Assessment of Anti-Psychotic Drugs

  • A. V. P. Mackay

Abstract

The last thirty years have witnessed intense activity in the field of clinical psychopharmacology, since the birth of contemporary psychopharmacology in Paris in 1952 with the production and clinical evaluation of chlorpromazine. That original evaluation of chlor-promazine was relatively straightforward (Delay & Deniker, 1952). Its efficacy in controlling psychotic manifestations was so clearly superior to existing means at that time that no subtle clinical rating scale or statistical device was required to throw the observed benefit into relief. Since that time there have been many developments in the field of psychopharmacology and several new families of anti-schizophrenic drugs have appeared. During this process certain rules of clinical assessment have evolved and have become incorporated into a research and development ritual which now tends to be applied to any new anti-schizophrenic candidate. There is no doubt that real evolution has taken place in the technology of clinical assessment and that experimenters are more aware of the basic requirements needed to arrive at some scientific conclusion.

Keywords

Bark Chlor Dystonia Metoclopramide Phenothiazine 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. ATKINSON, A.J. & KUSHNER, W. (1979). Clinical pharmacokinetics. Ann. Rev. Pharmac. Tox., 19, 105–127.CrossRefGoogle Scholar
  2. AYD, F. (1961). A survey of drug-induced extrapyramixal reactions. J. Am. med. Ass. 175, 1054–1060.CrossRefGoogle Scholar
  3. ANGUS, J.W.S. & SIMPSON, G.M. (1970). Handwriting changes and response to drugs—a controlled study. Acta Psychiat. Scand. Suppl, 212, 28–37.CrossRefGoogle Scholar
  4. BLACKWELL, B. (1972). For the first time in man. Clin. Pharmac. Ther., 13,812–823.Google Scholar
  5. BOULLIN, D.J., GRAHAME-SMITH, D.G., GRIMES, R.P.J. & WOODS, H.F. (1975). Resuspension of platelets: enhanced 5-hydroxytryptamine-induced aggregation in chlorpromazine treated patients due to changes in platelet properties. Br. J. clin. Pharmac., 2, 37–39.CrossRefGoogle Scholar
  6. BOULLIN, D.J., KNOX, J.M., PETERS, J. & ORR, M.W. (1978). Platelet aggregation and chlorpromazine therapy. Br. J. clin. Pharmac., 6, 538–540.CrossRefGoogle Scholar
  7. BOULLIN, D. J. & ORR, M. W. (1976). Effects of aspirin and prostaglandin E2 on secondary phase aggregation responses in schizophrenic patients treated with chlorpromazine. Br. J. clin. Pharmac., 3, 929–933.CrossRefGoogle Scholar
  8. BOULLIN, D.J., ORR, M.W., & PETERS, J.R. (1978). The platelet as a model for investigating the clinical efficacy of centrally acting drugs; relations between platelet aggregation and clinical condition in schizophrenics treated with chlorpromazine. In Platelets: A multi-disclipinary approach, eds Gaetano, S.E. & Garattini, S. New York: Raven Press.Google Scholar
  9. BOULLIN, D.J., WOODS, H.F, GRIMES, R.P.J., GRAHAME-SMITH, D.G., WILES, D., GELDER, M.G. & KOLA-KOWSKA, T. (1975). Increased platelet aggregation responses to 5-hydroxytryptamine in patients taking chlorpromazine. Br. J. clin. Pharmac., 2, 29–35.CrossRefGoogle Scholar
  10. CHOUINARD, G., ANNABLE, L., ROSS-CHOUINARD, A. & KROPSKY, M.L. (1979). Ethopropazine and benztropine in neuroleptic-induced Parkinsonism. J. clin. Psychiat., 40, 147–152.Google Scholar
  11. COLLINS, P., LEE, I. & TYRER, P. (1979). Finger tremor and extrapyramidal side effects of neuroleptic drugs. Br. J. Psychiat., 134, 488–493.CrossRefGoogle Scholar
