Atypical neuroleptics and selective attention]

GOALS: The aim of this study was to examine selective attention in patients with chronic and refractory schizophrenia who had been exposed for six months to atypical neuroleptic medications: risperidone or clozapine. METHOD: 17 patients satisfying DSM III-R criteria for schizophrenia were assessed according to BPRS and PANSS and abnormal involuntary movements to ESRS. Selective attention tasks were performed before treatment with risperidone or clozapine and at two times during the treatment (6 weeks, T1, and 24 weeks, T2). Patients' performance data were compared to data from a group of general population at T1. Selective attention refers to the ability to discriminate relevant information from irrelevant one. This was measured by a visual search task. Subjects had to search for a target specified by a conjunction of features (color and shape). The target was a black X, while the distracters were white X's, black O's and white O's. The stimuli were displayed on a Macintosh SE computer. A two-button response box was used for response production and the experiment was run in a dimly lit room. A white-fixation stimulus was shown at the center of the display screen between trials. The number of stimuli displayed on a single trial was 1, 4, 7 or 10. The median RTs and error rates of subjects were computed for each factor (target presence and number of stimuli). RESULTS: A Group X Number of items X Presence of target ANOVA applied on median correct RTs revealed a significant Group X Presence interaction [F(1,176) = 60.433, p < .0001]. Performances improved with the time (F2, p < .01). Correlations were found between positive score on PANSS and performance on selective attention (r39 = -.391). CONCLUSION: Atypical neuroleptic do not have a deleterious effect on selective attention but a favorable effect on the schizophrenic patients' performance.     

Delayed-action neuroleptics and maintenance treatments]

Neuroleptic therapeutic trial is a short time experience, usually lasting three months, or even less. A reference treatment (sometimes a placebo) or the studied neuroleptic are given respectively to two randomized samples from the same population. One variable is fixed, chemotherapy, and the other therapeutic variables--psychologic and socio-familial--are supposed to be constant during that short interval of time, though they are linked to the evaluation criteria. In a long term perspective, this robust methodology is questionnable. Psychosocial variables cannot be abstracted from the experience, and the treatment itself, volens nolens, is a composite variable in which biologic and psychologic variables interact. The singularity of the neuroleptic efficacy cannot be measured. Short term neuroleptic treatment answers a first question: how to cure a schizophrenia? Long term treatment, and incidentally long acting neuroleptics, respond to a second question: how to cure and prevent schizophrenia in one particular schizophrenic patient? Some empirical guidelines are given.     

Therapy of the adverse effects of neuroleptics]

The authors analyzed 65 women patients treated with neuroleptics and evaluated the results in accordance the SARS scale with regard to side-effects of the neuroleptic therapy. They dealt with the problem of convenience of treatment with antiparkinsonics to minimize side-effects of neuroleptics.     

Indications for individual child psychotherapy in a Guidance Center]

The aim of this article is to describe how we conceptualise in practical indications of individual psychotherapy in the frame of the consultation of a guidance center. We will not review the literature concerned with this subject. We shall start with the study of the following factors : parents, family, reality features (distance, time, money...). Then, we study the positive and negative features in the child. We explain first all we consider to be the main obstacles in the psychic structure of the child. Then we describe in detail the favorable elements to the psychotherapeutic work. We also recall cases who, without being impossible to treat, require a big experience from the therapist, because of complexity and demand. They are sometimes treated in our unit, according to the disponibility of the therapists. In conclusion, we indicate that the choice of psychotherapy depends not only from the sick child and his familial milieu, but also from the therapist who will involve himself in this type of treatment.     

Role of long-acting neuroleptics in the treatment of schizophrenia]

This paper summarizes the presentations made during the Lucca symposium (1-3 October, 1977) on long-acting neuroleptics. The authors tried to present advantages and inconveniences of this therapeutic compared to the "classical" neuroleptic therapeutics: - in patients with an acute symptomatology; - in stabilized patients. The main advantage is that one can be ensured that the drug has been or not been taken.     

Medico-economic assessment of neuroleptics in schizophrenia. Amisulpride versus haloperidol]

The aim of this study is to assess the economic impact of neuroleptic strategies in the long-term treatment of schizophrenic patients. In this respect a new neuroleptic strategy (amisulpride) was compared to a reference drug (haloperidol) using a cost minimization method. Clinical, demographic and economic (direct medical costs) data were obtained retrospectively from patients' charts. Patients (n = 160) were randomly selected according to diagnosis (schizophrenia, DSM III-R), treatment (outpatient, amisulpride or haloperidol) and follow up period (at least 6 months). The health insurance point of view was selected for the economic analysis. We found a significant reduction of the annual number of days of relapse when patients were treated with amisulpride compared to haloperidol. This reduction was associated with a significant reduction of direct costs mainly related to shorter length of hospitalization. This result was only partly explained by demographic and clinical variables such as the severity of the disease. The differences remained significant when populations were matched. This finding illustrates the validity of the concept of efficiency in psychiatry.     

