This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Douglas F. Levinson, MD; George M. Simpson, MD; Hardeep Singh, MD; Kashinath Yadalam, MD; Anil Jain, MD; Mary Jeanne Stephanos, RN; Paul Silver, MD

Arch Gen Psychiatry. 1990;47(8):761-768.

Abstract
• Fifty-three patients with acute exacerbations of Research Diagnostic Criteria schizophrenic, schizoaffective (mainly schizophrenic), and other nonaffective psychoses completed 24 or 28 days of treatment with randomized, fixed, double-blind doses of 10, 20, or 30 mg of oral fluphenazine hydrochloride daily. In the sample as a whole, improvement was not predicted by dose but was negatively related to duration of illness and of lifetime hospitalization, and to the presence of akathisia during the study (which was unrelated to chronicity). But among patients showing 40% or greater improvement in positive symptoms, percent improvement was predicted by dose and dose per kilogram of body weight; this was not the case for negative symptoms. Severity of acute extrapyramidal symptoms (excluding acute dystonia, dyskinesia, and akathisia) was significantly correlated with dosage per kilogram. Doses greater than 0.2 mg/kg per day were associated with greater clinical improvement but also with a high incidence of extrapyramidal symptoms; doses over O.3 mg/kg per day were associated with more severe extrapyramidal symptoms. These preliminary results suggest that there is a linear relationship between fluphenazine dosage and acute outcome, and that this relationship is observed in patients whose conditions improve to a criterion level. It is suggested that the nonresponder group may include many patients in whom dose is not relevant because they are unable (for a variety of reasons) to respond to the study treatment conditions; excluding them from analysis may allow a significant dose-response relationship to be observed. Akathisia deserves further study as a possible predictor of nonresponse.

Author Affiliations
From the Department of Psychiatry, Medical College of Pennsylvania, Philadelphia.

Footnotes
Accepted for publication September 25, 1989.

Reprint requests to Department of Psychiatry, Medical College of Pennsylvania at Eastern Pennsylvania Psychiatric Institute, 3200 Henry Ave, Philadelphia, PA 19129 (Dr Levinson).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Predicting Restorability of Incompetent Criminal Defendants
Mossman
J Am Acad Psychiatry Law 2007;35:34-43.
ABSTRACT | FULL TEXT  

Low dose typical antipsychotics - a brief evaluation
Taylor
Psychiatr. Bull. 2000;24:465-468.
FULL TEXT  

Olanzapine Versus Haloperidol Treatment in First-Episode Psychosis
Sanger et al.
Am. J. Psychiatry 1999;156:79-87.
ABSTRACT | FULL TEXT  

Schizophrenia
Kane
NEJM 1996;334:34-42.
FULL TEXT  

Clinical Characteristics and Predisposing Factors in Acute Drug-Induced Akathisia
Sachdev and Kruk
Arch Gen Psychiatry 1994;51:963-974.
ABSTRACT  

Fluoxetine, Akathisia, and Suicidality: Is There a Causal Connection?
Wirshing et al.
Arch Gen Psychiatry 1992;49:580-581.
ABSTRACT  

Blacks, Schizophrenia, and Neuroleptic Treatment
Stephen
Arch Gen Psychiatry 1992;49:164-165.
ABSTRACT