Granulocytopenia with clozapine and quetiapine.
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Agranulocytosis↗
Biomedical subjects
T P Hogan
Publications and source records attributed to T P Hogan.
Use of fetal cortical grafts in hypoxic-ischemic brain injury in neonatal rats.
In view of numerous studies demonstrating that intracerebral implants of fetal neural tissue can promote functional recovery and structural repair in the damaged brain, the present study examined the potential use of neocortical transplantation in newborn rats that sustained hypoxic-ischemic brain injury. Ischemic insult was induced in Long-Evans, black-hooded 1-week-old rats by unilateral common carotid artery occlusion followed by 2.5 h of hypoxia in 8% O2. One week later, animals received neocortical block transplants. At 2-6 weeks posttransplantation, animals were sacrificed and their brains examined histologically. Transplants survived in over 80% of the animals and the presence of acetylcholinesterase-positive fibers crossing the host-transplant interface provided evidence of transplant integration with the host brain. However, morphometric measurements revealed that the transplants were unable to reduce the hypoxia-ischemia-induced degeneration in the host hippocampus, caudate-putamen, or thalamus. Nonetheless the demonstrated survival of grafts in the neonatal hypoxia-ischemia model suggests a potential therapeutic effect.
Animals↗
Assessment of the patient's subjective experience in acute neuroleptic treatment: implications for compliance and outcome.
The concept of subjective response to neuroleptics in schizophrenia was reviewed with particular focus on scales for its measurement. The significance of recognizing such a phenomenon early on in the course of treatment has been illustrated by research data linking it to compliance, clinical improvement, quality of life, suicidal behaviour and comorbid drug abuse. Negative subjective response to neuroleptics has been identified as a strong predictor of compliance and outcome. Awareness of this subjective response in the management of the acute phase of the illness would require the physician to develop specific or additional approaches to the management of such dysphoric patients on neuroleptics at the time of discharge.
Antipsychotic Agents↗
Analysis of neocortical grafts placed into focal ischemic lesions in adult rats.
This study investigated the viability of fetal neocortical block grafts transplanted into adult ischemic cortical lesions. Recipient rats sustained focal ischemic lesions by permanent occlusion of the middle cerebral artery 4-7 days prior to transplantation. Twenty days later, the animals were sacrificed and the brains examined using triphenyltetrazolium chloride, routine Nissl or acetylcholinesterase histochemistry. Ischemic infarctions were localized to the ipsilateral sensorimotor cortex and transplants were integrated with the host cerebral cortex or striatum. Cholinergic fibers were found crossing the host-transplant interface, presumably innervating the graft. This study demonstrates that fetal neocortical block grafts placed into adult focal ischemic lesions following permanent arterial occlusion can survive and establish connections with the host brain.
Acetylcholinesterase↗
Patients' subjective experiences on antipsychotic medications: implications for outcome and quality of life.
The phenomenon of subjective response to antipsychotic medications in schizophrenia was reviewed, focusing on validity, measurement, implications for clinical outcome and quality of life. Recommendations were made on improvements in research approaches to important factors that may contribute to the genesis of this phenomenon. Clinicians should pay attention to the subjective complaints of their patients about medications and not ignore them as unreliable. Researchers should not dismiss research into subjective experiences as non-scientific, because it provides valuable information on recognizing psychopathology and for improving the management of patients.
Antipsychotic Agents↗
Subjective response to neuroleptics and the quality of life: implications for treatment outcome.
The concept of subjective response to neuroleptics in schizophrenic patients is reviewed in terms of its measurement and validity. Evidence is presented to link negative subjective response to neuroleptics to noncompliance and less favourable therapeutic outcome. The relevance of the construct of subjective responses to neuroleptics is examined in terms of its impact on the functional status and quality of life of patients. There is a great need for improved methods in researching subjective responses as well as better understanding of the factors that contribute to its genesis. The advent of new neuroleptics with superior risk-benefit ratios should encourage such research developments.
Antipsychotic Agents↗
Connectivity of fetal neocortical block transplants in the excitotoxically ablated cortex of adult rats.
