flupenthixol-decanoate and fluphenazine-depot

Long-acting injectable risperidone was assessed in schizophrenia patients who were symptomatically stable on conventional depot antipsychotics and who were then switched to long-acting risperidone. Participants in this open-label, multicentre, 12-week trial had received flupenthixol decanoate, fluphenazine decanoate, haloperidol decanoate, or zuclopenthixol decanoate for 4 months or longer. Each was considered symptomatically stable by investigators. After receiving two cycles of their conventional depot antipsychotic during the run-in period, patients were switched to receive long-acting risperidone every 2 weeks for 12 weeks at an initial dose of 25 mg. This dose could be increased in 12.5-mg increments at 4-week intervals. Ninety-two percent of the patients received all six injections; 62% received the 25-mg dose throughout the treatment period. Adverse events related to movement disorders were reported in 3%. Severity of movement disorders decreased during long-acting risperidone treatment. Positive and Negative Syndrome Scale (PANSS) total and factor scores and scores on the Clinical Global Impressions severity scale were significantly reduced during treatment; 48% of these stable patients showed further symptom improvement (> or =20% decrease in PANSS score at endpoint). The results indicate that patients with schizophrenia who are symptomatically stable during treatment with a conventional depot antipsychotic can be safely and effectively switched to long-acting injectable risperidone without a prior transition to oral risperidone.

Topics: Adult; Antipsychotic Agents; Clopenthixol; Delayed-Action Preparations; Dose-Response Relationship, Drug; Female; Flupenthixol; Fluphenazine; Haloperidol; Humans; Injections, Intramuscular; Male; Middle Aged; Movement Disorders; Psychiatric Status Rating Scales; Risperidone; Schizophrenia

An open clinical trial was carried out in 21 chronic schizophrenics to assess the effectiveness and side-effects of treatment with depot neuroleptics. All patients had been stabilized on fluphenazine decanoate for at least 6 months and on entry to the study were given the choice of continuing with this treatment or changing over to flupenthixol decanoate. Sixteen patients chose to receive flupenthixol decanoate (40 mg) and the other 5 fluphenazine decanoate (25 mg). Doses were given every 4 weeks during the 12-week study period. Clinical assessments were carried out every 4 weeks (Weeks 0, 4, 8 and 12) using the Brief Psychiatric Rating Scale and a side-effects checklist, and the Hamilton Rating Scale for Depression, the Schedule for Affected Disorders and Schizophrenia--Change Version, and the Global Assessment Scale were completed on entry (Week 0) and at the end of the study (Week 12). The results indicated that symptoms of depression, withdrawal, worrying, and psychomotor retardation were improved significantly (p less than 0.05) more with flupenthixol than with fluphenazine. The frequency of side-effects decreased during treatment with flupenthixol and there was a tendency towards fewer side-effects in the flupenthixol group than in the fluphenazine group after 8 weeks of treatment. It is concluded that a group of schizophrenic patients characterized by depressive symptoms or side-effects attributable to a prescribed neuroleptic might benefit from a switch to flupenthixol treatment.

Topics: Clinical Trials as Topic; Female; Flupenthixol; Fluphenazine; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Schizophrenia; Thioxanthenes; Tranquilizing Agents

Thirty-two chronic schizophrenics who had relapsed entered a double-blind randomised study and were followed-up for 2 years with the intention of measuring any difference in therapeutic effect and side effects between flupenthixol decanoate and fluphenazine decanoate. No differences could be seen as regards the global effect or the effect on the schizophrenic symptomatology during the first 6 months. After 1 year of treatment flupenthixol decanoate showed a trend towards a better effect on schizophrenic symptomatology. A corresponding result was seen for the depressive symptoms. There were no differences in the appearance of side effects. The need for additional neuroleptics in the initial phase seemed to be identical for both drugs. A possible slow antipsychotic effect with flupenthixol decanoate is probably due to the administered dose being somewhat low (in the present study approximately 31 mg flupenthixol corresponding to 27 mg fluphenazine). This suggests that flupenthixol should have been given in a somewhat higher dose (25 mg fluphenazine decanoate corresponding to 40 mg flupenthixol decanoate).

Topics: Adult; Aged; Chronic Disease; Clinical Trials as Topic; Depression; Double-Blind Method; Flupenthixol; Fluphenazine; Humans; Middle Aged; Random Allocation; Recurrence; Schizophrenia; Thioxanthenes; Time Factors

A double-blind randomized investigation compared withdrawal (placebo) with continued use of long-acting neuroleptics (fluphenazine decanoate or flupenthixol decanoate) in 41 chronic schizophrenic outpatients. After 6 weeks there was a tendency toward higher depressive scores in the placebo group, a difference which became statistically significant (p less than .05) at week 24. These results do not support earlier observations that neuroleptic drugs cause depression. Further analyses of the data indicated that depressive symptomatology could be an early sign of relapse.