  12. DELAY, J. & DENIKER, P. (1952). 38 cas de psychoses traitées par la cure prolongée et continué de 4560 RP, Le Congrés de Psychiat. Neurol. de Lange Française (Luxembourg, 1952) in C.R., 503–513, Ed. Masson.Google Scholar
  13. DENIKER, P. (1978). Impact of neuroleptic chemotherapies on schizophrenic psychoses. Am. J. Psychiat., 135, 923–927.PubMedCrossRefGoogle Scholar
  14. ECDEU ASSESSMENT MANUAL (1976). Early clinical drug evaluation programme assessment manual for psycho-pharmacology, ed. Giu, W., Maryland: U.S. Department of Health, Education and Welfare.Google Scholar
  15. ELLSWORTH, R.B. & CLAYTON, W.H. (1959). Measurement of improvement in mental illness. J. consult. Psychol., 23, 15–20.PubMedCrossRefGoogle Scholar
  16. FALLOON, I., WATT, D.C. & SHEPHERD, M. (1978). A comparative controlled trial of pimozide and fluphena-zine decanoate in the continuation therapy of schizophrenia. Psychol. Med., 8, 59–70.PubMedCrossRefGoogle Scholar
  17. FEIGHNER, J.P., ROBINS, E., GUZE, S.B., WOODRUFF, R. A., WINOKUR, G. & MUNOZ, R. (1972). Diagnostic criteria for use in psychiatric research. Arch. gen. Psychiat., 26, 57–63.PubMedCrossRefGoogle Scholar
  18. GAUTIER, J., JUS, A. & VILLENEUVE, A. (1977). Influence of the antiparkinsonian drugs on the plasma levels of neuroleptics. Biol. Psychiat. 12, 389–399.PubMedGoogle Scholar
  19. GODWIN-AUSTEN, R.B., TOMLINSON, E.B., FREARS, C.C. & KOK, H.W.L. (1969). Effects of L-DOPA in Parkinson’s disease. Lancet, ii, 165–168.CrossRefGoogle Scholar
  20. GREENBLATT, D.J. (1979). Predicting steady state serum concentrations of drugs. Ann. Rev. Pharmac. Toxi., 19, 347–356.CrossRefGoogle Scholar
  21. HALL, J.N. (1980). Ward rating scales for long-stay patients: a review. Psychol. Med., 10, 277–288.PubMedCrossRefGoogle Scholar
  22. HARPER, P. & CHACON, C. (1976). Work performance versus clinical assessment in the evaluation of phenothiazine treatment. Br. J. clin. Pharmac., 3, (Suppl.) 50–55.CrossRefGoogle Scholar
  23. HIRSCH, S.R., GAIND, R., RHODE, P.D., STEVENS, B.C. & WING, J.K. (1973). Outpatient maintenance of chronic schizophrenic patients with long-acting fluphenazine. Double-blind placebo trial. Br. med. J., 1, 633–637.PubMedPubMedCentralCrossRefGoogle Scholar
  24. HOGARTY, G.E. & GOLDBERG, S.C. (1973). Collaborative Study Group: Drugs and sociotherapy in the aftercare of schizophrenic patients; one year relapse rates. Arch. gen. Psychiat., 28, 54–64.PubMedCrossRefGoogle Scholar
  25. HOGARTY, G.E., GOLDBERG, S.C., SCHOOLER, N.R. & ULRICH, R.F. (1974). The Collaborative Group: Drugs and sociotherapy in the aftercare of schizophrenic patients II; two-year relapse rates. Arch. gen. Psychiat., 31, 603–608.PubMedCrossRefGoogle Scholar
  26. HOLLISTER, L.E. (1962). Studies of delayed-action medication. 1. Meprobamate administered as compressed tablets and as two delayed-action capsules. New Engl. J. Med., 266, 281–283.PubMedCrossRefGoogle Scholar
  27. HOLLISTER, L.E. (1972). Prediction of therapeutic uses of psychotherapeutic drugs from experiences with normal volunteers. Clin. Pharmac. Ther., 13,803–808.Google Scholar
  28. HOLLISTER, L.E., KANTER, S.L. & WRIGHT, A. (1968). Comparison of intramuscular and oral administration of chlorpromazine and thioridazine. Arch. int. Pharmacodyn., 144, 571–578.Google Scholar
  29. HONIGFELDT, G. & KLETT, C (1965). The Nurses’ Observation Scale for In-patient Evaluation (NOSIE): A new scale for measuring improvement in chronic schizophrenia. J. clin. Psychol., 21, 65–71.CrossRefGoogle Scholar
