[Evaluation of clinical usefulness of decaldol (haloperidol decanoate) produced by WZF Polfa in Warsaw in long-term treatment of schizophrenia]

In the study the usefulness was assessed of haloperidol depot preparation in 50 mg ampoules produced by Warsaw Pharmaceutical Works POLFA in the treatment of schizophrenia. The study group comprised 30 patients, 12 females and 18 males, aged 18-70 years. Before haloperidol administration all other drugs were withdrawn. Haloperidol depot was injected intramuscularly after 7-10 days of oral administration of haloperidol. The injections were done at 3-week intervals during 26 weeks. The mean interval between the injections was 17.8 days, and the mean dose was 77.0 mg. The effectiveness of the drug was assessed using Overall scale (BPRS) measuring the intensity of 18 psychotic symptoms in the following weeks of the trial: 0, 1, 2, 3, 4, 7, 10, 13, 17, 20, 23 and 26. The depot haloperidol preparation (Decaldol) was studied assessing its effects on productive and defect symptoms and depression. The strongest effect was exerted on productive symptoms, less pronounced effect was on psychotic defects, and lowest on depression symptoms. Improvement of the psychosis was noted in 20 cases, deterioration in 8 and no change was observed in two patients. The present trial period was not completed by 19 patients, 6 due to psychotic deterioration, 5 patients had intense extrapyramidal adverse effects and in 2 cases worsening of mental condition was associated with adverse effects. In this subgroup of 19 patients 9 were improved, 8 were worse, and 2 had no change in relation to initial status. In the remaining 11 cases who completed the study only full of considerable improvement was found.

Pharmacological interventions for agitation in head-injured patients in the acute care setting

Agitation following head injury challenges nurses to provide patient safety and participation in daily care and therapies. Diagnosis of the underlying disorder which causes agitative behavior is essential for rapid and successful treatment. A combination of pharmacological and nonpharmacological interventions are required to achieve this expected outcome. Propofol, lorazepam, midazolam and haloperidol are medications most commonly utilized in this patient care situation. The patient's sedation level should be monitored to avoid oversedation which may interfere with respiration and neurological status. Nurses need to understand the actions and adverse effects of these agents in order to advocate their proper usage in the agitated head-injured population.

Persistent catalepsy associated with severe dyskinesias in rats treated with chronic injections of haloperidol decanoate

Patients who develop persistent parkinsonism while on chronic neuroleptic therapy may be predisposed towards the development of tardive dyskinesia (TD). We investigated this issue in an animal model of TD by examining the association between catalepsy and the syndrome of neuroleptic-induced vacuous chewing movements (VCMs). VCMs were measured every 3 weeks for 33 weeks while rats received injections of haloperidol decanoate. Catalepsy was measured after the second through the seventh injections of the depot neuroleptic. There were no correlations between the severity of catalepsy scores after the second or third injections of haloperidol and the severity of the overall VCM syndrome. However, the severity of the catalepsy score following the third through seventh injections of haloperidol strongly correlated with the concurrent number of VCMs. Persistent high catalepsy scores across the six catalepsy rating sessions were strongly associated with the development of persistent severe VCMs. These findings suggest that, to the extent that persistent parkinsonian signs in humans are associated with a propensity towards the development of TD, the VCM syndrome in rats is at least a partially faithful animal model of this relationship.

Remoxipride versus haloperidol in healthy volunteers: psychometric performance and subjective tolerance profiles

The aim of the present study was to evaluate the psychometric effects of equivalent clinical doses of remoxipride and haloperidol in comparison with placebo in healthy volunteers. In a double-blind design, either 3 mg haloperidol, 150 mg remoxipride, or placebo were administered to 36 healthy male volunteers ranging in age from 19 to 39 years. Performance was assessed using time estimation, critical flicker fusion, and choice reaction time tasks. In addition, self-ratings on subjective well-being were obtained. In healthy subjects, an acute dose of 3 mg haloperidol caused more severe alteration in cognitive functioning, cortical arousal, and psychomotor performance than a clinically equipotent dose of 150 mg remoxipride. Also, self-rating scales showed that subjective tolerance of remoxipride was partly superior to haloperidol. In general, the results of this study strongly suggest a difference between the psychometric profiles of remoxipride and haloperidol. This difference may be essential for maintaining a high level of compliance, especially in the long-term treatment of psychotic patients.

