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Biomedical subjects

L A Opler

Publications and source records attributed to L A Opler.

At least 55 records · Page 3Linked to original sources
PubMed1988

Pimozide treatment of the negative schizophrenic syndrome: an open trial.

Reports over the last 20 years suggest that pimozide, a neuroleptic of the diphenylbutylpiperidine (DPBP) group, might be helpful in the treatment of negative symptoms of schizophrenia, which are considered less responsive to standard neuroleptics than are positive symptoms. Research suggests that neuroleptic drugs of the DPBP group possess a unique property--potent calcium channel antagonism--which could explain their ability to relieve negative symptoms. Earlier reports, however, used measures not specifically designed to assess the negative syndrome. The Positive and Negative Syndrome Scale (PANSS) was developed and standardized to measure the negative syndrome in schizophrenia. The authors used the PANSS to study the effects of pimozide in a 6-week, open clinical trial with 10 neuroleptic-resistant schizophrenic inpatients who had prominent deficit features. Negative but not positive symptoms improved significantly, suggesting that the drug might target the negative profile. The authors discuss possible pharmacologic mechanisms for pimozide's potentially distinct clinical properties.

Adult↗
PubMed1987

Anticholinergic-neuroleptic antagonism in terms of positive and negative symptoms of schizophrenia: implications for psychobiological subtyping.

In three studies of comparable design, 47 schizophrenics received anticholinergic anti-Parkinsonism (AP) medications for two to four weeks along the course of neuroleptic treatment. Clinical ratings during the AP phase were contrasted against the preceding and following two-week periods on neuroleptic alone, and these changes were analysed for a total of 27 psychopathology dimensions and for clusters of seven positive and seven negative symptoms. Schizophrenics overall exhibited significant exacerbation of total psychopathology, and positive but not negative symptoms. Only those with a predominantly positive syndrome when drug-free were susceptible to AP therapeutic reversal. However, other subgroup analyses revealed worsening of total psychopathology and positive symptoms among catatonic, schizophreniform, chronic, and good outcome cases, but negative symptoms alone were significantly increased among paranoids. The results were not supportive of a positive-negative dichotomy of schizophrenia, but instead suggested a tripartite model: a distinct paranoid group and a division of the non-paranoids into a positive and a negative type.

Adolescent↗
PubMed1987

The positive and negative syndrome scale (PANSS) for schizophrenia.

The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.

Adult↗
PubMed1987

Amantadine in the treatment of neuroendocrine side effects of neuroleptics.

An open-label reversal drug study was undertaken on 10 neuroleptic-treated schizophrenic inpatients to assess the impact of amantadine hydrochloride on presumed prolactin-mediated neuroendocrine side effects. Measures were conducted across 7 weeks, including a 2-week neuroleptic baseline, a 3-week neuroleptic-plus-amantadine phase, and a 2-week return to the baseline regimen. Significant reduction with amantadine was observed on all six indices of neuroendocrine side effects: serum prolactin levels, body weight, gynecomastia/galactorrhea, breast tenderness, decreased libido, and amenorrhea. Improvement on these parameters was noted for as many as nine or all 10 patients, while in no cases was there worsening. In terms of motor and clinical effects, significant diminution of extrapyramidal and psycho-pathological symptoms was also achieved during this phase. The results suggested that amantadine may be beneficial for the treatment of neuro-endocrine side effects of antipsychotic medication owing to its ability to reverse neuroleptic-induced hyperprolactinemia.

Adult↗
PubMed1987

The positive-negative dimension in schizophrenia: its validity and significance.

