MEDLINE Citations on the Treatment of Schizo-affective Disorder

Search by, Ivan Goldberg, M.D.

World J Biol Psychiatry  2002 Jul;3(3):156-61 

Double-blind antiglucocorticoid treatment in schizophrenia and schizoaffective
disorder: a pilot study.

Marco EJ, Wolkowitz OM, Vinogradov S, Poole JH, Lichtmacher J, Reus VI.

University of California, Langley Porter Psychiatric Institute, San Francisco,
USA.

BACKGROUND: Antiglucocorticoids, such as ketoconazole, have been investigated as
antidepressant agents in major depression and other conditions. Despite evidence
that a significant number of patients with schizophrenia and schizoaffective
disorder are both hypercortisolemic and depressed, the antidepressant effects of
antiglucocorticoids have never been assessed in these populations. METHODS:
Fifteen symptomatic patients with diagnoses of schizophrenia or schizoaffective
disorder, who were at least partially treatment-resistant, were treated with
ketoconazole, up to 800 mg/day, (n = 8) or placebo (n = 7) for four weeks in a
double-blind manner. The study medication was added to a pre-stabilized
antipsychotic and/or antidepressant medication regimen. RESULTS: Ketoconazole
treatment, compared to placebo, was associated with significant improvements in
observer-rated depression, but not in subjectively rated depression, positive or
negative psychotic symptom ratings, or cognitive performance scores.
CONCLUSIONS: These pilot data partially support the hypothesis that
antiglucocorticoids reduce depressive symptoms in patients with schizophrenia
and schizoaffective disorder, although objective and subjective ratings may not
be similarly affected during a four-week course of treatment. Further studies
with larger sample sizes, more extensive endocrine assessments and longer
duration of drug administration seem warranted.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 12478881 [PubMed - indexed for MEDLINE]



Eur Arch Psychiatry Clin Neurosci  2002 Oct;252(5):226-31 

The impact of duration of untreated psychosis and premorbid functioning on
outcome of first inpatient treatment in schizophrenic and schizoaffective
patients.

Bottlender R, Sato T, Jager M, Groll C, Strauss A, Moller HJ.

Department of Psychiatry, Ludwig Maximilians University, Nussbaumstr. 7, 80336
Munich, Germany. bottlend@psy.med.uni-muenchen.de

OBJECTIVE: The aim of the study was to investigate the association between the
duration of untreated psychosis, premorbid functioning and outcome from first
inpatient treatment in schizophrenic or schizoaffective patients. 

METHOD: The data of 196 first-hospitalized patients with a schizophrenic or 
schizoaffective disorder according to the ICD-10 criteria were analyzed using 
univariate and multivariate methods. Patients' characteristics were prospectively 
assessed using standardized instruments at the time of first admission and discharge.

RESULTS: The analyses revealed that a duration of untreated psychosis longer
than 12 months was independently and significantly associated with a poorer
outcome from first inpatient treatment. Premorbid functioning might have an
additional influence on outcome, but this influence seems to be dependent on the
diagnostic category. 

CONCLUSIONS: The findings suggest that the duration of untreated psychosis is an 
independent prognostic factor for the outcome in schizophrenic and schizoaffective 
disorders.

PMID: 12451464 [PubMed - in process]



Zh Nevrol Psikhiatr Im S S Korsakova  2002;102(10):52-7 

[Verapamil retard as a medication for the prevention of affective and
schizoaffective psychosis relapses]

[Article in Russian]

Raiushkin VA.

Twelve patients with affective and schisoaffective psychosis according to ICD-10
criteria were examined. In the earlier study, the patients displayed a
resistance to verapamil of short duration action. After 4-year treatment,
verapamil has been substituted for its retard dosage form--isoptin retard.
Regarding antirelapse action, i.e., reduction of affective phases number and
duration, increase of remissions and individual tolerability, isoptin retard
proved to be superior. Retard form of verapamil is more convenient for usage.
Recommendations for its use as a drug of choice for overcoming resistance to
verapamil of short duration action are substantiated.

PMID: 12449566 [PubMed - indexed for MEDLINE]



Ned Tijdschr Geneeskd  2002 Oct 12;146(41):1942-4 

[Deterioration of schizoaffective disorder due to an interaction between
haloperidol and carbamazepine]

[Article in Dutch]

Cohen D, Diemont WL.

Rijngeest Groep, Langevelderweg 27, 2211 AB Noordwijkerhout.
dcohen@rijngeestgroep.nl

A 40-year-old woman with a schizoaffective disorder was initially treated with
lithium carbonate and haloperidol decanoate, but after three years the lithium
was replaced with carbamazepine. Following this, her performance deteriorated
over several years despite increasing dosages of haloperidol. After withdrawal
of the carbamazepine a remarkable recovery occurred. A pharmacokinetic
interaction between haloperidol and carbamazepine, which results in decreased
haloperidol blood levels, provides a good explanation of this clinical picture.
This clinically relevant interaction should be incorporated into
pharmacovigilance systems.

PMID: 12404911 [PubMed - indexed for MEDLINE]



J Clin Psychiatry  2002 Sep;63(9):763-71 

Efficacy and safety of aripiprazole and haloperidol versus placebo in patients
with schizophrenia and schizoaffective disorder.

Kane JM, Carson WH, Saha AR, McQuade RD, Ingenito GG, Zimbroff DL, Ali MW.

Zucker Hillside Hospital, Glen Oaks, NY, USA.

BACKGROUND: Aripiprazole is an investigational agent for treating schizophrenia
that has a novel pharmacologic profile. The present study investigated the
efficacy, safety, and tolerability of aripiprazole and haloperidol compared with
placebo. 

METHOD: A 4-week, double-blind, randomized study, conducted at 36 U.S.
centers between July 1997 and June 1998, compared aripiprazole (15 mg/day, 30
mg/day) to placebo, with haloperidol (10 mg/day) as an active control. Fixed
doses of each agent were administered from day 1 throughout the study. A total
of 414 patients with a primary DSM-IV diagnosis of schizophrenia or
schizoaffective disorder were randomized. Efficacy measures included the
Positive and Negative Syndrome Scale (PANSS) total, PANSS positive, PANSS
negative, PANSS-derived Brief Psychiatric Rating Scale (BPRS) core, Clinical
Global Impressions (CGI)-Severity of Illness, and mean CGI-Improvement scores.
Safety and tolerability evaluations included extrapyramidal symptoms (EPS),
weight gain, serum prolactin level, and QTc interval. 

RESULTS: Both doses of
aripiprazole and haloperidol, 10 mg, produced statistically significant (p < or
= .05) improvements from baseline in PANSS total, PANSS positive, PANSS-derived
BPRS core, and CGI-Severity scores and significantly lower CGI-Improvement
scores at endpoint, compared with placebo. Aripiprazole, 15 mg, and haloperidol,
10 mg, significantly improved PANSS negative score compared with placebo. Both
aripiprazole doses and haloperidol separated from placebo for PANSS total scores
at week 2. Unlike haloperidol, aripiprazole was not associated with significant
EPS or prolactin elevation at endpoint compared with placebo. There were no
statistically significant differences in mean changes in body weight across the
treatment groups versus placebo, and no patients receiving aripiprazole
experienced clinically significant increases in QTc interval. 

CONCLUSION: Aripiprazole, effective against positive and negative symptoms, is a 
safe and well-tolerated potential treatment for schizophrenia and schizoaffective
disorder.

Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 12363115 [PubMed - indexed for MEDLINE]



Schizophr Res  2002 Oct 1;57(2-3):209-19 

Predictors of medication discontinuation by patients with first-episode
schizophrenia and schizoaffective disorder.

Robinson DG, Woerner MG, Alvir JM, Bilder RM, Hinrichsen GA, Lieberman JA.

Department of Psychiatry Research, Hillside Hospital, North Shore-Long Island
Jewish Health System, Glen Oaks, New York 11004, USA. robinson@lij.edu

BACKGROUND: Enhancing medication adherence early in the course of schizophrenia
and schizoaffective disorder may substantially improve long-term course.
Although extensively studied in multi-episode patients, little data exist on
medication adherence by first-episode patients. METHOD: Medication adherence was
assessed during the first year of treatment and following recovery from the
first relapse in patients treated by a standardized medication algorithm.
RESULTS: During the first year of treatment, patients with poorer premorbid
cognitive functioning were more likely to stop antipsychotics (t=-2.54, df=75,
p=0.01). Parkinsonian side effects increased the likelihood (hazard ratio=41.22;
95% CI=2.30, 737.89; p=0.01), and better executive function decreased the
likelihood (hazard ratio=0.40; 95% CI=0.18, 0.88; p=0.02) that patients
discontinued maintenance medication after a first relapse. CONCLUSION:
Interventions to ameliorate cognitive deficits and Parkinsonian side effects may
enhance treatment adherence.

PMID: 12223252 [PubMed - indexed for MEDLINE]



J Clin Psychopharmacol  2002 Aug;22(4):347-52 

Therapeutic tolerance and rebound psychosis during quetiapine maintenance
monotherapy in patients with schizophrenia and schizoaffective disorder.

Margolese HC, Chouinard G, Beauclair L, Belanger MC.

Clinical Psychopharmacology Unit, Allan Memorial Institute, McGill University
Health Centre, Montreal, Quebec, Canada. meggem@po-box.mcgill.ca

A 3-year open-label study was conducted to determine the long-term safety and
efficacy of quetiapine monotherapy in schizophrenia and schizoaffective
disorder.Twenty-three male outpatients previously stable but with inter-episode
residual symptoms on classical antipsychotics and/or risperidone and who had
complained of side effects were selected. To initiate quetiapine, patients were
hospitalized for 13 days and then treated as outpatients. Quetiapine dosage was
adjusted according to therapeutic effects.Only five patients (21.7%) completed
77 to 96 weeks of the study. Initial dose was 261 +/- 65.6 mg/day (mean +/-
S.D.) administered in divided doses, with an ending dose of 487 +/- 209.6
mg/day, corresponding with an 86.6% dose increase over the course of the study.
For those completing 12 weeks or less (n = 11), mean ending dose was 362 +/-
184.8 mg/day a 38.7% dose increase over baseline. For those completing 25 weeks
or more (n = 12), mean ending dose was 592 +/- 178.2 mg/day, a 126.8% dose
increase over baseline. Six of the seven patients who relapsed after being
stabilized on quetiapine for at least three months met criteria for
supersensitivity psychosis (SSP).Therapeutic tolerance and rebound psychosis
were found to develop with quetiapine in male patients with a history of chronic
treatment with classical antipsychotics. Seeman and Tallerico3 have proposed
pharmacologic explanations for quetiapine and clozapine drug-induced rebound
phenomena.

Publication Types:
Clinical Trial

PMID: 12172332 [PubMed - indexed for MEDLINE]



CNS Drugs  2002;16(9):645-52 

Spotlight on ziprasidone in schizophrenia and schizoaffective disorder.

Gunasekara NS, Spencer CM, Keating GM.

Adis International Limited, Auckland, New Zealand.

Ziprasidone is a novel antipsychotic agent with a pharmacological profile
distinct from that of other currently available novel or classical
antipsychotics. In preclinical studies, ziprasidone was predicted to have
efficacy against positive, negative and affective symptoms of schizophrenia with
a favourable tolerability profile, including a low propensity to induce
extrapyramidal adverse effects. The drug has been administered orally to >300
patients with an acute exacerbation of schizophrenia or schizoaffective disorder
in published 4- to 6-week randomised, double-blind trials. When given twice
daily at dosages of between 80 and 160 mg/day, ziprasidone produced
significantly greater improvements in overall symptomatology than placebo. In
the largest study, ziprasidone 80 or 160 mg/day was also significantly more
effective than placebo in reducing negative symptoms and, at 160 mg/day, was
significantly more effective than placebo in improving depressive symptoms in
patients with associated clinically significant depression. Data from a 4-week
trial indicate that ziprasidone 160 mg/day has similar efficacy to haloperidol
15 mg/day. Ziprasidone 40 to 160 mg/day was more effective than placebo with
respect to prevention of impending relapse and improvement of negative symptoms
in 294 stable patients with chronic schizophrenia who were treated for up to 1
year. In addition, significantly more ziprasidone than haloperidol recipients
achieved a negative symptom response in a 28-week study involving 301 stable
patients with chronic or subchronic schizophrenia. In general, oral ziprasidone
is well tolerated with an overall incidence of adverse events similar to
placebo. Importantly, the drug has a low propensity to induce extrapyramidal
effects and a negligible effect on bodyweight. Ziprasidone is associated with
slight prolongation of the QTc interval; the clinical significance of this is
not yet clear. The drug does not appear to be associated with sustained
elevation of plasma prolactin levels. Preliminary data indicate that long-term
oral ziprasidone treatment is well tolerated. Ziprasidone is the only novel
antipsychotic currently available in a rapid-acting intramuscular formulation.
Short-term treatment with intramuscular ziprasidone was effective and well
tolerated in patients with acute agitation associated with psychosis. In
addition, intramuscular ziprasidone reduced agitation scores by a significantly
greater extent than haloperidol in a study involving patients with acute
agitation associated with psychosis. CONCLUSIONS: Ziprasidone is a promising new
antipsychotic that has shown significant efficacy in the oral treatment of
patients with schizophrenia or schizoaffective disorder. The drug is well
tolerated with a low propensity to induce extrapyramidal effects and a
negligible effect on bodyweight. In addition, intramuscular ziprasidone shows
efficacy and good tolerability in the treatment of acute agitation associated
with psychotic disorders.

Publication Types:
Review
Review, Tutorial

PMID: 12153335 [PubMed - indexed for MEDLINE]



Psychiatry Res  2002 Aug 5;111(1):11-20 

Antipsychotic medication, prolactin elevation, and ovarian function in women
with schizophrenia and schizoaffective disorder.

Canuso CM, Goldstein JM, Wojcik J, Dawson R, Brandman D, Klibanski A,
Schildkraut JJ, Green AI.

Commonwealth Research Center, Boston, MA 02115, USA.
Carla_Canuso@hms.harvard.edu

Some, but not all, antipsychotics elevate serum prolactin. Antipsychotic-induced
hyperprolactinemia is thought to account for high rates of menstrual dysfunction
and diminished estrogen levels in women with schizophrenia. However, few studies
have directly assessed the relationships between prolactin, menstrual function,
and ovarian hormone levels in this population. Sixteen premenopausal women with
schizophrenia and schizoaffective disorder, eight treated with an antipsychotic
with prolactin-elevating potential (five with typical antipsychotics and three
with risperidone) and eight treated with an antipsychotic with prolactin-sparing
potential (seven with olanzapine and one with clozapine), were studied for eight
weeks. Data were collected on menstrual functioning and on serum prolactin,
estradiol, and progesterone levels, and were compared between subjects who
received an antipsychotic with prolactin-elevating potential and an
antipsychotic with prolactin-sparing potential, and between subjects with
hyperprolactinemia (N=6) and normoprolactinemia (N=10). Additionally, peak
ovarian hormone levels were compared to normal values. While mean prolactin
levels of subjects who received an antipsychotic with prolactin-elevating
potential were significantly greater than those of subjects who received an
antipsychotic with prolactin-sparing potential, there were no differences in
rates of menstrual dysfunction or in ovarian hormone values between the two
groups. Additionally, similar rates of menstrual dysfunction and ovarian hormone
values were observed between the hyperprolactinemic and normoprolactinemic
subjects. Moreover, irrespective of medication type or prolactin status, most
subjects had peak estradiol levels below normal reference values for the
periovulatory phase of the menstrual cycle. While our sample size is small,
warranting the need for further investigation, the findings of this preliminary
study suggest that antipsychotic-induced hyperprolactinemia, alone, may not
adequately explain the observed ovarian dysfunction in women with schizophrenia.