  30. HORNE, D.J. de L. (1973). Sensorimotor control in Parkinsonism. J. Neurol. Neurosurg. Psychiat., 36, 742–746.PubMedPubMedCentralCrossRefGoogle Scholar
  31. HUGHES, J.S. & LITTLE, J.C. (1976). An appraisal of the continuing practice of prescribing tranquillizing drugs for long-stay psychiatric patients. Br. J. Psychiat., 113, 867–873.CrossRefGoogle Scholar
  32. JOHNSTONE, E.C., CROW, T.J., FRITH, C.D., CARNEY, M. W. P. & PRICE, J. S. (1978). Mechanism of antipsychotic effect in acute schizophrenia. Lancet, i, 848–851.CrossRefGoogle Scholar
  33. JOHNSTONE, E.C., BOURNE, R.C., COTES, P.M., CROW, T.J., FERRIER, I.N., OWEN, F. & ROBINSON, J.D. (1980). Blood levels of flupenthixol in patients with acute and chronic schizophrenia. In Drug Concentrations in Neuropsychiatry, Ciba Foundation Symposium 74 (New series), pp. 99–111 Oxford: Excerpta Medica.Google Scholar
  34. KETY, S.S. (1980). The syndrome of schizophrenia: Unresolved questions and opportunities for research. Br. J. Psychiat., 136, 421–436.CrossRefGoogle Scholar
  35. KIDGER, T., BARNES, T.R.E., TRAUER, T. & TAYLOR, P.J. (1980). Sub-syndromes of tardive dyskinesia. Psychol. Med., 10, 513–520.PubMedCrossRefGoogle Scholar
  36. KNOX, J.M., ORR, M.W., ALLEN, R., GELDER, M.G. & GRAHAME-SMITH, D.G. (1981). The reliability of 5-hydroxytryptamine-induced platelet aggregation responses in schizophrenic patients treated with neuroleptic drugs. Br. J. clin. Pharmac., 11, 261–263.CrossRefGoogle Scholar
  37. KRAWIECKA, M., GOLDBERG, D. & VAUGHAN, M. (1977). A standardised psychiatric assessment scale for rating chronic psychotic patients. Acta Psychiat. Scand., 55, 299–308.PubMedCrossRefGoogle Scholar
  38. LEFF, J. (1976). Assessment of drugs in schizophrenia. Br. J. clin. Pharmac., 3, (Suppl.) 75–78S.CrossRefGoogle Scholar
  39. LEFF, J.P. & WING, J.K. (1971). Trial of maintenance therapy in schizophrenia. Br. med. J., 3, 599–604.PubMedPubMedCentralCrossRefGoogle Scholar
  40. LENTZ, R.J., PAUL, G.L. & CALHOUN, J.F. (1971). Reliability and validity of three measures of functioning with ‘hard core’ chronic mental patients. J. abn. Psychol, 78, 69–76.CrossRefGoogle Scholar
  41. LETEMENDIA, F.J.J. & HARRIS, A.D. (1967). Chlorpromazine and the untreated chronic schizo-phrenic: a long-term trial. Br. J. Psychiat., 113, 940–958.Google Scholar
  42. LYERLY, S.B. (1973). Handbook of Psychiatric Rating Scales, Edition 2. Bethesda, Maryland, U.S.A.: National Institutes of Mental Health.Google Scholar
  43. McGLASHAN, T. (1973). In The Documentation of Clinical Psychotropic Drug Trials, ed. McGlashan, T. Rockville, Maryland: National Institute of Mental Health.Google Scholar
  44. MACKAY, A.V.P. & CROW, T.J. (1980). Positive and negative schizophrenic symptoms and the role of dopamine. Br. J. Psychiat., 137, 379–386.CrossRefGoogle Scholar
  45. MACKAY, A.V.P. & SHEPPARD, G.P. (1979). Pharmacotherapeutic trials in tardive dyskinesia. Br. J. Psychiat., 135,489–499.CrossRefGoogle Scholar
  46. McNAIR, D.M. (1973). Self-evaluation of anti-depressants. Report prepared for the American College of Neuropsychopharmacology, Subcommittee of the Task Force on Antidepressants.Google Scholar
  47. MARSDEN, C.D., MINDHAM, R.H.S. & MACKAY, A.V.P. (1981). Extrapyramidal movement disorders produced by antipsychotic drugs. In The pharmacology and treatment of schizophrenia, eds. Bradley, P.B. & Hirsh, S.R. London: Oxford University Press, (in press.)Google Scholar
