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Biomedical subjects

J Volavka

Publications and source records attributed to J Volavka.

At least 19 recordsLinked to original sources
PubMed1995

Plasma haloperidol levels and clinical effects in schizophrenia and schizoaffective disorder.

BACKGROUND: Plasma haloperidol levels between 5 and 11 ng/mL may be clinically optimal for acutely exacerbated schizophrenia, but the evidence for this therapeutic window has been inconsistent. METHODS: Haloperidol was administered in a double-blind manner during two consecutive 3-week experimental periods to 65 patients with acutely exacerbated schizophrenia or schizoaffective disorder. Two plasma levels were targeted: "low" (2 ng/mL) and "moderate" (10 ng/mL). The subjects were randomly assigned to four treatment sequences (low-low, low-moderate, moderate-moderate, or moderate-low). RESULTS: In the first 3 weeks, the antipsychotic efficacy of haloperidol increased with plasma levels up to approximately 12 ng/mL. In the second 3 weeks, decrease of plasma levels reduced negative symptoms. CONCLUSION: For most patients, plasma levels not exceeding 12 ng/mL yield the best results in the first 3 weeks of treatment. Subsequent lowering of the plasma levels may improve negative symptoms.

Adult↗
PubMed1995

Effect of risperidone on hostility in schizophrenia.

The objective was to examine effects of risperidone on hostility and compare these effects with those of haloperidol. On the basis of risperidone's pharmacologic profile, we hypothesized that risperidone has a selective effect on hostility and that this effect is greater than that of haloperidol. The data were obtained in a multicenter clinical trial of risperidone under placebo-controlled, double-blind conditions (duration, 9 weeks). The patients were 139 patients with the diagnosis of DSM-III-R schizophrenia. Hostility was measured by the "hostility" item of the Positive and Negative Syndrome Scale. Change in hostility served as a dependent variable in the analyses. Change in "psychosis" was applied as a covariate; it helped us examine changes in hostility that were unrelated to change in psychosis (selective effect). Risperidone had a greater selective effect on hostility than did haloperidol or placebo. This finding should encourage tests of risperidone as a treatment for patients who show frequent overt physical aggression.

Adolescent↗
PubMed1995

Characteristics of state hospital patients arrested for offenses committed during hospitalization.

OBJECTIVE: The study was a preliminary exploration of the relatively new phenomenon of arresting psychiatric inpatients for offenses committed in the hospital. METHODS: A retrospective record review at two New York state hospitals identified all 73 inpatients arrested over a 30-month period for an offense committed while they were hospitalized. Logistic regression was used to compare arrestees with a control group of 1,438 non-arrested inpatients. RESULTS: The number of arrests at the two hospitals significantly increased over the study period. Seventy-nine percent of arrests resulted from a violent incident. At least 68 percent of arrestees had been arrested previously. Compared with the control group, arrestees were more likely to be young, male, and black and to have a shorter length of stay. Axis I diagnoses did not differentiate arrestees from control patients. Ninety percent of arrestees had a diagnosis of substance use or personality disorder or both. The sample more closely resembled the population of criminal offenders in the community than the psychiatric inpatient population. Prosecution resulted in jail or prison terms for 11 percent of arrestees. CONCLUSIONS: This descriptive preliminary study was limited by its retrospective nature and reliance on records of varying quality. Although the increase in arrests is clear, the cause of the increase and the impact of arrests on arrestees and hospitals remain to be clarified.

Adult↗
PubMed1994

Does the change of psychopathology during the placebo period predict the response to subsequent treatment with active medication.

We examined whether deterioration in psychiatric symptoms during the placebo period predicted short-term response to subsequent treatment. Acutely exacerbated chronic schizophrenic or schizoaffective patients (n = 123) received placebo for 6.2 days on average. Afterwards, fixed haloperidol plasma levels were maintained for 6 weeks. Psychopathology was evaluated on the basis of the Brief Psychiatric Rating Scale (BPRS), which was administered weekly by trained raters. The global BPRS score at the beginning of the active treatment accounted for 11% of the end-point variance of the global BPRS score (p < 0.0002) and the change of psychopathology during the preceding placebo period explained additional 3.1% (p < 0.053) of it. The change in most of the BPRS factor scores contributed significantly to the prediction of the end-point BPRS score. The patients who had low scores on admission to the study and high scores at the end of the placebo period showed the greatest improvement. The results suggest that in addition to the baseline severity of psychopathology, the change of psychopathology that occurs during the pretreatment placebo period can partially account for treatment response.

Adult↗
PubMed1994

BMY 14802, a sigma receptor ligand for the treatment of schizophrenia.

