PAN

Sharafi, M. (2005) Comparison of classical and clozapine treatment on schizophrenia using positive and negative syndrome scale of schizophrenia (PANSS) and SPECT imaging. IrU. J. Med. Sci. 2,79-86. 

Positive and Negative Syndrome Scale for Children and Adolescents (K-PANSS) (Fields et al., 1994) Rating scale for positive and negative symptoms and other symptoms Interviewer rating Parent/Child 6-16... 

All these studies essentially use the same definition for responder (i.e., 20% improvement on a standard rating instrument, usually the Positive and Negative Symptoms Scale [PANSS]). Because this criterion is the standard and was decided beforehand, there is no statistical problem of a post hoc choice of optimal cutoff points for dichotomization. 

Janicak et al. (87) studied the relative efficacy and safety of risperidone versus haloperidol in the treatment of schizoaffective disorder. Sixty-two patients (29 depressed type, 33 bipolar type) entered a randomized, double-blind, 6-week trial of risperidone (up to 10 mg/day) or haloperidol (up to 20 mg/day). They found no difference between risperidone and haloperidol in the amelioration of psychotic and manic symptoms nor any significant worsening of mania with either agent. For the total PANSS, risperidone produced a mean decrease of 16 points from baseline, compared with a 14-point decrease with haloperidol. For the total CARS-M scale, risperidone and haloperidol produced mean change scores of 5 and 8 points, respectively and for the CARS-M mania factor, 3 and 7 points, respectively. 

Using meta-analytic techniques based on the means and the standard errors presented graphically in the poster, we estimated pooled data of the four effective dosages of quetiapine both for the BPRS and the CGI severity of illness change scores from baseline to endpoint. Quetiapine produced an improvement of 0.43 effect-size units in comparison with placebo, a difference that was highly statistically significant and about the same improvement as haloperidol. Thus, based on the BPRS or PANSS, quetiapine was similar to neuroleptics in efficacy (i.e., differences were nonsignificant). Based on our meta-analysis, quetiapine is clearly superior to... 

H452Y Risperidone (8 wk) 73 Japanese patients with SCZ PANSS No correlation 96... 

Clozapine No overall change in PANSS three patients improved during donepezil... 

High potency typical P No changes in PANSS or cognitive measures... 

Standard antipsychotic medication Improvement in MMSE, CGI and PANSS... 

Symptomatic effects of NMDA blockade were better classified starting in the early 1990s in a series of ketamine challenge studies conducted in both normal volunteers and schizophrenia patients. In normal volunteers, significant increases in positive, negative, and cognitive symptoms were observed in schizophrenia, using scales such as the PANSS or BPRS/SANS. 

In a double-blind, multicenter, randomized, placebo-controlled study, 140 patients with treatment-refractory schizophrenia were treated with NAC (2 g/day) as an add-on to their antipsychotic maintenance medication over a 24-week interval followed by a 4-week washout. NAC administration moderately improved the clinical outcomes on the basis of the Clinical Global Impression (CGI) Severity and Improvement scales, and reduced positive and negative symptoms scores (based on the Positive and Negative Syndrome Scale (PANSS)). In addition, the severity of abnormal movements measured by the Barnes Akathisia Scale was diminished. The moderate effects of NAC treatment on a refractory cohort of patients indicate that NAC is an effective add-on strategy for chronic schizophrenia, (Berk et al., 2008). 

Clozapine has also been compared with risperidone in 60 treatment-resistant patients with schizophrenia in India (16). There was clinical improvement (a more than 20% reduction from baseline PANSS scale scores) in 80% of the clozapine-treated patients and 67% of the risperidone-treated patients. The predominant adverse effects with clozapine (n = 30) were tachycardia (77%), hypersalivation (60%), sedation (60%), weight gain (43%), and constipation (30%) one patient had a seizure. The adverse effects of risperidone (n = 30) were constipation (50%), dry mouth (47%), weight gain (43%), akathisia (37%), insomnia (33%), tachycardia (30%), and impotence (27%). The final mean daily doses after 16 weeks of treatment were 343 mg for clozapine and 5.8 mg for risperidone. 

Compared with clozapine, considered the gold standard for treatment of patients with refractory schizophrenia, olanzapine had the same level of efficacy (according to the Positive and Negative Syndrome Scale (PANSS), and the Brief Psychiatric Rating Scale (BPRS)) in 150 patients (mean age, 38 years 60% men) who had failed to respond to conventional neuroleptic drugs because of either insufficient effectiveness or intolerable adverse effects (52). Of these, 147 patients, 52 from Hungary and 95 from South Africa, were randomized to olanzapine (n = 75) or clozapine (n = 72) there were no statistically significant... 

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