Topics: Adult; Depressive Disorder; Double-Blind Method; Female; Flupenthixol; Fluphenazine; Humans; Male; Psychiatric Status Rating Scales; Random Allocation; Recurrence; Schizophrenia; Schizophrenic Psychology; Substance Withdrawal Syndrome; Thioxanthenes; Tranquilizing Agents

This study investigated the effects of transferring patients on combined depot and oral neuroleptics to a single depot preparation; a secondary objective was to assess the effects of transferring patients from one depot neuroleptic to another. It was found that, whereas transferring from one depot preparation (flupenthixol) to another (fluphenazine) had no clear disadvantage for the patients, changing over from a combined oral and depot (fluphenazine) regimen to equivalent doses of depot alone resulted in an unacceptably high rate of relapse. The reasons for this may relate to either the unique pharmacokinetics of these drugs or subtle qualitative differences between them. It is suggested that caution is necessary whenever attempts are made to rationalize polypharmacy in schizophrenic patients.

Topics: Administration, Oral; Antipsychotic Agents; Chronic Disease; Drug Therapy, Combination; Dyskinesia, Drug-Induced; Female; Flupenthixol; Fluphenazine; Humans; Injections, Intramuscular; Male; Middle Aged; Neurologic Examination; Psychiatric Status Rating Scales; Recurrence; Schizophrenia; Schizophrenic Psychology

Two cases of agranulocytosis occurring after addition of a butyrophenone to a course of phenothiazine treatment are reported and possible mechanisms for this interaction are discussed.

Topics: Agranulocytosis; Antipsychotic Agents; Chlorpromazine; Clomipramine; Depressive Disorder; Dose-Response Relationship, Drug; Droperidol; Drug Therapy, Combination; Female; Flupenthixol; Fluphenazine; Humans; Long-Term Care; Male; Middle Aged; Paranoid Disorders; Psychotic Disorders

Platelet-rich plasma from healthy controls was pre-treated with neuroleptics of the phenothiazine, butyrophenone or benzamide variety before aggregation with one of the following agonist agents: ADP, adrenaline, 5-HT, collagen, platelet activating factor or ristocetin. All compounds effective as antipsychotics, except sulpiride, depressed aggregation. Unmedicated schizophrenics showed aggregation responses indistinguishable from healthy controls. However, within days of treatment with either trifluoroperazine or haloperidol responses became abnormal in acutely psychotic patients. Increased responses to 5-HT and depressed responses to platelet activating factor were detected. After 4 weeks of treatment responses tended to return to normal. Aggregation responses were normal in those patients on long-term depot neuroleptics.

Topics: Adolescent; Adult; Antipsychotic Agents; Chlorpromazine; Delayed-Action Preparations; Flupenthixol; Fluphenazine; Haloperidol; Humans; Male; Platelet Aggregation; Procyclidine; Schizophrenia; Sulpiride; Trifluoperazine

Twenty-six chronic schizophrenic patients on well-established depot neuroleptic regimes with stable doses (16 on fluphenazine decanoate, 10 on flupenthixol decanoate) had serum neuroleptic levels measured by radioreceptor assay (RRA) and were followed for six months. The serum prolactin (PRL) concentration and resting electrocardiogram (ECG) were also taken at the beginning of the study period. Correlations had previously been noted between RRA measured neuroleptic levels and outcome in both acute and chronic patients on oral medication. However, in this study of depot medication no significant correlations were found between serum neuroleptic concentration, serum prolactin concentration and the clinical state or outcome. The prevalence (33%) and type of ECG abnormality observed was similar to that previously reported.

Topics: Adult; Delayed-Action Preparations; Dose-Response Relationship, Drug; Electrocardiography; Female; Flupenthixol; Fluphenazine; Heart; Humans; Male; Middle Aged; Prolactin; Radioligand Assay; Schizophrenia; Thioxanthenes

It has previously been demonstrated that direct opiate infusion into nucleus accumbens elicits psychomotor activation in rats. In the present study, the effects of chronic treatment with five different neuroleptics on this behavioral response were investigated. All neuroleptics tested (haloperidol, sulpiride, flupentixol decanoate, perphenazine enanthate, fluphenazine decanoate, palmitic ester of pipotiazine) induced a marked behavioral supersensitivity to intraaccumbens opiate infusion. A similarly enhanced sensitivity was observed in chronic reserpine-treated rats. The maximum sensitivity to opiates appeared 2-3 weeks after the beginning of neuroleptic treatment and was present up to 1 month after the end of treatment. Naloxone blocked the neuroleptic-induced enhanced response to opiates. It is concluded that chronic blockade of dopaminergic transmission results in considerable functional alterations of the endogenous opiate systems. The results are discussed in terms of possible underlying neuronal mechanisms, and important clinical implications are noted.

