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Biomedical subjects

M I Herz

Publications and source records attributed to M I Herz.

At least 19 recordsLinked to original sources
PubMed2000

A program for relapse prevention in schizophrenia: a controlled study.

BACKGROUND: This study examined whether a program for relapse prevention (PRP) is more effective than treatment as usual (TAU) in reducing relapse and rehospitalization rates among outpatients with schizophrenia. METHODS: Eighty-two outpatients with DSM-III-R schizophrenia or schizoaffective disorder were randomly assigned to receive either PRP (experimental group, n = 41) or TAU (control group, n = 41) and were followed up for an 18-month prospective controlled study. Patients in both groups were prescribed standard doses of maintenance antipsychotic medication. Treatment with PRP consisted of a combination of psychoeducation, active monitoring for prodromal symptoms with clinical intervention when such symptoms occurred, weekly group therapy for patients, and multifamily groups. The TAU consisted of biweekly individual supportive therapy and medication management. RESULTS: Outcome rates over 18 months were 17% for relapse (7 patients) and 22% for rehospitalization (9 patients) in the PRP group, compared with 34% for relapse (14 patients) and 39% for rehospitalization (16 patients) in the TAU group (P = .01 and P = .03, respectively). Addition of age, sex, baseline Global Assessment Scale score, Positive and Negative Syndrome Scale scores (3 measures), and substance abuse to the proportional hazards regression models all yielded nonsignificant effects. The PRP teams were much more likely than the TAU psychiatrists to identify prodromal episodes before patients met objective relapse criteria or needed hospitalization. CONCLUSIONS: The PRP was effective in detecting prodromal symptoms of relapse early in an episode. Crisis intervention including increased antipsychotic medication use during the prodromal phase reduced relapse and rehospitalization rates.

Adult↗
PubMed1996

Long-term impact of clozapine and psychosocial treatment on psychiatric symptoms and cognitive functioning.

OBJECTIVE: The long-term effects of a combination of clozapine and psychosocial treatment were evaluated in a sample of treatment-refractory state hospital patients with schizophrenia. METHODS: A repeated-measure design was used. Thirty-one patients with schizophrenia received both clozapine and an enhanced psychosocial treatment program. Data were collected at baseline and at one-year, two-year, and three-year follow-ups. Psychiatric symptoms, cognitive functioning, dyskinetic movements, and discharge rate were evaluated. RESULTS: Significant reductions in psychiatric symptoms and improvement in cognitive functioning were found. Differences in the pattern of reductions in positive and negative symptoms over the course of the study were noted. The majority of subjects improved sufficiently to be discharged. CONCLUSIONS: Clozapine, when combined with psychosocial treatment, is effective for treatment of patients with schizophrenia who are not responsive to other medications.

Adult↗
PubMed1995

Prodromal symptoms and relapse prevention in schizophrenia.

The value of monitoring for prodromal symptoms in patients with schizophrenia has been questioned by some investigators who point out that their positive predictive value, sensitivity, and specificity can be low in relation to relapse. This article focuses on methodological and conceptual issues which should be considered in evaluating the usefulness of prodromal symptoms and behaviors as part of the relapse process. The article presents the following conclusions: Many relapses are preceded by the appearance of prodromal symptoms and behaviors which may last from a few days to a few weeks or more. The presence of prodromal symptoms often does not predict impending relapse since the probability of progression to relapse depends on the complex interaction of many personal and environmental factors including the availability of prompt and effective psychiatric intervention. Finally, studies have shown that monitoring for prodromal symptoms and early intervention when they emerge is effective in reducing the likelihood of relapse in individuals with schizophrenia.

Humans↗
PubMed1991

Intermittent vs maintenance medication in schizophrenia. Two-year results.

This is a 2-year, double-blind, placebo-controlled study of 101 patients, evaluating the relative efficacy of intermittent medication (given only when the patient shows early signs of relapse) compared with moderate doses of maintenance medication for stable schizophrenic outpatients. Patients were dropped from the study if they had three prodromal episodes in 1 year or if an episode lasted more than 9 weeks. Fourteen percent of patients given maintenance treatment were dropped from the study compared with 46% of intermittently treated patients. Relapse rates were 16% for patients given maintenance treatment and 30% for intermittently treated patients, a nonsignificant difference. Intermittently treated patients were receiving significantly less medication, but there were no differences found in drug side effects. There appears to be no advantage in using the intermittent approach, but we found that the use of an early intervention strategy reduced the relapse and rehospitalization rates for these patients.

Adult↗
PubMed1989

Intermittent medication for schizophrenic outpatients: who is eligible?

The Medication Clinic of a large, urban Mental Health Center was screened for schizophrenic patients eligible for an intermittent medication approach. A total of 112 patients were evaluated, and 39, or 34.8 percent of the sample, met our basic inclusion criteria. No sex or age differences were found for eligibility. Sufficient eligible patients were found to make the intermittent medication approach a useful part of a comprehensive psychopharmacological program for schizophrenia, if the efficacy of the approach is demonstrated in clinical trials.

