Intramuscular long-acting fluphenazine in the treatment of schizophrenia

Do specific neurocognitive deficits predict specific domains of community function in schizophrenia?

We examined whether specific neurocognitive deficits predicted specific domains of community outcome in 40 schizophrenic patients. Neuropsychological assessments were conducted before hospital discharge, and measures of functional outcome were obtained 1 to 3.5 years later. A priori hypotheses were generated based upon a recent review by Green (Green MF [1996] What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry, 153(3):321-330). As hypothesized, verbal memory predicted all measures of community outcome, vigilance predicted social outcomes, and executive functioning predicted work and activities of daily living (ADLs). However, in addition to the predicted relationships, many other associations were found between neuropsychological test scores and adaptive function. Furthermore, both cognitive and functional measures were intercorrelated. If deficits in adaptive functioning are neurocognitively multi-determined, utilizing compensatory strategies to bypass multiple areas of cognitive impairment may be more efficient than cognitive remediation in improving community outcomes.

High doses of fluphenazine enanthate in schizophrenia. A controlled study

The results from this controlled study of 12 schizophrenics refractory to ordinary doses of neuroleptics indicate that treatment with fluphenazine enanthate in higher doses than normal (10--20 times higher) might give reduction in psychopathology beyond what can be obtained with normal doses. In four patients the symptom reduction on high doses was pronounced. Moreover, we found that the high fluphenazine plasma levels demonstrated did not increase extrapyramidal and general side effects. The results presented also speak in favour of certain "non-responding" patients needing a higher plasma level of a neuroleptic drug than the average patient.

Three years' maintenance neuroleptic treatment in schizophrenia--before and beyond

A group of patients with schizophrenia, initially 67 patients, was studied over a period of 3 years. After three years 36 out of 67 patients were still on the same depot neuroleptic. The main aim was to describe and compare maintenance neuroleptic therapy using two depot neuroleptics, fluphenazine decanoate and pipotiazine palmitate, given monthly. Before the outpatient care the patients had participated in the department's comprehensive hospital treatment including depot neuroleptic medication. After a 1-year clinical trial with frequent assessments of the patients, significant symptom reductions were found on all rating scales. During the last 2 years of the study only drug therapy was given. Improvement concerning social function in the community and work level as well as the low-rated psychopathology noted at the start of study also persisted at the 3-year follow-up. The side effects were low in frequency and quality. These results show the clinical value of long-term maintenance treatment with depot neuroleptics. The results also confirm that the favourable effects of the hospital treatment demonstrated before the start of the clinical trial could be maintained. The possibilities of further improving aftercare and outpatient treatment beyond medication alone are discussed.

The side-effects of fluphenazine decanoate

The unwanted effects of the phenothiazines can be divided into two categories; those effects which represent the pharmacodynamic actions of a particular drug and occur as a function of dosage and individual susceptibility; and the hyper-sensitivity reactions (Shepherd et al., 1968). This latter group of side-effects is relatively rare, and there is no suggestion in the literature that they occur more frequently with the injectable long-acting phenothiazines (LAP) than with the oral forms. With the first available long-acting phenothiazine (fluphenazine enanthate) motor side-effects were frequently observed, particularly during the first few days after injection (Millar and Daniel, 1967; Lowther, 1969; Malm, 1970). Initial studies have suggested that fluphenazine decanoate is less likely to produce these unwanted extrapyramidal effects (Neal and Imlah, 1968; Ayd, 1970). So far, however, no study has attempted to make a quantitative evaluation of the problem of side-effects in the clinical situation of longterm medication. Since both the therapeutic efficacy and the unwanted extra-pyramidal side-effects are dose-dependent, it is meaningless to measure the incidence of side-effects without also recording the therapeutic gain: a low incidence of side-effects might only reflect a non-therapeutic dose of medication. Further, any such study should be continued for at least two months after the last reduction in dosage, as it is well recognized that loss of clinical control may be postponed for many weeks after phenothiazines have been discontinued.