Effectiveness of zuclopenthixol compared with haloperidol in the treatment of behavioural disturbances in learning disabled patients

BACKGROUND

We compared the efficacy of two neuroleptics with different receptor profiles (zuclopenthixol and haloperidol) in learning disabled patients with behavioural disturbance.

METHOD

A double-blind crossover study (2 x 8 weeks; n = 34), interrupted by a two-week single-blind washout period, was employed. Assessments included the Schedule for Handicaps, Behaviour, and Skills (SHBS) and Clinical Global Impression (CGI).

RESULTS

The SHBS score was significantly reduced for the zuclopenthixol cohort only. End-point analysis between the two drugs also showed an enhanced effect for zuclopenthixol over haloperidol. CGI scores did not reveal significant differences between the two drugs.

CONCLUSION

Zuclopenthixol may be superior to haloperidol for the treatment of behavioural disturbances in mentally retarded subjects.

Extrapyramidal side effects of clozapine and haloperidol

Neuroleptic-induced extrapyramidal side effects (EPS) were evaluated in 92 patients treated with clozapine for the first time and 59 patients treated with haloperidol followed in a drug monitoring program. Side effects were measured by the Columbia University Rating Scale, the Simpson Dyskinesia Scale and the Hillside Akathisia Scale. The cumulative incidence rate for tremor was found to be 24.4% in the clozapine group and 39.3% in the haloperidol group. This did not amount to a statistically significant group difference. Bradykinesia was observed in 21.8% of the patients treated with clozapine and in 47.7% of the patients of haloperidol (P = 0.011). In the clozapine group the akathisia incidence rate was 5.6%, whereas haloperidol patients showed a higher rate of 31.7% (P = 0.005). Our results show higher incidence rates of tremor and bradykinesia during clozapine treatment than previous studies. We conclude that clozapine is not entirely free of EPS, but they are usually less severe and of a different quality than side effects induced by typical antipsychotics.

Development of tolerance and reverse tolerance to haloperidol- and SCH23390-induced cataleptic effects during withdrawal periods after long-term treatment

The development of tolerance and reverse tolerance and reverse tolerance to the cataleptic effects of selective D1 antagonist, SCH23390, and the mainly D2 antagonist, haloperidol, was investigated in mice that had been chronically treated (7 or 30 days) with haloperidol (1 mg/kg SC), SCH23390 (0.5 mg/kg SC), or saline (5 ml/kg SC). In control animals, SCH23390 (0.1-1.0 mg/kg IP) and haloperidol (0.1-1.0 mg/kg IP) produced cataleptic responses in a dose-dependent manner, although the responses had different time course profiles. SCH23390 catalepsy had a rapid onset but a short duration, whereas haloperidol catalepsy had a slower onset and longer duration. This could be due to differences in lipid solubility of the drugs, or at least pertly to an action of the drugs on different neuronal pathways. The cataleptic effects of SCH23390 (0.3 mg/kg IP) and haloperidol (0.3 mg/kg IP) were significantly reduced in mice when given 24 h, but not 72 h, after the last dose of a 7 day-pretreatment course (short-term treatment) of SCH23390. However, after long-term treatment (30 days) with SCH23390, a challenge dose of SCH23390 exhibited reverse tolerance (i.e., increased catalepsy) when given 7-21 days, but not 1-3 days, after the last injection of the SCH23390 pretreatment course. In contrast, haloperidol catalepsy was not affected by long-term SCH23390 treatment. However, after the last dose of long-term haloperidol treatment both SCH23390 and haloperidol exhibited tolerance to their cataleptic effects at 1-3 days, a normal response at 7 days, and an exaggerated response (reverse tolerance) at 15-21 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Diurnal variation in tardive dyskinesia

Tardive dyskinesia (TD) is a common movement disorder that is associated with chronic neuroleptic exposure. To better characterize the clinical aspects of TD, we investigated the diurnal pattern of involuntary movements by blindly rating videotaped examinations of patients from the morning shortly after awakening and later in the same afternoon. In 10 patients, average TD ratings were worse in the afternoon than in the morning, especially in the case of limb-trunk dyskinesias. These findings suggest that it is important to rate patients at the same time of day in TD studies. Moreover, patients should be evaluated at least several hours after awakening.

