Optimal haloperidol dosage in first-episode psychosis.

OBJECTIVE: To determine optimal doses of haloperidol for the treatment of a first episode of psychosis. METHOD: A 4-week prospective controlled clinical trial with "optimal dose" defined as the dose at which either of the following occurs: 1) significant improvement, defined as a 15% or greater decrease in scores on the Positive And Negative Syndrome Scale (PANSS), or 2) the onset of extrapyramidal symptoms. Beginning with 2 mg daily, haloperidol was increased weekly to 5 mg, 10 mg, and finally 20 mg daily until either 1) or 2) occurred. RESULTS: Optimal doses for the 36 subjects were 2 mg daily for 15 subjects, 5 mg daily for 11, 10 mg daily for 7, and 20 mg daily for 3. On average, subjects whose optimal dose was 2 mg daily showed the greatest improvement. Among the 27 subjects evidencing clinical response to treatment, 20 had plasma haloperidol levels below 5 ng/ml. CONCLUSION: Many people suffering a first psychotic episode respond to haloperidol doses well below levels in common use.     

Childhood predictors of states of anxiety

Development of the characteristics of social phobia often requires a diathesis in the form of a temperamental bias. A behavioral profile marked by vigorous motor activity and crying to unfamiliar stimuli at 4 months of age - called high reactivity- is characteristic of about 20% of healthy, Caucasian infants. This pattern predicts shy behavior in preschool children and symptoms of social anxiety at age 7, and, at age 11, a subdued personality and biological features that are consonant with a hypothesis of amygdalar excitability. The biological variables that best characterize the children who had been high-reactive infants are right-hemisphere activity in the electroencephalogram (EEC), a larger evoked potential from the inferior colliculus, higher sympathetic tone in the cardiovascular system, and larger event-related potentials to discrepant stimuli. About a quarter of 11-year-olds who had been high reactives displayed behavioral and biological characteristics that are in theoretical accord with the hypothesis of amygdalar excitability, while only 1 of 20 displayed a profile characterized by features in opposition to their temperament. The evidence points to a modest temperamental contribution to the development of symptoms currently regarded as diagnostic of social phobia.     

Low dose neuroleptanxiolysis in anxiety states.

1. In order to prove that neuroleptanxiolysis represents a therapeutical alternative in the treatment of patients suffering from anxiety we conducted four investigations. 2. In the first study it was experimentally proved with 45 outpatients suffering from anxiety that fluspirilene (1.5 mg per week) is superior to bromazepam (6 mg/day), especially in patients with a high degree of somatic anxiety. 3. In the second study the tolerance of fluspirilene (1.5 mg per week) was investigated in 1261 patients with anxiety states and psychoreactive disorders under controlled and open conditions for a period of six weeks. Side effects were found in 11.5% of the patients. All side effects had in common that they occurred already within the first few weeks of treatment. 4. In the third study investigating the dose-effect relationship 106 patients received either 0.5, 1.0, or 1.5 mg fluspirilene per week for a period of 6 weeks. The main result of this study was the verification of a clear dose-effect relationship. 5. The fourth study compared 155 patients who had received long-term treatment with fluspirilene (max 1.5 mg/week) and 121 patients with long-term benzodiazepine treatment. No differences were found with regard to the frequency and intensity of extra-pyramidal disturbances. 6. The therapeutical relevance of the findings was emphasized in the general discussion.     

Assessment of childhood anxiety

Anxiety disorders among children are quite common with prevalence rates estimated at up to 20%. Although somewhat neglected in the past, recent empirical studies have increased our understanding of childhood anxiety significantly. Along with the development of empirically supported treatments, the assessment of anxiety among youth has been refined, with more sophisticated and methodologically sound measures developed and revised within the last decade. In addition, the field has benefited from an increased awareness of the importance of systematic and standardized assessment procedures for both diagnosis and treatment of anxiety in children. The primary aims of this article are to review several important considerations particular to the assessment of child anxiety, and to describe and review the most commonly used procedures and instruments for the assessment of anxiety in children.     

Characteristics of galvanic skin response in anxiety states

Twenty patients with anxiety states were compared with 20 normal subjects under response and no-response conditions with respect to a variety of skin conductance and GSR variables. The patients had more skin conductance fluctuations under no-response conditions than the controls, smaller responses to significant stimuli and more sluggish responses.     

Quetiapine dosage in bipolar disorder episodes and mixed states

OBJECTIVE: Although the maximal quetiapine doses in the published studies were restricted to 800 mg/day, higher quetiapine doses are not unusual in clinical practice. The aim of the present study was to evaluate the effectiveness, tolerability and clinical reasons associated to the use of high dosage of quetiapine (>800 mg), when used under routine clinical conditions, in a sample of bipolar disorder and schizoaffective bipolar inpatients. METHODS: Charts of all bipolar and schizoaffective adult inpatients, who had received quetiapine for a mood episode between 1999 and 2005 were retrospectively reviewed. These charts also included the assessment of manic and depressive symptoms on admission and at discharge using the Beck-Rafaelsen Mania Scale (MAS) and the Montgomery Asberg depression rating scale (MADRS), respectively. RESULTS: Data of 50 patients were analyzed. The overall F in repeated measures ANOVA revealed a significant MAS scores reduction between admission and discharge. MAS scores reduction did not differ between the high and low quetiapine groups. Similarly, a significant MADRS reduction was found. Again, no differences between the high and the low dose group were found. Logistic regression analysis of the 50 patients revealed only mixed episodes predicted high quetiapine dosage. CONCLUSIONS: The present study confirms quetiapine efficiency and tolerability in the treatment of bipolar episodes, even in doses > to 800 mg and found a link between quetiapine doses and mixed episodes.