Fetal neocortical block grafts placed into newborn recipients are able to exchange axonal projections with the host central nervous system, as shown in several previous experiments. The present study examined the connectivity of fetal neocortical block transplants placed into the excitotoxically ablated cortex of adult rats. Young adult rats received injections of the excitotoxic amino acid N-methyl-D-aspartate into the sensorimotor cortex area 1 week prior to receiving a fetal (E14-15) neocortical transplant. Afferent and efferent connections of these grafts were examined 3-6 months after transplantation by injecting the transplants with the fluorescent retrograde tracers fast blue and diamidino yellow or with the anterograde tracer Phaseolus vulgaris leucoagglutinin. Retrogradely labeled neurons were observed within several host brain regions including the ipsilateral neocortex, several thalamic nuclei, subcortical areas such as claustrum and lateral hypothalamus, nucleus basalis, dorsal raphe nuclei and locus coeruleus. Fibers labeled with Phaseolus vulgaris leucoagglutinin were found extending throughout the transplants, but with rare exceptions fibers were not observed within the host brain. The experiments showed that neocortical block grafts placed into the excitotoxically ablated neocortex receive afferent input from areas in the host brain that normally innervate the sensorimotor cortex. The extensive Phaseolus vulgaris leucoagglutinin-positive axonal labeling found within the grafts demonstrated the ability of the grafted neurons to establish extensive intrinsic graft connections.(ABSTRACT TRUNCATED AT 250 WORDS)
Acetylcholinesterase↗
Subjective response to neuroleptics and outcome in schizophrenia: a re-examination comparing two measures.
The schizophrenic patient's early psychological response to neuroleptic treatment has been demonstrated to be a significant predictor of treatment response. The validity of the construct of subjective response is evaluated by comparison of two measures. Fifty-five recently admitted and unmedicated schizophrenic patients were randomly allocated to chlorpromazine or haloperidol. Subjective responses at 24 and 48 hours as assessed by two different scales, the Van Putten & May scale and the self-administered Drug Attitude Inventory, were strongly correlated with outcome at three weeks. Early emergence of extrapyramidal symptoms was not related to subjective response, but dysphoric patients had a greater incidence of EPS by the end of treatment than did non-dysphoric patients. The two measures showed high concordance in identification of early drug dysphoria.
Adolescent↗
The pharmacoepidemiology of treatment-refractory schizophrenia.
Treatment-refractory schizophrenia is a major clinical problem for which there is relatively little scientific information, and no consensus has been reached on approaches to treatment. The pharmacotherapy used for 103 patients with a diagnosis of schizophrenia or schizoaffective disorder at one psychiatric hospital was examined. Data were gathered on neuroleptic choice and dose, the use of adjunctive treatments and serum neuroleptic levels. The daily neuroleptic dose was compared with that of random samples of patients receiving outpatient maintenance treatment, and short-stay patients receiving acute treatment. The patients in our sample received high doses of neuroleptics despite a persistent lack of response to treatment, and despite the fact that these were in excess of the recommended maximum beneficial dose. The appropriateness of this therapy is discussed.
Activities of Daily Living↗
Heterotopic neocortical transplants. An anatomical and electrophysiological analysis of host projections to occipital cortical grafts placed into sensorimotor cortical lesions made in newborn rats.
Plates of presumptive occipital neocortex obtained from fetal rats at 14-16 days gestation were grafted into the cerebral hemisphere of newborn rats. The transplants were placed heterotopically into sensorimotor cortical lesion cavities made immediately prior to grafting. At maturity, some of the transplants were injected with the retrograde fluorescent tracers Fast Blue and Diamidino yellow. In other animals, single-unit activity in the transplants or in normal cortex was recorded using standard electrophysiological techniques. Histologically, host projections to the transplants were demonstrated by the presence of retrogradely labeled neurons in the host primary and secondary somatosensory cortices as well as several thalamic areas including the anteroventral, anteromedial, ventrobasal, mediodorsal and central medial nuclei. Additional labeling was found in the claustrum, lateral hypothalamus, zona incerta and basal forebrain. Electrophysiologically, transplant single-unit activity was evoked in 43/69 (62%) neurons by thalamic stimulation, but only 1/69 transplant neurons responded to electrical stimulation of the contralateral forepaw. In further work, volumetric measurements showed that the transplants did not ameliorate the thalamic atrophy found after neocortical lesions. These results are compared to previous studies involving the homotopic placement of sensorimotor cortical grafts.