Topics: Animals; Antipsychotic Agents; Enkephalin, Methionine; Flupenthixol; Fluphenazine; Haloperidol; Male; Nucleus Accumbens; Perphenazine; Phenothiazines; Rats; Rats, Inbred Strains; Receptors, Dopamine; Reserpine; Septal Nuclei; Sulpiride; Time Factors

Ninety-one schizophrenics (mean age 34 years) were examined for tardive dyskinesia (TD) during chronic neuroleptic treatment. Dyskinesia was found in 23 (25.3%). The only variable that showed an association with TD was the current doses of neuroleptics: in none of the TD patients did the dose of fluphenazine decanoate (or equivalent) exceed 45 mg/week, whereas it was higher in 23 of the 68 without TD (p less than 0.01). When these 23 "high-dose" patients were disregarded, the TD group differed significantly from the 45 dose-matched non-TD subjects in that it had more common anticholinergic drugs, more common parkinsonian symptoms, and less instances of good remission (p less than 0.05 in each case). There was no association between TD and other considered variables (drug history, age, sex, clinical characteristics, size of the lateral brain ventricles, neurological "soft" signs, cognitive impairment). The results illustrate a relationship between TD prevalence and current doses of neuroleptics and indicate that differences in doses between the groups with and without TD may obscure associations between dyskinesia and other factors.

Topics: Adult; Antipsychotic Agents; Chronic Disease; Dose-Response Relationship, Drug; Dyskinesia, Drug-Induced; Female; Flupenthixol; Fluphenazine; Humans; Male; Prognosis; Schizophrenia

Topics: Adult; Antipsychotic Agents; Dose-Response Relationship, Drug; Dyskinesia, Drug-Induced; Flupenthixol; Fluphenazine; Humans; Middle Aged; Psychotic Disorders; Schizophrenia

Topics: Adult; Chronic Disease; Female; Flupenthixol; Fluphenazine; Humans; Male; Middle Aged; Schizophrenia; Thioxanthenes

In a prospective follow-up the outcome of 60 chronic schizophrenic patients who discontinued neuroleptic therapy after remaining stable 12-48 months was compared with controls continuing medication. Not only did the drug-discontinued patients have more relapses (P less than 0.001), but the form of relapse was both more severe and acute, resulting in differences of self-injury (P less than 0.05), anti-social behaviour (P less than 0.01), inpatient admissions (P less than 0.001), and the use of compulsory powers (P less than 0.01). In patients who relapsed, both social and work function was affected adversely for some months. Patients who remained relapse-free without drugs (20%) had a level of work and social function similar to medicated patients. At the end of 18 months the patients who discontinued depot maintenance therapy were found to have been prescribed one-third more neuroleptic drugs than controls, with a possible increase in the risk of long-term tardive dyskinesia.

Topics: Adult; Antipsychotic Agents; Chronic Disease; Drug Administration Schedule; Female; Flupenthixol; Fluphenazine; Humans; Male; Psychiatric Status Rating Scales; Recurrence; Schizophrenia; Schizophrenic Psychology; Social Adjustment; Thioxanthenes

Topics: Adult; Antipsychotic Agents; Drug Therapy, Combination; Dyskinesia, Drug-Induced; Dystonia; Flupenthixol; Fluphenazine; Humans; Long-Term Care; Male; Schizophrenia, Paranoid; Torticollis

Anterior pituitary response to TRH 200 micrograms i.v. was studied in ten chronic schizophrenic patients during long-term neuroleptic treatment. Nine patients had normal prolactin (PRL) response as compared with controls but in one the response was blunted; one patient had an exaggerated response. Prolactin increment was higher following TRH than haloperidol challenge. No growth hormone (GH) response to TRH was found and TSH responses were comparable to controls.

Topics: Adult; Aged; Antipsychotic Agents; Delayed-Action Preparations; Female; Flupenthixol; Fluphenazine; Growth Hormone; Haloperidol; Humans; Male; Middle Aged; Pituitary Function Tests; Prolactin; Schizophrenia; Stimulation, Chemical; Thyrotropin-Releasing Hormone

The effects of two neuroleptics (pipotiazine and fluphenazine) and five long-acting neuroleptics (pipotiazine undecylenate and palmitate, fluphenazine enanthate and decanoate, fluopentixol decanoate) are tested in the rat, during an observation period of 20 to 40 days following only one injection of compound. The compounds administered at three different and non toxic doses, are showing effects, the intensity and duration of which are different according to the dose and the compound: diestrus of pseudo-gestation or more than 15 days, hypertrophy of mammary gland, decreasing of the uterine weight. Some long-acting neuroleptics are active during more than forty days.

Topics: Animals; Antipsychotic Agents; Caproates; Estrus; Female; Flupenthixol; Fluphenazine; Mammary Glands, Animal; Organ Size; Ovary; Phenothiazines; Pregnancy; Pseudopregnancy; Rats; Thiazines; Uterus