The theoretical role of sigma receptors in psychosis has led to the development of selective sigma receptor ligands as potential antipsychotic agents. BMY 14802 has its most potent binding at the sigma binding site, with some degree of serotonin subtype 1A and negligible dopamine receptor binding. It is atypical of standard neuroleptics in that it does not induce catalepsy in rats. It has been shown to have efficacy in animal models of psychosis. It was hypothesized that the drug would have antipsychotic effects in humans without producing the extrapyramidal side effects typical of standard neuroleptics. We report here the results of an uncontrolled, multicenter safety and efficacy study of patients with acute exacerbations of schizophrenia treated with BMY 14802. After 1 week of single-blind placebo treatment, 28 patients were treated with BMY 14802 (up to 3000 mg/day) for up to 4 weeks. There was no significant improvement in psychiatric symptoms, as measured by the total Brief Psychiatric Rating Scale scores or Clinical Global Improvement. There were no changes in involuntary movements, as measured by the Abnormal Involuntary Movement Scale, or in extrapyramidal symptoms as measured by the Simpson-Angus Scale.

Adult↗
PubMed1993

Quantitative electroencephalogram examination of effects of risperidone in schizophrenic patients.

The objective of this study was twofold: (1) to describe the effects of risperidone on the quantitative electroencephalogram (EEG) in schizophrenic patients and (2) to explore the relationships between EEG changes and clinical improvement. The subjects were nine male schizophrenic patients participating in a placebo-controlled, double-blind clinical trial (duration, 9 weeks) aimed to assess the effects of risperidone. The EEG effects of risperidone were compared with those of haloperidol. Nine haloperidol patients were selected from a separate treatment study that had a similar design and selection criteria and used identical EEG methods. We found that risperidone treatment induced widespread changes in interhemispheric power asymmetry. Furthermore, overall clinical improvement was related to two EEG measures: (1) absolute power changes in the beta frequency band and (2) power asymmetry in the theta and delta bands. Both relationships were most expressed in the anterior areas. The first relationship could not be linked to any specific cluster of behavioral symptoms. The second relationship was linked to improvements of affective symptoms and hostility-suspiciousness. The relationships observed in the risperidone group could not be detected in the haloperidol-treated patients. We hypothesized that the first relationship is attributable to an interaction between the serotonergic and dopaminergic system; the second relationship was associated with serotonergic mechanisms.

Adolescent↗
PubMed1992

Haloperidol blood levels and clinical effects.

This study explored the relationships between plasma levels and the clinical effects of haloperidol in 176 acutely exacerbated schizophrenic or schizoaffective patients. After a single-blind placebo period of 1 week (period 1), they entered the double-blind period 2 randomly assigned to one of three plasma levels of haloperidol: low (2 to 13 ng/mL), medium (13.1 to 24 ng/mL), or high (24.1 to 35 ng/mL). Patients whose conditions did not improve in period 2 continued on one of the three haloperidol levels (period 3). Periods 2 and 3 lasted 6 weeks each. Only minor differences in clinical responses were noted among the three levels of haloperidol. These results imply that low or moderate doses of neuroleptics are appropriate for many acutely psychotic patients.

Acute Disease↗
PubMed1992

Level of haloperidol in plasma is related to electroencephalographic findings in patients who improve.

This study analyzed interrelationships among plasma level of haloperidol (HAL), electroencephalographic (EEG) changes, and clinical response in 37 acutely exacerbated schizophrenic patients after a 6-week period of treatment. Two hypotheses were tested: (1) EEG theta response to HAL depends on levels of HAL in plasma, and this relationship is expressed in patients showing a clear clinical response (responders). (2) Responders and nonresponders are characterized by a different neuroleptic EEG profile. EEG examinations (resting, waking EEG) were performed at study entry, end point of the placebo period ("baseline"), and weekly during the entire HAL treatment period. EEG response was measured by power spectral changes in four frequency bands (delta, theta, alpha, and beta); clinical response was assessed by the Brief Psychiatric Rating Scale. There was a significant relationship between HAL plasma levels and EEG theta activity for treatment responders, whereas no relationship was detected for the nonresponders. Furthermore, there were EEG changes (in the delta and alpha bands) that depended on clinical response but did not show any relationship, either in responders or nonresponders, to HAL plasma levels. These results supported both hypotheses.

Adult↗
PubMed1992

Brief pulse ECT in melancholia. EEG and clinical effects.

In a visual analysis of electroencephalograms (EEGs) obtained in 33 melancholic men before and after six brief pulse right unilateral, left unilateral, or bilateral electroconvulsive therapy (ECT) treatments, the authors were unable to detect the relation between therapeutic outcome and differential hemispheric lateralization of ECT-induced EEG slowing that had been reported previously for sine wave ECT at the same clinical site. These results may be related to differences in neurophysiologic effects between sine wave and brief pulse ECT, and do not support the hypothesis that lateralization of ECT-induced EEG slowing is central to the antidepressant effects of ECT.