PMID: 12140115 [PubMed - indexed for MEDLINE]



Cochrane Database Syst Rev  2002;(3):CD001258 

Update of:
 Cochrane Database Syst Rev. 2000;(2):CD001258.

Carbamazepine for schizophrenia and schizoaffective psychoses.

Leucht S, McGrath J, White P, Kissling W.

Psychiatrische Klinik und Poliklinik der Technischen Universitat Munchen
Klinikum rechts der Isar, Ismaningerstr. 22, Munchen, Germany, D-81675.
stefan.leucht@lrz.tu-muenchen.de

BACKGROUND: Many people with schizophrenia do not achieve a satisfactory
treatment response with ordinary antipsychotic drug treatment and various
additional medications are used to promote additional response. The
antiepileptic carbamazepine is one such drug. 

OBJECTIVES: To review the effects
of carbamazepine and its derivatives for the treatment of schizophrenia and
schizoaffective psychoses. 

SEARCH STRATEGY: We searched Biological Abstracts
(1980-2001), The Cochrane Library (Issue 3, 2001), The Cochrane Schizophrenia
Group's Register of Trials (December 2001), EMBASE (1980-2001), MEDLINE
(1966-2001), PsycLIT (1886-2001) and PSYNDEX (1974-2001). Citations from
included trials were also inspected and relevant companies and authors contacted
for additional data. 

SELECTION CRITERIA: All randomised controlled trials
comparing carbamazepine or compounds of the carbamazepine family to placebo or
no intervention, whether as sole treatment or as an adjunct to antipsychotic
medication for the treatment of schizophrenia and/or schizoaffective psychoses.
DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were
independently inspected by reviewers, papers ordered, re-inspected and quality
assessed. Data were extracted independently by at least two reviewers.
Dichotomous data were analysed using Peto odds ratio (OR) and the 95% confidence
interval (CI) estimated. Where possible the number needed to treat (NNT) or
number needed to harm statistics were calculated. 

MAIN RESULTS: Ten studies with
a total of 258 participants were included. One study comparing carbamazepine
with placebo as the sole treatment for schizophrenia (n=31) was stopped early
due to high relapse rate. No effect of carbamazepine was evident (OR relapse 1.5
CI 0.2 to 9.7). Another study (n=38) compared carbamazepine with antipsychotics
as the sole treatment for schizophrenia. No differences in terms of mental state
were found (OR 50% BPRS reduction 1.9 CI 0.5 to 7.2). More people who received
the antipsychotic (perphenazine) had parkinsonism (OR 0.03 CI 0.01 to 0.1, NNH 1
CI 0.9 to 1.4). Eight studies compared adjunctive carbamazepine plus
antipsychotics versus placebo plus antipsychotics. Adding carbamazepine was as
acceptable as adding placebo (n=182, OR leaving the study early 0.4 CI 0.1 to
1.4). Carbamazepine augmentation of antipsychotics was superior compared with
antipsychotics alone, but participant numbers were low (n=38, OR 0.1 CI 0.02 to
0.4, NNT 2 CI 1 to 5). There were no differences for mental state outcomes (6
RCTs, n=147, OR 50% BPRS reduction 0.99 CI 0.2 to 6.0). Less people in the
carbamazepine augmentation group had movement disorders than those taking
haloperidol alone (1 RCT, n=20, OR 0.15 CI 0.03 to 0.8). The effects of
carbamazepine on subgroups of people with schizophrenia and aggressive
behaviour, negative symptoms or EEG abnormalities or with schizoaffective
disorder are unknown. 

REVIEWER'S CONCLUSIONS: Based on currently available
evidence from randomised trials, carbamazepine cannot be recommend for routine
clinical use for sole treatment, or augmentation of antipsychotic treatment, of
schizophrenia. Large, simple well-designed and reported trials are justified
especially if focusing on those with violent episodes and people with
schizoaffective disorders or on those with both schizophrenia and EEG
abnormalities.

Publication Types:
Review
Review, Academic

PMID: 12137621 [PubMed - indexed for MEDLINE]



Eur Psychiatry  2002 May;17(3):148-54 

Predictors of noncompliance in males with first-episode schizophrenia,
schizophreniform and schizoaffective disorder.

Novak-Grubic V, Tavcar R.

University Psychiatric Hospital, Studenec 48, SI-1260 Ljubljana-Polje, Slovenia.
grubicvg@siol.net

PURPOSE: Many factors influencing compliance in schizophrenia have been reported
in the literature. Our aim was to assess predictors of noncompliance in male
patients with first-episode schizophrenia, schizophreniform and schizoaffective
disorder in a naturalistic setting. 

SUBJECTS AND METHODS: Fifty-six male
patients, discharged from hospital, were included in a 1-year follow-up study.
Psychopathological symptoms were assessed with positive and negative syndrome
scale at admission and discharge, while extrapyramidal side effects were
recorded weekly during hospitalisation using the Simpson-Angus and Barnes
akathisia scales. Socio-demographic and some other variables were also recorded.


RESULTS: Thirty patients (53.6%) dropped out of treatment in the first year and
21 of them relapsed. With the Cox survival analysis three predictors of
noncompliance were found: diagnosis of schizophrenia versus the other two
diagnoses, positive symptoms at admission, and lack of insight at discharge.
Discussion. In spite of a specific methodology and selection of only
first-episode male patients, the results are in accordance with the findings of
other authors. This confirms the universality of noncompliance in psychotic
patients. 

CONCLUSIONS: First-episode patients have a high dropout rate. However,
in compliant patients, the relapse rate was low, and therefore special attention
and compliance-promoting interventions in first-episode patients are needed.

PMID: 12052575 [PubMed - indexed for MEDLINE]



Schizophr Res  2002 Jun 1;55(3):229-37 

Recovery from psychosis in schizophrenia and schizoaffective disorder: symptoms
and neurocognitive rate-limiters for the development of social behavior skills.

Smith TE, Hull JW, Huppert JD, Silverstein SM.

Department of Psychiatry, Westchester Division, Weill Medical College of Cornell
University and New York-Presbyterian Hospital, 21 Bloomingdale Road, White
Plains 10605, USA. tsmith@med.cornell.edu

Neurocognitive deficits are believed to be important predictors of functional
outcome in chronic psychotic disorders, but few supporting studies have utilized
prospective designs and adequate control. The aim of this study was to estimate
the relative influence of symptoms and neurocognitive deficits on the
development of social behavior skills in a cohort of individuals with
schizophrenia or schizoaffective disorder recovering from acute symptom
exacerbations. Forty-six individuals were recruited upon discharge from an
inpatient unit and completed assessments of symptoms, neurocognitive function,
and social behavior at 3-month intervals for 1 year. Correlational analyses and
random regression models were used to model social behavioral capacities
longitudinally. Social behavior improved modestly (10% improvements in ratings)
over the follow-up period for the group as a whole. Disorganized and negative
symptoms, as well as neurocognitive deficits in short-term and working memory
predicted changes in social behavior over time. Individuals with better working
memory function showed significantly greater abilities to recover social
behavior skills, whereas those with working memory deficits showed no functional
improvement over time. Both symptoms and neurocognitive deficits are important
determinants of functional outcome in schizophrenia. It is proposed that
clinicians should consider neurocognitive thresholds for treatment response when
developing rehabilitation plans.

PMID: 12048146 [PubMed - indexed for MEDLINE]



Schizophr Bull  2002;28(1):75-84 

Recent trends in antipsychotic combination therapy of schizophrenia and
schizoaffective disorder: implications for state mental health policy.

Clark RE, Bartels SJ, Mellman TA, Peacock WJ.

Dartmouth Medical School, Department of Community and Family Medicine, Hanover,
NH 03755-3862, USA. robin.e.clark@dartmouth.edu

Little is known about antipsychotic combination therapy, although this practice
is becoming increasingly common in the treatment of schizophrenia. Medicaid
pharmaceutical claims for a cohort of 836 New Hampshire beneficiaries with
schizophrenia or schizoaffective disorder were followed from 1995 through 1999.
Use of traditional and atypical antipsychotic medications, antidepressants,
anxiolytic hypnotics, and mood stabilizers was tracked monthly. The number of
medications, frequency of coprescription, and Medicaid pharmaceutical costs are
described. The proportion of individuals with schizophrenia and schizoaffective
disorder treated with atypical antipsychotics grew from 43 percent in 1995 to 70
percent in 1999. At the same time, concurrent use of two or more antipsychotic
medications quadrupled, increasing from 5.7 percent to 24.3 percent. Persons
with schizophrenia were also prescribed more antidepressants (increased from
18.5% in 1995 to 35.6% in 1999), anxiolytics (increased from 19.9% to 33.5%),
and mood stabilizers (increased from 17.7% to 30.0%). The increase in multiple
agent therapy appears to be broad-based. Data are needed on the effectiveness
and cost-effectiveness of these practices to inform clinical decision making and
health policy.

PMID: 12047024 [PubMed - indexed for MEDLINE]



Am J Psychiatry  2002 Jun;159(6):1018-28 

Comment in:
 Am J Psychiatry. 2002 Dec;159(12):2118; author reply 2118-9.

Neurocognitive effects of clozapine, olanzapine, risperidone, and haloperidol in
patients with chronic schizophrenia or schizoaffective disorder.

Bilder RM, Goldman RS, Volavka J, Czobor P, Hoptman M, Sheitman B, Lindenmayer
JP, Citrome L, McEvoy J, Kunz M, Chakos M, Cooper TB, Horowitz TL, Lieberman JA.

Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA.
bilder@nki.rfmh.org

OBJECTIVE: Newer antipsychotic drugs have shown promise in ameliorating
neurocognitive deficits in patients with schizophrenia, but few studies have
compared newer antipsychotic drugs with both clozapine and conventional agents,
particularly in patients who have had suboptimal response to prior treatments.

METHOD: The authors examined the effects of clozapine, olanzapine, risperidone,
and haloperidol on 16 measures of neurocognitive functioning in a double-blind,
14-week trial involving 101 patients. A global score was computed along with
scores in four neurocognitive domains: memory, attention, motor function, and
general executive and perceptual organization. 

RESULTS: Global neurocognitive
function improved with olanzapine and risperidone treatment, and these
improvements were superior to those seen with haloperidol. Patients treated with
olanzapine exhibited improvement in the general and attention domains but not
more than that observed with other treatments. Patients treated with risperidone
exhibited improvement in memory that was superior to that of both clozapine and
haloperidol. Clozapine yielded improvement in motor function but not more than
in other groups. Average effect sizes for change were in the small to medium
range. More than half of the patients treated with olanzapine and risperidone
experienced "clinically significant" improvement (changes in score of at least
one-half standard deviation relative to baseline). These findings did not appear
to be mediated by changes in symptoms, side effects, or blood levels of
medications. 

CONCLUSIONS: Patients with a history of suboptimal response to
conventional treatments may show cognitive benefits from newer antipsychotic
drugs, and there may be differences between atypical antipsychotic drugs in
their patterns of cognitive effects.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 12042192 [PubMed - indexed for MEDLINE]



Drugs  2002;62(8):1217-51 

Ziprasidone: a review of its use in schizophrenia and schizoaffective disorder.

Gunasekara NS, Spencer CM, Keating GM.

Adis International Limited, Auckland, New Zealand.

Ziprasidone is a novel antipsychotic agent with a pharmacological profile
distinct from that of other currently available novel or classical
antipsychotics. In preclinical studies, ziprasidone was predicted to have
efficacy against positive, negative and affective symptoms of schizophrenia with
a favourable tolerability profile, including a low propensity to induce
extrapyramidal adverse effects. The drug has been administered orally to >300
patients with an acute exacerbation of schizophrenia or schizoaffective disorder
in published 4- to 6-week randomised, double-blind trials. When given twice
daily, at dosages of between 80 and 160 mg/day, ziprasidone produced
significantly greater improvements in overall symptomatology than placebo. In
the largest study, ziprasidone 80 or 160 mg/day was also significantly more
effective than placebo in reducing negative symptoms and, at 160 mg/day, was
significantly more effective than placebo in improving depressive symptoms in
patients with associated clinically significant depression. Data from a 4-week
trial indicate that ziprasidone 160 mg/day has similar efficacy to haloperidol
15 mg/day. Ziprasidone 40 to 160 mg/day was more effective than placebo with
respect to prevention of impending relapse and improvement of negative symptoms
in 294 stable patients with chronic schizophrenia who were treated for up to 1
year. In addition, significantly more ziprasidone than haloperidol recipients
achieved a negative symptom response in a 28-week study involving 301 stable
patients with chronic or subchronic schizophrenia. In general, oral ziprasidone
is well tolerated with an overall incidence of adverse events similar to
placebo. Importantly, the drug has a low propensity to induce extrapyramidal
effects and a negligible effect on bodyweight. Ziprasidone is associated with
slight prolongation of the QTc interval; the clinical significance of this is
not yet clear. The drug does not appear to be associated with sustained
elevation of plasma prolactin concentrations. Preliminary data indicate that
long-term oral ziprasidone treatment is well tolerated. Ziprasidone is the only
novel antipsychotic currently available in a rapid-acting intramuscular
formulation. Short-term treatment with intramuscular ziprasidone was effective
and well tolerated in patients with acute agitation associated with psychosis.
In addition, intramuscular ziprasidone reduced agitation scores by a
significantly greater extent than haloperidol in a study involving patients with
acute agitation associated with psychosis. CONCLUSIONS: Ziprasidone is a
promising new antipsychotic that has shown significant efficacy in the oral
treatment of patients with schizophrenia or schizoaffective disorder. The drug
is well tolerated with a low propensity to induce extrapyramidal effects and a
negligible effect on bodyweight. In addition, intramuscular ziprasidone shows
efficacy and good tolerability in the treatment of acute agitation associated
with psychotic disorders.

Publication Types:
Review
Review, Tutorial

PMID: 12010089 [PubMed - indexed for MEDLINE]



Convuls Ther  1993;9(3):167-175 

The Effect of Short-Term Electroconvulsive Treatment Plus Neuroleptics in
Treatment-Resistant Schizophrenia and Schizoaffective Disorder.

Sajatovic M, Meltzer HY.

Department of Psychiatry, Case Western Reserve University School of Medicine,
Cleveland, Ohio, USA.

The effect of electroconvulsive therapy (ECT) plus loxapine in nine patients
with treatment-refractory schizophrenia or schizoaffective disorder was studied
in an open trial. Five of the nine patients (55.6%) improved significantly
(>/=20%) in the Brief Psychiatric Rating Scale total scores by the end of the
course of ECT. Improvement was greater in positive than in negative symptoms. A
sixth patient improved 3-6 weeks after the completion of the acute course of
ECT. Five patients who responded to ECT received maintenance ambulatory ECT; two
patients remained improved for at least 6-9 months, whereas the other three
relapsed within 4 months. Further study of the indications for and the
effectiveness of ECT plus neuroleptic drugs in treatment-resistant schizophrenia
is indicated.

PMID: 11941209 [PubMed - as supplied by publisher]



Neuropsychobiology  2002;45 Suppl 1:37-42 

Clozapine as add-on medication in the maintenance treatment of bipolar and
schizoaffective disorders. A case series.

Hummel B, Dittmann S, Forsthoff A, Matzner N, Amann B, Grunze H.

Department of Psychiatry, LMU University Hospital, Munich, Germany.

