[Proceedings: Clinical trials: Methodology versus practice? - An attempted Compromise (author's transl)].
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Biomedical subjects
Publications and source records attributed to B Woggon.
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Lofepramine, an imipramine derivative, shows lower acute toxicity in animals when compared with desipramine and imipramine. Its anticholinergic effect is less pronounced than that of desipramine. In an open clinical trial lofepramine showed a marked antidepressive action. A double-blind multicenter trial of lofepramine v. imipramine, evaluated by means of the AMP system, showed a remarkable degree of concurrence with regards to the effects of those two products.
Five depot neuroleptics (fluphenazinedeconoate, fluspirilene, pipothiazinepalmitate, penfluridol and perphenazine-enanthate) were compared based on clinical trials in subacute and chronic schizophrenic patients. The psychopathological symptoms were documented by means of the AMP-system. Statistical analyses showed several differences between the effects of the five substances. The AMP-system proved a useful instrument to differentiate similar drugs.
Lofepramin is a new derivative of imipramine. Its effects and side effects were compared to those of imipramine in a double-blind trial. 49 hospitalized patients, suffering from endogenous depression, were treated for 20 days with 210 mg lofepramin daily and 52 other patients with 150 mg imipramine daily. The results of the repeated psychiatric examinations were documented using the AMP system. Both substances proved to have high antidepressant effects and showed no significant difference in the quality of their effects.
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Based on a sample of 42 chronic schizophrenic patients and 42 carefully matched controls, we investigated potential relationships between acoustic variables on the one hand, and negative syndromes, positive syndromes and affective disturbances, on the other. A set of 12 acoustic variables automatically assessed in a standardized experimental setting allowed an almost perfect discrimination between schizophrenic patients and normal subjects. Acute side-effects of medication did not explain this finding. However, the question of whether the observed changes in speaking behavior and voice sound characteristics were caused by long-term neuroleptic treatment, for example, as a consequence of tardive dyskinesia, could not be answered by our investigation. In view of a biological validation of the negative-positive model of schizophrenia, the reliability of various psychopathological subscales was tested through repeated assessments at 14 day intervals. We found most psychopathology scores to be sufficiently stable and reproducible over time, thus representing a suitable basis for the estimation of severity with respect to the negative and positive component of schizophrenia. Using the first measurements as training samples and the second measurements of 14 days later as test samples, discriminant analysis yielded conclusive proof of a close relationship between acoustic variables and the severity of the negative and positive component of schizophrenia. In particular, by means of "objective" acoustic variables and under the constraint of reproducibility, 75.9% of patients were correctly classified as low or high scorers with respect to the negative syndrome, 71.9% of patients with respect to the positive syndrome, and 79.4% of patients with respect to their depressive symptomatology.
In 1975 we performed an open trial with bromperidol in 25 hospitalized schizophrenic patients. Effects and side-effects were registered by means of the AMP system. Patients were treated up to 30 days and the dosage of bromperidol was increased depending on effects and side-effects up to 5 mg per day. Bromperidol showed a good effect on productive schizophrenic symtpoms and caused a significant reduction of accompanying depressive symptoms. Data of this open trial were compared with data of two open trials with clozapine and haloperidol which were performed using the same methods. We compared the three open trials and found similar effects on psychotic symptomatology, but a different severity of extrapyramidal side-effects. A double-blind comparison between bromperidol and perphenazine in 40 schizophrenic patients showed a strong antipsychotic efficacy of bromperidol and an earlier onset of its effects.