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Treatment of Chronic Schizophrenia

  • Practical Therapeutics
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Summary

The comprehensive treatment of schizophrenia requires the full resources of a clinical team that is able to offer treatment for the acute psychotic state in a hospital environment, and appropriate rehabilitation following resolution of the florid symptoms. Following a second or subsequent relapse, maintenance therapy with long-acting injections of depot antipsychotics will be required for an unknown period. Although drugs form an essential part of all treatments, it is essential to examine the environment for precipitating factors and to involve the patient’s family in the rehabilitation. Recent studies have reported that some patients still have a relatively poor prognosis; although this proportion may be in the minority, the strain on the whole family of an even moderately handicapped patient can be enormous, and it is important to examine the needs of the whole family in evaluating care within the community.

The effect of antipsychotic drugs is much wider than the mere control of acute symptoms and can influence the patterns of social behaviour and rehabilitation, in addition to offering protection against stress. The proper use of depot injections requires that they be kept under constant review. The current widespread practice of prescribing anti-cholinergic drugs on a prophylactic basis, or even as the initial treatment of extrapyramidal side-effects, needs revision.

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References

  • Alarcon, R. de, and Carney, M.W.P.: Severe depressive mood changes following slow-release intramuscular fluphenazine injections. British Medical Journal 3: 464–467 (1969).

    Article  Google Scholar 

  • Ananth, J.V.; Horodesky, J.; Lechman, H.E. and Bon, T.A.: Effect of withdrawal of chronic hospitalised psychiatric patients. Laval Medicine 41: 934–938 (1974).

    Google Scholar 

  • Angrup-Andersson, L.; Bengtsson, A.; Erlandsson, K.; Gottfries, CG. and Witzell-Ostlund, G.: Flupenthixol decanoate: Controlled investigations concerning dosage. Acta Psychiatrica Scandinavica Supplement 255: 7–14 (1974).

    Article  Google Scholar 

  • Ayd, F.J. A survey of drug-induced extrapyramidal reactions. Journal of the American Medical Association 175: 1054–1060 (1961).

    Article  PubMed  CAS  Google Scholar 

  • Ayd, F.J.: International Drug Therapy Newsletter, 9: 8 (1974).

    Google Scholar 

  • Ballinger, B.R.; Ramsay, A.C. and Stewart, J.M.: Methods of assessment of drug administration in psychiatric hospitals. British Journal of Psychiatry 127: 494–498 (1975).

    Article  PubMed  CAS  Google Scholar 

  • Berg, S.; Gabriel, A.R. and Impastato, D.J.: Comparative evaluation of the safety of chlorpromazine and reserpine used in conjunction with ECT. Journal of Neuro-Psychiatry 1: 104 (1959).

    CAS  Google Scholar 

  • Birley, J.L.T. and Brown, G.W.: Crisis and life changes preceding the onset or relapse of schizophrenia. British Journal of Psychiatry 116: 327–333(1970).

    Article  PubMed  CAS  Google Scholar 

  • Brown, G.W.: Experiences of discharged chronic schizophrenic patients in various types of living group. Milbank Memorial Fund Quarterly 37: 105(1959).

    Article  PubMed  CAS  Google Scholar 

  • Brown, G.W. and Birley, J.L.T.: Crises and life changes and the onset of schizophrenia. Journal of Health and Social Behaviour 9: 203–214(1968).

    Article  Google Scholar 

  • Brown, G.W.; Birley, J.L.T. and Wing, J.K.: Influence of family life on the course of schizophrenic disorders: A replication. British Journal of Psychiatry 121: 241–258 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Brown, G.W.; Carstairs, G.M. and Topping, G.: Post hospital adjustment of chronic mental patients. Lancet 2: 685 (1958).

    Article  PubMed  CAS  Google Scholar 

  • Brown, G.W.; Monck, E.M.; Carstairs, G.M. and Wing, J.K.: Influence of family life on the course of schizophrenic illness. British Journal of Preventive and Social Medicine 16: 55 (1962).