Nicotine intake in smokers increases following a single dose of haloperidol

The effects of oral haloperidol on nicotine intake, subjective measures of craving and smoking satisfaction were compared with placebo in light-to-moderate smokers from a post-prandial cigarette and during the subsequent hour of unrestricted smoking. Subjects smoked significantly more, as measured by blood nicotine levels, when they had received haloperidol, although there was no difference between haloperidol and placebo on any subjective measures. These findings may be interpreted to reflect a compensatory increase in smoking in order to obtain the usual nicotine reward. Having achieved usual levels of reward, subjects did not experience a decrease in subjective measures of smoking satisfaction or an increase in nicotine craving.

A path-analytical approach to differentiate between direct and indirect drug effects on negative symptoms in schizophrenic patients. A re-evaluation of the North American risperidone study

The hypothesis that differences in drug effects of risperidone and haloperidol on negative symptoms in schizophrenia are secondary to effects on positive, extrapyramidal, and depressive symptoms was investigated by means of an analysis of the data from the USA-Canada risperidone double-blind randomized clinical trial of 523 chronic schizophrenic patients. Regression analyses in the total sample and within treatment groups confirmed a strong relationship between changes in negative symptoms and the other variables studied (R2 = 0.50-0.51, p < 0.001). Only depressive symptoms did not contribute significantly to these results (p > 0.10). Path analysis showed that the greater mean change (p < 0.05) of negative symptoms with risperidone compared to haloperidol could not be fully explained by correlations with favourable effects on positive and extrapyramidal symptoms. The relationship between shift in extrapyramidal symptoms and shift in negative symptoms failed to reach statistical significance; however, there was a clear tendency in the expected direction in both treatment groups.

Effects of chronic naloxone administration on vacuous chewing movements and catalepsy in rats treated with long-term haloperidol decanoate

Most antipsychotic medications produce motoric side effects, including parkinsonism and tardive dyskinesia (TD). Correlates of these behaviors in rats (catalepsy and vacuous chewing movements, respectively) were used as a model to assess the usefulness of chronic naloxone administration in symptom reduction. Previous studies have suggested that increased neurotransmission in the endogenous opioid system modulates neuroleptic-induced motoric side effects. Rats were treated with haloperidol decanoate or vehicle for 27 weeks, and withdrawn for 30 weeks. Subsequently, naloxone (0.5 to 2.0 mg/kg SC twice daily) was given for 5 weeks. Long-term haloperidol treatment produced a syndrome of vacuous chewing movements (VCMs) that persisted during the drug withdrawal period. Catalepsy developed rapidly and also persisted. Naloxone treatment had little effect on VCMs but increased catalepsy scores in both haloperidol and vehicle treated groups. Naloxone reduced rearing and grooming in haloperidol rats while increasing these measures in vehicle treated rats. The results indicate that neuroleptic-induced motoric side effects are not reversed by naloxone in rats. Furthermore, they suggest that increased opioid neurotransmission may not underlie the expression of VCMs. This does not rule out the possibility that endogenous opioid system may be involved in the development of VCMs. To the extent that this animal model is valid, naloxone may not be effective in treating TD and neuroleptic-induced parkinsonism in humans.

Suspension therapy in acute schizophrenia. Clinical and neuroendocrine/biochemical effects of abrupt discontinuation of neuroleptic medication

22 acutely schizophrenic patients with partial remission under standard haloperidol therapy (reduction in BPRS total score by 50% or less) were included in this prospective study. There was a significant correlation between the BPRS total score or the BPRS factors Anxiety/depression and Anergia and extrapyramidal side effects at the end of the 3-week neuroleptic treatment phase. In these patients abrupt discontinuation of neuroleptic medication (suspension therapy) brings about a significant further reduction in BPRS total scores together with a favorable effect on the BPRS factors Anxiety/depression, Anergia and Thought disturbance. There was a trend towards low serum prolactin values before neuroleptic discontinuation being linked with a favorable effect of subsequent suspension therapy. Urinary dopamine and homovanillic acid excretion before neuroleptic discontinuation did not predict the clinical suspension effect. Thus peripheral neuroendocrine and biochemical effects of haloperidol-induced dopamine blockade and their changes after discontinuation of neuroleptic medication seem not to be linked with the clinical effect of suspension therapy in acute schizophrenia. There was, however, a significant relationship between low urinary epinephrine, norepinephrine, vanillylmandelic acid and cortisol excretion before suspension therapy and a favorable suspension effect. On the other hand, the more pronounced a nonspecific stress constellation (catecholamines, cortisol) was in patients with an unsatisfactory remission under neuroleptics, the less favorable was the clinical effect of suspension therapy. Until now, the treatment courses of suspension therapy have been evaluated in 43 schizophrenic patients. According to both clinical aspects and observer rating, three types of therapeutic suspension effects have been distinguished in one-third of the cases respectively; none (at best temporary remission, no improvement in the overall treatment situation); partial (substantial remission, neuroleptic medication resumed for therapeutic reasons), and favorable (almost complete remission, neuroleptic medication resumed for prophylactic reasons).

