Results of a multicenter AMDP study with fluperlapine in schizophrenic patients

In an open multicenter trial (7 hospitals) 85 schizophrenic patients were treated with 3-fluoro-6-(4-methyl-piperazinyl)- 11H -dibenz[b,e]azepine ( fluperlapine , NB 106-689) during 20 days. Symptomatology was documented with the AMDP system on days 0, 1, 5, 10, 15 and 20. A mean daily dosage of about 400 mg caused a significant antipsychotic effect and pronounced improvement of depressive symptoms. Fluperlapine was well tolerated. Extra-pyramidal side-effects were very rare.

Assessment of adverse drug reactions in psychiatric hospitals

A system for monitoring adverse drug reactions (ADR) in psychiatric inpatients was introduced in psychiatric hospitals in the FRG in May 1979. It consists of intensive drug monitoring (IDM) and a so-called "organized spontaneous reporting system" (OSR). ADR are rated separately according to impact on therapy and probability of causal relationship. With IDM all ADR (Grades I-III) are assessed in a randomly selected sample of inpatients. With OSR only ADR leading to discontinuation of the drugs in question (= ADR Grade III) are assessed. In 406 drug-treated inpatients monitored by IDM in the psychiatric hospitals of Berlin and Munich from May 1979 to Dec. 1981, ADR were observed in 60,4%. In 15% of IDM-patients ADR led to discontinuation of the drugs in question; with OSR the relative frequency of these Grade III ADR was 9,0% in 5096 patients monitored throughout the entire period. Life-threatening events were observed in 1,2% of patients undergoing IDM as well as 1.2% of those undergoing OSR. The most frequently observed ADR by IDM were sedation, extrapyramidal signs, disturbances of the autonomic nervous system and increase in transaminases, and by OSR Parkinsonism, akathisia, sedation, toxic delirium and increased transaminases. The relative frequency of Grade III ADR was similar for neuroleptics and antidepressants (5,4% and 5,3% in OSR); a very low relative frequency of ADR Grade III was found for tranquilizers and hypnotics (0,7% and 0,2%). Methodological aspects of this drug monitoring system are discussed in the light of current literature.

Methysergide decreases prolactin release after FK 33-824 [Tyr-D-Ala-Gly-MePhe-Met(o)-ol], a potent analogue of methionine enkephalin. A study in man

This study investigated the mechanisms which may underly the prolactin (PRL) stimulating effects of FK 33-824, a potent enkephalin analogue. FK 33-824 (1 mg) was infused in healthy volunteers before and after pretreatment with 3 mg methysergide, a serotonin receptor blocker. All subjects showed a release of PRL after FK 33-824, which was significantly diminished after pretreatment with methysergide.

The prediction of acute response, remission and general outcome of neuroleptic treatment in acute schizophrenic patients

The prognosis of a clinical neuroleptic treatment was prospectively examined in 26 schizophrenic patients using a predetermined set of predictors and outcome criteria. Prognosis before treatment did not discriminate significantly between patients with good and poor outcome. Significant differences of outcome were observed between the prognostic groups, if prognosis was established after 5 days of treatment. Retrospective analysis of individual predictors indicated the following rank order: initial improvement, age, duration of symptoms before treatment, sex, subjective tolerance of the treatment. The relative weight of the individual predictor in forming the prognosis is still an open question.

Acute effects of the synthetic analogue of methionine enkephalin FK 33-824 on depressive symptoms

Nine patients with endogenous depression have been treated with infusions of the synthetic methionine enkephaline analogue FK 33-824 for two days. Only on the first day acute effects on depressive symptoms could be observed. It cannot be decided if the observed mood alterations on the first treatment day are placebo effects. Depressive patients showed fewer adverse reactions than healthy volunteers. This might be explained by the previously described greater pain tolerance in depressives.

Effects of beta-receptor blockers in pharmacology EEG

10 normal volunteers (5 females, 5 males, 18-30 years) were treated for 4 days with the beta-blocker sotalol, 320 or 960 mg/day, 5 persons each in random order. A placebo was applied 5 days before and 2 days afterwards. Changes in blood pressure and pulse were not pronounced. EEG data from vigilance-controlled EEGs, evaluated in a spectral parameter analysis, showed a significant decrease of the absolute and relative alpha-power and the dominant alpha-amplitude and so far indicate a central nervous system action of sotalol.

