A comprehensive treatment program for schizophrenia and chronic mental illness

The failure of deinstitutionalization and the community mental health movement to improve the treatment of chronic psychiatric patients, particularly schizophrenics, is described. Problems with the current treatment paradigm include unrealistic expectations concerning the rehabilitative effects of antipsychotic medications, inadequate funding of the community mental health system, and the predominance of the "infectious disease model," rather than the more appropriate "chronic disease model" of mental illness. A model for the comprehensive treatment of chronic mental illness is proposed that includes: treatment, rehabilitation, social services, and continuity of care. The need for an integrated community approach to rehabilitating chronic psychiatric patients is stressed, and some of the specific ingredients essential to such a program are identified.     

A primate model of anterograde and retrograde amnesia produced by convulsive treatment

A nonhuman primate model of the key cognitive effects of convulsive treatment was developed and tested. Rhesus macaques were trained on 3 tasks: a long-term memory task that required selection of a constant target from a background of distracters, an anterograde task that involved learning a new target each day against a variable number of distracters, and a task that assessed learning and memory for new and previously trained 3-item serial lists. This battery samples a range of cognitive functions, including orientation, working memory, retrograde amnesia for temporally graded stimuli, and anterograde amnesia. Using a within-subject, sham-controlled design, the amnestic effects of electroconvulsive shock (ECS) were evaluated in 2 monkeys. Significant effects of the interventions (sham and ECS) were seen on all tasks. The degree of impairment varied across tasks and as a function of task difficulty. ECS did not impair accuracy on the less difficult tasks (memory for an overlearned item and acquisition of a new item) but did increase the amount of time required to complete the tasks, consistent with a period of disorientation acutely after the intervention. This effect was progressive across the treatments. ECS impaired the acquisition and memory of new lists compatible with an anterograde memory deficit, whereas recall for old lists was relatively spared. This study developed and validated a cognitive battery to assess amnesia in nonhuman primates, providing new experimental paradigms for evaluating the cognitive effects of convulsive treatment.     

奎硫平与利培酮治疗慢性精神分裂症研究

目的：比较奎硫平与利培酮对慢性精神分裂症的疗效和安全性。方法：将70例慢性精神分裂症患者随机分为两组,分别选用奎硫平或利培酮治疗,疗程8周。采用阳性与阴性症状量表（PANSS）及治疗中出现的症状量表（TESS）评定疗效和不良反应。结果：2药对慢性精神分裂症的疗效相当,不良反应发生率及严重程度均相仿。结论：奎硫平与利培酮治疗慢性精神分裂症均有肯定的疗效,且安全性高。     

A controlled study of penfluridol in the treatment of chronic schizophrenia

Twenty patients were treated with penfluridol and 21 with fluphenazine for a period of up to 1 year. Penfluridol, an oral neuroleptic administered weekly was as efficacious as fluphenazine administered twice daily and appeared to be superior to fluphenazine in improving emotional withdrawal and anergia. The low incidence of side effects and other signs of toxicity, coupled with an effective prophylactic activity, suggests that penfluridol is an important addition to our therapeutic armamentarium for the treatment of chronic schizophrenia.     

A nonhuman primate model of panic disorder

In this article we report on the reliable production of several features of panic attacks following subcutaneous administration of sodium lactate to nonhuman primates. Unrestrained monkeys were evaluated by an observer without knowledge of the subjects' treatment with either sodium lactate or a dextrose control solution. The lactate produced temporally circumscribed episodes of agitation, wariness, and motor responses, normally elicited under stressful or threatening conditions. In an initial pharmacological intervention, we found that pretreatment with imipramine blocked the response to lactate. The further development of this model offers promise for the systematic examination of etiological factors in susceptibility to lactate induction of panic attacks, the physiological basis of the response, and new modes of treatment of panic disorder.     

A proposed primate animal model of autism

Based on the fact that thalidomide, at a certain point in human pregnancy, produces autism, we propose administering thalidomide to pregnant monkeys at an appropriate point after conception. The infant monkeys born after thalidomide treatment of the pregnant mothers should manifest aberrations in social vocalization and in socialization behavior. Histological analysis of their brains should reveal areas whose damage will lead to autism. This can then be produced stereotaxically in infant monkeys to allow the better determination of the relation of degree of damage in these areas to the severity of autism.     

Evaluation of a neurodevelopmental model of schizophrenia--early postnatal PCP treatment in attentional set-shifting

Phencyclidine (PCP) was administered to male and female Lister hooded rats on postnatal days (PND) 7, 9 and 11. All PCP animals tested in adulthood (PND 53-93) showed deficits in cognitive flexibility, specifically in their ability to shift attentional set, compared to controls. This novel finding is reminiscent of the impairment observed in schizophrenia patients, and supports the validity of the early postnatal PCP regimen as a disease-like model.     

