Biomedical subjects
Publications and source records attributed to G P Sheppard.
Eleven patients with tardive dyskinesia were treated with lithium carbonate in a placebo-controlled double-blind crossover study. No significant effect of lithium on either tardive dyskinesia or blood prolactin concentrations was demonstrated, but 5 patients developed pseudo-Parkinsonian features.
Eight male schizophrenics were treated in an open study with d.l. propranolol. The dose was increased by 160 mg/day until a maximum of 2,400 mg/day was achieved on day 15, and this remained constant until day 21. Seven patients showed significant clinical evidence of psychiatric improvement, while the incidence of toxic side-effects was low. There was wide inter-patient variation in plasma levels of propranolol. Despite a significant increase of plasma propranolol between day 15 and day 21 of the study, there was no significant change in serum prolactin.
Some of the clinical factors contributing to the currently unsatisfactory state of therapy for tardive dyskinesia are reviewed. Problems such as lack of clear syndrome delineation and phenomenological description, the lack of standardization in rating scales and the lack of attention to trial design have all probably contributed to a rather confusing picture. Controlled trials suggest that several pharmacological agents may be of therapeutic value but that clinical prediction of an individual's response is impossible. The strategy of acute drug challenge has emerged as perhaps the most promising approach to the definition of pharmacological subtypes and therefore the choice of optimal treatment.