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Biomedical subjects

L D Alphs

Publications and source records attributed to L D Alphs.

At least 19 recordsLinked to original sources
PubMed1999

Clozapine: the commitment to patient safety.

Clozapine represents the "gold standard" therapy for treatment-resistant schizophrenia including use for symptom reduction and use in patients intolerant of extrapyramidal side effects associated with other antipsychotics. Despite its clear benefit in these areas, its use has been associated with a serious, and sometimes life-threatening, risk for agranulocytosis. Effective white blood cell monitoring systems have been developed by Novartis affiliates across the world to ensure its safe use and to meet local health standards. The goals of the monitoring programs include: (1) weekly white blood cell monitoring during the initial months of therapy for early detection of severe leukopenia; (2) immediate discontinuation of clozapine if severe leukopenia is observed; (3) exclusion from reexposure to clozapine if a patient experiences clozapine-induced agranulocytosis; and (4) early cessation of treatment if hematologic guidelines are not followed ("no blood, no drug" policy). Together, these systems have demonstrated a worldwide reduction in the observed rate of agranulocytosis and in fatalities related to the emergence of agranulocytosis when rigorous monitoring systems are in place.

Agranulocytosis↗
PubMed1998

Health status and health care costs for publicly funded patients with schizophrenia started on clozapine.

OBJECTIVE: The study examined the effect of clozapine treatment on the health care costs and health status of people with schizophrenia who are supported by public funds. METHODS: Thirty-three patients with schizophrenia hospitalized in a state facility were interviewed within one week of starting clozapine and six months later. Health status was assessed with four clinical rating scales measuring severity of psychopathology, negative symptoms, depression, and quality of life. Cost and health care utilization data were collected for the six months before and after initiation of clozapine. RESULTS: Only 52 percent of the subjects stayed on clozapine for six months. Subjects who continued on clozapine were more likely to be discharged within six months than those who did not continue. Six months after clozapine was started, health care costs showed a sayings of $11,464 per person, even after adjustment for pretreatment costs, and health status was improved. CONCLUSIONS: For subjects who continued on clozapine for six months, clozapine treatment was associated with reduced days of psychiatric hospital care, reduced overall costs despite increased outpatient treatment and residential costs, and improved health status.

Adult↗
PubMed1994

Motor mechanisms in schizophrenic patients with tardive dyskinesia.

A specific aspect of the motor output of patients with tardive dyskinesia was investigated with an experimental procedure referenced in force control function (i.e., the maintenance of sustained force output). We hypothesized that response output (button press) at a given level would be significantly altered when preceded by an output of a higher force than when preceded by an output of a lower force. The difference could be interpreted as a behavioral measure of fatigability and/or threshold change, and its quantitative aspects could serve as a marker of motor impairment. Three groups of subjects participated in the study: schizophrenic patients with tardive dyskinesia (TD), schizophrenic patients without tardive dyskinesia, and normal control subjects. The test used was a target-matching task with force output ranging from 5 to 560 cN. Three dependent measures were used: output force, steadiness of force maintenance, and latency of target capture. Results indicated that precedent output at the previous trial significantly altered force, but even better group separation was attained with the measure of steadiness. The TD schizophrenic group's performance was least efficient, the control group's was most efficient, and the non-TD schizophrenic group's performance was intermediate. The principal conclusions reached were that the target-matching response reflects mechanisms related to both fatigability and recruitment of motor units involved in output control.

Adult↗
PubMed1993

Training novice raters on the Negative Symptom Assessment Scale.

The Negative Symptom Assessment (NSA), a scale for rating negative symptoms of schizophrenia, has been shown to have high interrater and test-retest reliabilities as well as high concurrent validity with similar instruments. In this study, the facility of clinicians unfamiliar with the NSA to learn this scale was evaluated. After attending a 30-min training lecture, 27 experienced researchers, who had never previously used the NSA, viewed and rated a videotaped, semi-structured NSA interview of a schizophrenic patient. These ratings were compared with those of an experienced rater. Scores for most items met our criteria for learning with this level of training. These data demonstrate that high levels of agreement with experienced raters can be achieved on the NSA after brief periods of training.

Arousal↗
PubMed1993

Negative symptom assessment of chronic schizophrenia patients.

A new scale for assessing negative symptoms in schizophrenia, the Negative Symptom Assessment (NSA), was administered to 101 male chronic, inpatient schizophrenia patients. Factor analysis of the NSA yielded seven factors, but most of the explained variance resided in Factor 1, Restricted Affect/Emotion. The factors that emerged from this study closely resembled NSA factors derived from an earlier study of outpatient schizophrenia patients, which indicates the factor structure of the NSA is robust. A constellation of variables reflecting long-term or chronic illness were significantly related to six of the seven factors. These results suggest that "institutionalism" may play a role in the evolution of some negative symptoms.

Activities of Daily Living↗
PubMed1992

Limbic system abnormalities identified in schizophrenia using positron emission tomography with fluorodeoxyglucose and neocortical alterations with deficit syndrome.

