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Biomedical subjects

P C Bermanzohn

Publications and source records attributed to P C Bermanzohn.

At least 19 recordsLinked to original sources
PubMed2000

Hierarchical diagnosis in chronic schizophrenia: a clinical study of co-occurring syndromes.

Co-occurring or associated psychiatric syndromes (APS) such as depression, obsessive-compulsive disorder (OCD), and panic disorder have largely been hidden from view by exclusion rules that prohibit their being diagnosed in the presence of schizophrenia. This article presents data from a clinical study of APS in chronic schizophrenia and reviews the relevant literature. Thirty-seven chronic schizophrenia patients consecutively admitted to a day program were administered the Structured Clinical Interview for Diagnosis for DSM-IV and the Yale-Brown Obsessive Compulsive Scale symptom checklist. Exclusion rules prohibiting the diagnosis of APS were bypassed. Eighteen patients (48.6%) had one or more APS. Ten patients (27%) had major depression. Eleven (29.7%) met criteria for OCD. Four patients (10.8%) met criteria for panic disorder. These findings suggest that APS may be common in chronic schizophrenia and that there is a need to study these syndromes' clinical validity, including their treatability. A research plan to study the validity of these syndromes further is discussed.

Adult↗
PubMed1998

Clinical trials and tribulations: implementation processes in schizophrenia research outcome.

This article focuses on an area in clinical drug trials for new antipsychotic medications for the treatment of schizophrenia which has not received sufficient attention in the literature: the day-to-day implementation tasks performed by research staff which have potential effects on study results. Implementation tasks are viewed as dynamic processes involving interactions among research and nonresearch staff, patients, families, and pharmaceutical company staff. Research-related demands and possible sources of stress for all participants in the process, such as recruiting and maintaining patients in studies, are discussed. Suggestions are offered for increasing the ease of participation. Further investigation is called for in several areas including variability in the effectiveness of research teams and in the rarely discussed interactions between site staff and pharmaceutical company personnel, as they may affect research outcomes. It is posited that increased knowledge about implementation processes in schizophrenia drug development is needed to more fully understand study results and to enhance patients' and their families' willingness to participate.

Antipsychotic Agents↗
PubMed1997

Cognitive-behavioral treatment of panic attacks in chronic schizophrenia.

Although panic attacks have been described as relatively common in schizophrenia, few studies have examined treatments for this problem. Because cognitive-behavioral therapy (CBT) has demonstrated efficacy for panic disorder without schizophrenia, the authors conducted an open clinical trial of CBT for the treatment of panic attacks in schizophrenic patients. Eight patients meeting DSM-III-R criteria for schizophrenia and panic disorder were given a 16-week clinical trial of CBT. Ratings after treatment demonstrated both a statistically significant reduction in panic symptoms and a diminution in the number of panic attacks compared with baseline ratings. These results suggest use of CBT in the integrated treatment of patients with a diagnosis of schizophrenia and panic disorder is a promising approach that merits further investigation.

Adult↗
PubMed1994

Maintenance imipramine therapy for secondary depression in schizophrenia. A controlled trial.

BACKGROUND: Although recent studies have documented the benefit of adjunctive antidepressant medication for the short-term treatment of certain patients with operationally defined syndromes of postpsychotic depression, the value of maintenance adjunctive antidepressant treatment in this circumstance has not been properly established. METHODS: This study examined 24 schizophrenic or schizoaffective patients with postpsychotic depression or negative symptoms. These patients had all been benefited over the short term by the addition of adjunctive imipramine hydrochloride to their ongoing fluphenazine decanoate/benztropine mesylate regimens, and this adjunctive treatment had been successfully continued for 6 months. In a randomized double-blind protocol, treatment with adjunctive imipramine hydrochloride (mean, 233 +/- 72 mg/d) was then either maintained or tapered to placebo for an ensuing 1-year trial, while treatment with fluphenazine and benztropine continued. RESULTS: Significantly more patients who received placebo substitution relapsed into depression (P < .001). Patients who received placebo substitution were also more likely to experience relapses into psychosis (P < .02). CONCLUSIONS: These results support the clinical value of maintenance adjunctive imipramine therapy among initially responsive patients with postpsychotic depressions.