利培酮与氯氮平治疗慢性精神分裂症对照研究

目的　了解利培酮治疗慢性精神分裂症的疗效及安全性。方法　将68 例慢性精神分裂症病人随机分为利培酮组和氯氮平组,每组各34例,进行为期8 周的对照研究,采用阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及安全性。结果　利培酮有效率为64.7%,氯氮平为61.8%,两者疗效相当,无统计学差异(P>0.05)。利培酮对阴性症状的疗效优于氯氮平(P<0.05),利培酮的副作用较氯氮平少而轻。结论　利培酮是治疗慢性精神分裂症安全有效的药物。     

抗精神病药合并帕罗西汀治疗慢性精神分裂症

目的：探讨抗精神病药合并帕罗西汀治疗慢性精神分裂症阴性症状的疗效。方法：对68例以阴性症状为主的慢性精神分裂症患者，在原用抗精神病药基础上，随机分为合用组和对照组，分别给予帕罗西汀和安慰剂，疗程12周。疗效和药物不良反应评定采用阳性与阴性症状量表（PANSS）和治疗中出现的症状量表（TESS），于治疗前及治疗4、8、12周各评定一次。结果：治疗第8周起合用组PANSS总分及阴性因子分均比治疗前显著降低。结论：以阴性症状为主的慢性精神分裂症患者，在使用抗精神病药同时联用帕罗西汀可改善阴性症状，两组不良反应无明显差异。     

Medication and psychotherapy in the treatment of chronic schizophrenia

Current theory in the treatment of schizophrenia emphasizes medication and expresses considerable doubt about the value of psychotherapy. Yet the data that lead to this conclusion have been gathered in studies of carefully selected groups of cooperative patients who consent to treatment and participate well in scientific studies. In public psychiatry, where many patients are uncooperative and even coerced into treatment, we have found that attention to the patient's individual psychology is essential to success. We examine the role of the psychiatrist who provides psychotherapy and medication in the context of a comprehensive program for patients with chronic schizophrenia.     

Associative memory in chronic schizophrenia: a computational model

We developed a computer model to simulate associative memory recall of patients with chronic schizophrenia. Model inputs consisted of words derived from normative data that differed in terms of connectivity and network size, with the former quantitatively represented by parametric weights and the latter by the specific number of word associates that formed a particular network. Previous behavioral studies of normal subjects indicated better recall for words of high connectivity-small network (HCSN), followed by low connectivity-small network (LCSN), high connectivity-large network (HCLN), and low connectivity-large network (LCLN). This pattern of recall differed from that observed in behavioral studies of schizophrenic patients, which showed better recall for high connectivity words, regardless of network size. Holding constant network size while manipulating connection weights effectively simulated this schizophrenic pattern of recall. That is, manipulation of parametric weights coupled with a slight increase in noise significantly and reliably elicited the response pattern of abnormal connectivity demonstrated in the prior behavioral study of patients with chronic schizophrenia. An increase in noise was a necessary, but insufficient step in modeling the response pattern of abnormal connectivity. These findings provide support for the use of computational models to investigate dynamics of associative word recall in patients with chronic schizophrenia.     

舒血宁治疗36例慢性精神分裂症双盲对照研究

对３６例住院慢性精神分裂症患者进行舍血宁治疗的双盲对照研究，患者随机分为舒血宁治疗组和安慰剂治疗组。舒血宁治疗组经八周治疗后其ＣＧＩ评分显著优于安慰剂治疗组，其ＳＡＮＳ，ＳＡＮ五项总评及ＣＧＩ减分差都显著优于安慰剂治疗组。并观察不同剂量舒血宁的副反应，作者认为舒血宁与传统抗精神病药物合用，对治疗精神分裂症阴性症状有效。     

维思通与氯氮平治疗慢性精神分裂症的临床对照研究

目的 探讨维思通和氯氮平治疗慢性精神分裂症的临床疗效及副反应。方法 对９６例符合ＣＣＭＤ－２－Ｒ中精神分裂症诊断标准,病程≥５年,ＰＡＮＳＳ总分≥６０分的住院患者并随机分为维思通组（ｎ＝５１例）和氯氮平组（ｎ＝４５例）。研究期限为９周。两组均采用药物固定剂量法,维思通组每日４ｍｇ,氯氮平组每日３７５ｍｇ。分别于研究前、后评定两次ＰＡＮＳＳ量表。以研究前后减分２０分为有效果限值;利用副反应清单比较了     

A multivariate prediction model of schizophrenia

Univariate prediction models of schizophrenia may be adequate for hypothesis testing but are narrowly focused and limited in predictive efficacy. Therefore, we used a multivariate design to maximize the prediction of schizophrenia from premorbid measures and to evaluate the relative importance of various predictors. Two hundred twelve Danish subjects with at least one parent diagnosed in the schizophrenia spectrum (high risk) and 99 matched subjects with no such parent (low risk) were assessed on 25 premorbid variables in seven domains (genetic risk, birth factors, autonomic responsiveness, cognitive functioning, rearing environment, personality, and school behavior) when the subjects averaged 15 years of age. Twenty-five years later, 33 subjects had received lifetime diagnoses of schizophrenia. Discriminant function analyses were used to discriminate schizophrenia outcomes from no mental illness and nonschizophrenia outcomes on the basis of premorbid measures. Regardless of the comparison group used, schizophrenia was predicted by the interaction of genetic risk with rearing environment, and disruptive school behavior. Within the high-risk group, two-thirds of schizophrenia outcomes were correctly predicted by these premorbid measures; three-quarters of those with no mental illness were also correctly predicted. Prediction was enhanced among those with two schizophrenia spectrum parents, lending support to a multiplicative gene x environment model. Implications for early identification/primary prevention efforts are discussed.