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T Van Putten

Publications and source records attributed to T Van Putten.

At least 55 records · Page 3Linked to original sources
PubMed1986

Fluphenazine plasma levels in patients receiving low and conventional doses of fluphenazine decanoate.

Plasma fluphenazine concentrations (FLU) were measured in 45 patients with schizophrenic disorders who participated in a double-blind comparison of 5 and 25 mg fluphenazine decanoate (FD). The rise in plasma level of FLU 24 h after a "test dose" was significantly correlated with steady state FLU concentration at 12 weeks (for 5 mg patients, r = 0.45, P = 0.04; for 25 mg, r = 0.78, P = 0.005). Patients who had low FLU at baseline required nearly 6 months to reach a steady state when they received 25 mg. Patients who received 5 mg and had low FLU at baseline continued to demonstrate relatively low plasma levels for the entire 1st year. Although the mean FLU at 6 months was lower for patients who relapsed during the subsequent 18 months (0.57 ng/ml for relapsers vs 1.01 ng/ml for nonrelapsers), this difference was not statistically significant. When plasma levels from both dosage groups were combined, FLU at 12 weeks correlated significantly with factor scores for akinesia (r = 0.52, P = 0.002) and BPRS cluster scores for retardation (r = 0.52, P = 0.002). These results indicate that the measurement of fluphenazine plasma levels may be useful in determining when patients treated with FD are receiving drug doses which are likely to cause discomforting side effects.

Adult↗
PubMed1986

Low-dose treatment strategies.

Dose-comparison studies in chronic, continuously hospitalized patients show that megadoses of antipsychotic drugs are reasonably well tolerated. These findings, together with dose-comparison studies in acute patients, support the notion (and current practice) that the therapeutic index of antipsychotic drugs is wide. Recent work with outpatients indicates that fluphenazine decanoate 5 mg (versus 25 mg) every 2 weeks is effective for at least the first year. In addition, patients report feeling better when they take the lower dose. A dose-comparison study with haloperidol in newly admitted patients indicates that a 20 mg daily dose has neurotoxic effects. A similar dose-comparison study with oral fluphenazine indicates that a 5 mg daily dose is efficacious over a 3-week period. Thus, both inpatients and outpatients can be managed on doses that were formerly regarded as homeopathic. Patients taking low doses have fewer side effects (particularly less akinesia) and probably fewer dysphoric emotions than patients taking high doses, although they improve at a slower rate.

Adult↗
PubMed1985

Therapeutic monitoring of chlorpromazine I: Pitfalls in plasma analysis.

Pooled plasma from healthy volunteers was spiked with pure, synthetic chlorpromazine (CPZ), chlorpromazine sulfoxide (CPZSO), or chlorpromazine N-oxide (CPZNO), and then made alkaline with either sodium hydroxide or sodium carbonate. The samples were allowed to stand at room temperature for various timed intervals before extraction with organic solvent. It was found that CPZNO was reduced to CPZ in plasma made alkaline with sodium hydroxide, but not in protein-free buffer solution at high pH nor in plasma made alkaline with sodium carbonate. The reaction appears to take place through reducing equivalents generated by the action of sodium hydroxide on plasma proteins. Thus, apparent concentrations of CPZ in plasma from patients were elevated by as much as 343% when sodium hydroxide was used compared with concentrations in aliquots of the same plasma samples alkalinized with sodium carbonate. The amount of CPZ produced from CPZNO depends on the type of extraction procedure employed as well as on the quantity of sodium hydroxide added to the plasma. By contrast, no interconversion between CPZ and CPZSO or CPZNO and CPZSO was observed in plasma alkalinized and extracted under any of the conditions tested.

Chlorpromazine↗
PubMed1985

Psychotic patients' understanding of informed consent.

Courts have found psychiatric patients to have the qualified right to refuse treatment. Particularly problematic is whether newly admitted psychiatric patients can comprehend information and give informed consent. The authors examined the ability of voluntary and involuntary psychotic patients to understand information about antipsychotic medication, related this assessment to psychopathology, and evaluated factors involved in hypothetical acceptance or refusal of treatment. Although most patients stated they had understood informed consent material, objective ratings did not support this. Impaired understanding was significantly associated with thought disturbance but did not affect hypothetical acceptance or refusal of antipsychotics. Legal status was not a significant factor.

Adult↗
PubMed1984

Costs and benefits of two doses of fluphenazine.

The relative costs and benefits of low- and conventional-dose neuroleptic maintenance therapy were evaluated in a double-blind comparison of 5 and 25 mg of fluphenazine decanoate administered every two weeks. Subjects were 50 patients fulfilling DSM-III criteria for schizophrenic disorder who had been successfully maintained with 25 mg or less of fluphenazine decanoate. A one-year survival analysis disclosed that there were no statistically significant differences between the two doses insofar as preventing relapse. Patients receiving the higher dose appeared to feel more uncomfortable, as indicated by higher scores on subscales of the Hopkins Symptom Checklist-90. In addition, patients receiving the higher dose had higher side-effect scores. These findings suggest that a substantial proportion of patients who are presently maintained with 25 mg or less of fluphenazine decanoate every two weeks will do just as well with as little as 5 mg.

Adult↗
PubMed1984

Akathisia with haloperidol and thiothixene.

We studied the incidence of akathisia in two populations of newly admitted schizophrenic patients: one group was treated with haloperidol and the other group was treated with thiothixene hydrochloride. Within six hours after taking a 5-mg test dose of haloperidol, 40% of the patients experienced akathisia; during maintenance treatment with 10 mg of haloperidol taken at bedtime, 75% of the patients experienced akathisia by the seventh day. With thiothixene hydrochloride (0.22-mg/kg test dose; 0.44-mg/kg maintenance dose), the respective percentages were 20% and 46%. The akathisia experienced after administration of the test of haloperidol dose was not mild or inconsequential; 28% of the patients experienced moderate, 17% of the patients experienced severe, and 22% of the patients experienced very severe akathisia. Akathisia with haloperidol could not be suppressed completely in half of the patients. Treatment-resistant akathisia was experienced as anxiety and depression. We believe these tallies to be important because akathisia causes much misery and often goes undiagnosed.

Adult↗
PubMed1984

Information processing and neuroleptic response in acute and stabilized schizophrenic patients.

Information processing was measured in 13 acute and 18 stabilized schizophrenic patients using the span of apprehension task. Acutely disturbed patients demonstrated improved performance on this task after 14 days of treatment with haloperidol. Stabilized patients maintained on fluphenazine decanoate did not show a significant change in performance during 3 months of treatment. Among the acutely disturbed patients, those with good baseline performance or the greatest initial improvement on the span of apprehension task showed the greatest reduction in various aspects of schizophrenic thought disturbance in response to drug treatment. These preliminary results suggest that information-processing measures may be useful in defining clinically meaningful subtypes in schizophrenia.

Adult↗
PubMed1984

Response to antipsychotic medication: the doctor's and the consumer's view.

The subjective response to antipsychotic medication was systematically evaluated in two samples of schizophrenic patients, one treated with haloperidol, the other with thiothixene. For both groups, a dysphoric response to the first dose was found to be a powerful predictor of noncompliance. A persisting dysphoric response was associated with a poor clinical outcome. Dysphoric responses were powerfully associated with akathisia. Patients' subjective responses were consistent throughout therapy, and there was moderate agreement between the patients' evaluation of the medication and the staff's ratings of improvement. The authors suggest that the subjective response to antipsychotic medication should not be dismissed and that dysphoric responses should be acknowledged.

Adult↗