    Google Scholar 

  • Carney, M.W.P. and Sheffield, B.F.: The long term maintenance treatment of schizophrenic out-patients with depot flupenthixol. Current Medical Research and Opinion 1: 423–426 (1973).

    Article  PubMed  CAS  Google Scholar 

  • Carney, M.W.P. and Sheffield, B.F.: Forty-two months experience of flupenthixol decanoate in the maintenance treatment of schizophrenia. Current Medical Research and Opinion 3: 447–452(1975).

    Article  Google Scholar 

  • Carney, M.W.P. and Sheffield, B.F.: Comparison of antipsychotic depot injections in the maintenance treatment of schizophrenia. British Journal of Psychiatry 129: 476–481 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Chan, T.L.; Sakalis, G. and Gershon, S.: Some aspects of chlorpromazine metabolism in humans. Clinical Pharmacology and Therapeutics 14: 133 (1973).

    CAS  Google Scholar 

  • Chien, C.P. and Cole, J.D.: Depot phenothiazine treatment in acute psychosis: A sequential comparative clinical study. American Journal of Psychiatry 130: 13–18 (1973).

    PubMed  CAS  Google Scholar 

  • Cole, J.O.: A symposium on long acting phenothiazines in psychiatry. Diseases of the Nervous System Supplement 31: 5–6 (1970).

    Google Scholar 

  • Curry, S.H.: Chlorpromazine concentrations in plasma, excretion in urine and duration of effect. Proceedings of the Royal Society of Medicine 64: 285–289 (1971).

    PubMed  CAS  Google Scholar 

  • Curry, S.H.; Lewis, D.M.; Samuel, G. and Mould, G.P.: Fluphenazine decanoate in patients absorbing oral chlorpromazine ineffectively; in Ayd (Ed.) The Future of Pharmacotherapy, New Drug Delivery Systems (International Drug Therapy Newsletter, Baltimore 1973).

    Google Scholar 

  • Delay, J.; Deniker, P. and Harl, J.M.: Utilisation en therapeutique psychiatrique d’une phenothiazine d’action centrale elective (45-60 RP), Annales Medico-Psychologiques 110: 112–117 (1952).

    CAS  Google Scholar 

  • Dencker, S.J.: High dose treatment with neuroleptics in the acute phase of mental disease. Proceedings of the Royal Society of Medicine 69 (Suppl. 1): 32–34 (1976).

    PubMed  Google Scholar 

  • Dencker, S.J. and Malm, U.: in Daniel (Ed.) Squibb Symposium on Long-acting Phenothiazines, p. 29 (Groningen, 1970).

  • Denham, J. and Adamson, L.: The contribution of fluphenazine enanthate and decanoate in the prevention of readmission of schizophrenic patients. Acta Psychiatrica Scandinavica 47: 420–430(1971).

    Article  PubMed  CAS  Google Scholar 

  • Diamond, L.S. and Marks, J.B.: Discontinuance of tranquillisers among chronic schizophrenic patients receiving maintenance dosage. Journal of Nervous and Mental Diseases 131: 247–251 (1960).

    Article  CAS  Google Scholar 

  • Ekdawi, M.Y. and Fowke, R.: A controlled trial of anti-parkinson drugs in drug induced parkinsonism. British Journal of Psychiatry 112: 633–636(1966).

    Article  PubMed  CAS  Google Scholar 

  • Gittelman, R.K.; Klein, D.F. and Pollock, M.: Effects of psychotropic drugs on long term adjustment. A review. Psychopharmacologia 5: 317–338 (1964).

    Article  CAS  Google Scholar 

  • Goldberg, S.C.; Klerman, G.L. and Cole, J.O.: Changes in psychopathology and word behaviour as a function of phenothiazine treatment. British Journal of Psychiatry 3: 120–133(1965).

    Article  Google Scholar 

  • Gottfries, C.G.: Clinical trial of flupenthixol decanoate as a depot neuroleptic. Nordisk Psyckiatrisk Tidsskrift 25: 296–303 (1971).

    Article  CAS  Google Scholar 

  • Gottfries, CG. and Green, L.: Flupenthixol decanoate in the treatment of out-patients. Acta Psychiatrica Scandinavica Supplement 255: 15–24(1974).