Adult↗
PubMed1986

Toward an integrated approach to the treatment of schizophrenia.

Long-term outcome studies have shown that schizophrenia is an illness whose course is usually characterized by exacerbations and remissions. This chapter summarizes pertinent literature regarding treatment of acute episodes; early intervention to prevent the development of full relapse; and pharmacological, behavioral, and psychotherapeutic strategies designed to decrease the amount of stress and patients' vulnerability to stress and thus decrease the likelihood of relapse. An emphasis is placed on a comprehensive treatment approach involving continuity of care.

Antipsychotic Agents↗
PubMed1985

Treatment strategies for reducing costs of acute psychiatric hospitalization.

Under new cost-containment regulations such as diagnostically related groups (DRGs) and capitation-based programs such as health maintenance organizations (HMOs), it will be advantageous to employ treatment strategies which reduce the utilization of hospitalization for acute psychiatric episodes. Results of clinical research studies have demonstrated that if a comprehensive system of mental-health care delivery is employed, alternatives to hospitalization can be less costly and often more effective clinically. Examples of alternative ambulatory treatment strategies include vigorous treatment of prodromal symptoms to prevent full relapse from occurring, family crisis therapy, home care, and day hospitalization. If hospitalization cannot be avoided, brief hospitalization is often at least as effective clinically as standard hospitalization and is certainly less expensive. As the impact of prospective payment plans increases, it is predicted that there will be a shift away from the central role of hospitalization in the treatment of acute psychiatric disorders.

Cost Control↗
PubMed1984

Recognizing and preventing relapse in patients with schizophrenia.

Although clinicians know that the acute symptoms of schizophrenia exacerbate and remit during the course of the illness, few studies detail the process leading to psychotic episodes. As an introduction to the problem of recognizing relapse in schizophrenic outpatients, the author discusses interviews that were conducted with one group of family members and two groups of schizophrenic patients, one whose psychotic episodes had just occurred and one whose episodes had occurred more than six months previously. The results confirm the existence of a prodromal period before relapse and the importance of prompt therapeutic interventions during such periods. Finally, the author presents a literature survey of the role of stress, the family, and psychotropic medication in relation to the relapse process, and discusses comprehensive therapeutic strategies that aim to either prevent or mitigate full-blown relapse.

Adult↗
PubMed1982

Intermittent medication for stable schizophrenic outpatients: an alternative to maintenance medication.

Because of neuroleptics' potential long-term side effects, the authors conducted a pilot study of an alternative to maintenance medication for stable schizophrenic outpatients. The doses of 19 patients were gradually reduced to zero over 8 weeks, and medication was then given only when a patient experienced early signs of relapse. The patients attended weekly group therapy and were closely monitored for prodromal signs, especially at times of stress; significant others helped observe patients. Five patients experienced increased symptoms during the drug washout period and were dropped from the study; of the remaining 14, 10 remained stable on the intermittent medication protocol.

Adult↗
PubMed1980

Relapse in schizophrenia.

Although schizophrenia is a chronic illness with exacerbations and remissions, there has been surprisingly little systematic study of early signs of relapse. The authors gave 145 chronic schizophrenic patients and 80 family members a structured interview regarding early signs of relapse and other information related to the relapse period. Most patients and family informants were aware of a prodromal period during which patients experienced such symptoms as having trouble sleeping, having trouble concentrating, loss of appetite, and feeling depressed. The authors discuss the implications of these findings for the treatment of chronic schizophrenic patients.

Adult↗
PubMed1979

Brief hospitalization: two-year follow-up.

This article presents the long-term follow-up effects of brief vs standard hospitalization on families. One hundred seventy-five newly admitted inpatients who lived with their families were randomly assigned to standard inpatient care, brief hospitalization followed by the availability of transitional day care, and brief hospitalization. All patients were offered follow-up outpatient treatment. Initial length of stay was 11 days for both brief hospitalization groups and 60 days for the standard group. The long-term results generally indicate little differential effect between treatments. When differences occurred, they generally favored the brief groups. For example, at one year the standard group families were judged to have a higher overall level of burden than the brief-day families. The findings suggest that patients are more likely to be rehospitalized because of their psychopathology than because of family burden.

Adult↗
PubMed1979

Brief vs standard hospitalization: for whom?

An effort was made to determine patient characteristics that have differential prognostic significance, depending on treatment assignment to one of three treatment approaches: standard inpatient care (n = 63), brief hospitalization followed by day care (n = 61), and brief hospitalization without day care (n = 51). All were followed by outpatient care. Both demographically and clinically assessed behavioral variables were related to a number of outcome measures, including days in the community, clinical ratings, and family assessment. Generally, the standard treatment was inferior to the two brief treatments. Multiple previous admissions were particularly contraindicative for standard treatment. High overt anger score was especially contraindicative for brief hospitalization without day care and particularly indicative for brief hospitalization with day care.

Adult↗