[The antidepressant viloxazin. A multicenter study under practice conditions]

As part of an open multicentre study involving 22 psychiatric clinics 212 patients with depressive symptoms (predominantly endogenous depression) were treated over one month with viloxazine. The drug was administered either alone or- if it seemed clinically necessary--in combination with minor or major tranquilizers. Overall, the depressive symptoms improved in 77% of the cases (10-20% total remissions) of both endogenous and reactive depression. Depressive mood, anxiety and reduced activity were the symptoms which responded best to therapy. In sleep disturbances, psychomotor and internal unrest combination therapy with minor or major tranquilizers was superior to viloxazine given alone.

Initial improvement as predictor of outcome of neuroleptic treatment

Improvement of acute psychotic exacerbations under neuroleptic therapy can depend on the time course of the disease itself, on the individual patient or on the specific neuroleptic applied. Previous studies demonstrated that neither the characteristics of the patients nor the disease qualities could predict the outcome of neuroleptic therapy (review by May and Goldberg 1978). In this study the initial improvement after the onset of neuroleptic treatment was tested for its predictive value. In 33 patients treated with constant doses of butyrophenones the decrease of psychotic symptomatology during the first 5 days of treatment not only accounted for the major part of the overall improvement, but was also a relatively reliable predictor for the further course of the therapy.

[On the practice of clinical therapy with psychotropic drugs -- retrospective investigation of physicians prescribing practices in a psychiatric hospital (author's transl)]

1. At the psychiatric hospital of the University of Munich physicians' practices in prescribing psychotropic drugs have been analyzed retrospectively for 1974. Case report of 2,100 patients from a total of 2,118 newly admitted inpatients in 1974 have been evaluated and various methods of analyzing data are compared. 2. 414 (19.7%) patients out of a total of 2100 have not been medicated by any drugs. On the average 2.7 psychotropic drugs/patient have been precribed in the remaining 1,186 patients (80.3%). 3. 37.4% of 4627 applications made have been allotted to neuroleptics. Clozapine has been found to be the drug most extensively used (37.4%). It was prescribed to 595 patients, followed by chloralhydrate (425 patients) and amitriptyline (374 patients). 4. Out of a total of 5373 prescriptions, 2,004 were allotted to a single substance and 3,369 to a combination of different drugs. With regard to combined medications, in 1,856 prescriptions two drugs were combined, in 1,015 three, in 404 four, in 70 five, in 18 six and finally in 6 prescriptions seven medications were applied to one patient. 5. Antidepressants and neuroleptics have been combined on the same patient in 768 prescriptions. As to neuroleptics most frequently clozapine and haloperidol have been prescribed together. 6. The mean time during which a defined combination of drugs was given continuously, never exceeded a quarter of the total time the individual had been admitted to the hospital. 7. It is evident that in clinical practice the combinations of psychotropic drugs are widely used. This pattern of psychopharmacological drug treatment is in conflict with the present accepted rules of psychotropic pharmacotherapy. Furthermore it is a remarkable result of the present studies that in therapeutical practice the single components of drug combinations are changed very often. Compounds with sedative effects are preferred within all classes of psychotropic drugs.

Effects of the beta-adrenoceptor blocking agent sotalol on CNS: sleep, EEG, and psychophysiological parameters

Sotalol (Sotalex), 320 or 960 mg, was administered to 12 healthy subjects daily for a period of four days in a double-blind trial over 11 days. The effects of sotalol on heart rate, blood pressure, EEG, subjective quality of sleep, polygraphically determined sleep pattern, and psychophysiological parameters such as psychomotor performance, memory, perception, vigilance, and general condition were studied and were related to dosage and plasma levels. Steady-state plasma levels of sotalol were reached within 24 hours after a single dose; 960 mg resulted in plasma levels three times higher than those reached with 320 mg, which indicates first-order linear absorption. The effects of sotalol on EEG, sleep, and performance in psychological tests were equivocal and do not yield evidence for CNS activity of sotalol.