It has been recently proposed that positive (productive) and negative (deficit) symptoms in schizophrenia constitute distinct syndromes that carry different etiological, prognostic, and treatment implications. Inconclusive results to date may be attributable to methodological weaknesses, including problems of measurement and lack of longitudinal, dynamic, and multiphasic investigation. We describe a series of multidimensional studies on the validity and significance of this distinction, deriving from a new rating instrument and separate typological, dimensional, longitudinal, phasic, and psychopharmacological research perspectives. The data suggest that positive and negative features represent opposing polarities of psychopathology which can be reliably assessed. Various sources of syndromal validation were demonstrated, including construct and criterion-related validity and differential response to psychotropic medication. Positive and negative syndromes were equally prevalent in the acute and chronic phases of schizophrenia but stable only in the latter. The meaning of the syndromes also varied according to chronicity. In the chronic stage, a negative profile was uniquely associated with ominous genealogical, premorbid, and phenomenological signs, whereas in acute schizophrenia it carried favorable import and predicted successful outcome. The results contest a monolithic concept of the positive-negative distinction and fail to support the prevalent hypothesis of structural organic impairment underlying the negative syndrome. We instead postulate a dual-process model that distinguishes between neuroleptic responsive arousal-related (positive) and neuroleptic resistant development (negative) components in chronic schizophrenia.

Antipsychotic Agents↗
PubMed1987

Attention deficit disorder psychosis as a diagnostic category.

The hypothesis is advanced that certain psychoses in adults devolve from attention deficit disorder (ADD), which has a fundamental impact on cognitive and social development and thus affects personality structure and psychodynamics. This 'ADD psychosis' often masquerades as schizophrenia or an affective disorder and hence is frequently misdiagnosed, precluding appropriate clinical intervention. Based upon clinical evidence and empirical research involving phenomenological comparisons, premorbid history, high risk studies, neurodiagnostic evaluations, and pharmacotherapeutic response, it is suggested that ADD psychosis in adults be regarded as a separate diagnostic entity. Distinguishing symptomatology, anamnesis, family history, therapeutics, as well as prognosis, are discussed. The concept of attention deficit disorder (ADD), until recently referred to as minimal brain dysfunction (MBD), has been conceived as a childhood affliction with rather specific and circumscribed manifestations. The diverse features which embrace this syndrome, such as hyperactivity and dyslexia, were first identified and subsumed under the collective banner of MBD about 2 decades ago. The complex hypotheses concerning its possible etiology have been detailed elsewhere and need not be repeated here. Rutter, based on his extensive literature review and seminal studies, has come to regard MBD as a subclinical brain disorder developing from a genetically determined biochemical abnormality, which produces symptoms of hyperactivity, impulsivity, attention deficit, aggressivity, and conduct disturbance. Indeed, factor analytic studies reviewed by Rutter support the co-occurrence of these pathological features in children, yet the empirical evidence for a distinct syndrome and for a precise etiology has been admittedly weak, with some contending that MBD or ADD is simply a catch-all for disparate neurological symptoms of unknown and variable pathogenesis.

Adult↗
PubMed1986

Positive and negative syndromes in schizophrenia as a function of chronicity.

The construct validity and extended stability of positive and negative syndromes were studied via multidimensional cross-sectional assessment of 134 schizophrenics in the acute, chronic, and long-term chronic stages. For all groups the syndromes were internally reliable, not significantly intercorrelated, and of similar severity. The syndromal correlates with clinical, motor, historical, and genealogical dimensions, however, differed as a function of chronicity. In acute schizophrenics, a negative syndrome was associated with clinical and genealogical indicators of good prognosis, whereas the converse obtained for a positive syndrome in the acute stage and a negative syndrome in the chronic stage. The relationship of education, marital status, and attention disorder to the positive-negative distinction also varied according to length of illness. Its meaning, therefore, appeared phase-specific and subject to evolution, obviating generalizations across all phases. Implications for theory, prognosis, current research, and future study are presented.

Acute Disease↗
PubMed1986

Significance of positive and negative syndromes in chronic schizophrenia.

Positive and negative syndromes were studied in relation to demographic, historical, genealogical, clinical, psychometric, extrapyramidal, and follow-up measures of 101 chronic schizophrenic patients. The criterion scales proved to be reliable, normally distributed, and strongly correlated with general psychopathology, but otherwise inversely related to one another. Multiple regression analysis identified sets of 4-6 independent variables that explained 74%-81% of the scales' variance. A positive syndrome was associated chiefly with productive features, family history of sociopathy, more previous hospital admissions, and longer in-patient stay during the 30-month follow-up period. A negative syndrome correlated with deficits in cognitive, affective, social, and motor spheres, higher incidence of major psychiatric illness but less affective disorder among relatives, lower education, and greater cognitive developmental impairment. The results underscore the importance of genetic and biodevelopmental variables for understanding schizophrenic syndromes.