Atypical neuroleptics are increasingly used in the treatment of bipolar and
schizoaffective disorders. Currently, numerous controlled short-term studies are
available for clozapine, olanzapine, risperidone or quetiapine, but long-term
data are still missing. Three patients (2 with bipolar disorder, 1 with
schizoaffective disorder) are described who showed a marked reduction of
affective symptomatology after clozapine had been added to mood stabilizer
pretreatment. The patients were seen once a month before and after the
introduction of clozapine for at least 6 months. Treatment response was
evaluated using different rating scales (IDS, YMRS; GAF; CGI-BP) and the NIMH
Life Chart Methodology. All patients showed a marked improvement after the
add-on treatment with clozapine had been initiated. Clozapine was tolerated well
with only transient and moderate weight gain and fatigue as only side effects.
This case series underlines the safety and efficacy of clozapine as add-on
medication in the treatment of bipolar and schizoaffective disorders. Copyright
2002 S. Karger AG, Basel

PMID: 11893876 [PubMed - indexed for MEDLINE]



19: J Clin Psychiatry  2002 Jan;63(1):54-8 

Vitamin B6 as add-on treatment in chronic schizophrenic and schizoaffective
patients: a double-blind, placebo-controlled study.

Lerner V, Miodownik C, Kaptsan A, Cohen H, Loewenthal U, Kotler M.

Ministry of Health Mental Health Center, Faculty of Health Sciences, Ben-Gurion
University of the Negev, Be'er-Sheva, Israel. lernervld@yahoo.com

BACKGROUND: Vitamin B6, or pyridoxine, plays an intrinsic role in the synthesis
of certain neurotransmitters that take part in development of psychotic states.
Several reports indicate that vitamin B6 may be a factor in a number of
psychiatric disorders and related conditions, such as autism, Alzheimer's
disease, hyperactivity, learning disability, anxiety disorder, and depression.
Moreover, there are anecdotal reports of a reduction in psychotic symptoms after
vitamin B6 supplementation of psychopharmacologic treatment of patients
suffering from schizophrenia or organic mental disorder. The aim of this study
was to examine whether vitamin B6 therapy influences psychotic symptoms in
patients suffering from schizophrenia and schizoaffective disorder. 

METHOD: The effects of the supplementation of vitamin B6 to antipsychotic 
treatment on positive and negative symptoms in 15 schizophrenic and schizo-
affective patients (DSM-IV criteria) were examined in a double-blind, placebo-
controlled, crossover study spanning 9 weeks. All patients had stable psycho-
pathology for at least 1 month before entry into the study and were maintained 
on treatment with their prestudy psychoactive and antiparkinsonian medications 
throughout the study. All patients were assessed using the Positive and Negative 
Syndrome Scale (PANSS) for schizophrenia on a weekly basis. Patients randomly 
received placebo or vitamin B6, starting at 100 mg/day in the first week and 
increasing to 400 mg/day in the fourth week by 100-mg increments each week. 

RESULTS: PANSS scores revealed no differences between vitamin B6- and placebo-
treated patients in amelioration of their mental state. 

CONCLUSION: Further studies with larger
populations and shorter duration of illness are needed to clarify the question
of the possible efficacy of vitamin B6 in treatment of psychotic symptoms in
schizophrenia.

Publication Types:
Clinical Trial
Controlled Clinical Trial
Randomized Controlled Trial

PMID: 11838627 [PubMed - indexed for MEDLINE]



20: Am J Psychiatry  2002 Feb;159(2):255-62 

Erratum in:
 Am J Psychiatry 2002 Dec;159(12):2132

Comment in:
 Am J Psychiatry. 2002 Feb;159(2):177-9.

Clozapine, olanzapine, risperidone, and haloperidol in the treatment of patients
with chronic schizophrenia and schizoaffective disorder.

Volavka J, Czobor P, Sheitman B, Lindenmayer JP, Citrome L, McEvoy JP, Cooper
TB, Chakos M, Lieberman JA.

Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10982, USA.
volavka@nki.rfmh.org

OBJECTIVE: The authors compared the efficacy and safety of three atypical
antipsychotics (clozapine, olanzapine, and risperidone) with one another and
with haloperidol in the treatment of patients with chronic schizophrenia or
schizoaffective disorder. 

METHOD: In a double-blind trial, 157 inpatients with a
history of suboptimal treatment response were randomly assigned to treatment
with clozapine, olanzapine, risperidone, or haloperidol for 14 weeks (an 8-week
escalation and fixed-dose period followed by a 6-week variable-dose period).


RESULTS: Clozapine, risperidone, and olanzapine (but not haloperidol) resulted
in statistically significant improvements in total score on the Positive and
Negative Syndrome Scale. Improvements seen in total and negative symptom scores
with clozapine and olanzapine were superior to haloperidol. The atypical drugs,
particularly olanzapine and clozapine, were associated with weight gain.

CONCLUSIONS: The effects of atypical antipsychotics in this population were
statistically significant but clinically modest. The overall pattern of results
suggests that clozapine and olanzapine have similar general antipsychotic
efficacy and that risperidone may be somewhat less effective. Clozapine was the
most effective treatment for negative symptoms. However, the differences among
treatments were small.

Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 11823268 [PubMed - indexed for MEDLINE]



21: Psychiatr Serv  2002 Jan;53(1):94-6 

Pharmacologic treatment of hospitalized patients with schizoaffective disorder.

Flynn J, Grieger TA, Benedek DM.

Department of Psychiatry, Walter Reed Army Medical Center, Washington, DC, USA.

This study examined changes in the pharmacologic treatment of 70 patients who
were hospitalized with a diagnosis of schizoaffective disorder at some time
during a six-year period. An increasing use of divalproex sodium and atypical
antipsychotics instead of lithium and conventional antipsychotics was observed.
The use of a combination of an antipsychotic and a thymoleptic medication was
more common than monotherapy, and physicians tended to continue antidepressants
if patients had a history of depression. Patients with a new diagnosis of
schizoaffective disorder were stabilized less quickly than those with a previous
diagnosis. The use of divalproex sodium and newer antipsychotics did not reduce
the time to stabilization in routine clinical practice.

PMID: 11773657 [PubMed - indexed for MEDLINE]



Psychiatr Serv  2002 Jan;53(1):94-6

Pharmacologic treatment of hospitalized patients with schizoaffective disorder.

Flynn J, Grieger TA, Benedek DM.

This study examined changes in the pharmacologic treatment of 70 patients who
were hospitalized with a diagnosis of schizoaffective disorder at some time
during a six-year period. An increasing use of divalproex sodium and atypical
antipsychotics instead of lithium and conventional antipsychotics was observed.
The use of a combination of an antipsychotic and a thymoleptic medication was
more common than monotherapy, and physicians tended to continue antidepressants
if patients had a history of depression. Patients with a new diagnosis of
schizoaffective disorder were stabilized less quickly than those with a previous
diagnosis. The use of divalproex sodium and newer antipsychotics did not reduce
the time to stabilization in routine clinical practice.

PMID: 11773657 [PubMed - in process]



J Affect Disord  2001 Dec;67(1-3):133-40 

Olanzapine versus haloperidol in schizoaffective disorder, bipolar type.

Tohen M, Zhang F, Keck PE, Feldman PD, Risser RC, Tran PV, Breier A.

Lilly Research Laboratories, Indianapolis, IN, USA. m.tohen@lilly.com

BACKGROUND: The present analysis was performed on data from a subsample of
patients with schizoaffective disorder, bipolar type, who participated in a
multicenter, double-blind study comparing olanzapine to haloperidol. 

METHODS:
Patients with schizoaffective disorder bipolar type, characterized as currently
manic, mixed, depressed, or euthymic, were assessed weekly for 6 weeks during
treatment with either olanzapine or haloperidol. Manic symptoms were measured
using the sum of six items of the BPRS, and depressive symptoms were assessed
using the Montgomery-Asberg Depression Rating Scale. In addition, cognitive
functioning was measured using the sum of seven items from the PANSS. Repeated
measures analyses were performed using random coefficients regression of the
serial measurement of manic, cognitive, and depressive symptoms. 

RESULTS: A significant treatment difference was detected overall, indicating 
that olanzapine was significantly more effective than haloperidol in reducing
symptoms of depression and improving patients' cognitive symptoms. The
superiority of olanzapine over haloperidol in the reduction of manic symptoms
did not reach statistical significance (P=.052). The greatest improvement in
both manic and cognitive symptoms was seen in the olanzapine-treated 'currently
manic' subgroup, and least improvement in the haloperidol-treated 'euthymic'
subgroup. Depressive symptoms were most improved in the olanzapine-treated
'depressed' subgroup, and least improved in the corresponding haloperidol
subgroup. 

CONCLUSIONS: Overall, olanzapine was superior to haloperidol with respect to 
thymoleptic effects in patients with schizoaffective disorder, bipolar type.

Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 11869760 [PubMed - indexed for MEDLINE]



Pharmacopsychiatry  2001 Nov;34(6):242-50

Oxcarbazepine in affective and schizoaffective disorders.

Dietrich DE, Kropp S, Emrich HM.

Department of Clinical Psychiatry and Psychotherapy, Hannover Medical School,
Germany.

Anticonvulsants have been successfully used in pharmacopsychiatry after their
therapeutic value in affective and schizoaffective disorders had been documented
in several clinical trials. As the authorities in several countries registered
newer anticonvulsants with fewer side effects, their therapeutic value in
psychiatric disorders was studied. Clinical studies from the early 80's onward
have demonstrated the efficacy of oxcarbazepine (OCBZ), a keto derivative of
carbamazepine, in treating mania in affective and schizoaffective disorders. In
addition, OCBZ has a distinct pharmacokinetic profile concerning drug-drug
interactions compared to carbamazepine and other anticonvulsants. Therefore, the
value of OCBZ in the treatment of affective and schizoaffective disorders needs
to be evaluated. We reviewed the literature with regard to pharmacokinetic and
pharmacodynamic characteristics of OCBZ, drug-drug interactions relevant in
pharmacopsychiatry, and the clinical effects of OCBZ in the treatment of
patients with affective and schizoaffective disorders. According to the
literature, OCBZ is regarded as effective in acute mania and appears to reduce
the dosage of neuroleptics required for the treatment of affective and
schizoaffective disorders. In addition, it has a preferable pharmacokinetic
profile with less severe side effects compared to carbamazepine and
neuroleptics. Furthermore, since OCBZ does not interact substantially with the
cytochrome P450 enzyme system, co-administration with neuroleptics or
antidepressants appears to be well tolerated in affective disorders. However,
despite promising effects of OCBZ, few clinical studies have been published in
the last 15 years. We conclude that further studies should validate the efficacy
of OCBZ in treating mania and evaluate possible pharmacopsychiatric indications
as well as limitations for this psychotropic compound.

PMID: 11778145 [PubMed - in process]



J Clin Psychiatry  2001 Aug;62(8):623-30

Efficacy and safety of risperidone in the treatment of schizoaffective disorder:
initial results from a large, multicenter surveillance study. Group for the
Study of Risperidone in Affective Disorders (GSRAD).

Vieta E, Herraiz M, Fernandez A, Gasto C, Benabarre A, Colom F, Martinez-Aran A,
Reinares M.

Hospital Clinic, University of Barcelona, Spain. EVIETA@clinic.ub.es

BACKGROUND: An adequate therapy for psychotic disorders needs to be effective
against mood as well as psychotic symptoms. Analyses of data from clinical
trials of risperidone in schizophrenia and small open-label studies in mania
suggest that risperidone may have this broad efficacy profile. We present data
on a 6-week trial of risperidone for the treatment of schizoaffective disorder
that was part of a larger, 6-month surveillance study of patients with affective
disorders. 

METHOD: One hundred two patients suffering from schizoaffective
disorder (DSM-IV or ICD-10) entered the trial. Inclusion criteria consisted of a
current DSM-IV diagnosis of schizoaffective disorder, bipolar type; DSM-IV manic
or mixed psychotic episode; and a Young Mania Rating Scale (YMRS) score > 7 for
a mixed episode (> 20 for a manic episode). Assessments included the YMRS, the
Positive and Negative Syndrome Scale (PANSS), the Hamilton Rating Scale for
Depression (HAM-D), the 4-item Clinical Global Impressions (CGI) scale, and the
UKU Side Effect Rating Scale subscale for neurologic side effects. For patients
entering the study, open-label risperidone therapy was added to their existing
regimens of mood-stabilizing treatments. Other antipsychotic drugs were not
allowed. 

RESULTS: Ninety-five patients completed the 6-week trial. At week 6,
the mean +/- SD dose of risperidone was 4.7+/-2.5 mg/day. The mean scores on the
assessment scales at baseline and week 6 (unless otherwise stated) were as
follows: YMRS, 22.7 and 4.7, an improvement of 18.0 points (p < .0001); PANSS
(at baseline and week 4), 74.1 and 54.2, an improvement of 19.9 points (p <
.0001); HAM-D, 14.0 and 7.4, an improvement of 6.6 points (p < .0001); CGI (at
baseline and week 4), 2.6 and 1.7, an improvement of 0.9 points (p < .0001). At
week 4, most patients had shown improvement in symptom severity, and 9.3% were
completely symptom-free. There were no statistically significant differences
between baseline and week 4 in the severity of extrapyramidal symptoms as
measured by the UKU. Risperidone was well tolerated; side effects were few and
generally mild. 

CONCLUSION: The results to date with risperidone indicate that
it may have both antipsychotic and mood-stabilizing properties. Despite the
limitations of the open-label design, the results indicate that risperidone is a
safe and effective therapy in combination with mood-stabilizers for the
treatment of patients with manic, hypomanic, and depressive symptoms of mixed
episodes in schizoaffective disorder, bipolar type.

Publication Types:
Clinical Trial
Multicenter Study

PMID: 11561935 [PubMed - indexed for MEDLINE]



J Clin Psychopharmacol  2001 Aug;21(4):360-8

A double-blind, randomized, prospective evaluation of the efficacy and safety of
risperidone versus haloperidol in the treatment of schizoaffective disorder.

Janicak PG, Keck PE Jr, Davis JM, Kasckow JW, Tugrul K, Dowd SM, Strong J,
Sharma RP, Strakowski SM.

The Psychiatric Clinical Research Center and Department of Psychiatry, College
of Medicine, University of Illinois at Chicago, 60612, USA.
pjanicak@psych.uic.edu

The relative efficacy and safety of risperidone versus haloperidol in the
treatment of schizoaffective disorder was studied. Sixty-two patients (29
depressed type; 33 bipolar type) entered a three-site, randomized, double-blind,
6-week trial of risperidone (up to 10 mg/day) or haloperidol (up to 20 mg/day).
Trained raters assessed baseline, weekly, and end-of-study levels of
psychopathology with the Positive and Negative Syndrome Scale (PANSS), the
24-item Hamilton Rating Scale for Depression (HAM-D-24) and the
Clinician-Administered Rating Scale for Mania (CARS-M). The authors were unable
to statistically distinguish between risperidone and haloperidol in the
amelioration of psychotic and manic symptoms. In addition, there was no
difference in worsening of mania between the two agents in either subgroup
(i.e., depressed or bipolar subgroups). 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 subscale, 3 and 7 points, respectively. Additionally,
risperidone produced a mean decrease of 13 points from the baseline 24-item
HAM-D, compared with an 8-point decrease with haloperidol. In those patients who
had more severe depressive symptoms (i.e., HAM-D baseline score >20),
risperidone produced at least a 50% mean improvement in 12 (75%) of 16 patients
in comparison to 8 (38%) of 21 patients receiving haloperidol. Haloperidol
produced significantly more extrapyramidal side effects and resulted in more
dropouts caused by any side effect. There was no difference between risperidone
and haloperidol in reducing both psychotic and manic symptoms in this group of
patients with schizoaffective disorder. Risperidone did not demonstrate a
propensity to precipitate mania and was better tolerated than haloperidol. In
those subjects with higher baseline HAM-D scores (i.e., >20), risperidone
produced a greater improvement in depressive symptoms than haloperidol.

Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 11476119 [PubMed - indexed for MEDLINE]



Am J Psychiatry  2001 May;158(5):765-74

Erratum in:
 Am J Psychiatry 2001 Oct;158(10):1759

A randomized double-blind study of risperidone and olanzapine in the treatment
of schizophrenia or schizoaffective disorder.

Conley RR, Mahmoud R.

Maryland Psychiatric Research Center, University of Maryland, USA.

OBJECTIVE: The safety and efficacy of risperidone and olanzapine were compared
in a double-blind trial that used doses widely accepted in clinical practice.

METHOD: Subjects (N=377) who met DSM-IV criteria for schizophrenia or
schizoaffective disorder were randomly assigned to receive 2-6 mg/day of
risperidone (mean modal dose=4.8 mg/day) or 5-20 mg/day of olanzapine (mean
modal dose=12.4 mg/day) for 8 weeks. 

RESULTS: The two study groups were similar
at baseline except that the olanzapine group was slightly younger than the
risperidone group. Seventy-five percent of the participants completed the trial,
with no between-treatment differences in the proportion of dropouts. Similar
proportions of the risperidone and olanzapine groups reported extrapyramidal
symptoms (24% and 20%, respectively). Severity of extrapyramidal symptoms was
low in both groups, with no between-group differences. Total Positive and
Negative Syndrome Scale scores and scores on the five Positive and Negative
Syndrome Scale factors were improved in both groups at week 8 (subjects who
completed the study) and endpoint (all subjects, including dropouts). There were
overall between-treatment differences in efficacy. Comparison of individual
factors found no significant differences at endpoint; at week 8, however,
improvements on Positive and Negative Syndrome Scale factors for positive
symptoms and anxiety/depression were greater with risperidone than olanzapine.
An increase in body weight of > or =7% was seen in 27% of olanzapine
participants and 12% of risperidone participants. 

CONCLUSIONS: Both treatments were well tolerated and efficacious. The frequency 
and severity of extrapyramidal symptoms were similar in the two treatment groups. 
Greater reductions in severity of positive and affective symptoms were seen with
risperidone than with olanzapine treatment among study completers. There was no
measure on which olanzapine was superior. Greater weight gain was associated
with olanzapine than with risperidone treatment.

Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 11329400 [PubMed - indexed for MEDLINE]



Neurocase  2001;7(2):105-10

A double-blind placebo-controlled case study of the use of donepezil to improve
cognition in a schizoaffective disorder patient: functional MRI correlates.

Risch SC, McGurk S, Horner MD, Nahas Z, Owens SD, Molloy M, Gilliard C, Christie
S, Markowitz JS, DeVane CL, Mintzer J, George MS.

Institute of Psychiatry, Medical University of South Carolina, 67 President
Street, Room 502N, PO Box 250861, Charleston, SC 29425, USA. rischc@musc.edu

Cognitive impairment in multiple domains is common in patients with
schizophrenia and may be a powerful determinant of poor functional ability and
quality of life. We report a double-blind, placebo-controlled, cross-over study
of donepezil augmentation in a schizoaffective disorder patient stabilized on
olanzapine pharmacotherapy. The patient showed significant improvements in
several cognitive measures and increased activation of prefrontal cortex and
basal ganglia on functional MRI during the donepezil augmentation. In addition,
the donepezil augmentation resulted in a reduction of depressive symptoms and in
significant improvements in functional abilities and quality of life. Further
studies of donepezil augmentation of neuroleptics in schizophrenia are
warranted.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 11320158 [PubMed - indexed for MEDLINE]



Pharmacopsychiatry  2001 Mar;34(2):80-1

Atypical antipsychotics in bipolar and schizoaffective disorders.

Brown ES, Thomas NR, Carmody T, Mahadi S, Nejtek VA.

University of Texas Southwestern Medical Center at Dallas Department of
Psychiatry, 75390-9070, USA. sherwood.brown@utsouthwestern.edu

No data are available comparing the relative efficacy of different atypical
agents in patients with bipolar disorder. A chart review of bipolar and
schizoaffective disorder patients who had received courses of at least two
atypical agents (n = 33) in a community psychiatry system was conducted. No
differences in rates of hospitalizations were found between individual atypical
agents or between atypical agents as a class and conventional neuroleptics.
However, a significant reduction in rates of emergency room visits was found
with atypical agents compared to conventional neuroleptics, with a trend toward
greater reduction with clozapine compared to other atypical antipsychotics.
Larger prospective studies are needed to confirm these preliminary observations.

PMID: 11302568 [PubMed - indexed for MEDLINE]



J Clin Psychopharmacol  2001 Feb;21(1):27-35

Ziprasidone in the short-term treatment of patients with schizoaffective
disorder: results from two double- blind, placebo-controlled, multicenter
studies.

Keck PE Jr, Reeves KR, Harrigan EP;  Ziprasidone Study Group.

Department of Psychiatry, University of Cincinnati College of Medicine, Ohio
45267-0559, USA.

This study assessed the efficacy of ziprasidone for the treatment of
schizoaffective disorder. Data were taken from subsets of patients with
schizoaffective disorder, derived from two separate double-blind,
placebo-controlled, parallel-group, multicenter studies. A total of 115
hospitalized patients with an acute episode of schizoaffective disorder were
randomly assigned to receive either fixed oral doses of ziprasidone 40 mg/day (N
= 16), 80 mg/day (N = 18), 120 mg/day (N = 22), 160 mg/day (N = 25), or placebo
(N = 34) for 4 to 6 weeks. Mean baseline-to-endpoint changes in Brief
Psychiatric Rating Scale (BPRS) total, BPRS Core, Clinical Global Impressions
Severity scale (CGI-S), BPRS Depressive, BPRS Manic, and Montgomery-Asberg
Depression Rating Scale total scores were compared between the placebo and
ziprasidone groups. Neurological (Simpson-Angus, Barnes Akathisia, Abnormal
Involuntary Movement Scale [AIMS]) and other side effects were also assessed.
Significant dose-related improvements on all primary efficacy variables (BPRS
total, BPRS Core, CGI-S) and for BPRS Manic items were observed with ziprasidone
treatment in a combined analysis of data from both studies (p < or = 0.01).
Ziprasidone 160 mg/day was significantly more effective than placebo in
improving mean BPRS total, BPRS Core, BPRS Manic, and CGI-S scores (p < 0.05).
At 120 mg/day, ziprasidone was significantly more effective than placebo in
improving mean CGI-S scores (p < 0.05). The incidence of individual adverse
events was generally low in all treatment groups and was not dose-related. In
addition, no significant differences were observed between baseline-to-endpoint
mean changes in Simpson-Angus and AIMS scores with placebo or ziprasidone 40 to
160 mg/day. These results suggest that ziprasidone may have efficacy in the
treatment of affective as well as psychotic symptoms of schizoaffective
disorder, with a low side-effect burden.

Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 11199944 [PubMed - indexed for MEDLINE]



Neuropsychobiology  2001 Jan;43(1):23-8

Maintenance electroconvulsive therapy in affective and schizoaffective disorder.

Swoboda E, Conca A, Konig P, Waanders R, Hansen M.

Department of Psychiatry I, Landeskrankenhaus Rankweil, Austria.

Twenty-one patients (13 depressives and 8 schizoaffectives) who underwent
maintenance electroconvulsive therapy (M-ECT) were compared with controls who
received maintenance pharmacotherapy alone. Measures of effectiveness and safety
of maintenance treatment were prospectively obtained during a 1-year follow-up.
Survival analysis demonstrated a significantly better outcome defined by time to
rehospitalization for all patients of the M-ECT group. Regarding the subgroups,
depressives of the M-ECT group had markedly decreased rehospitalization rates
compared to depressive controls. Furthermore, M-ECT in depressives resulted in a
significant reduction in hospitalization rates and duration during follow-up. In
schizoaffective patients, a significant difference in survival time was found in
favor of the M-ECT group. In both groups, schizoaffectives had a markedly poorer
outcome compared to depressive subjects. Our results indicate that in selected
patients M-ECT, at least in combination with supporting medication, may be an
efficient and safe alternative to pharmacological continuation or maintenance
therapy alone. Copyright 2001 S. Karger AG, Basel

Publication Types:
Clinical Trial

PMID: 11150895 [PubMed - indexed for MEDLINE]



Br J Psychiatry  2000 Nov;177:421-6

Ten-year outcome: patients with schizoaffective disorders, schizophrenia,
affective disorders and mood-incongruent psychotic symptoms.

Harrow M, Grossman LS, Herbener ES, Davies EW.

Department of Psychiatry, University of Illinois College of Medicine, Chicago,
IL, USA.

BACKGROUND: It is unclear whether outcome in schizoaffective disorders is more
similar to schizophrenia or affective disorders. AIMS: To provide longitudinal
data on clinical course and outcome in schizoaffective disorders versus
schizophrenia and affective disorders, and determine whether mood-incongruent
psychotic symptoms have negative prognostic implications. 

METHOD: A total of 210 patients with schizoaffective disorders, schizophrenia, 
bipolar manic disorders and depression were assessed at hospitalisation and then 
followed up four times over 10 years. \

RESULTS: At all four follow-ups, fewer patients with
schizoaffective disorders than with schizophrenia showed uniformly poor outcome.
Patients with mood-incongruent psychotic symptoms during index hospitalisation
showed significantly poorer subsequent outcome (P < 0.05). 

CONCLUSIONS: Schizoaffective outcome was better than schizophrenic outcome and 
poorer than outcome for psychotic affective disorders. Mood-incongruent psychotic 
symptoms have negative prognostic implications. The results could fit a symptom 
dimension view of schizoaffective course.

PMID: 11059995 [PubMed - indexed for MEDLINE]



J Clin Psychopharmacol  2000 Oct;20(5):520-2

Efficacy of divalproex therapy for schizoaffective disorder.

Bogan AM, Brown ES, Suppes T.

University of Texas Health Science Center, Houston, USA.

Schizoaffective disorder is a common, severe, and lifelong illness; however,
little is known about the pharmacologic treatment of this mental disorder.
Divalproex has proven efficacy in the treatment of bipolar disorder. Therefore,
to determine whether divalproex is also effective as adjunctive therapy for
schizoaffective disorder, the authors performed a retrospective study of 20
patients in the public mental health system with schizoaffective disorder,
bipolar type, who initiated divalproex therapy. The mean maximum dose of
divalproex (+/-1 SD) was 1,150 mg (+/-400 mg; range, 500-2,000). The mean peak
serum valproic acid level was 61 microg/mL (+/-25 microg/mL; range, 20-92). The
overall improvement in Clinical Global Impression Scale scores was observed in
75% (15/20) of the patients (p = 0.0001). None in the sample worsened, and none
discontinued divalproex because of side effects. These data suggest that
divalproex is well-tolerated and effective as treatment of persistent
schizoaffective disorder, bipolar type. Thus, divalproex may be an effective
agent in the treatment of schizoaffective disorder as well as bipolar disorder.
Controlled prospective trials in patients with schizoaffective disorder are
needed to verify these findings.

PMID: 11001235 [PubMed - indexed for MEDLINE]



J Clin Psychiatry  2000 Jul;61(7):498-504

Comparative efficacy of risperidone and clozapine in the treatment of patients
with refractory schizophrenia or schizoaffective disorder: a retrospective
analysis.

Sharif ZA, Raza A, Ratakonda SS.

Schizophrenia Research Unit, Creedmoor Psychiatric Center, Queens Village, NY
11427, USA.

BACKGROUND: Clozapine is effective in up to 60% of patients with refractory
schizophrenia, whereas the efficacy of risperidone remains unknown. This
retrospective study examined the relative efficacy of these drugs in chronically
institutionalized patients refractory to conventional antipsychotic agents.

METHOD: A total of 24 patients who at different time periods had received
adequate trials of both clozapine and risperidone and met our inclusion criteria
for minimum dose and duration of each trial were included; for clozapine, a
minimum dose of 300 mg/day had to be maintained for at least 12 weeks, and for
risperidone, a minimum dose of 6 mg/day for at least 6 weeks. Information
obtained from systematic retrospective chart review was blindly rated by 2
psychiatrists using the 7-point Clinical Global Impressions-Improvement (CGI-I)
scale on overall clinical state and along specific symptom domains of positive
symptoms, negative symptoms, and aggressive behavior. 

RESULTS: The mean +/- SD dose was 520+/-94 mg/day for clozapine and 7.5+/-2.2 
mg/day for risperidone. Fourteen patients (58%) were classified as responders to 
clozapine, while 6 (25%) responded to risperidone (CGI-I score of 1 or 2); on 
specific symptom domains, response rates to clozapine were 38% (9/24) on positive 
symptoms, 29% (7/24) on negative symptoms, and 71% (12/17) on aggressive behavior. 
For risperidone, response rates were 17% (4/24) on positive symptoms, 8% (2/24) on
negative symptoms, and 41% (7/17) on aggressive behavior. 

CONCLUSION: The results of this study support the utility of first giving a 
risperidone trial in a treatment algorithm for refractory patients because of its 
better risk/benefit profile compared with clozapine. Clozapine, however, remains 
our gold standard in the management of these patients.

PMID: 10937608 [PubMed - indexed for MEDLINE]



J Clin Psychiatry  2000 May;61(5):329-34

Clozapine for treatment-refractory schizophrenia, schizoaffective disorder, and
psychotic bipolar disorder: a 24-month naturalistic study.

Ciapparelli A, Dell'Osso L, Pini S, Chiavacci MC, Fenzi M, Cassano GB.

Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology,
University of Pisa, Italy.

BACKGROUND: The aim of this study was to evaluate the 24-month response to
clozapine in patients with schizophrenia, schizoaffective disorder, or psychotic
bipolar disorder. 

METHOD: Ninety-one psychotic patients with a principal
DSM-III-R diagnosis of schizophrenia (N = 31), schizoaffective disorder (N =
26), or bipolar disorder with psychotic features (N = 34) were treated
naturalistically with clozapine at flexible dosages over a 24-month period.
Improvement was assessed by the 18-item Brief Psychiatric Rating Scale and the
Clinical Global Impressions-Severity of Illness scale. 

RESULTS: All patients showed significant improvement 24 months from intake 
(p < .001). Such an improvement was significantly greater among patients with 
schizoaffective disorder or bipolar disorder than in patients with schizophrenia 
(p < .05). The presence of suicidal ideation at intake predicted greater improvement 
at endpoint. 

CONCLUSION: Clozapine appears to be effective and relatively well
tolerated in acute and long-term treatment of patients with psychotic bipolar
disorder or schizoaffective disorder who have not responded to conventional
pharmacotherapies.

Publication Types:
Clinical Trial

PMID: 10847306 [PubMed - indexed for MEDLINE]



Cochrane Database Syst Rev  2000;(2):CD001258

Carbamazepine for schizophrenia and schizoaffective psychoses.

Leucht S, McGrath J, White P, Kissling W.

Psychiatrische Klinik und Poliklinik der Technischen Universitat Munchen
Klinikum rechts der Isar, Ismaningerstr. 22, Munchen, Germany, D-81675.
stefan.leucht@lrz.tu-muenchen.de

BACKGROUND: A sizeable minority of people with schizophrenia do not have
complete remission of symptoms. A variety of adjunctive treatments have been
used to treat schizophrenia, carbamazepine being one. 

