Search PubMed⌕ Search

Biomedical subjects

W C Wirshing

Publications and source records attributed to W C Wirshing.

47 records · Page 3Linked to original sources
PubMed1991

Electromechanical characteristics of tardive dyskinesia.

Fifty patients with mild-to-moderate tardive dyskinesia (TD), who were devoid of other clinically apparent movement abnormalities, and 70 neurologically normal controls were assessed with a battery of instruments developed to measure and analyze the hyperkinetic movements of TD directly, objectively, and noninvasively. The electro-mechanical features that most consistently characterized and differentiated the TD group were a greater variability of all movements, increased energy in the 1-2 Hz frequency band in hand and foot movements, and a marked increase in movements during distracting tasks. This instrumentation promises to be useful in quantitating abnormal involuntary movements, in prospectively following individual patients to scan for small deviations from an instrument-established baseline, and in examining patients with combined movement abnormalities.

Adult↗
PubMed1991

Early prediction of relapse in schizophrenia: an application of receiver operating characteristic (ROC) methods.

We compared different methods of identifying prodromal periods with regard to their ability to predict relapse in schizophrenia. Fifty stabilized schizophrenic patients, who received a low dose of schizophrenic patients, who received a low dose of fluphenazine decanoate (5 to 10 mg every 2 weeks) were monitored with weekly evaluations to determine whether they met criteria for nonpsychotic prodromal episodes. We evaluated three different scales: (1) the Anxious-Depression subscale of the Brief Psychiatric Rating Scale (BPRS); (2) a modification of the patient self-report Early Signs Questionnaire and (3) the Idiosyncratic Prodromal Scale (IPS). We used receiver operating characteristic (ROC) methods for comparing the different instruments as methods for predicting whether patients would or would not demonstrate a psychotic exacerbation in the 4 weeks following the assessment. Both the IPS and the BPRS cluster scores were better than chance at correctly identifying periods of vulnerability to psychotic exacerbation. The ROC analyses suggest that relatively small changes in the signs and symptoms of chronic schizophrenic patients in maintenance treatment may be clinically meaningful.

Humans↗
PubMed1991

Plasma fluphenazine levels and clinical response in newly admitted schizophrenic patients.

Seventy-two newly readmitted, drug-free men with the diagnosis of schizophrenia by DSM-III were assigned randomly to receive fluphenazine hydrochloride at 5 mg, 10 mg, or 20 mg daily for 4 weeks. Fluphenazine (FLU), fluphenazine sulfoxide, 7-hydroxyfluphenazine, and fluphenazine N-oxide were measured by highly specific and sensitive radioimmunoassays. Data were analyzed by logistic regression using the Clinical Global Impressions Disabling Side Effects and Global Improvement as the outcome measures. Disabling side effects were defined as "side effects that significantly interfered with patient's functioning" or "side effects that outweigh therapeutic effects" (National Institute of Mental Health 1985, p. 839). Higher plasma FLU levels (up to 4.23 ng/mL) were significantly (p = .015) associated with a higher rate of global improvement. However, close to 90 percent of these acute patients had disabling side effects at a plasma FLU level of 2.7 ng/mL. At least in the patient's view, these disabling side effects negated or compromised the improvement in psychosis. Fluphenazine N-oxide may be a toxic metabolite in that it was more powerfully associated with side effects than was the parent FLU.

Adult↗
PubMed1989

Comparison of electromechanical measures and observer ratings of tardive dyskinesia.

Thirty-three patients with tardive dyskinesia (TD) were studied with multiple-observer consensus ratings of videotaped examinations, ultrasound counts of movement, and electromechanical frequency measures of the movements. There were statistically significant correlations between orofacial ultrasound measures and TD severity determinations made by observers. Clinical ratings did not correlate with frequency measures. Ultrasound measures substantiate observer rating scales, whereas frequency measures appear to provide information not available from clinical rating scale scores.

Dyskinesia, Drug-Induced↗
PubMed1989

Recognition and differential diagnosis of tardive dyskinesia.

Tardive dyskinesia (TD) is a consequence of chronic neuroleptic therapy. It is an irregular stereotyped movement disorder that is usually choreic in appearance, and is subject to temporary volitional control. Dystonia, akathisia, and tics are uncommon variants of the classic tardive syndrome. Characteristic clinical features including amelioration by action, augementation by distraction, partial volitional suppressibility, and lack of subjective distress help differentiate TD from other movement disorders such as resting tremor, Huntington's disease, spontaneous dyskinesias, and abnormal movements accompanying psychiatric illnesses.

Antipsychotic Agents↗
PubMed1989

Effects of anticholinergic agents on patients with tardive dyskinesia and concomitant drug-induced parkinsonism.

Twenty-five percent of 80 consecutive patients who met research criteria for persistent tardive dyskinesia (TD) were found to have an energy peak in the parkinsonian tremor band (3-6 Hz) of the frequency spectrum of their machine-measured resting hand movements in addition to the abnormalities consistent with TD (increased energy in the 0.5-3 Hz frequency spectrum). Twelve of these patients were studied again in double-blind fashion 2 hours after receiving a placebo and again 2 hours after a single 4 mg dose of trihexyphenidyl hydrochloride (HCl). Compared with the placebo condition, the trihexyphenidyl HCl markedly diminished the measured energy in the 4 Hz band and had no effect or slightly decreased the energy at all other points on the frequency spectrum. Simultaneous Abnormal Involuntary Movement Scale ratings revealed no change in the dyskinetic movements between the conditions; there was a significant subjective improvement reported by the patients following the trihexyphenidyl HCl administration. These observations indicate that electromechanical devices identify a subpopulation of TD patients who may acutely benefit from anticholinergic treatment.

Antipsychotic Agents↗
PubMed1989

Extrapyramidal syndromes in the elderly: diagnosis and management.

Extrapyramidal syndromes are among the most common neurologic conditions afflicting the geriatric patient. Most generally, these disorders can be categorized into those with hypokinetic characteristics (eg, parkinsonism) and those with hyperkinetic features (eg, chorea). Finer diagnostic and etiologic classification can be gained by observing the details of the movement (eg, regular vs. irregular, action vs. resting, proximal vs. distal) and considering accompanying signs, symptoms, and histories (eg, pyramidal signs, ocular abnormalities, cognitive impairments, history of treatment with neuroleptics). Optimal management of these varied syndromes hinges on the accurate identification of their clinical forms and a thorough search for their possible etiologies.

Aged↗
PubMedDate not supplied

Drug treatment of schizophrenia. Overview of recent research.

The authors review recent research findings on the drug treatment of schizophrenia. A number of studies emphasize that neuroleptic medications are severely limited by neurological side effects that include acute extrapyramidal syndromes and tardive dyskinesia. Studies comparing neuroleptic doses in both acute and maintenance therapy have encouraged clinicians to evaluate methods for treating patients with the lowest effective dose. Other studies, but not all, indicate that plasma level measurement may be helpful in decision making about drug dosage. The management of schizophrenic patients with illnesses that are refractory to conventional neuroleptics is also discussed. Clozapine, an atypical neuroleptic, may be more effective than other available neuroleptics for severely ill, treatment refractory patients or patients who are unable to tolerate the neurological side effects of typical neuroleptics.

Antipsychotic Agents↗