Clinical profile and serum concentration of viloxazine as compared to amitriptyline

The antidepressive effect of viloxazine (300 mg/d) was investigated during three weeks in 41 patients with depressive syndromes requiring drug-treatment against amitriptyline (150 mg/d), using a controlled double-blind design. Viloxazine differs from amitriptyline by selective inhibition of norepinephrine re-uptake, whereas amitriptyline acts also on serotonin re-uptake. Psychopathological changes were documented by means of the Hamilton Depression Rating Scale, the Bf-S (v. Zerssen), the AMDP-System, and videotaped recordings. Besides routine clinical-chemical tests, the serum concentrations of viloxazine and partly of amitriptyline were determined. Repeated EEG-recordings were evaluated by spectral analysis. The number of global responders and non-responders -- defined according to the final HDRS-scores -- was equally distributed between the two drug-groups. The AMDP-evaluation suggests that viloxazin has a somewhat more marked and more rapid effect on symptoms of retardation, whereas amitriptyline acts predominantly on depressive mood, disturbances of sleep and vital feelings. The EEG-profile of both drugs was similar to the spectral changes seen under tricyclic antidepressants, through only the viloxazine-induced changes reached statistical significance on the 10th and 20th day, the variability of the EEG-recordings being greater in the amitriptyline group. The viloxazine blood levels showed a remarkably low inter- and intraindividual variance. Steady state was reached at day 5 at the latest. Amitriptyline serum concentrations still increased between the 10th and the 21st day. The average blood concentration of viloxazine was higher in the responder- than in the non-responder-group.

Clozapine induced increase of human plasma norepinephrine

Four psychotic patients and 5 controls were treated with clozapine (200--400 mg/day during 30 days, patients, respectively 100 mg/day during 7 days, controls) and plasma norepinephrine (NE) concentration was measured. In the morning, shortly after end of sleep, plasma NE concentration was significantly increased under clozapine treatment in both populations. The effects of clozapine were explained with a direct pharmacological action of the drug on NE receptors.

Effects of the synthetic analogue of methionine enkephalin FK 33-824 on psychotic symptoms

In an open pilot study, 9 schizophrenic patients were treated with the synthetic analogue of methionin-enkephalin FK 33-824 on two consecutive days in a dose of 0.5 mg on the first day, and 1.0 mg on the second day (infusion for 2 hours). 3 patients refused therapy during or after the first infusion; of the remaining 6 patients (2 hebephrenic, 4 paranoid type) 5 patients improved remarkably on the first and second day. The total BPRS-score and 4 of the 5 factors of the BPRS-scale were reduced significantly the day after treatment compared to pretreatment values. The improvement continued for 28-168 hours.

Treatment of schizophrenia

1. Progress in 25 years' history of the neuroleptics is briefly reviewed. 2. Development of certain butyrophenones more directly effective in "minus" symptoms of schizophrenia and introduction of depot neuroleptics is discussed. 3. Extrapyramidal motor side effects (EPMS) are still a serious problem in the treatment. 4. Clozapine does not have EPMS. This drug could therefore become the starting point of a series of less hazardous antipsychotic drugs. 5. The neuroleptics can be used as tools for exploration of the etiopathogenesis of schizophrenia. Some important pharmacological mechanisms, i.e. their antidopaminergic activity, are briefly outlined.

Serum dopamine-beta-hydroxylase in parkinsonism

Serum dopamine-beta-hydroxylase activities of a group of 16 parkinsonian patients under L-Dopa plus decarboxylase inhibitor showed a distribution with a drift towards higher activities compared to a group of normals of the same age range. Acute doses of L-Dopa failed to cause any change in the serum enzyme activities as well as in the serum concentration of 3-methoxy-4-hydroxyphenylethylene glycol, in parkinsonian patients and in normals. The data support the idea of a limited influence of L-Dopa on the noradrenaline synthesis and release in parkinsonism.

Baclofen (para-chlorphenyl-GABA) in schizophrenia

21 schizophrenic patients were treated in a single blind study with para-chlorphenyl-GABA (baclofen) for 20 days after a placebo period of at least 1 week. Global clinical impression identified five patients as behaviorally unchanged, seven as improved and nine as worsened during the active drug administration. Four patients had to be withdrawn from the trial because of serious and unmanageable psychotic exacerbations. Overall incidence of psychotic symptoms in the group of the schizophrenic patients did not change substantially neither did the remission coefficient as calculated from the AMP documentation system. No differential effect was detected either on selected Schneiderian first rank symptoms or on symptoms more characteristic for chronic defectuous schizophrenia. It is concluded that baclofen is not a useful drug in the therapy of schizophrenia.