OBJECTIVES: To review the effects of carbamazepine and its derivatives for the 
treatment of schizophrenia and schizoaffective psychoses. 

SEARCH STRATEGY: Biological Abstracts
(1980-1998), The Cochrane Library (Issue 3, 1998), The Cochrane Schizophrenia
Group's Register of Trials (August 1998), EMBASE (1980-1998), MEDLINE
(1966-1998), PsycLIT (1886-1998) and PSYNDEX (1974-1998) were searched.
Citations from included trials were also inspected and relevant companies and
authors contacted for additional data. 

SELECTION CRITERIA: All randomised
controlled trials comparing carbamazepine, or compounds of the carbamazepine
family, to placebo or no intervention, whether as sole treatment or as an
adjunct to antipsychotic medication for the treatment of schizophrenia and/or
schizoaffective psychoses. 

DATA COLLECTION AND ANALYSIS: Citations and, where
possible, abstracts were independently inspected by reviewers, papers ordered,
re-inspected and quality assessed. Data were extracted independently by at least
two reviewers. Dichotomous data were analysed using Peto odds ratio (OR) and the
95% confidence interval (CI) estimated. Where possible the number needed to
treat (NNT) or number needed to harm statistics were calculated. 

MAIN RESULTS:
There is no clear effect of carbamazepine as the sole maintenance treatment for
those with schizophrenia. Eight trials provided very limited data on the value
of carbamazepine as an adjunct to antipsychotics. Studies were small and poorly
reported. Currently no published data provides convincing evidence that
adjunctive carbamazepine has an effect on global functioning, mental state, side
effects or acceptability of treatment. 

REVIEWER'S CONCLUSIONS: Based on
currently available randomised trial-derived evidence, carbamazepine cannot be
recommend for routine clinical use for treatment or augmentation of
antipsychotic treatment of schizophrenia. However, for those with a past history
of being responsive to carbamazepine, or for those with associated EEG
abnormalities, a trial of the drug may be warranted. More data is expected from
trialists and the results of this review may be changed by their inclusion. At
present large, simple well designed and reported trials are justified especially
if focusing on those with both schizophrenia and EEG abnormalities or violent
episodes and people with schizoaffective disorders.

Publication Types:
Review
Review, Academic

PMID: 10796431 [PubMed - indexed for MEDLINE]



Acta Psychiatr Scand  2000 Apr;101(4):318-22

Effects of a coping-orientated group therapy for schizophrenia and
schizoaffective patients: a pilot study.

Andres K, Pfammatter M, Garst F, Teschner C, Brenner HD.

University of Bern Psychiatric Services, Switzerland.

OBJECTIVE: This controlled pilot study was designed, first, to examine the
efficacy of two different group therapy formats for schizophrenia and
schizoaffective patients: a patient-centred, psychoeducative and
coping-orientated group therapy approach and a supportive therapy group.
Secondly, it intended to establish preliminary hypotheses on the therapeutically
relevant factors. 

METHOD: In a sample of 32 patients suffering from
schizophrenia or a schizoaffective disorder the effect sizes of the
coping-orientated therapy approach and a supportive group therapy on several
outcome variables were examined and the predictive power of different effect
variables on outcome was analysed. 

RESULTS: The effect sizes show improvements
in the cognizance of the disorder and the related pharmacotherapy, the
psychopathology and the social functioning for both therapy conditions.
Moreover, outcome as measured after 1 year was best predicted by the patient's
mastery of active, problem-focused coping strategies. 

CONCLUSION: The results corroborate the appropriateness of focusing on aspects 
of coping-behaviour in psychological interventions.

PMID: 10782553 [PubMed - indexed for MEDLINE]



J Clin Psychopharmacol  2000 Feb;20(1):94-8

Effects of clozapine on substance use in patients with schizophrenia and
schizoaffective disorder: a retrospective survey.

Zimmet SV, Strous RD, Burgess ES, Kohnstamm S, Green AI.

Commonwealth Research Center, Department of Psychiatry, Harvard Medical School,
Boston, Massachusetts, USA.

Substance use disorders, particularly those involving alcohol, marijuana, and
cocaine, are highly prevalent among patients with schizophrenia and contribute
markedly to its overall morbidity. Unfortunately, standard (typical)
antipsychotic medications do not seem to reduce substance use in patients with
schizophrenia and may even increase it. Recently, however, a few anecdotal case
reports and two previous small "N" surveys have found that clozapine, an
atypical antipsychotic medication, seems to decrease substance use in patients
treated with this drug for their psychoses. The authors report data from a
retrospective survey of substance use in 58 patients treated with clozapine who
had a history of comorbid schizophrenia (or schizoaffective disorder) and
substance use disorder. Of these 58 patients, 43 were being treated with
clozapine at the time of the survey; the remaining 15 patients had discontinued
clozapine before the survey. The survey involved chart review and clinician
interview to assess change in substance use and global clinical symptoms while
receiving treatment with clozapine. More than 85% of the patients who were
active substance users at the time of initiation of treatment with clozapine
decreased their substance use over the course of clozapine administration. For
patients who continued treatment with clozapine up to the present, the decrease
in substance use was strongly correlated with a decrease in global clinical
symptoms. Data from this retrospective survey further support the previous
observations that clozapine reduces substance use among patients with
schizophrenic disorders. Moreover, the data suggest the need for prospective
controlled studies of the effects of clozapine on substance use in this
population.

PMID: 10653215 [PubMed - indexed for MEDLINE]



J Clin Psychiatry  1999 Dec;60(12):874-82

Schizoaffective disorder: a form of schizophrenia or affective disorder?

Evans JD, Heaton RK, Paulsen JS, McAdams LA, Heaton SC, Jeste DV.

Department of Psychiatry, University of California, San Diego, USA.
djeste@ucsd.edu

BACKGROUND: The diagnostic status of schizoaffective disorder continues to be
controversial. Researchers have proposed that schizoaffective disorder
represents a variant of schizophrenia or affective disorder, a combination of
the 2, or an intermediate condition along a continuum between schizophrenia and
affective disorder. 

METHOD: We compared outpatients aged 45 to 77 years with
DSM-III-R diagnosis of schizoaffective disorder (N = 29), schizophrenia (N =
154), or nonpsychotic mood disorder (N = 27) on standardized rating scales of
psychopathology and a comprehensive neuropsychological test battery. A
discriminant function analysis was used to classify the schizoaffective patients
based on their neuropsychological profiles as being similar either to
schizophrenia patients or to those with nonpsychotic mood disorder. 

RESULTS: The
schizoaffective and schizophrenia patients had more severe dyskinesia, had a
weaker family history of mood disorder, had been hospitalized for psychiatric
reasons more frequently, were more likely to be prescribed neuroleptic and
anticholinergic medication, and had somewhat less severe depressive symptoms
than the mood disorder patients. The schizophrenia patients had more severe
positive symptoms than the schizoaffective and mood disorder patients. The
neuropsychological performances of the 2 psychosis groups were more impaired
than those of the nonpsychotic mood disorder patients. Finally, on the basis of
a discriminant function analysis, the schizoaffective patients were more likely
to be classified as having schizophrenia than a mood disorder. 

CONCLUSION: These findings suggest that schizoaffective disorder may represent 
a variant of schizophrenia in clinical symptom profiles and cognitive impairment.

PMID: 10665641 [PubMed - indexed for MEDLINE]



J Affect Disord  1999 Aug;54(3):315-7

Gabapentin as a promising treatment for antipsychotic-induced movement disorders
in schizoaffective and bipolar patients.

Hardoy MC, Hardoy MJ, Carta MG, Cabras PL.

Institute of Psychiatry, University of Cagliari, Italy. ugolini@tin.it

Improvement of antipsychotic-induced blepharospasm and involuntary
oral-mandibulo movements was observed with the use of the anticonvulsant drug
gabapentin among 14 of 16 affectively ill patients who had been exposed to
maintenance neuroleptics of the conventional type. In many cases, the movement
disorders of these patients had not responded to more standard measures such as
clozapine. This finding permits a potential strategy for patients with
treatment-emergent tardive dyskinesia, a well-known complication of extended
conventional neuroleptic use. Gabapentin, whose mood stabilizing properties have
been reported in several clinical reports, represents a more natural treatment
in the setting of bipolar spectrum disorders.

PMID: 10467977 [PubMed - indexed for MEDLINE]



Am J Psychiatry  1999 Aug;156(8):1138-48

Treatment of schizoaffective disorder and schizophrenia with mood symptoms.

Levinson DF, Umapathy C, Musthaq M.

Department of Psychiatry, MCP Hahnemann School of Medicine, Allegheny University
of the Health Sciences, Philadelphia, PA 19129, USA. levinson@auhs.edu

OBJECTIVE: Patients with concurrent schizophrenic and mood symptoms are often
treated with antipsychotics plus antidepressant or thymoleptic drugs. The
authors review the literature on treatment of two overlapping groups of
patients: those with schizoaffective disorder and those with schizophrenia and
concurrent mood symptoms. 

METHOD: MEDLINE searches (from 1976 onward) were
undertaken to identify treatment studies of both groups, and references in these
reports were checked. Selection of studies for review was based on the use of
specified diagnostic criteria and of parallel-group, double-blind design (or,
where few such studies addressed a particular issue, large open studies). A
total of 18 treatment studies of schizoaffective disorder and 15 of
schizophrenia with mood symptoms were selected for review. 

RESULTS: For acute
exacerbations of schizoaffective disorder or of schizophrenia with mood
symptoms, antipsychotics appeared to be as effective as combination treatments,
and there was some evidence for superior efficacy of atypical antipsychotics.
There was evidence supporting adjunctive antidepressant treatment for
schizophrenic and schizoaffective patients who develop a major depressive
syndrome after remission of acute psychosis, but there were mixed results for
treatment of subsyndromal depression. There was little evidence to support
adjunctive lithium for depressive symptoms and no evidence concerning its use
for manic symptoms in patients with schizophrenia. 

CONCLUSIONS: Empirical data suggest that both groups of patients are best 
treated by optimizing antipsychotic treatment and that atypical antipsychotics 
may prove to be most effective. Adjunctive antidepressants may be useful for 
patients with major depression who are not acutely ill. Careful longitudinal 
assessment is required to ensure identification of primary mood disorders.

Publication Types:
Review
Review, Tutorial

PMID: 10450252 [PubMed - indexed for MEDLINE]



J Clin Psychopharmacol  1999 Aug;19(4):354-61

Use of atypical antipsychotic agents in bipolar and schizoaffective disorders:
review of the empirical literature.

Ghaemi SN, Goodwin FK.

Center on Neuroscience, Medical Progress, and Society, Department of Psychiatry,
George Washington University, Washington, DC, USA. nghaemi@partners.org

Atypical antipsychotic agents seem to be effective treatments for bipolar
disorder, especially as adjunctive treatments. They may be a safer and more
effective alternative to the common practice of maintenance adjunctive treatment
with traditional antipsychotic agents in patients with bipolar disorder.
However, currently available research studies are limited methodologically
mainly to open-label, uncontrolled designs. Further research is required before
the definitive efficacy of these agents in bipolar disorder is established. If
randomized or double-blind data support the open-label data reviewed here,
atypical antipsychotic agents may possess an important role in the adjunctive
treatment of bipolar disorder.

Publication Types:
Review
Review, Tutorial

PMID: 10440464 [PubMed - indexed for MEDLINE]



Suicide Life Threat Behav  1999 Spring;29(1):10-24

Psychosis and functioning as risk factors for later suicidal activity among
schizophrenia and schizoaffective patients: a disease-based interactive model.

Kaplan KJ, Harrow M.

Suicide Research Center, Michael Reese Hospital and Medical Center, Chicago, IL
60616-3390, USA.

The present research explores the relationship of positive symptoms, negative
symptoms, and posthospital functioning to subsequent suicidal behavior over a 7
1/2-year period, and examines whether these patterns vary with diagnosis. The
results support a multifactor model of suicide risk. Both psychosis and poor
functioning show some relationship to later suicidal activity for both
schizophrenic and schizoaffective patients. Psychosis may remain a risk factor
for suicidal activity for schizoaffective patients, even when functioning is
partialed out. This is in contrast to the schizophrenia patients, for whom
funtioning seems to mediate the effects of psychosis on later suicidality. In
general, adequacy of overall posthospital functioning mediates the effects of
some risk factors on suicidal activity within different diagnostic groups.

PMID: 10322617 [PubMed - indexed for MEDLINE]



J Clin Psychiatry  1999 Apr;60(4):245-8

Clinical experience with gabapentin in patients with bipolar or schizoaffective
disorder: results of an open-label study.

Cabras PL, Hardoy MJ, Hardoy MC, Carta MG.

Department of Neurological and Psychiatric Sciences, University of Florence,
Italy.

BACKGROUND: This study was carried out to evaluate the efficacy, tolerability,
and safety of gabapentin as an adjunctive treatment in patients with bipolar or
schizoaffective disorder with manic or hypomanic symptoms. 

METHOD: Twenty-five
patients fulfilling DSM-IV diagnostic criteria for bipolar I disorder or
schizoaffective disorder underwent a 16-week, open-trial treatment with
gabapentin. Symptom severity was measured using the Clinical Global Impressions
scale (CGI) and the Brief Psychiatric Rating Scale (BPRS). Baseline scores and
final scores were compared by using the Student t test and the Friedman range
variance analysis. 

RESULTS: Twenty-two patients (88%) completed the 16 weeks of
treatment with gabapentin; 19 (76%) had a positive response as measured by
changes in CGI and BPRS scores. The mean dose was 1440 mg/day. The only side
effect observed was oversedation, which decreased with continuing treatment.


CONCLUSION: Gabapentin was effective in the treatment of mania and hypomania in
patients with bipolar and schizoaffective disorders. If confirmed in controlled
studies, these findings suggest that gabapentin represents a well-tolerated,
rapidly acting antimanic agent.

Publication Types:
Clinical Trial

PMID: 10221286 [PubMed - indexed for MEDLINE]



Br J Psychiatry  1999 Jan;174:15-22

Olanzapine versus haloperidol in the treatment of schizoaffective disorder.
Acute and long-term therapy.

Tran PV, Tollefson GD, Sanger TM, Lu Y, Berg PH, Beasley CM Jr.

Psychopharmacology Division, Lilly Research Laboratories, Indianapolis, IN
46285, USA.

BACKGROUND: The effectiveness of antipsychotic monotherapy in schizoaffective
disorder is limited, and further constrained by safety concerns. 

AIMS: We aimed to compare the efficacy, tolerability and safety profile of the new
pharmaceutical, olanzapine, with haloperidol. 

METHOD: Data were assessed from
300 DSM-III-R schizoaffective subjects from a larger double-blind prospective
international study. Subjects were randomly allocated to six weeks of olanzapine
(5-20 mg) or haloperidol (5-20 mg) treatment; responders were followed for up to
one year of double-blind, long-term maintenance therapy. 

RESULTS: Olanzapine-treated patients achieved a statistically significant greater
improvement than haloperidol treated patients on overall measures of efficacy,
including clinical response. Significantly fewer olanzapine patients left the
study early, and fewer adverse events were observed among those receiving
olanzapine. During maintenance, olanzapine-treated patients continued to
experience additional improvement, with fewer EPS but more weight gain than
those on haloperidol. 

CONCLUSIONS: Olanzapine demonstrated substantial advantages over the conventional 
antipsychotic haloperidol in the management of schizoaffective disorder.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 10211146 [PubMed - indexed for MEDLINE]



Am J Psychiatry  1999 Apr;156(4):544-9

Comment in:
 Am J Psychiatry. 1999 Apr;156(4):501-3.

