5 male and 1 female, mean age 47.5k9.9 years, mean age of onset of illness 21f3'years, mean duration of lithium therapy 11.522.3 years, mean lithium plasma level 0.7?0.01 mval/l) had entered the trial, severe manic relapses occurred in five patients, so that the trial had to be stopped because of ethical reasons. All relapses occurred during the placebo period within ten days to six weeks. One patient, a rapid cycler, entered the study in a subdepressive state which improved and worsened during the lithium period as well as during the placebo period (severe depression after six weeks on placebo). The high rate of early relapse on placebo suggests the existence of a when lithium is withdrawn suddenly in patients rebound phenomenon, with schizoaffective disorder.
213
TABLE 1. Six patients with schizoaffective R simultaneously) withdrawn from lithium Pat. No. and initials
l(KW)
Sex/age now Age at first episode No. of schizophr. adm. No. of schizoaff. adm. No. of manic adm. No. of depressive adm. Interval since last illness (years) Neuroleptic med. Antidepressive med. Time on lithium (yrs) Serum-lithium before withdrawal (mval/l) Time on placebo before relapse
LOW DOSE FLUPHENAZINE OUTPATIENTS
F/44 20 1 2 6 2 6 no yes 12 0.7 6 wk
DECANOATE
2(GW) M/50 21 2 1 1 rapid cycles yes no 3 0.6 after 6 wk max of depression
disorder
I
4(QN) M/64 24 1 2
M/43 21 1 1 3
(RDC and DSM-III5(RE)
6(RW)
M/36 M/43 16 24 3 1 1 3 6 1 1 1 chron. subdepr. yes yes no yes 11 11
10
9
no no 10
no no 14
0.6
0.7
0.6
0.8
10 d
4 wk
3 wk
6 wk
AND SKILLS TRAINING
Stephen R. Marder, M.D. and Robert P. Liberman,
IN SCHIZOPHRENIC
M.D.
West Los Angeles Veterans Administration Medical Center, Brentwood Division, and the UCLA Department of Psychiatry, Los Angeles, CA, USA Two promising biobehavior treatment strategies for patients with chronic schizophrenia are being evaluated in a controlled clinical trial: (1) low dose fluphenazine decanoate maintenance therapy supplemented by either placebo or additional fluphenazine at the times when patients demonstrate early signs (or prodromal signs) of relapse; and (2) behavioral training of patients in a number of selfmanagement skills. Self-management skills are presented in four modules: medication self-management, symptom self-management, recreation for leisure, and social problem solving. Medication and symptom self-management are presented during the first year since skills in the managing of the illness itself are viewed as the basic foundation upon which other skills may be added. The study was designed to maximize the interactions between psychosocial and pharmacological interventions. For example, patients in the selfmanagement groups are taught to recognize the earliest signs of schizophrenic and to take effective remedial action. We relapse predict that self-management skills will yield the greatest therapeutic impact with patients who receive active drug when they demonstrate prodromal symptoms. Preliminary data are presented for the 25 patients who have entered the first year of the study on the feasibility of involving therapy and on the generalized.
schizophrenic patients degree to which the
in structural behavioral skills are acquired and