Adult↗
PubMed1992

Assessment of risk behaviors for HIV infection among psychiatric inpatients.

A 13-item questionnaire was constructed to assess risk factors for HIV infection among 476 patients newly admitted over a one-year period to a state psychiatric hospital in New York City. Because psychopathology can affect patients' self-reports, the validity of the instrument was established by HIV antibody tests in a subset of 352 patients. Results of the questionnaire indicated that the 352 patients were almost equally divided between the high-risk and low-risk categories. HIV seroprevalence was .6 percent among the low-risk patients, but 14.4 percent among the high-risk patients. The findings suggest that a screening program to detect HIV-positive patients should be undertaken in this population, that it should be focused on the high-risk subgroup, and that the questionnaire can be used to define that subgroup. However, results of the study may not generalize to other geographic areas.

AIDS Serodiagnosis↗
PubMed1992

Psychobiology of the violent offender.

The antecedents of violent crime may include childhood victimization, head injuries, and alcohol and drug abuse. Neuropsychological and neuropsychiatric findings suggest temporal and frontal lobe dysfunctions in violent offenders; these dysfunctions appear to be more pronounced in the dominant hemisphere. Recent studies implicate disturbances of central serotonergic functions in impulsive homicide and arson. These results provide an adequate rationale for larger interdisciplinary studies using neurochemical, neuropsychiatric/neuropsychological, and psychosocial methods on the same subjects.

Alcohol Drinking↗
PubMed1991

Pretreatment EEG predicts short-term response to haloperidol treatment.

This study analyzed the relationship between pretreatment electroencephalogram (EEG) and response to haloperidol medication in a group of acutely exacerbated schizophrenic patients (n = 34). Improvement was assessed after 3 and 6 weeks of treatment; it was measured globally, as decrease in the total score on the Brief Psychiatric Rating Scale (BPRS), as well as multidimensionally through the individual BPRS factors. Relative powers from four clinical EEG frequency bands were employed as predictor variables. Baseline alpha activity was significantly related to clinical response. Higher alpha values were associated with poorer response to treatment. Specifically, improvements on the "thought disturbance" and "hostility-suspiciousness" factors underlied the relationship between the pretreatment EEG and outcome.

Adult↗
PubMed1991

Lateralized abnormality in the EEG of persistently violent psychiatric inpatients.

Twenty-one consecutive right-handed male psychiatric inpatients treated on a unit designed for the management of violent behavior were given computerized EEGs. We recorded their violent behaviors, the number of staff interventions needed to control their behavior, and their medications. The number of instances of violence as well as the number of staff interventions were related to increased delta band activity and to decreased alpha band activity in the temporal and the parietooccipital areas. These relationships were independent of the current medications and of the length of stay on the special unit. Furthermore, our results demonstrate that violence is very significantly related to the hemispheric asymmetry in EEG for the frontotemporal derivations. With increased levels of violence there was a greater level of delta power in the left compared with the right.

Adult↗
PubMed1991

HIV seroprevalence and risk behaviors in psychiatric inpatients.

The seroprevalence of the human immunodeficiency virus (HIV) in 515 patients consecutively admitted to a state psychiatric hospital in New York City was 8.9%. There were 365 patients whose results were individually traceable; the remaining 150 patients were tested anonymously. Risk factors including parenteral drug abuse, male homosexual behaviors, and other sexual behaviors were studied in the traceable patients. Logistic regressions indicated that parenteral drug abuse was the main risk factor in both males and females. In females, two additional factors were significant: sex with parenteral drug users or with partners who have the acquired immunodeficiency syndrome (AIDS), and sex with bisexual men. Females with bipolar disorders were particularly likely to report sex with parenteral drug users or with partners who have AIDS.

Adult↗
PubMed1991

Relationship between the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms: a study of their correlation and redundancy.

Because overlapping psychometric scales are used frequently in psychiatric research, examination of the relationship between scales has become increasingly important. The concept of relationship is the focus of this article. By way of illustration, the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS) were compared for correlation and redundancy. Since these scales are frequently represented by derived summary variables (e.g., factors, total scores), it is also important to assess the effect of such representation on measures of relationship. The SANS and the BPRS were found to be highly intercorrelated. Nevertheless, the individual items and the subscale scores of the SANS contain information independent from the BPRS: the best BPRS predictor variates can explain only approximately half of the total variance of the SANS. When the SANS, however, is represented by a single variable (composite score), it becomes highly redundant with the anergia factor of the BPRS.

Adult↗