  48. MARSDEN, C.D. & SCHACHTER, M. (1981). Assessment of extrapyramidal disorders. Br. J. clin. Pharmac., 11, 129–152.CrossRefGoogle Scholar
  49. MILLER, R.J. & HILEY, R. (1974). Antimuscarinic properties of neuroleptics and drug-induced Parkinsonism. Nature, 248, 596–579.PubMedCrossRefGoogle Scholar
  50. MILLS, D.CB. & ROBERTS, G.C.K. (1967). Membrane active drugs and the aggregation of human blood platelets. Nature, 213, 35–38.CrossRefGoogle Scholar
  51. MINDHAM, R.H.S. (1976). Assessment of drug-induced extrapyramidal reactions and of drugs given for their control. Br. J. clin. Pharmac., 3, (Suppl). 395–400S.CrossRefGoogle Scholar
  52. MINDHAM, R.H.S., GAIND, R., ANSTEE, B.H. & RIMMER, L. (1972) Comparison of amantidine, orphenadrine, and placebo in the control of phenothiazine-induced Parkinsonism. Psychol. Med., 2, 406–413.PubMedCrossRefGoogle Scholar
  53. NAKRA, B.R.S., BOND, A.J. & LADER, M.H. (1975). Comparative psychotropic effects of metolopramide and prochlorperazine in normal subjects. J. clin. Pharmac., 15,499–454.CrossRefGoogle Scholar
  54. ONUAGULUCHI, G. (1964). Parkinsonism. London: Butterworth.Google Scholar
  55. ORR, M.W. & BOULLIN, D.J. (1976). The relationship between changes in 5-HT induced platelet aggregation and clinical state in patients treated with fluphenazine. Br. J. clin. Pharmac., 3, 925–928.CrossRefGoogle Scholar
  56. ORR, M.W., KNOX, J.M., ALLEN, R., GELDER, M.G. & GRAHAME-SMITH, D.G. (1981). The effects of neuroleptic drugs on 5-hydroxytryptamine-induced platet aggregation in schizophrenic patients. Br. J. clin. Pharmac., 11, 255–259.CrossRefGoogle Scholar
  57. OVERALL, J.E. (1976). The brief psychiatric rating scale in psychopharmacologic research. In ECDEU Assessment Manual, ed. Guy, W. pp. 166–169. Maryland: U.S. Department of Health, Education and Welfare.Google Scholar
  58. OVERALL, J.E. & GORHAM, D.R. (1962). The brief psychiatric rating scale. Psychol. Rep., 10,799–812.CrossRefGoogle Scholar
  59. QUITKIN, F., RIFKIN, A., KANE, J., RAMOS-LORENZI, J.R. & KLEIN, D.F. (1978). Long-acting oral versus injectable antipsychotic drugs in schizophrenics. Arch. gen. Psychiat., 35, 889–892.PubMedCrossRefGoogle Scholar
  60. RIFKIN, A., QUITKIN, F. & KLEIN, D.F. (1975). Akinesia. Arch. gen. Psychiat., 32, 672–674.CrossRefGoogle Scholar
  61. RIVERA-CALIMLIM, L., NASRALLAH, H. & STRAUSS, J. (1976). Clinical response and plasma levels: effect of dose, dosage schedules and drug interactions on plasma chlorpromazine levels. Am. J. Psychiat., 133, 646–652.PubMedCrossRefGoogle Scholar
  62. ROBINSON, S.E., BERNEY, S., MISHRA, R. & SULSER, F. (1979). The relative role of dopamine and norepinephrine receptor blockade in the action of antipsychotic drugs: metoclopramide, thiethylperazine and molindone as pharmacological tools. Psychopharmac., 64, 141–147.CrossRefGoogle Scholar
  63. SAINSBURY, P. & KREITMAN, N. (1975). Methods of psychiatric research, Second Edition. London: Oxford University Press.Google Scholar
  64. SCHACHTER, M., BEDARD, P., DEBONO, AG. JENNER, P., MARSDEN, C.D., PRICE, P., PARKES, J.D., KEENAN, J., SMITH, B., ROSENTHALER, J., HOROWSKI, R. &. DORROW, R. (1980). The role of D-1 and D-2 receptors. Nature, 286, 157–159.PubMedCrossRefGoogle Scholar
  65. SCHNEIDER, K. (1959). In Clinical Psychopathology, English translation Hamilton, M.W. & Anderson, E.W., pp. 89–114. New York: Grune & Stratton.Google Scholar
