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Pharmacotherapy of impaired affect in recovering schizophrenic patients.

Publication ,  Journal Article
Hogarty, GE; McEvoy, JP; Ulrich, RF; DiBarry, AL; Bartone, P; Cooley, S; Hammill, K; Carter, M; Munetz, MR; Perel, J
Published in: Arch Gen Psychiatry
January 1995

BACKGROUND: Prominent and persistent anxiety, depression, and/or negative features characterize a substantial minority of recovered or residually psychotic schizophrenic outpatients and contribute to poor outcome. Because extrapyramidal side effects of typical neuroleptic medications often resemble such features, we first systematically studied the contribution of extrapyramidal side effects to these problems and their treatment. For patients who remained distressed, controlled trials of supplemental thymoleptics were undertaken. METHODS: In trial 1, 92 distressed (depressed and/or anxious) patients and 36 patients in a defect state (patients with negative symptoms) participated in a double-blind, intramuscular challenge that compared centrally acting benztropine mesylate with peripherally acting glycopyrrolate. In trial 2, 57 distressed patients and 22 patients in a defect state were randomly assigned to a double-blind, neuroleptic medication dose-reduction group. In trial 3, 57 chronically distressed patients who were maintained on a low dose of fluphenazine decanoate were randomly assigned to a supplemental desipramine hydrochloride, lithium carbonate, or placebo group under double-blind conditions for 12 weeks. RESULTS: For patients who were already maintained on antiparkinsonian medication, impaired affect was not resolved by additional benztropine. Only distressed patients with a family history of severe mental disorder (often affective) showed improvement with neuroleptic medication dose reduction. Patients in the defect-state group reported less dysphoria on a reduced neuroleptic medication dose, but negative symptoms persisted. Desipramine improved diverse aspects of mood and residual psychoticism, possibly as a prophylaxis against minor affective exacerbations. Depression improved in women only. Lithium positively affected multiple indexes of anxiety and anxious depression. CONCLUSION: Most often, persistent affective impairments are neither resistant extrapyramidal side effects nor characterological traits. Thymoleptics improve the nonphasic, chronic types of anxiety and depression in contrast to the acute, episodic forms, for which little support can be found in the literature.

Duke Scholars

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Published In

Arch Gen Psychiatry

DOI

ISSN

0003-990X

Publication Date

January 1995

Volume

52

Issue

1

Start / End Page

29

Location

United States

Related Subject Headings

  • Sex Factors
  • Schizophrenic Psychology
  • Schizophrenia
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Placebos
  • Middle Aged
  • Male
  • Lithium Carbonate
  • Humans
 

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Hogarty, G. E., McEvoy, J. P., Ulrich, R. F., DiBarry, A. L., Bartone, P., Cooley, S., … Perel, J. (1995). Pharmacotherapy of impaired affect in recovering schizophrenic patients. Arch Gen Psychiatry, 52(1), 29. https://doi.org/10.1001/archpsyc.1995.03950130029004
Hogarty, G. E., J. P. McEvoy, R. F. Ulrich, A. L. DiBarry, P. Bartone, S. Cooley, K. Hammill, M. Carter, M. R. Munetz, and J. Perel. “Pharmacotherapy of impaired affect in recovering schizophrenic patients.Arch Gen Psychiatry 52, no. 1 (January 1995): 29. https://doi.org/10.1001/archpsyc.1995.03950130029004.
Hogarty GE, McEvoy JP, Ulrich RF, DiBarry AL, Bartone P, Cooley S, et al. Pharmacotherapy of impaired affect in recovering schizophrenic patients. Arch Gen Psychiatry. 1995 Jan;52(1):29.
Hogarty, G. E., et al. “Pharmacotherapy of impaired affect in recovering schizophrenic patients.Arch Gen Psychiatry, vol. 52, no. 1, Jan. 1995, p. 29. Pubmed, doi:10.1001/archpsyc.1995.03950130029004.
Hogarty GE, McEvoy JP, Ulrich RF, DiBarry AL, Bartone P, Cooley S, Hammill K, Carter M, Munetz MR, Perel J. Pharmacotherapy of impaired affect in recovering schizophrenic patients. Arch Gen Psychiatry. 1995 Jan;52(1):29.

Published In

Arch Gen Psychiatry

DOI

ISSN

0003-990X

Publication Date

January 1995

Volume

52

Issue

1

Start / End Page

29

Location

United States

Related Subject Headings

  • Sex Factors
  • Schizophrenic Psychology
  • Schizophrenia
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Placebos
  • Middle Aged
  • Male
  • Lithium Carbonate
  • Humans