Animals↗
Measurement of therapeutic response in schizophrenia. A critical survey.
A recurrent criticism of measurement in schizophrenia research is that symptom suppression is overemphasized as the sole criterion measure of treatment effectiveness, to the neglect of other endpoints, such as the quality of life and subjective experience of the patient. This paper addresses the current status of response measures used in schizophrenia therapeutics. A computer literature search of all clinical trials (drug, psychosocial, or rehabilitative) in schizophrenia for the years 1986 through 1989 yielded 175 papers, 79 of which were trials of therapy. Almost all the trials focused on productive symptoms, with 19% considering negative symptoms scales as well. Approximately one-quarter of the studies incorporated some measure of patient functioning, but only 13% considered the patient's self-report or ratings of significant others. The findings suggest that the measurement of treatment response in schizophrenia research continues to be unidimensional and symptom-based. It is proposed that treatment effectiveness may be obscured when measures of patient functioning, subjective experience and assessments of significant others are not included with those of symptomatology.
Activities of Daily Living↗
Quality of life in chronically mentally ill patients in day treatment.
A structured assessment instrument, the Quality of Life Interview, was used to explain the quality of life of seventy patients with chronic psychiatric illness attending a day treatment programme. The interview was found to have acceptable psychometric properties. Factors that best predicted the quality of life of these patients included the number of re-admissions in the last year, frequency of family contacts, satisfaction with social life, psychiatric health and adult education. The theoretical implications and potential clinical benefits of these findings for chronic psychiatric patients are discussed.
Adult↗
Early treatment events and prediction of response to neuroleptics in schizophrenia.
Events that occur early in the course of neuroleptic drug therapy in schizophrenia and which may be useful in predicting clinical outcome were investigated. Early subjective response and symptom change at twenty-four and forty-eight hours following initiation of drug therapy with either CPZ or haloperidol were the only variables that significantly related to therapeutic outcome. These preliminary results replicate and confirm previous results and provide a tool which can be included with other available approaches in developing a battery for prediction of drug response.
Adolescent↗
Early subjective response and prediction of outcome to neuroleptic drug therapy in schizophrenia.
Events that occur early in the course of neuroleptic treatment, and which may have utility in predicting short-term clinical outcome, were investigated. Such events include the patient's subjective response to drug, early clinical response, and the emergence of side effects. From all the variables examined, early subjective response and symptom change at 24 and 48 hours following initiation of neuroleptic drug therapy were found to be significantly related to short-term outcome. These findings are assessed with respect to their predictive utility and relative contribution to the development of a strategy for individualized drug treatment approaches in schizophrenia.
Antipsychotic Agents↗
A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity.
Schizophrenic patients' self-reports of their experience of neuroleptic treatment were used as the basis for the construction of a scale predictive of drug compliance. Reliability analysis of the responses of 150 patients indicated high internal consistency in the 30-item scale, and preliminary validation in the form of discriminant classification accurately assigned 89% of the sample to complaint and non-compliant groupings. Both discriminant and factor analyses suggest that maximum variability in responding is accounted for by items reflecting how the patient feels on medication, rather than what he knows or believes about medication.
Adult↗
The role of the behavioral sciences in North American medical schools: an overview.
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Behavioral Sciences↗
Pharmacotherapy and suicide risk in schizophrenia.
The authors examined drug prescribing patterns and incidence of side effects in schizophrenic patients who committed suicide as compared with a matched control group. The groups did not differ in type of drug prescribed, though patients in the suicide group received significantly higher doses of fluphenazine enanthate. Extrapyramidal reactions occurred more frequently among the patients in the suicide group in the thirty days preceding suicide, and autonomic side effects less frequently, than in control patients for a corresponding period prior to discharge. The authors conclude that the probability of suicide is not related to the type of drug prescribed.
Adult↗
A method of re-aligning bent pin-burs.
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Dental Amalgam↗