Predictors of treatment response from a first episode of schizophrenia or
schizoaffective disorder.

Robinson DG, Woerner MG, Alvir JM, Geisler S, Koreen A, Sheitman B, Chakos M,
Mayerhoff D, Bilder R, Goldman R, Lieberman JA.

Department of Psychiatry, Hillside Hospital, Long Island Jewish Medical Center,
New Hyde Park, N.Y., USA.

OBJECTIVE: This study examined the treatment response of patients with
first-episode schizophrenia and schizoaffective disorder and potential
predictors of response. 

METHOD: First-episode patients were assessed on measures
of psychopathology, cognition, social functioning, and biological parameters and
treated according to a standardized algorithm. 

RESULTS: One hundred eighteen
patients (52% male, mean age 25.2 years) entered the study. The cumulative
percentage of patients responding by 1 year was 87%; the median time to response
was 9 weeks. The following variables were significantly associated with less
likelihood of response to treatment: male sex, obstetric complications, more
severe hallucinations and delusions, poorer attention at baseline, and the
development of parkinsonism during antipsychotic treatment. Variables not
significantly related to treatment response were diagnosis (schizophrenia versus
schizoaffective disorder), premorbid functioning, duration of psychotic symptoms
prior to study entry, baseline disorganization, negative and depressive
symptoms, baseline motor function, akathisia and dystonia during treatment,
growth hormone and homovanillic acid measures, psychotic symptom activation to
methylphenidate, and magnetic resonance measures. 

CONCLUSIONS: Patients with first-episode schizophrenia and schizoaffective disorder 
have high rates of response to antipsychotic treatment; there are specific clinical 
and pathobiologic predictors of response.

Publication Types:
Clinical Trial

PMID: 10200732 [PubMed - indexed for MEDLINE]



Neuropsychopharmacology  1999 May;20(5):491-505

Ziprasidone 80 mg/day and 160 mg/day in the acute exacerbation of schizophrenia
and schizoaffective disorder: a 6-week placebo-controlled trial. Ziprasidone
Study Group.

Daniel DG, Zimbroff DL, Potkin SG, Reeves KR, Harrigan EP, Lakshminarayanan M.

Clinical Studies Ltd., Falls Church, VA 22041, USA.

In this double-blind study, patients with an acute exacerbation of schizophrenia
or schizoaffective disorder were randomized to receive either ziprasidone 80
mg/day (n = 106) or 160 mg/day (n = 104) or placebo (n = 92), for 6 weeks. Both
doses of ziprasidone were statistically significantly more effective than
placebo in improving the PANSS total, BPRS total, BPRS core items, CGI-S, and
PANSS negative subscale scores (p < .05). Ziprasidone 160 mg/day significantly
improved depressive symptoms in patients with clinically significant depression
at baseline (MADRS > or = 14, over-all mean 23.5) (p < .05) as compared with
placebo. The percentage of patients experiencing adverse events was similar in
each treatment group, and resultant discontinuation was rare. The most frequent
adverse events associated with ziprasidone were generally mild dyspepsia,
nausea, dizziness, and transient somnolence. Ziprasidone was shown to have a
very low liability for inducing movement disorders and weight gain. The results
indicate that ziprasidone is effective and well tolerated in the treatment of
the positive, negative, and depressive symptoms of an acute exacerbation of
schizophrenia or schizoaffective disorder.

Publication Types:
Clinical Trial
Clinical Trial, Phase III
Multicenter Study
Randomized Controlled Trial

PMID: 10192829 [PubMed - indexed for MEDLINE]



J Clin Psychiatry  1999;60 Suppl 5:16-21; discussion 22

Comment in:
 J Clin Psychiatry. 2001 Jan;62(1):59-60.

An overview of the treatment of schizoaffective disorder.

McElroy SL, Keck PE Jr, Strakowski SM.

Department of Psychiatry, University of Cincinnati College of Medicine, Ohio
45267-0559, USA.

Schizoaffective disorder is a common, chronic, and frequently disabling
psychiatric disorder. However, its pharmacologic treatment has not been well
studied. The authors review studies of traditional and novel pharmacologic
agents in treatment of schizoaffective disorder, and based on the findings,
present preliminary pharmacologic treatment guidelines for the disorder.

Publication Types:
Review
Review, Tutorial

PMID: 10192403 [PubMed - indexed for MEDLINE]



Schizophr Res  1999 Mar 1;35 Suppl:S5-12

Schizoaffective disorder: role of atypical antipsychotics.

Keck PE Jr, McElroy SL, Strakowski SM.

Department of Psychiatry, University of Cincinnati College of Medicine, OH
45267-0559, USA.

The pharmacologic treatment of schizoaffective disorder is one of the least
well-studied areas of contemporary pharmacotherapy. The authors review available
literature on the traditional pharmacologic treatment of schizoaffective
disorder, new data on the atypical antipsychotics, and potential pharmacologic
mechanisms by which these new agents may produce thymoleptic activity.

Publication Types:
Review
Review, Tutorial

PMID: 10190221 [PubMed - indexed for MEDLINE]



Arch Gen Psychiatry  1999 Mar;56(3):241-7

Predictors of relapse following response from a first episode of schizophrenia
or schizoaffective disorder.

Robinson D, Woerner MG, Alvir JM, Bilder R, Goldman R, Geisler S, Koreen A,
Sheitman B, Chakos M, Mayerhoff D, Lieberman JA.

Department of Psychiatry, Hillside Hospital, Long Island Jewish Medical Center,
Glen Oaks, NY 11004, USA. robinson@lij.edu

BACKGROUND: We examined relapse after response to a first episode of
schizophrenia or schizoaffective disorder. 

METHODS: Patients with first-episode
schizophrenia were assessed on measures of psychopathologic variables,
cognition, social functioning, and biological variables and treated according to
a standardized algorithm. The sample for the relapse analyses consisted of 104
patients who responded to treatment of their index episode and were at risk for
relapse. 

RESULTS: Five years after initial recovery, the cumulative first
relapse rate was 81.9% (95% confidence interval [CI], 70.6%-93.2%); the second
relapse rate was 78.0% (95% CI, 46.5%-100.0%). By 4 years after recovery from a
second relapse, the cumulative third relapse rate was 86.2% (95% CI,
61.5%-100.0%). Discontinuing antipsychotic drug therapy increased the risk of
relapse by almost 5 times (hazard ratio for an initial relapse, 4.89 [99% CI,
2.49-9.60]; hazard ratio for a second relapse, 4.57 [99% CI, 1.49-14.02]).
Subsequent analyses controlling for antipsychotic drug use showed that patients
with poor premorbid adaptation to school and premorbid social withdrawal
relapsed earlier. Sex, diagnosis, obstetric complications, duration of psychotic
illness before treatment, baseline symptoms, neuroendocrine measures,
methylphenidate hydrochloride challenge response, neuropsychologic and magnetic
resonance imaging measures, time to response of the initial episode, adverse
effects during treatment, and presence of residual symptoms after the initial
episode were not significantly related to time to relapse. 

CONCLUSIONS: There is a high rate of relapse within 5 years of recovery from a 
first episode of schizophrenia and schizoaffective disorder. This risk is diminished 
by maintenance antipsychotic drug treatment.

PMID: 10078501 [PubMed - indexed for MEDLINE]



J Nerv Ment Dis  1999 Feb;187(2):102-8

The relative influences of symptoms, insight, and neurocognition on social
adjustment in schizophrenia and schizoaffective disorder.

Smith TE, Hull JW, Goodman M, Hedayat-Harris A, Willson DF, Israel LM, Munich
RL.

Department of Psychiatry, Weill Medical College of Cornell University, New York
Presbyterian Hospital, White Plains 10605, USA.

Impaired insight and neurocognitive deficits are commonly seen in schizophrenia.
No study to date, however, has documented the relative influences of insight
deficits, neurocognitive functioning, and psychotic symptoms on overall social
adjustment in this population. This was done in a cohort of individuals
recovering from acute exacerbations. Forty-six individuals with schizophrenia or
schizoaffective disorder were recruited upon discharge from an inpatient unit.
Symptom levels, neurocognitive functioning (information processing, memory, and
executive functioning), and symptom awareness were documented, and social
adjustment was assessed in three domains: treatment compliance, social behavior,
and subjective quality of life. Cross-sectional data from initial assessments
are reported. Sequential linear regression analyses identified differential
associations between illness characteristics and outcome domains. Treatment
compliance was most influenced by insight; social behavior deficits were
associated with thought disorder and neurocognitive (working memory and
visuo-spatial) impairments; and quality of life was associated with mood
disturbances. Outcome is multidimensional in schizophrenia, and there are
differential patterns of associations between illness characteristics and
domains of social adjustment. Studies such as this can guide clinicians in
determining the most appropriate treatments for specific individuals and should
also guide researchers in efforts to clarify the processes that underlie
treatment response and recovery in schizophrenia.

PMID: 10067950 [PubMed - indexed for MEDLINE]



Psychopharmacology (Berl)  1998 Nov;140(2):173-84

Ziprasidone 40 and 120 mg/day in the acute exacerbation of schizophrenia and
schizoaffective disorder: a 4-week placebo-controlled trial.

Keck P Jr, Buffenstein A, Ferguson J, Feighner J, Jaffe W, Harrigan EP,
Morrissey MR.

University of Cincinnati College of Medicine, Department of Psychiatry, OH
45267-0559, USA.

A double-blind, placebo-controlled, multicenter study, was performed to evaluate
the efficacy and safety of ziprasidone in 139 patients with an acute
exacerbation of schizophrenia or schizoaffective disorder. Patients were
randomized to receive ziprasidone 40 mg/day, 120 mg/day or placebo for 28 days.
Ziprasidone 120 mg/day was significantly more effective than placebo in
improving the BPRS total, CGI-S. BPRS depression cluster and BPRS anergia
cluster scores (all P < 0.05). Similarly, the percentages of patients classified
as responders on the BPRS (> or = 30% reduction) and the CGI improvement (score
< or = 2) were significantly greater with ziprasidone 120 mg/day compared with
placebo (P < 0.05). The number of patients who experienced an adverse event was
similar in all three treatment groups, and discontinuation due to adverse events
was rare (five of 91 ziprasidone-treated patients). The most frequently reported
adverse events, that were more common in either ziprasidone group than in the
placebo group, were dyspepsia, constipation, nausea and abdominal pain. There
was a notably low incidence extrapyramidal side-effects (including akathisia)
and postural hypotension and no pattern of laboratory abnormalities or apparent
weight gain. Ziprasidone-treated patients were not clinically different from
placebo-treated patients on the Simpson-Angus Rating scale, Barnes Akathisia
scale and AIMS assessments. These results indicate that ziprasidone 120 mg/day
is effective in the treatment of the positive, negative and affective symptoms
of schizophrenia and schizoaffective disorder with a very low side-effect
burden.

Publication Types:
Clinical Trial
Clinical Trial, Phase II
Multicenter Study
Randomized Controlled Trial

PMID: 9860108 [PubMed - indexed for MEDLINE]



Pharmacopsychiatry  1998 Sep;31(5):163-9

Therapeutic window of serum haloperidol concentration in acute schizophrenia and
schizoaffective disorder.

Ulrich S, Neuhof S, Braun V, Meyer FP.

Institute of Clinical Pharmacology, University Hospital, Otto-von-Guericke
University, Magdeburg, Germany.

Although several studies have been performed on the serum level-therapeutic
effect relationship of neuroleptic drugs, the application of therapeutic
drug-monitoring of neuroleptics is still a matter of controversy. Until now,
haloperidol provided the most promising results. For this reason, an
investigation of the dependence of clinical improvement on haloperidol serum
levels was conducted in an acute psychiatric ward (Landeskrankenhaus Bernburg).
In an open clinical trial haloperidol serum levels were measured in 57 acute
schizophrenic patients for at least three weeks and correlated with clinical
outcome (percent change of Brief Psychiatric Rating Scale, BPRS). A bisigmoidal
model was used for data analysis. After three weeks of treatment, the major
result proved to be a significant relationship between haloperidol serum level
and therapeutic effect with pseudo-r2=0.316 and p=0.0031. Clinical improvement
is enhanced by increasing haloperidol concentration up to about 10 ng/ml. It
attains a maximum at about 10 ng/ml and decreases at haloperidol serum levels in
a range of 10 ng/ml to 50 ng/ml. A simulation of this dependence of clinical
improvement on serum levels, mediated by the variable dose design, can be
excluded because of the results of a retrospective analysis of dosing behavior.
Further evidence is thus provided for the dependence of therapeutic effect on
the serum haloperidol concentration in acute schizophrenia. For practical
application the position of a therapeutic window can be defined by a lower
threshold level of about 5 ng/ml and an upper threshold of about 17 ng/ml.
However, a maximal therapeutic effect is assured at 10 ng/ml. This should be the
target value in serum level-guided dose adjustments.

Publication Types:
Clinical Trial

PMID: 9832347 [PubMed - indexed for MEDLINE]



Psychiatry Res  1998 Oct 19;81(1):51-5

Change in plasma prolactin and clinical response to haloperidol in schizophrenia
and schizoaffective disorder.

Chou JC, Douyon R, Czobor P, Volavka J, Cooper TB.

Nathan Kline Institute, Orangeburg, NY 10962, USA. chou@nki.rfmh.org

There has been a long-standing interest in plasma prolactin as a potential in
vivo indicator of blockade of tuberoinfundibular D2 dopamine receptors.
Potential relationships between prolactin response and neuroleptic treatment
have been obscured by the use of high doses which have caused prolactin to
plateau. With lower doses of neuroleptic now commonly in use, prolactin may be
more valuable as a correlate of clinical response. In this study, 23 acutely
exacerbated schizophrenic and schizoaffective patients were washed out for at
least 6 days and were then treated with haloperidol to achieve fixed low to
moderate plasma levels under double-blind conditions. Clinical response, plasma
prolactin, and haloperidol plasma levels were measured weekly for 3 weeks.
Clinical symptoms at endpoint were related to both prolactin change and final
prolactin level during haloperidol treatment. Specifically, fewer symptoms at
endpoint were associated with a greater increase in prolactin over time and a
higher prolactin level at endpoint. Thus, prolactin increase caused by low to
moderate doses of haloperidol may be a correlate of endpoint symptomatology. As
lower doses of typical neuroleptics are now in use, prolactin response as a
predictor of clinical response may have more clinical utility. Further study of
prolactin and clinical response to typical neuroleptics should focus on low
neuroleptic doses.

Publication Types:
Clinical Trial

PMID: 9829650 [PubMed - indexed for MEDLINE]



Neuropsychobiology  1998 Oct;38(3):204-5

Lamotrigine in the treatment of schizoaffective disorder.

Erfurth A, Walden J, Grunze H.

Department of Psychiatry, University of Munich and University of Freiburg,
Germany. erfurth@uni-muenster.de

There is accumulating evidence for the efficacy of lamotrigine in the treatment
of bipolar disorder, including bipolar depression, both as monotherapy and in
combination with sodium valproate. We present the cases of 3 female patients
admitted to our hospital with the diagnosis of schizoaffective disorder who were
treated with lamotrigine. While dosages up to 200 mg/day, resulting in serum
concentrations of less than 5 mg/l, were only partially effective, 400 mg/day
(with serum concentrations >10 mg/l) led to considerable mood stability, with
complete remission from paranoid symptoms. We suggest that lamotrigine might be
helpful in the treatment of schizoaffective disorder, probably with serum
concentrations of more than 5 mg/l.