Adult↗
PubMed1994

Noncompliance with antiparkinsonian medications in neuroleptic-treated schizophrenic patients: three cases of an unreported phenomenon.

BACKGROUND: Depression is commonly associated with the longitudinal course of schizophrenia. Several etiologies for this problem have been proposed but, to our knowledge, noncompliance with antiparkinsonian medications has not been considered. METHOD: Case histories of two patients who were noncompliant and one who threatened noncompliance with antiparkinsonian medications are presented. All three patients were diagnosed with schizophrenia by DSM-III-R criteria and had been clinically stable for long periods. RESULTS: All three patients became depressed when their adjunctive benztropine was stopped, and their depressions remitted when their benztropine was reinstated. CONCLUSION: Noncompliance with antiparkinsonian medications may be associated with a reversible depression in patients receiving maintenance neuroleptics for schizophrenia. Since this is a newly described phenomenon, the scope of the problem is not known; however, it may contribute to the wide prevalence of depressive symptoms in schizophrenia. Clinical measures to facilitate detection of such noncompliance are discussed.

Adult↗
PubMed1993

Adjunctive imipramine in substance-abusing dysphoric schizophrenic patients.

Previous controlled studies have presented evidence that adjunctive tricyclic antidepressant medication may be useful in the treatment of schizophrenic and schizoaffective patients with phenotypic post-psychotic depressions and that tricyclic antidepressants may be useful in the treatment of certain substance-abusing nonschizophrenic patients. The potential value of adjunctive antidepressant medication among substance-abusing dysphoric schizophrenic and schizoaffective patients, however, has not previously been addressed. The present report details the results of carefully controlled adjunctive antidepressant trials among 11 such substance-abusing schizophrenic or schizoaffective patients. The results of this acute treatment trial appeared to be favorable for at least some individuals and can be interpreted in the context of models that heretofore have been advanced for the understanding of this clinical situation.

Adult↗
PubMed1992

Adjunctive imipramine for dysphoric schizophrenic patients with past histories of cannabis abuse.

1. Twenty-one schizophrenic or schizoaffective patients with histories of cannabis abuse and operationally-defined syndromes of post-psychotic depression completed a double-blind trial of adjunctive imipramine added to their on-going medication regimen of fluphenazine decanoate and benztropine. 2. The imipramine-treated patients had superior global outcome. 3. Subscales suggested that specific improvement occurred in imipramine-treated patients in the domain of depression-like features. 4. Psychotic symptomatology was not found to be exacerbated by the imipramine.

Adolescent↗
PubMed1992

Continuation treatment with adjunctive imipramine in schizophrenia.

An open continuation treatment trial was undertaken for schizophrenic and schizoaffective patients with postpsychotic depressions who had manifested favorable responses to initial treatment with adjunctive imipramine added to their fluphenazine decanoate and benztropine regimen. Of 27 patients enrolled, none had a psychotic or depressive relapse, and 23 completed the 6-month study. The patients did well; completers' Global Assessment Scale scores improved with statistical significance during the trial. Side effects also appeared to improve during the trial. The results therefore support continuation treatment with adjunctive antidepressant medication for those patients with postpsychotic depressions who initially respond favorably to this regimen.

Adult↗
PubMed1991

Antidepressant for substance-abusing schizophrenic patients: a minireview.

1. Substance abuse and post-psychotic depression are both frequently encountered concomitants of schizophrenia. 2. Substance abuse may be associated with depression-like symptomatology in the course of schizophrenia, and patients may attempt to self-medicate these symptoms with substances of abuse. 3. Antidepressant medication has been found to be a useful adjunct to treatment in at least some cases of substance abuse and some cases of post-psychotic depression. 4. Preliminary evidence exists suggesting that adjunctive antidepressant medication, added to a neuroleptic, may be useful for at least some stable dysphoric substance-abusing schizophrenic patients. 5. It is important to attempt to rule out even subtle neuroleptic-induced akinesia in such patients with a vigorous trial of antiparkinsonian medication.