  66. SCHONECKER, M. (1957). Ein eigenümliches Syndrome in oralen Bereich bei Megaphenaplikation. Nerventartz, 28, 35.Google Scholar
  67. SIMPSON, G.M. & ANGUS, J.W.S. (1970). A rating scale for extrapyramidal side-effects. Acta Psychiat. Scand., Suppl., 212, 11–19.CrossRefGoogle Scholar
  68. SIMPSON, G.M., AMUSO, D., BLAIR, J.H. & FARKAS, T. (1964). Phenothiazine-produced extrapyramidal system disturbance. Arch. gen. Psychiat., 10, 127–136.CrossRefGoogle Scholar
  69. SIMPSON, GM., COOPER, T.B., BARK, N., SUD, I. & LEE, J.H. (1980). Effect of antiparkinsonian medication on plasma levels of chlorpromazine. Arch. gen. Psychiat., 37, 205–208.PubMedCrossRefGoogle Scholar
  70. SNYDER, S.H. & GOODMAN, R.R. (1980). Multiple neurotransmitter receptors. J. Neurochem., 35, 5–15.PubMedCrossRefGoogle Scholar
  71. SNYDER, S.H., GREENBERG, D. & YAMAMURA, H.I. (1974). Antischizophrenic drugs and brain cholinergic receptors. Arch. gen. Psychiat., 31, 58–61.PubMedCrossRefGoogle Scholar
  72. SPITZER, R.L. & ENDICOTT, J. (1975). Psychiatric rating scales. In Comprehensive Textbook of Psychiatry, eds Freedman, A.M., Kaplan, H.I. & Sadock, B.J. 2, 2nd Edition, pp. 2015–2031. Baltimore: The Williams & Wilkins Co.Google Scholar
  73. SPITZER, R., ENDICOTT, J. & ROBINS, E. (1975). Research Diagnostic Criteria. Instrument No, 58, New York: New York State Psychiatric Institute.Google Scholar
  74. STRAUSS, J.S. & GIFT, T.E. (1977). Choosing an approach for diagnosing schizophrenia. Arch. gen. Psychiat., 34, 1248–1253.CrossRefGoogle Scholar
  75. TARRIER, N., VAUGHN, C., LADER, M.H. & LEFF, J.P. (1979). Bodily reactions to people and events in schizophrenics. Arch. gen. Psychiat., 36, 311–315.PubMedCrossRefGoogle Scholar
  76. TUCKER, G.T. (1980). Principles of pharmacokinetics. In Drug concentrations in neuropsychiatry, Ciba Foundation Symposium 74 (new series), pp. 13–26. Oxford: Excerpta Medica.Google Scholar
  77. TYRER, P.J. (1976). Screening procedures in volunteers and patients. Br. J. clin. Pharmac., Suppl., 3, 35–405.CrossRefGoogle Scholar
  78. VAN PUTTEN, T. & MAY, P.R.A. (1978). ‘Akinetic depression’ in schizophrenia. Arch. gen. Psychiat., 35, 1101–1107.PubMedCrossRefGoogle Scholar
  79. VAUGHN, C.E. & LEFF, J.P. (1976). The influence of family and social factors on the course of psychiatric illness. Br. J. Psychiat., 129, 125–137.CrossRefGoogle Scholar
  80. WING, J.K. (1961). A simple and reliable subclassification of chronic schizophrenia. J. ment. Sci., 107, 862–875.PubMedGoogle Scholar
  81. WING, J.K. (1978). The social context of schizophrenia. Am. J. Psychiat., 135, 1333–1339.PubMedCrossRefGoogle Scholar
  82. WING, J.K., COOPER, J.E. & SARTORIUS, N. (1974). The measurement and classification of psychiatric symptoms. London: Cambridge University Press.Google Scholar
  83. WODE-HELGODT, B., BORG, S., FURO, B. & SEDVALL, G. (1978). Clinical effects and drug concentrations in plasma and cerebrospinal fluid in psychotic patients treated with fixed doses of chlorpromazine. Acta Psychiat. Scand. 58, 149–173.PubMedCrossRefGoogle Scholar
  84. YAMAMURA, H.I., MARIAN, A.A. & SNYDER, S.H. (1976). Muscarinic cholinergic receptor binding: influence of pimozide and chlorpromazine metabolites. Life Sci., 18, 685–692.PubMedCrossRefGoogle Scholar

Copyright information

© Palgrave Macmillan, a division of Macmillan Publishers Limited 1981

Authors and Affiliations

  • A. V. P. Mackay
    • 1
  1. 1.Argyll and Bute HospitalArgyllshireUK

Personalised recommendations