A hypothesis of psychosis localization in schizophrenia was derived from studying metabolic alterations in rat brain in response to phencyclidine hydrochloride administration. Since phencyclidine and its selective agonist dizocilpine maleate (MK801) induced overlapping and long-lasting metabolic alterations predominantly in limbic areas, the hypothesis developed that schizophrenic patients with psychosis would evidence functional abnormalities in limbic circuits compared with normal controls. Accordingly, 12 actively psychotic, drug-free patients with schizophrenia and matched normal controls underwent functional brain scans using positron emission tomography and fluorodeoxyglucose. Regions of interest were identified on five matched axial slices in each patient and control subject, and average metabolic rates were calculated. Patients with schizophrenia showed a significantly lower regional cerebral metabolic rate of glucose in the hippocampus and the anterior cingulate cortex than did normal controls, but not in neocortical areas or in the extrapyramidal system. When the group of schizophrenic patients was divided into deficit and nondeficit types, a preliminary exploratory analysis suggested thalamic, frontal, and parietal cortical hypometabolism in the deficit subgroup, with normal metabolism in the nondeficit patient group in those areas; in contrast, hippocampal and anterior cingulate cortical metabolism was reduced in both deficit and nondeficit subtypes. These results suggest that the limbic system, especially the hippocampus, is functionally involved in schizophrenic psychosis and that different manifestations of schizophrenia may involve different neuronal circuits.

Adolescent↗
PubMed1991

Isometric force control in schizophrenic patients with tardive dyskinesia.

Force control (FC) function, considered to be a constituent component of motor output, was investigated in psychiatric patients with dyskinetic impairments. Twenty-one patients with mild-to-moderate tardive dyskinesia were compared to 25 nondyskinetic patients on an FC test for both hands and oromandibular region. Results indicate that FC impairment is readily observed in dyskinetic subjects. The FC steadiness (i.e., the ability to maintain a sustained force output) in dyskinetic and control subjects was found to be inversely proportional to the amount of force generated. This method provides an objective, simple, and precise quantification of motor impairment along a force-defined continuum. It may be useful in studying tardive dyskinesia and the effects of neuroleptic medication on motor output control.

Adult↗
PubMed1991

Reduction of perseverative errors in patients with schizophrenia using monetary feedback.

The influence of monetary feedback on Wisconsin Card Sort Test (WCST) performance of 14 male schizophrenics was investigated. Patients were administered the test under standard instructions and with monetary feedback in counterbalanced order. Monetary reinforcement reduced perseverative errors and increased correct responses (p less than .05). These findings suggest that the WCST perseverative errors of schizophrenics reflect motivational as well as cognitive factors.

Adult↗
PubMed1991

Comparison of withdrawal of typical and atypical antipsychotic drugs: a case study.

Haloperidol and clozapine were rapidly withdrawn from a schizophrenic patient on separate occasions several months apart. Mental status changes and fluctuations in involuntary movements were carefully observed under both conditions. Although little change in either mental status or involuntary movements was observed within the 3 weeks following the withdrawal of haloperidol, marked deterioration in mental status and involuntary movements occurred within 1 week of withdrawal of clozapine. Implications of this differential response to withdrawal of antipsychotic medications are discussed.

Acute Disease↗
PubMed1989

Increased numbers of CD5+ B lymphocytes in schizophrenic patients.

Autoimmune mechanisms have been postulated to play a role in the pathogenesis of schizophrenia. Recently, increased numbers of B lymphocytes expressing the CD5 (Leu-1) surface antigen have been observed in patients with certain autoimmune diseases. In the present study, approximately 30% of schizophrenic patients (11/34) were found by cytofluorometric methods to have similarly increased levels of circulating CD5+ B cells compared with 6% (2/33) of healthy individuals and 5% (1/20) of patients with bipolar affective disorder. In schizophrenic patients with a "high" CD5+ B-cell phenotype, the percentage of B cells expressing the CD5 surface marker (mean +/- SEM, 52.4% +/- 3.5%) was comparable to that reported for patients with rheumatoid arthritis and significantly greater than that reported for patients with bipolar affective disorder (25.7% +/- 2.5%) and healthy controls (31.0% +/- 1.8%). Schizophrenic patients with high levels of CD5+ B cells had increased numbers of total B cells compared with control subjects and patients with low levels of CD5+ B cells. An elevation in CD5+ B cells may delineate a subgroup of schizophrenic patients whose disease has an underlying autoimmune and/or genetic cause.

Adult↗
PubMed1989

Development of the Clozaril Patient Management System.

The Clozaril Patient Management System (CPMS) has been developed to provide a 100% fail-safe system for monitoring white blood cell counts (WBCs) in patients being treated with clozapine (Clozaril/Leponex) in the United States and to provide comprehensive data collection on the incidence and development of agranulocytosis. CPMS provides a case administrator and a registered pharmacist. Their role is to support the physician by facilitating the determination of WBC's at a national laboratory and by distributing clozapine to the patient. Specific tasks of the case administrator include: keeping track of outpatient phlebotomy appointments, following up missed appointments, ensuring that WBCs are obtained and analyzed weekly by the national laboratory, following up the results of these tests, providing liason with the pharmacy, maintaining a data base for all patients receiving clozapine and conveying these data to the physician. Initial experience with this program in Cleveland is described in this paper. The characteristics of patients enrolled in CPMS, satisfaction with the program and its success in meeting predetermined objectives are described. Experience with 31 patients in this outpatient setting suggests that CPMS can be an effective, reliable system for assisting in blood monitoring of patients being treated with clozapine.

Adult↗
PubMed1989

The Schedule for the Deficit syndrome: an instrument for research in schizophrenia.

The Schedule for the Deficit Syndrome (SDS) is an instrument for categorizing schizophrenic patients into those with and those without the deficit syndrome. In a study of 40 schizophrenic patients diagnosed by DSM-III criteria, raters using the SDS demonstrated good interrater reliability for this categorization, as well as for individual negative symptoms and a rating of global severity.

Affective Symptoms↗