Antidepressive Agents↗
PubMed1991

The use of antidepressants for negative symptoms in a subset of schizophrenic patients.

The authors used a randomized, placebo-controlled design to assess the therapeutic efficacy of adjunctive imipramine, added to fluphenazine decanoate and benztropine, among well-stabilized, negative-symptom schizophrenia and schizoaffective disorder patients who additionally met operationalized criteria for postpsychotic depression. The outcome of the imipramine-treated group was superior in both global ratings and a specific negative-symptom scale. Exacerbation of psychotic symptomatology was not found to be problematic. The implications of this study are discussed in terms of a potential strategy for pharmacotherapy among certain negative-symptom patients and in terms of its relevance to a possible pathophysiological basis for the negative-symptom state.

Adult↗
PubMed1990

Adjunctive imipramine maintenance in post-psychotic depression/negative symptoms.

Fourteen schizophrenic or schizoaffective patients, who had had operationalized syndromes of post psychotic depression or negative symptoms unresponsive to adjunctive benztropine but responsive to adjunctive imipramine, completed a double-blind maintenance treatment trial of adjunctive imipramine vs. placebo. All patients were maintained on standing doses of fluphenazine decanoate and benztropine throughout. All six patients tapered to placebo relapsed into their depression-like, negative symptom state, whereas only 2 of 8 patients maintained on imipramine had such a course (p = .009, favoring imipramine maintenance). No patients maintained on imipramine relapsed into psychosis. These results suggest the advisability of maintaining adjunctive imipramine treatment, in conjunction with appropriate neuroleptic and antiparkinsonian regimens, in stable, syndromally defined, postpsychotic depressed or negative symptom patients initially responsive to adjunctive imipramine.

Adult↗
PubMedDate not supplied

Bromocriptine for "negative" schizophrenia.

The hypothesis that the pathophysiology of negative symptoms in schizophrenia may involve relative hypoactivity of central dopaminergic neurotransmission prompts the exploration of dopamine agonist strategies in the treatment of this condition. Although the use of dopamine agonists in otherwise unmedicated schizophrenic patients often leads to the exacerbation of psychosis, trials of dopamine agonists in combination with neuroleptic agents warrant investigation. We therefore report on open clinical experience involving six patients with chronic negative symptoms of schizophrenia, maintained on neuroleptic medication, who appeared to have favorable responses to the addition of moderate doses of bromocriptine (10 to 20 mg/d orally in divided doses). One particular factor that makes these trials potentially informative is that five of the six patients had failed to respond to standard treatments with anticholinergic antiparkinsonian medication before the bromocriptine trial, making it unlikely that the bromocriptine had its effect purely by counteracting neuroleptic-induced akinesia. A trial of bromocriptine under these circumstances has never been reported. A second unique feature of this report concerns the lengthy period of follow-up. Adjunctive bromocriptine was continued for a total of 27 patient-years in the six individuals, with maintenance of favorable course and minimal incidence of psychotic exacerbation.

Activities of Daily Living↗
PubMedDate not supplied

Akinesia: a syndrome common to parkinsonism, retarded depression, and negative symptoms of schizophrenia.

A distinct hypokinetic syndrome appears to exist across several different neuropsychiatric diagnoses, involving (1) slowed motor activity with difficulty initiating and sustaining behaviors, (2) anhedonia with depressed mood and reduced affective range, and (3) cognitive impairment. Specifically, three well-recognized states--parkinsonism, retarded depression, and the negative symptoms of schizophrenia--prominently feature the components of this syndrome, and reduced dopamine turnover in the brain has been hypothesized to play a part in the pathophysiology of each. While aspects of this conceptualization remain controversial, it generates testable hypotheses that could have implications for the understanding and treatment of these states.

Antipsychotic Agents↗