    Article  CAS  Google Scholar 

  • Hall, P, and Coleman, J.: Flupenthixol in the treatment of schizophrenia. British Journal of Psychiatry 120: 241–244 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Hanson, H.M.; Stone, CA. and Witoslawski, J.J.: Antagonisms to the antiavoidance effects of various agents by anti-cholinergic drugs. Journal of Pharmacology and Experimental Therapeutics 173: 117–124(1970).

    PubMed  CAS  Google Scholar 

  • Hare. E.H. and Wilcox, D.R.C.: Do psychiatric inpatients take their pills? British Journal of Psychiatry 113: 1435 (1967).

    Article  PubMed  CAS  Google Scholar 

  • Hirsch, S.R.; Gaind, R.; Rhode, P.D.; Stevens, B.C. and Wing, J.K.: Out patient maintenance of chronic schizophrenic patients with long acting phenothiazine. British Medical Journal 1: 633–637(1973).

    Article  PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: The side-effects of fluphenazine decanoate. British Journal of Psychiatry 123: 519–523 (1973a).

    Article  PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: Treatment of depression in general practice. British Medical Journal 2: 18–20 (1973b).

    Article  PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: A study of the use of antidepressant medication in general practice. British Journal of Psychiatry 125: 186–192 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: Observations on the dose regimes of fluphenazine decanoate in maintenance therapy of schizophrenia. British Journal of Psychiatry 126: 457–461 (1975).

    Article  PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: The expectation of outcome from maintenance therapy in chronic schizophrenic patients. British Journal of Psychiatry 128: 246–250 (1976a).

    Article  PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: The duration of maintenance therapy in chronic schizophrenia. Acta Psychiatrica Scandinavica 53: 298–301 (1976b).

    Article  PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: Practical considerations in the use of depot neuroleptics for the treatment of schizophrenia. British Journal of Hospital Medicine 17: 546–559 (1977a).

    PubMed  CAS  Google Scholar 

  • Johnson, D.A.W.: The prevalence and treatment of drug induced extrapyramidal symptoms. British Journal of Psychiatry (In press, 1977b).

  • Johnson, D.A.W. and Freeman, H.L.: The long-acting tranquillisers. The Practitioner 208: 395–400 (1972).

    PubMed  CAS  Google Scholar 

  • Johnson, D.A.W. and Malik, N.A.: A double-blind comparison of fluphenazine decanoate and flupenthixol decanoate in the treatment of acute schizophrenia. Acta Psychiatrica Scandinavica 51: 257–267(1975).

    PubMed  CAS  Google Scholar 

  • Kennedy, P.F.; Hershon, H.I. and McGuire, R.G.: Extrapyramidal disorders after prolonged phenothiazine therapy. British Journal of Psychiatry 118: 509–518 (1971).

    Article  PubMed  CAS  Google Scholar 

  • Leff, J.P. and Wing, J.K.: Trial of maintenance therapy in schizophrenia. British Medical Journal 3: 559–604 (1971).

    Article  Google Scholar 

  • McClelland, H.A.; Blessed, G.; Bhate, S.; Ali, N. and Clarke, P.A.: The abrupt withdrawal of antiparkinson drugs in schizophrenic patients. British Journal of Psychiatry 124: 151–159(1974).

    Article  PubMed  CAS  Google Scholar 

  • McClelland, H.A.; Farquharson, R.G.; Leyburn, P.; Furness, J.A. and Schiff, A.A.: Very high dose fluphenazine decanoate. Archives of General Psychiatry 33: 1435–1439 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Marsden, CD.: The neuropharmacology of abnormal movement disorders; in Modern Trends in Neurology, pp.141–157 (Butterworths, London 1975).

    Google Scholar 

  • Mindham, R.H.S.; Gaind, R.; Anstee, B.H. and Rimmer, L.: Comparison of amantidine, orphenadrine and placebo in the control of phenothiazine induced parkinsonism. Psychological Medicine 2: 406–413 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Neve, H.K.: Demonstration of chlorpromazine hydrochloride inurine. Journal of Mental Science 104: 488–490 (1958).