PMID: 9778612 [PubMed - indexed for MEDLINE]



Zh Nevrol Psikhiatr Im S S Korsakova  1998;98(7):29-34

[The use of verapamil for the prevention of relapses of affective and
schizoaffective psychoses]

[Article in Russian]

Raiushkin VA.

Efficiency of verapamil was studied in secondary prophylaxis of phasic affective
disorders, 50 patients with affective and schizoaffective psychoses were treated
during 2 years. Daily dose of verapamil was 80-320 mg (average dose-240 mg).
Three groups were formed. Group 1 (10 patients) included patients which didn't
receive any prophylactic therapy during previous 2 years. In group 2 (25
patients) and 3 (15 patients) verapamil was administrated after 2 years of
prophylactic therapy with either lithium carbonate or carbamazepine,
respectively. Clear prophylactic activity of verapamil was observed. There was
preference of its reducing effect on the depressive phases. The data obtained
and good tolerance of verapamil evidence for effectiveness of prolonged
administration of this preparation as a drug with antirelapsed properties.

Publication Types:
Clinical Trial

PMID: 9721375 [PubMed - indexed for MEDLINE]



Psychiatr Serv  1998 Aug;49(8):1029-33

Suicide prevention effects associated with clozapine therapy in schizophrenia
and schizoaffective disorder.

Reid WH, Mason M, Hogan T.

University of Texas Health Science Center in San Antonio, USA.
reidpsychiatry@compuserve.com

OBJECTIVE AND METHODS: Suicide is a significant cause of death among patients
with schizophrenia and schizoaffective disorder, affecting some 10 to 15 percent
of these patients. This study examined annual suicide rates over a two-year
period (1993-1995) among more than 30,000 patients with schizophrenia and
schizoaffective disorder who received services from the Texas Department of
Mental Health and Mental Retardation and suicide rates over a six-year period
(1991-1996) among a subgroup of patients treated with clozapine. 

RESULTS: The annual suicide rate for all patients with schizophrenia and schizo-
affective disorder was 63.1 per 100,000 patients, approximately five times higher 
than in the general population. In contrast, only one suicide occurred in six years
among patients treated with clozapine who were of similar diagnosis, age, and
sex, for a suicide rate of about 12.7 per 100,000 patients per year. This rate
is similar to the 15.7 per 100,000 patients per year for all U.S. patients
treated with clozapine, calculated from data reported as of June 1996 to the
clozapine national registry system maintained by Novartis Pharmaceuticals
Corporation, the U.S. manufacturer of clozapine. 

CONCLUSIONS: The study results suggest that clozapine therapy is associated with a 
reduced risk of suicide among patients with schizophrenia and schizoaffective disorder.

PMID: 9712207 [PubMed - indexed for MEDLINE]



J Clin Psychopharmacol  1998 Aug;18(4):296-304

An exploratory haloperidol-controlled dose-finding study of ziprasidone in
hospitalized patients with schizophrenia or schizoaffective disorder.

Goff DC, Posever T, Herz L, Simmons J, Kletti N, Lapierre K, Wilner KD, Law CG,
Ko GN.

Psychotic Disorders Program, Massachusetts General Hospital, Boston, USA.

Ninety patients with schizophrenia or schizoaffective disorder according to
DSM-III-R criteria participated in this double-blind, exploratory, dose-ranging
trial. After a single-blind washout period of 4 to 7 days, patients were
randomly assigned to receive one of four fixed doses of the new antipsychotic,
ziprasidone 4 (N = 19), 10 (N = 17), 40 (N = 17), or 160 (N = 20) mg/day or
haloperidol 15 mg/day (N = 17) for 4 weeks. A dose-response relationship among
ziprasidone groups was established for improvements in Clinical Global
Impression Severity (CGI-S) score (p = 0.002) but not in Brief Psychiatric
Rating Scale (BPRS) total score (p = 0.08). The intent-to-treat analysis of mean
changes from baseline in the BPRS total, BPRS Psychosis core, and CGI-S scores
demonstrated that ziprasidone 160 mg/day was comparable with haloperidol in
reducing overall psychopathology and positive symptoms and was superior to
ziprasidone 4 mg/day. Despite the small sample size and short duration of the
trial, the improvement in CGI-S with both ziprasidone 160 mg/day and haloperidol
15 mg/day was statistically significantly greater than with ziprasidone 4 mg/day
(p = 0.001 andp = 0.005, respectively). The percentage of patients classified as
responders on both the BPRS total (> or = 30% improvement) and CGI-Improvement
(score of 1 or 2) scales in the ziprasidone 160 mg/day group was similar to that
in the haloperidol group and nonsignificantly greater than that in the
ziprasidone 4 mg/day group. On all assessments of clinical efficacy, the
improvements associated with ziprasidone 4 mg/day, 10 mg/day, and 40 mg/day were
similar. Concomitant benztropine use at any time during the study was less
frequent with ziprasidone 160 mg/day (15%) than with haloperidol (53%).
Haloperidol was associated with a sustained hyperprolactinemia, unlike
ziprasidone, where only transient elevations in prolactin that returned to
normal within the dosing interval were observed. Ziprasidone was well tolerated,
and the incidence of adverse events was similar in all groups. The results of
this study suggest that ziprasidone 160 mg/day is as effective as haloperidol 15
mg/day in reducing overall psychopathology and positive symptoms of an acute
exacerbation of schizophrenia or schizoaffective disorder but has a lower
potential to induce extrapyramidal symptoms.

Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 9690695 [PubMed - indexed for MEDLINE]



Zh Nevrol Psikhiatr Im S S Korsakova  1998;98(3):15-8

[The efficacy of lithium carbonate and Contemnol in preventing affective and
schizoaffective psychoses]

[Article in Russian]

Mosolov SN, Kostiukova EG, Kuzavkova MV.

Two groups of patients (30 patients in each group) were treated by lithium
carbonate and contemnol. High preventive efficiency of both drugs was found:
average annual duration of manic and depressive exacerbation as well as their
frequency decreased practically by equal value--40-50%. The efficiency was
somewhat higher in the group of patients treated by contemnol (80%) as compared
with the group on lithium carbonate (70%). Total number of side-effects and
spontaneous complaints was twice as much in prophylaxis by lithium carbonate.
Wide application of contemnol in psychiatric practice for prophylaxis of
aggravations (fits) of affective and schizoaffective psychoses is recommended.

Publication Types:
Clinical Trial

PMID: 9575624 [PubMed - indexed for MEDLINE]



Zh Nevrol Psikhiatr Im S S Korsakova  1997;97(10):35-9

[The use of nifedipine for overcoming the insufficient preventive effect of
lithium carbonate in patients with affective and schizoaffective psychoses]

[Article in Russian]

Snedkova LV, Vasiuk VK, Fursov GG, Panteleeva GP.

26 patients with affective and schizoaffective psychoses either therapeutically
resistant to lithium salts or with intolerance to them were treated. Control
period of preventive therapy (lithium carbonate in average doses O.6-O.9 g
daily) and experimental period (nifedipine, average doses 30-40 mg daily) were
equal in duration, 2 years exactly. Preventive effect of nifedipine exceeded the
same effect of lithium carbonate in 65.4% of patients. The total duration of
affective attacks in the experimental period was reduced on 46.8% and their
frequency-on 31.7% in comparison with the control period. A number of hospital
admissions decreased (on 52.2%) with a simultaneous tendency to transition of a
disease to a more light level (a number of attacks of cyclothymic level
increased on 17.3%). The data gives ground for the perspectives of application
of nifedipine in the cases of insufficient prophylactic effect or intolerance to
lithium salts.

PMID: 9424345 [PubMed - indexed for MEDLINE]



Aust N Z J Psychiatry  1997 Jun;31(3):424-6

Clozapine in the management of bipolar and schizoaffective manic episodes
resistant to standard treatment.

Mahmood T, Devlin M, Silverstone T.

Department of Psychological Medicine, Dunedin School of Medicine, University of
Otago, New Zealand.

OBJECTIVE: To test the efficacy of clozapine in treatment-resistant manic
episodes. 

CLINICAL PICTURE: Three cases, two with bipolar disorder (manic) and
one of schizoaffective disorder (manic), were treated with clozapine. 

TREATMENT: Clozapine was used after the failure of standard antipsychotics and 
mood stabilizers. OUTCOME: All three cases were successfully treated. 

CONCLUSION: A controlled trial of clozapine in treatment-resistant bipolar and 
schizoaffective manic episodes is indicated.

PMID: 9226089 [PubMed - indexed for MEDLINE]



Am J Psychiatry  1997 Apr;154(4):457-65

Comment in:
 Am J Psychiatry. 1998 Aug;155(8):1133-4.
 Am J Psychiatry. 1998 Jan;155(1):152-3; discussion 153-5.
 Am J Psychiatry. 1998 Jan;155(1):152; discussion 153-5.
 Am J Psychiatry. 1998 Jan;155(1):153; discussion 153-5.

Olanzapine versus haloperidol in the treatment of schizophrenia and
schizoaffective and schizophreniform disorders: results of an international
collaborative trial.

Tollefson GD, Beasley CM Jr, Tran PV, Street JS, Krueger JA, Tamura RN, Graffeo
KA, Thieme ME.

Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center,
Indianapolis, IN 46285, USA.

OBJECTIVE: This international, multicenter double-blind trial was designed to
compare the therapeutic profile of an atypical antipsychotic, olanzapine, with
that of a conventional dopamine D2 antagonist, haloperidol. 

METHOD: A total of 1,996 patients at 174 sites in Europe and North America were 
randomly assigned to treatment with olanzapine (N = 1,336) or haloperidol (N = 660) 
over 6 weeks. The primary efficacy analysis involved the mean change from baseline 
to endpoint in total scores on the Brief Psychiatric Rating Scale (BPRS). 
Secondary analyses included comparisons of the mean change in positive and 
negative symptoms, comorbid depression, extrapyramidal symptoms, and overall drug 
safety. 

RESULTS: Olanzapine demonstrated clinical results superior to those of haloperidol 
on overall improvement according to the BPRS and on every secondary measure,
including depression. Olanzapine was also associated with significantly fewer
discontinuations of treatment due to lack of drug efficacy or adverse events.
Substantially more olanzapine-treated patients (66.5%) than haloperidol-treated
patients (46.8%) completed 6 weeks of therapy. Statistically significant
advantages of olanzapine treatment were related to 1) change in negative
symptoms, 2) extrapyramidal symptom profile, 3) effect on prolactin levels, and
4) response rate. 

CONCLUSIONS: Olanzapine shows a superior and broader spectrum of efficacy in the 
treatment of schizophrenic psychopathology, with a substantially more favorable 
safety profile, than haloperidol. It meets several of the criteria for a novel 
atypical antipsychotic agent.

Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 9090331 [PubMed - indexed for MEDLINE]



Psychiatr Prax  1997 Mar;24(2):88-9

[Risperidone after clozapine in therapy refractory schizoaffective psychosis--a
case report]

[Article in German]

Konrad C, Schormair C, Eikelmann B, Telger K.

Westf. Klinik fur Psychiatrie und Psychotherapie, Munster.

Recently, American authors pronounced the hypothesis that Clozapine-response may
be considered as a predictor of response to atypical neuroleptic. We report the
history of a schizoaffektive patient unresponsive to butyrophenone and
phenothiazine neuroleptic who was first treated with Clozapine and then with
Risperidone and who reacted very differently to these atypical neuroleptic.

PMID: 9190618 [PubMed - indexed for MEDLINE]



Eur Arch Psychiatry Clin Neurosci  1997;247(1):42-50

Lithium vs carbamazepine in the maintenance treatment of schizoaffective
disorder: a randomised study.

Greil W, Ludwig-Mayerhofer W, Erazo N, Engel RR, Czernik A, Giedke H,
Muller-Oerlinghausen B, Osterheider M, Rudolf GA, Sauer H, Tegeler J, Wetterling
T.

Psychiatric Hospital of the University of Munich, Germany.
wgreil@psy.med.uni-muenchen.de

In a randomised multicentre study, the prophylactic efficacy of lithium and
carbamazepine was compared in schizoaffective disorder. A total of 90 ICD-9
schizoaffective patients were included in the maintenance phase (2.5 years).
They were also diagnosed according to RDC and DSM-III-R and classified into
subgroups. Mean serum levels were 0.58 +/- 0.12 mmol/l for lithium and 6.4 +/-
1.5 micrograms/ml for carbamazepine (mean dose 643 +/- 179 mg/d). Outcome
criteria were hospitalisation, recurrence, concomitant psychotropic medication
and adverse effects leading to discontinuation. There were more non-completers
under carbamazepine than under lithium (p = 0.02). Survival analyses
demonstrated no significant differences between lithium and carbamazepine in
treatment outcome. Patient's ratings of side effects (p = 0.003) and treatment
satisfaction (p = 0.02) favoured carbamazepine. Following the RDC criteria,
patients of the schizodepressive and non-classifiable type did better under
carbamazepine (p = 0.055 for recurrence), whereas in the schizomanic patients
equipotency of both drugs was found. Applying DSM-III-R, carbamazepine
demonstrated a superiority in the patient group with more schizophrenia-like or
depressive disorders (p = 0.040 for recurrence), but not in patients fulfilling
the DSM-III-R criteria of bipolar disorder. Lithium and carbamazepine seem to be
equipotent alternatives in the maintenance treatment of broadly defined
schizoaffective disorders. However, in subgroups with depressive or
schizophrenia-like features and regarding its long-term tolerability
carbamazepine seems to be superior.

Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial

PMID: 9088805 [PubMed - indexed for MEDLINE]



J Nerv Ment Dis  1996 May;184(5):295-301

Treatment of negative symptoms in schizophrenia and schizoaffective disorder by
selegiline augmentation of antipsychotic medication. A pilot study examining the
role of dopamine.

Bodkin JA, Cohen BM, Salomon MS, Cannon SE, Zornberg GL, Cole JO.

McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical School,
Belmont, Massachusetts 02178, USA.

It has been suggested that schizophrenic negative symptoms may be manifestations
of regionally deficient CNS dopaminergic activity. We sought to test this
hypothesis by openly treating patients on chronic antipsychotic medication who
showed prominent negative symptoms with low-dose selegiline (5 mg b.i.d.), a
monoamine oxidase-B inhibitor that selectively enhances dopaminergic activity.
Twenty-one patients meeting DSM-III-R criteria for chronic schizophrenia (N =
14) or schizoaffective disorder (N = 7) with prominent negative symptoms were
studied. Subjects had been kept at their current antipsychotic and
antiparkinsonian medication dose levels for at least a month before the study,
which was continued unchanged throughout the trial. Over 6 weeks of selegiline
treatment, a 34.7% reduction in negative symptoms was demonstrated on the Scale
for the Assessment of Negative Symptoms. There were also reductions in
depressive symptoms (21-item Hamilton Depression Scale dropped 36.8%) and
extrapyramidal symptoms (Simpson-Angus Extrapyramidal Symptom Scale scores
dropped 27.7%), but no change was observed in the severity of positive symptoms
as measured by the Brief Psychiatric Rating Scale. Global clinical improvement
was demonstrated, with mean Clinical Global Impressions Scale score rising
17.6%. These findings support the hypothesis that negative symptoms, as well as
extrapyramidal symptoms and certain depressive symptoms, may be manifestations
of regionally deficient dopaminergic activity.

Publication Types:
Clinical Trial

PMID: 8627275 [PubMed - indexed for MEDLINE]



Am J Psychiatry  1996 May;153(5):711-3

Trends in pharmacotherapy of Schizoaffective and bipolar affective disorders: a
5-year naturalistic study.

