Schizophrenia evaluation

Schooler NR, Levine J, Severe JB. NIMH-PRB collaborative fluphenazine study group. Depot fluphenazine in the prevention of relapse in schizophrenia evaluation of a treatment regimen. Psychopharmacol Bull 1979 15 44-47. 

The molten carbonate fuel ceU uses eutectic blends of Hthium and potassium carbonates as the electrolyte. A special grade of Hthium carbonate is used in treatment of affective mental (mood) disorders, including clinical depression and bipolar disorders. Lithium has also been evaluated in treatment of schizophrenia, schizoaffective disorders, alcoholism, and periodic aggressive behavior (56). 

A related issue is the question of which patients to include in an evaluation. The most usefirl evaluation would be one that included all patients likely to use a service in the real world. However, in order to make evaluations feasible, and because of the need to achieve the informed consent of patients, many prospective clinical trials exclude certain patient groups. For example, many schizophrenia trials exclude patients with... 

Guest JF, Hart WM. Cookson RF, et al (1996). Pharmacoeconomic evaluation of long-term treatment with risperidone for patients with chronic schizophrenia. Br JMedEcon 10, 59-67. 

Revicki DA (1999). Pharmacoeconomic evaluation of treatments for refractory schizophrenia ... 

Pharmacoeconomic evaluation of the treatment of schizophrenia in Germany a comparison of olanzapine and haloperidol. Poster presented at the 12th Congress of rhe European College of... 

Jeste DV, Klausner M, Brecher M, et al (1996). A clinical evaluation of risperidone in the treatment of schizophrenia a ten week open label multicentre trial. Psychopharmacology... 

How the different neurotransmitters may be involved in the initiation and maintenance of some brain disorders, such as Parkinson s disease, epilepsy, schizophrenia, depression, anxiety and dementia, as well as in the sensation of pain, is then evaluated and an attempt made to see how the drugs which are used in these conditions produce their effect by modifying appropriate neurotransmitter function (section C). The final section (D) deals with how neurotransmitters are involved in sleep and consciousness and in the social problems of drug use and abuse. 

The localisation of a particular peptide to a particular brain area and possibly associated with a particular transmitter (e.g. CCK with dopamine in mesolimbic pathways) has often prompted a prediction of function (e.g. CCK may have a role in schizophrenia). Animal studies in which the peptide has been injected into the appropriate brain area or tested on slices taken from the brain area have sometimes been taken to confirm such hypotheses. These approaches have lined up the peptides for a whole range of potential roles, some of which are listed in Table 12.4. Whether these predictions are realities will depend on the availability of chemical agents and their evaluation, not only in animals but also in humans. 

Voruganti, L. N. P. 8t Awad, A. G. (2002). Personal evaluation of transitions in treatment (PETiT) a scale to measure subjective aspects of antipsychotic drug therapy in schizophrenia. Schizophr. Res., 56, 37-46. 

Collaborative Working Group on Clinical Trial Evaluations. (1998). Measuring outcome in schizophrenia differences among the atypical antipsychotics. 

The mental status examination remains an essential part of the evaluation. Often patients with schizophrenia will appear nnkempt or otherwise oddly dressed. Sometimes they will be friendly and affable, but when they are paranoid, they can be angry and hostile. Patients may have odd stereotypical movements that can become extreme in catatonic states. The patient with schizophrenia is usually quite alert and well oriented to his/her surroundings. This observation helps to distinguish the psychosis of schizophrenia from that of a delirium due to a medical illness or substance use. 

Psychotic Disorder Due to Generai Medical Condition. Certain medical illnesses occasionally present with symptoms of paranoid delnsions or hallucinations that resemble schizophrenia (Table 4.4). When these illnesses are snccessfully treated, fnll resolntion of the psychotic symptoms invariably occnrs. All patients presenting with new-onset psychosis shonld nndergo a thorongh medical evaluation including a physical exam, family and personal medical history, and laboratory stndies inclnding electrolytes, thyroid function tests, syphilis screen, vitamin B12 and folate levels, and a CT or MRI brain scan. A lumbar puncture (spinal tap) and electroencephalogram are sometimes also warranted. 

Maintenance Evaluation of patients with schizophrenia who had been stable on other antipsychotic medications for periods of 3 months or longer, were discontinued from those medications, and were then administered aripiprazole 15 mg/day and who were observed for relapse for up to 26 weeks demonstrated a benefit of such maintenance treatment. Periodically reassess patients to determine the need for maintenance treatment. 

In a 1994 study Teplin evaluated 728 male jail detainees, and found that nearly two-thirds of this population had a psychiatric disorder with antisocial personality disorder (ASP), the most common diagnosis at 50%. However, 35% of the population had a current diagnosis other than ASP, and two-thirds had previously been given a lifetime diagnosis other than ASP. Substance abuse was common, with a 62% lifetime prevalence. More than one out of three detainees had a severe mental disorder (schizophrenia, bipolar affective disorder, or major depression). In another study, 693 homicide offenders were evaluated and elevated rates of schizophrenia and ASP were found (Eronen et al., 1996). Earlier studies found schizophrenia in 29%-75% and affective disorders in 4%-35% of prisoners. 

Braff DL, Geyer MA Sensorimotor gating and schizophrenia human and animal model studies. Arch Gen Psychiatry 47 181-188, 1990 Bramanti P, Bianchi L, Benedetto M, et al Study of the hypnic effect of amineptine evaluation by polygraphy and tests. Prog Neuropsychopharmacol Biol Psychiatry 9 157-165, 1985... 

Neurokinins comprise a group of peptides involved in nerve transmission. Specific members of this class of mediators control such diverse functions as visceral regulation and CNS function. The nonpeptide neurokinin antagonist talnetant (32-6), for example, has been evaluated for its effect on irritable bowel syndrome and urinary incontinence as well as depression and schizophrenia [36]. The quinoline portion of this compound is prepared by base-catalyzed Pfitzinger condensation of isatin (32-1) with the methoxy acetophenone (32-2). The methoxy ether in the product (32-3) is next cleaved by means of hydrogen bromide (32-4). Amide formation with the chiral a-phenylpropylamine (32-5) affords the neurokinin antagonist talnetant (32-6) [37]. 

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