    PubMed  CAS  Google Scholar 

  • Parkes, CM.; Brown, G.W.; and Monck, E.M.: The general practitioner and the schizophrenic patient. British Medical Journal 1: 972(1962).

    Article  PubMed  CAS  Google Scholar 

  • Passamanick, B.; Scarpitti, F.R., Lifton, M.; Dinitz, S.; Wenert, J.J. and McPheeters, J.L: Home vs. hospital care for schizophrenics. Journal of the American Medical Association 187: 177–181 (1964).

    Article  Google Scholar 

  • Prien, R.F. and Cole, J.O.: High dosage chlorpromazine therapy in chronic schizophrenia. Archives of General Psychiatry 18: 482–495 (1968).

    Article  Google Scholar 

  • Rees, L.: Electronarcosis in treatment of schizophrenia. Journal of Mental Science 95: 625 (1949).

    PubMed  CAS  Google Scholar 

  • Renton, CA.; Affleck, J.W.; Carstairs, M and Forrest, A.D.: A follow-up of schizophrenic patients in Edinburgh. Acta Psychiatrica Scandinavica 39: 548–600 (1963).

    Article  PubMed  CAS  Google Scholar 

  • Rifkin, A.; Quitkin, F.; Carrillo, C. and Klein, D.F.: Very high dosage fluphenazine for non-chronic treatment refractory patients. Archives of General Psychiatry 25: 398–403 (1971).

    Article  PubMed  CAS  Google Scholar 

  • Rivera-Calimlim, L.: Impaired absorption of chlorpromazine in rats given trihexyphenidyl. British Journal of Pharmacology 56: 301–305(1976).

    Article  PubMed  CAS  Google Scholar 

  • Rivera-Calimlim, L.; Castenda, L. and Lasagna, L.: Effects on mode of management of chlorpromazine in psychiatric patients. Clinical Pharmacology and Therapeutics 14: 978–986 (1973).

    PubMed  CAS  Google Scholar 

  • Rivera-Calimlim, L.; Narallah, H.; Strauss, J. and Lasagna, L.: Clinical response and plasma levels: Effects of dose, dose schedules, and drug interactions on plasma chlorpromazine levels. American Journal of Psychiatry 133: 646–652 (1976).

    PubMed  CAS  Google Scholar 

  • Simpson, G.M.: Controlled studies of anti-parkinson agents in the treatment of drug induced extrapyramidal symptoms. Acta Psychiatrica Scandinavica Supplement 212: 44–51 (1970).

    Article  CAS  Google Scholar 

  • Singh, M.M. and Smith, J.: Reversal of some therapeutic effects of an antipsychotic agent by an antiparkinson drug. Journal of Nervous and Mental Diseases 157: 50–57 (1973).

    Article  CAS  Google Scholar 

  • Stevens, B.C.: Role of fluphenazine decanoate in lessening the burden of chronic schizophrenics on the community. Psychological Medicine 3: 141–158 (1973).

    Article  PubMed  CAS  Google Scholar 

  • Vaughn, C and Leff, J.P.: The measurement of expressed emotion in families of psychiatric patients. British Journal of Social and Clinical Psychology 15: 157–165 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Wilcox, D.R.C; Gillan, R. and Hare, E.H.: Do psychiatric out-patients take their drugs? British Medical Journal 2: 790–792 (1965).

    Article  Google Scholar 

  • Wing, J.K.: Social treatment, rehabilitation and management; in Coppen and Walk (Eds.) Recent Developments in Schizophrenia (Headley Bros, London 1967).

    Google Scholar 

  • Yaryura-Tobias, J.A.; Wolpert, A.; Dana. L. and Merlis, S.: action of L-dopa in drug induced extrapyramidalism. Diseases of the Nervous System 31: 60–63 (1970).

    PubMed  CAS  Google Scholar 

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Johnson, D.A.W. Treatment of Chronic Schizophrenia. Drugs 14, 291–299 (1977). https://doi.org/10.2165/00003495-197714040-00004

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