Prolactin and TSH responses to TRH and to haloperidol in schizophrenic patients before and after treatment

The prolactin (PRL) and the TSH responses to thyrotropin releasing hormone (TRH, 0.4 mg i.v.) and to haloperidol (5 mg i.m.) were studied in 11 male schizophrenic patients in a drug-free state and after treatment with haloperidol, 60 mg daily. The PRL responses observed after i.m. haloperidol in the drug-free state, on average 35.4 ng/ml, were abolished after treatment, indicating complete receptor blockade, while the PRL responses to TRH were preserved, although moderately reduced (from 19.4 to 14.8 ng/ml on average). The TSH responses to TRH were unaltered by the treatment (means 8.25 and 7.74 mIU/l). The results show that the TSH and partially the PRL releasing actions of TRH are not mediated via receptors that are effectively blocked by haloperidol.

Predictors of acute dystonia in first-episode psychotic patients

Sixty-two first-episode psychotic patients who were neuroleptic-naive were studied to examine predictors of acute dystonia after treatment with haloperidol. Twenty-three patients developed dystonia, two of them despite being treated with biperiden. Biperiden significantly prevented dystonic reactions. Dystonia development was significantly related to younger age, severity of illness, and negative symptoms at baseline and showed a trend to be related to positive symptoms as well. No significant effect of gender or diagnosis was found. The authors suggest that young, severely ill patients in their first psychotic episode who have never been treated with neuroleptics might be at higher risk to develop dystonia.

A double-blind controlled study of intramuscular zuclopenthixol acetate and liquid oral haloperidol in the treatment of schizophrenic patients with acute exacerbation

We carried out a 9-day double-blind clinical trial comparing intramuscular zuclopenthixol acetate with liquid oral haloperidol in the treatment of 40 newly admitted schizophrenic patients with acute exacerbation. A parallel-group design was used with stratification by sex. Zuclopenthixol acetate (50 to 150 mg) was given intramuscularly every 3 days, whereas liquid haloperidol (10 to 30 mg daily) was given orally three times a day, with supplementary doses of each medication given under double-blind conditions when needed for agitation. No other sedative drugs, including benzodiazepines, were administered. The mean daily dose was 18.9 mg for haloperidol as compared with a mean dose per 3 days of 117.6 mg for zuclopenthixol. The two treatments were found to be equally efficacious on the Brief Psychiatric Rating Scale and Clinical Global Impression Scale. Both drugs induced similar extrapyramidal side effects. However, more tremors were associated with zuclopenthixol as was a tendency for tardive dyskinesia to be unmasked at the end of the injection interval. Sedation was higher with zuclopenthixol acetate than with haloperidol. Serum creatinine phosphokinase levels were not significantly increased after zuclopenthixol injections. The results of this trial suggest that zuclopenthixol acetate given intramuscularly every second to third day offers an alternative to conventional liquid oral haloperidol in the management of acute schizophrenia.

Persistent neuroleptic-induced rigidity and dystonia in AIDS dementia complex: a clinico-pathological case report

Patients with AIDS dementia complex (ADC) appear to have an increased likelihood of developing acute onset parkinsonism and dystonia when treated with dopamine antagonists. It has been hypothesized, based on clinical evidence, that hypersensitivity to these drugs in ADC is probably related to direct invasion of the basal ganglia by the HIV virus and a secondary alteration in dopaminergic mechanisms. We report the first pathological description of a patient with ADC who developed acute onset, generalized rigidity and dystonia after a brief trial of low dose neuroleptic therapy administered for psychotic symptoms. An unusual clinical feature of this case was the persistence of his movement disorder. Pathological examination revealed a generalized encephalitic process with substantial neuronal loss observed primarily in the medial and lateral globus pallidus. Correlation with a current model of basal ganglia pathophysiology and other disorders with pallidal lesions is discussed. Clinical and pathological features of this case confirm the previous contention and indicate that dopamine antagonists should be utilized with extreme caution in patients with ADC.