Adult↗
PubMed1986

Mesoridazine and thioridazine: clinical effects and blood levels in refractory schizophrenics.

Seven schizophrenic (according to DSM-III criteria) inpatients completed a two-phase study; each phase had a 1-week drug-free period followed by 6 weeks of a drug trial. The first phase uniformly involved treatment with chlorpromazine, and in the second phase patients received either mesoridazine (N = 3) or thioridazine (N = 4). Clinical ratings (Brief Psychiatric Rating Scale and Clinical Global Impressions) and neuroleptic blood levels were obtained weekly throughout the study. Whereas patients failed to respond to chlorpromazine 1800 mg/day, response to mesoridazine 400 mg/day and to thioridazine 800 mg/day was established on all Brief Psychiatric Rating Scale factors except for anxiety-depression. A higher neuroleptic blood level was achieved with mesoridazine or thioridazine at less than half the reference chlorpromazine dosage. Correlations between neuroleptic blood level and clinical response were positive for mesoridazine, negative for chlorpromazine, and nonsignificant for thioridazine. These findings are consistent with earlier research. We conclude that drug-resistant schizophrenics seem to improve clinically with mesoridazine or thioridazine, unlike with chlorpromazine, and that for mesoridazine this difference may be a function of selective dopamine receptor blockade.

Adult↗
PubMed1984

Positive and negative syndromes in chronic schizophrenic inpatients.

This study considered whether chronic schizophrenics with positive and negative syndromes represent distinct subtypes. From a survey of 47 schizophrenic inpatients, 18 showed preponderance of productive or deficit features, and four were mixed. The discrete groups were compared on clinical symptoms, cognitive tests, demographic and historical data, and drug side effects. They were significantly distinguished on most criterion symptoms and affect scales but, otherwise, essentially comparable in psychopathology and extrapyramidal symptoms. The tests revealed similar levels of intellectual impairment and visual-motor deficit, yet the negative patients displayed more primitive cognitive mode and greater psychomotor retardation. They also proved older, less educated, more often born in winter-time, hospitalized later in life, and less heavily medicated. The results supported the validity of the positive-negative dimension for identifying schizophrenic subtypes and suggested etiological implications regarding developmental deficiency.

Adult↗
PubMed1980

Tardive dyskinesia and institutional practice: current issues and guidelines.

Despite increasing public and legal pressures to minimize the occurrence of tardive dyskinesia, the practicing clinician often feels there are no alternatives to the use of neuroleptic medication in the treatment of psychosis. However, there are many clinical situations in which the use of neuroleptics may be avoided; guidelines for such situations, including the treatment of affective disorders and of chronic schizophrenia, are presented. The authors also discuss the use of alternative treatment programs and psychosocial interventions that may allow significant reduction in neuroleptics, and they describe new areas of research aimed at preventing and treating tardive dyskinesia.

Affective Symptoms↗
PubMedDate not supplied

SCID-PANSS: two-tier diagnostic system for psychotic disorders.

The SCID-PANSS was developed as a two-tier diagnostic system for psychotic disorders to supplement categorical diagnosis with functional-dimensional assessment. The procedure combines the DSM-III-R Structured Clinical Interview and Rating Criteria (SCID) with those from the Positive and Negative Syndrome Scale (PANSS). The comprehensive 50- to 60-minute interview yields diagnostic classification, plus a profile of 30 symptoms and 10 dimensional scales, including positive and negative syndromes, depression, thought disturbance, and severity of illness. A study of 34 psychotic inpatients assessed by five psychiatrists showed strong interrater correlations (0.85 to 0.97 for summary scales, P less than .0001), supporting the reliability of the SCID-PANSS for clinical and research applications.

Adult↗