Indications and expectations for neuropsychological assessment in epilepsy surgery in children and adults

In our first paper in this series (Epilepsia 2015; 56(5): 674–681), we published recommendations for the indications and expectations for neuropsychological assessment in routine epilepsy care. This partner paper provides a comprehensive overview of the more specialist role of neuropsychological assessment in the pre and postoperative evaluation of epilepsy surgery patients. The paper is in two parts. The first part presents the framework for the mandatory role of neuropsychologists in the presurgical evaluation of epilepsy surgery candidates. A preoperative neuropsychological assessment should be comprised of standardised measures of cognitive function in addition to wider measures of behavioural and psychosocial function. The results from the presurgical assessment are used to: (1) establish a baseline against which change can be measured following surgery; (2) provide a collaborative contribution to seizure characterization, lateralization and localization; (3) provide evidence‐based predictions of cognitive risk associated with the proposed surgery; and (4) provide the evidence base for comprehensive preoperative counselling, including exploration of patient expectations of surgical treatment. The second part examines the critical role of the neuropsychologist in the evaluation of postoperative outcomes. Neuropsychological changes following surgery are dynamic and a comprehensive, long‐term assessment of these changes following surgery should form an integral part of the postoperative follow‐up. The special considerations with respect to pre and postoperative assessment when working with paediatric populations and those with an intellectual disability are also discussed. The paper provides a summary checklist for neuropsychological involvement throughout the epilepsy surgery process, based on the recommendations discussed.     

Induction by neuroleptics of certain genes in the central nervous system]

Prolonged administration of neuroleptic drugs increases the density of dopamine D2 receptors in several brain regions. We have recently shown that such treatment also raises dopamine D2 receptor mRNA levels in the striatum. To elucidate some of the initial events which lead to this upregulation, we studied the acute effects of dopamine D2 agonists and antagonists on the expression of c-jun and c-fos. A single injection I.P. of haloperidol (2 mg/kg) produced a rapid and transient increase in c-jun and c-fos mRNA in the rat striatum. This induction was specifically blocked by a D2 agonist (1 mg/kg quinelorane). In contrast, by itself quinelorane was without effect. These results show that dopamine D2 receptors inhibit the expression of a set of immediate early genes in the striatum, and these may be involved in the up-regulation of D2 mRNA upon prolonged neuroleptic treatment.     

Stimulants, neuroleptics, and children's friendship training for children with fetal alcohol spectrum disorders

BACKGROUND: Peer relationship problems are a significant part of the clinical presentation of children with Fetal Alcohol Spectrum Disorders (FASD). Many of these children have been prescribed psychotropic medications by community practitioners. The present study reports on the interaction between medication status and parent and teacher-reported outcomes for parent-assisted Children's Friendship Training (CFT). METHODS: Seventy seven children (40 boys and 37 girls, age range was 71-139 months) diagnosed with FASD were given 12 sessions of CFT. Parent- and teacher-reported social outcomes were compared across four subgroups of children who were prescribed either stimulant or neuroleptic medication, neither or both types of medications. RESULTS: According to parent and teacher reports, children prescribed neuroleptic medication showed greater improvement on all outcome measures when compared to children not prescribed neuroleptics. In contrast, children prescribed stimulant medication either failed to show improvement or showed poorer outcomes when compared to children not prescribed stimulants. IMPLICATIONS: Children with FASD frequently present with symptoms of inattention and hyperactivity. The present results suggest physicians routinely ask about prenatal alcohol exposure as part of history taking to treat children more effectively who appear to be displaying attention-deficit/hyperactivity disorder symptomatology but who may have FASD.     

The effect of neuroleptics in a attempt at understanding the vulnerability to schizophrenia]

Animal and human data suggest that neuroleptic drugs act by decreasing the special significance of some stimulations, especially those of importance for the subject. The two following hypotheses are therefore considered as a basis for the work presented in this paper: 1) the target of neuroleptic drugs is a neuro-psychological mechanism whose function is to focalize the subject on important stimulations and to involve the subject in responding; 2) schizophrenia vulnerability could imply an excessive and abnormal propensity to be over-involved, especially in existentially loaded problems. A careful clinical study of the mode of decrease, and sometimes of disappearance, of schizophrenic delusions under the influence of neuroleptic treatment confirms the hypotheses. Results are of interest for clinical treatment and for research.     

Corneal and lens deposits due to treatment by phenothiazine type neuroleptics]

The authors have studied the corneal and lens lesions which appeared following a prolonged treatment by phenothiazines. They examined 186 patients: 147 took phenothiazines of which 35 of them presented anterior segment alterations. It seems that all phenothiazines can be held responsible for the apparition of these lesions. At this point the authors evaluated the global dose of the various phenothiazines which were administered. The threshold at which the association of these lesions seem to appear, seems to be situated around 300 gr. The total quantity of phenothiazines which are absorbed seems to be a good measure of the risk of ocular toxicity. In the case of one patient they observed that his visual keenness was lowered due to the importance of his corneal and lens lesions.