Differential effects of abrupt versus gradual withdrawal of chlorpromazine in hospitalized chronic schizophrenic patients. The clinical relevance of an auditory attention task (PAT) in a longitudinal study of chronic schizophrenia, with placebo substitution for chlorpromazine. Prediction of relapse in schizophrenic outpatients treated by drug and sociotherapy. DISCONTINUATION OR REDUCTION OF CHEMOTHERAPY IN CHRONIC SCHIZOPHRENICS. Prolonged withdrawal of chlorpromazine in chronic patients. A controlled trial of phenothiazine withdrawal in chronic schizophrenic patients. Use of chlorpromazine and reserpine in the treatment of emotional disorders. A study of the withdrawal of chlorpromazine or trifluoperazine in chronic schizophrenia. Comparison of chlorpromazine and reserpine in maintenance drug therapy.
nan A new auditory attention task (PAT) is described. The test comprises four different subtest combinations (diotic/dichotic, slow/fast) each of 5 min duration. Omission and commission errors are combined by an index of errors (IE). The PAT was given fortnightly to 20 chronic schizophrenic inpatients for more than one year. Independent psychiatrists rated the patients according to the Brief Psychiatric Rating Scale and a Global Rating Scale. All measures yielded significant test-retest reliabilities. The patients were stabilized on individualized doses of chlorpromazine (CPZ) and randomized to two groups. Placebo was substituted for CPZ during 10 weeks, according to a double-blind cross-over design. Significant deterioration under placebo was detected by all three methods, but the PAT was the most sensitive to change. The PAT mean score (M IE) was correlated with both rating scales. Unlike the rating scales, it also correctly ordered the twenty patients along a dimension which measured the severity of illness and 'predicted' hospital discharge. Despite the established efficacy of neuroleptics for maintaining schizophrenics in the community, there are data suggesting that those with very good prognostic signs may do as well without drugs. In testing this, we find no evidence that patients with good signs are not in need of drugs; instead they profit most from drug treatment. Patients who benefit little (1) are men whose families were disrupted earlier in their lives, (2) live alone or with extended families whose attitudes toward the study are not positive, and (3) are irregular in taking their medication. The practical implication is that the drug nonresponder can be helped by some means to ensure regularity of medication taking, such as a visiting nurse or long-acting medication. A second research question is whether major role therapy (MRT, a combination of social casework and vocational rehabilitation) can lengthen the time until relapse. Major role therapy affected time to relapse in a disordinal manner; asymptomatic patients benefited from MRT, while in patients with greater symptom severity MRT- suprisingly--hastened relapse. It is hypothesized that symptomatic patients are suffering from an inability to manage an expanded and enriched cognitive field; MRT, a therapy that urges the patient to become more responsible and to expand his horizons, may actually induce a state with which the patient cannot cope. It is recommended that a therapy such as MRT be deferred until the patient is essentially asymptomatic. nan nan Phenothiazine drugs were withdrawn from 17 chronic schizophrenic in-patients, with a control group of 14 patients remaining on active medication. The trial was conducted under double blind conditions over a period of 42 weeks with weekly assessment of the patients by ward nurses. Of the placebo group 35% relapsed, relapse being related to the level of previous active medication. nan nan nan
This review confirms clinical experience and quantifies the risks of stopping chlorpromazine medication for a group of people with schizophrenia who are stable on this drug. With its moderate adverse effects, chlorpromazine is likely to remain one of the most widely prescribed treatments for schizophrenia.