Fenn HH, Robinson D, Luby V, Dangel C, Buxton E, Beattie M, Kraemer H, Yesavage
JA.

Psychiatry Service 116A/5C4, Veterans Affairs Health Care System, Palo Alto, CA
94304, USA.

OBJECTIVE: The authors' goal was to determine if the actual treatment of
schizoaffective and bipolar affective disorders had changed in light of recent
clinical drug trials that have suggested that valproate and carbamazepine may be
equivalent in efficacy to lithium. 

METHOD: Medication utilization rates for each
6-month period from July 1, 1989, to June 30, 1994, were compiled from the
clinical database of the Palo Alto Veterans Affairs Medical Center. 
RESULTS: The use of valproate and valproate plus lithium was negligible in 1989. 
by 1994, these medication regimens accounted for 25% of the standard antimanic 
treatments used for bipolar affective disorder and 38% of the treatments used for
schizoaffective disorder. Regimens of carbamazepine and carbamazepine plus
lithium dropped from 24% of antimanic treatments in 1989 to 18% in 1994. From
1989 to 1994, there was a decline in the rate of lithium monotherapy for
treatment of bipolar affective disorder (from 84% to 43%) and schizoaffective
disorder (from 100% to 53%). 

CONCLUSIONS: In the past 5 years, valproate monotherapy has increased as a 
percentage of total antimanic pharmacotherapies, while lithium monotherapy has 
declined.

PMID: 8615421 [PubMed - indexed for MEDLINE]



Am J Psychiatry  1996 Mar;153(3):417-9

Different side effect profiles of risperidone and clozapine in 20 outpatients
with schizophrenia or schizoaffective disorder: a pilot study.

Daniel DG, Goldberg TE, Weinberger DR, Kleinman JE, Pickar D, Lubick LJ,
Williams TS.

Washington Clinical Research Center, Falls Church, VA 22044, USA.

OBJECTIVE: The purpose of this study was to compare the side effect +profiles of
clozapine and risperidone. 

METHOD: The subjects were 20 outpatients with
schizophrenia or schizoaffective disorder who were clinically stable on a
regimen of clozapine at the time of screening. They underwent a randomized-order
crossover comparison of 6 weeks of risperidone treatment and 6 weeks of
clozapine treatment. Clinical and neurocognitive variables were assessed by
raters blind to medication status, and severity of side effects was determined
from patients' self-reports. 

RESULTS: Side effect measures, but not clinical
ratings, were significantly different after 6 weeks of treatment with the two
drugs. Patients required more benztropine for motor effects and complained of
more insomnia with risperidone and more sedation with clozapine. Body weight was
higher at the end of clozapine treatment than at the end of risperidone
treatment. 

CONCLUSIONS: In this exploratory study, the side effect profiles of
clozapine and risperidone were consistent with the different pharmacodynamic
profiles of the two drugs.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 8610833 [PubMed - indexed for MEDLINE]



Psychopharmacol Bull  1996;32(1):75-9

Effect of varying haloperidol plasma levels on negative symptoms in
schizophrenia and schizoaffective disorder.

Volavka J, Cooper TB, Czobor P, Meisner M.

Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA.

Double-blind haloperidol was administered during two consecutive 3-week periods
to 65 patients with acutely exacerbating schizophrenia or schizoaffective
disorder. Two plasma levels were targeted. low (2 ng/mL) and moderate (10
ng/mL). The subjects were randomly assigned to four treatment sequences
(low-low, low-moderate, moderate-moderate, or moderate-low). Data from 28
patients were available for the analyses of the second study period. In that
period, decrease of plasma levels reduced mild but not severe negative symptoms.
Thus, lowering of the plasma levels after the first 3 weeks of treatment may
improve mild negative symptoms. Conversely, increasing the plasma levels may
make mild negative symptoms worse.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 8927679 [PubMed - indexed for MEDLINE]



Psychopharmacol Bull  1996;32(1):55-61

Risperidone therapy in treatment refractory acute bipolar and schizoaffective
mania.

Sajatovic M, DiGiovanni SK, Bastani B, Hattab H, Ramirez LF.

Cleveland Veterans Administration Medical Center, OH-44141, USA.

This pilot study evaluated the efficacy of risperidone therapy in patients with
bipolar I or schizoaffective mania who were treatment resistant or treatment
intolerant. Patient psychopathology and involuntary movements were evaluated
with a variety of scales, and risperidone was administered on an open-label
basis. Five of six patients (all bipolar) discontinued risperidone therapy
because of adverse drug effects (2 patients), lack of significant drug response
and subjective clinical worsening (1 patient), or worsening of manic symptoms (2
patients). One patient with schizoaffective illness improved. Risperidone used
without the addition of a mood stabilizer was ineffective in treating pure manic
psychosis. In some vulnerable bipolar patients, risperidone monotherapy may have
antidepressant activity that could exacerbate mania. If risperidone proves to
have antidepressant activity, it may become an important agent in the therapy of
patients with depressive symptoms and psychosis.

PMID: 8927675 [PubMed - indexed for MEDLINE]



J Clin Psychiatry  1996;57 Suppl 9:41-8

New developments in the pharmacologic treatment of schizoaffective disorder.

Keck PE Jr, McElroy SL, Strakowski SM.

Biological Psychiatry Program, University of Cincinnati College of Medicine, OH
45267-0559, USA.

BACKGROUND: Schizoaffective disorder is a common, chronic, and frequently
disabling psychiatric disorder. However, the pharmacologic treatment of this
disorder has not been well studied. 

METHOD: The authors reviewed the available
literature regarding the acute and prophylactic pharmacologic treatment of
schizoaffective disorder 

RESULTS: Fourteen controlled studies, and only 10 using
modern criteria to define the disorder, reported on the efficacy of typical
antipsychotics, thymoleptics, or the combination in the acute treatment of
schizoaffective disorder. In acute treatment studies of schizoaffective
disorder, bipolar type (manic), typical antipsychotics and lithium were
comparable in efficacy except in agitated patients for whom antipsychotics were
superior. The combination of lithium and antipsychotics appeared to be superior
to antipsychotics alone in this patient subtype. In the only controlled study of
the acute treatment of schizoaffective disorder, depressive type, combined
treatment with antipsychotics and antidepressants was not superior to treatment
with antipsychotics alone. 

CONCLUSION: Although combination treatment with
antipsychotics and thymoleptics is common practice in the prophylactic
management of schizoaffective disorder, the efficacy of this strategy has not
been studied in controlled trials. Recent preliminary data from open trials
suggest that the mood stabilizers valproate and carbamazepine and the novel
antipsychotics clozapine and risperidone may be promising new treatments for
schizoaffective disorder. Evidence implicating 5-HT2 receptor blockade as an
important mechanism underlying possible thymoleptic activity for clozapine and
risperidone is also reviewed.

Publication Types:
Review
Review, Tutorial

PMID: 8823349 [PubMed - indexed for MEDLINE]



Zh Nevropatol Psikhiatr Im S S Korsakova  1996;96(1):61-6

[A trial of the use of nifedipine for preventing relapses in affective and
schizoaffective psychoses]

[Article in Russian]

Snedkova LV.

Nifedipine was applied for the secondary prophylaxis of affective phasic
disorders. 21 patients with both affective and schizoaffective psychoses were
treated with nifedipine for 1-3 years (mostly for 2 years) in a dose of 20-60 mg
daily (usually 30-40 mg). The clear prophylactic effect of nifedipine was
observed in 76.2% of cases. The duration of affective phases reduced by 44.8%
while their frequency decreased by 40.4% as compared with the control group. The
positive therapeutic effect was more pronounced for manic disorders (the
transition of the disturbances to subclinical, ambulant level). The preventive
effect of the drug was more clear in affective than in schizoaffective psychoses
(91.7% and 55.6%, respectively) as well as it was more expressed in bipolar
(84.6%) than in monopolar (62.5%) patients. The low frequency (23.8%) of
side-effects occurred to be the positive characteristics of nifedipine treatment
especially in long-term therapy.

Publication Types:
Clinical Trial
Controlled Clinical Trial

PMID: 8677723 [PubMed - indexed for MEDLINE]



Arch Gen Psychiatry  1995 Oct;52(10):837-45

Comment in:
 Arch Gen Psychiatry. 1996 Dec;53(12):1167-9.

Plasma haloperidol levels and clinical effects in schizophrenia and
schizoaffective disorder.

Volavka J, Cooper TB, Czobor P, Meisner M.

Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA.

BACKGROUND: Plasma haloperidol levels between 5 and 11 ng/mL may be clinically
optimal for acutely exacerbated schizophrenia, but the evidence for this
therapeutic window has been inconsistent. 

METHODS: Haloperidol was administered
in a double-blind manner during two consecutive 3-week experimental periods to
65 patients with acutely exacerbated schizophrenia or schizoaffective disorder.
Two plasma levels were targeted: "low" (2 ng/mL) and "moderate" (10 ng/mL). The
subjects were randomly assigned to four treatment sequences (low-low,
low-moderate, moderate-moderate, or moderate-low). 

RESULTS: In the first 3 weeks, the antipsychotic efficacy of haloperidol 
increased with plasma levels up to approximately 12 ng/mL. In the second 3 weeks, 
decrease of plasma levels reduced negative symptoms. 

CONCLUSION: For most patients, plasma levels not exceeding 12 ng/mL yield the 
best results in the first 3 weeks of treatment. Subsequent lowering of the plasma 
levels may improve negative symptoms.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 7575103 [PubMed - indexed for MEDLINE]


J Clin Psychiatry  1995 Nov;56(11):514-8

Efficacy of risperidone treatment for psychoses associated with schizophrenia,
schizoaffective disorder, bipolar disorder, or senile dementia in 11 geriatric
patients: a case series.

Madhusoodanan S, Brenner R, Araujo L, Abaza A.

Department of Psychiatry, St. John's Episcopal Hospital South Shore, Far
Rockaway, NY 11691, USA.

BACKGROUND: Clinical trials of risperidone, a recently approved novel
antipsychotic, included elderly healthy patients, but more data are needed on
the effects of risperidone in this population, especially those with comorbid
medical illnesses. 

METHOD: Risperidone was used to treat 11 elderly hospitalized
patients between 61 and 79 years of age who manifested signs of psychoses
related to schizophrenia, schizoaffective disorder, bipolar disorder, or senile
dementia. All patients had been treated previously with classic antipsychotics.
Response was assessed by clinical observation of the patients' behavior.


RESULTS: Eight patients responded to treatment, 1 did not respond, and 2 had
treatment discontinued because of hypotension or dizziness. Positive and
negative symptoms decreased markedly in 7 of the responding patients. Four
patients had preexisting extrapyramidal symptoms (EPS) and symptoms of tardive
dyskinesia that also decreased in response to risperidone treatment. In
addition, 4 patients were able to discontinue anti-parkinsonian medications, and
2 were able to discontinue antihypertensive medications. Side effects related to
blockade of dopamine, histamine, and serotonin were negligible. No adverse
consequences occurred when electroconvulsive therapy, carbamazepine, or lithium
was given concurrently. 

CONCLUSION: The reduction of both positive and negative
symptoms of schizophrenia and the lack of significant EPS, tardive dyskinesia,
sedation, and anticholinergic side effects indicate that risperidone is a safe
and effective medication for the elderly.

Publication Types:
Clinical Trial

PMID: 7592504 [PubMed - indexed for MEDLINE]



J Clin Psychiatry  1995 Oct;56(10):466-70

Clinical predictors of acute risperidone response in schizophrenia,
schizoaffective disorder, and psychotic mood disorders.

Keck PE Jr, Wilson DR, Strakowski SM, McElroy SL, Kizer DL, Balistreri TM,
Holtman HM, DePriest M.

Department of Psychiatry, University of Cincinnati College of Medicine, OH
45267-0559, USA.

BACKGROUND: In studies of patients with schizophrenia, the atypical
antipsychotic risperidone has been shown to be comparable in efficacy to
haloperidol and, at dosages of 4 to 8 mg/day, to have a lower rate of
extrapyramidal side effects. However, little is known about the efficacy of
risperidone in patients with schizophrenia refractory to treatment with typical
antipsychotics, schizoaffective disorder, and psychotic mood disorders. The
purpose of this study was to assess the efficacy of risperidone in the treatment
of these disorders and to identify clinical factors associated with risperidone
response. 

METHOD: By surveying treating clinicians and chart data, we assessed
response to risperidone and factors associated with response to risperidone in
144 consecutive patients treated with the drug for at least 2 weeks at a
regional state psychiatric hospital. 

RESULTS: Patients displaying a
moderate-to-marked response to risperidone were more likely to be younger;
receive diagnoses of bipolar disorder or schizoaffective disorder, depressive
type; and have a shorter duration of illness and shorter length of stay prior to
risperidone treatment. Response to risperidone was sufficient to allow discharge
in 26% of patients with treatment-refractory schizophrenia hospitalized for at
least 10 weeks prior to risperidone and in 11% of patients with
treatment-refractory schizophrenia hospitalized for greater than 1 year.

CONCLUSION: Risperidone may be a useful alternative or adjunctive treatment for
patients with schizophrenia refractory to treatment with standard antipsychotic
agents, schizoaffective disorder (especially the depressive type), and bipolar
disorder when used in conjunction with mood stabilizers.

PMID: 7559373 [PubMed - indexed for MEDLINE]



Psychiatry Res  1995 Mar 27;56(2):121-34

Family interactions of schizophrenic and schizoaffective patients: determinants
of relatives' negativity.

Sayers SL, Bellack AS, Mueser KT, Tierney AM, Wade JH, Morrison RL.

Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute,
Philadelphia 19129, USA.

Videotaped family problem-solving interactions of 57 schizophrenic or
schizoaffective patients and their relatives were examined for predictors of
negativity of their communication behavior. Ratings of patients' behaviors and
independent assessments of patients' symptomatology were used to predict the
negativity of relatives in the videotaped interaction. The results indicated
that severity of symptomatology was not related to relatives' negativity.
Patients' social skill, as independently assessed by a role-play test, also was
not associated with relatives' negativity. The regression results suggest that
with both members of a patient-relative dyad, the quality of communication in a
discussion is related to the other participant's level of negativity.

PMID: 7667437 [PubMed - indexed for MEDLINE]



Schizophr Bull  1995;21(4):693-701

Erratum in:
 Schizophr Bull 1996;22(2):followi

Maintenance medication for schizophrenia and schizoaffective patients.

Lerner V, Fotyanov M, Liberman M, Shlafman M, Bar-El Y.

Beer Sheva Mental Health Ctr., Israel.

This study assesses the different approaches to treating patients with
schizoaffective and paranoid schizophrenia in remission. Individualized
treatment of 220 outpatient schizophrenia patients was conducted for 4 years.
The choice of treatment was based on the course of the disease and the frequency
of relapses. The influence of changes in treatment on the patterns of relapses
is presented. The results of this prospective followup open study were evaluated
by comparing data received during our research with data from the two preceding
4-year periods and with data from the control group. Compared with routine
methods, special treatment tactics led to a significantly decreased frequency of
relapses in patients with frequent relapses (p < 0.001). In patients with rare
relapses, full cessation of treatment did not lead to increasing mean frequency
of relapses. Treatment in remission should be based on the peculiarities of the
course of disease, specifically, frequency of relapses, type of schizophrenia,
and presence or absence of positive psychopathological signs in remission.

PMID: 8749895 [PubMed - indexed for MEDLINE]

R E T U R N to DEPRESSION CENTRAL

Revised 2/15/03