It is often an important clinical task to predict how long a given patient will need to be hospitalized, but past research efforts to provide an empirical basis for such predictions have not been highly successful. The authors propose a conceptual model for predicting length of stay that goes beyond previous research; they not only include a range of traditionally employed patient characteristics but also take into account the nature of the treatment goals and the availability of post-hospital treatment resources. The model forms the basis for an objective prediction procedure which will be tested in a large-scale research project on long-term hospital treatment outcome.

This study examined the effects of phenothiazine treatment on attentional-perceptual, cognitive, and psychophysiological dysfunction in chronic schizophrenics. Under double-blind conditions, 20 patients receiving chlorpromazine and 20 receiving placebo for eight weeks were tested by performance measures, clinically rated, and monitored for skin resistance and heart rate on four occasions. Phenothiazine effects on measures of attention-perception and on psychophysiological response were demonstrable, but not on tests and ratings of cognitive dysfunction. The direction of effects was toward normalization of function. Drug treatment tended to improve ability to sustain set, to increase efficiency of selective attention, and to increase rate of information processing. Autonomic reactivity was reduced and a deactivation effect suggested. Clinical improvement was correlated with reduction in attentional dysfunction. The results are discussed in terms of their implications for hypothesized behavioral mechanisms of drug action, primary "behavioral site" of drug action, therapeutic response measurement, and functional theories of schizophrenic psychopathology.

How long does chlorpromazine last? This question regarding the persistence of chlorpromazine (CPZ) in chronically medicated schizophrenic patients after drug discontinuation led to wide ranging preliminary answers. These varied from a few to several days for blood studies up to many months for urinary and clinical studies. At least two implications of the question need to be considered: a) the pharmacological persistence of active drug and/or metabolites after drug discontinuation; and b) the persistence of the therapeutic effects regardless of whether or not active drug and/or metabolites are pharmacologically present. For example, a patient's behavior may improve while on CPZ and this improvement may persist after the active drug and/or metabolites cease to be present in the patient's body. These two areas of inquiry were examined by looking at blood, urinary, and clinical data. Although blood studies undoubtedly give the most definitive data, they are greatly complicated by the lack of definitive information regarding the active moiety (moieties) and crucial sites of action, the large number of metabolites (up to 150 or so), the minute quantities involved (ng/ml), the wide inter- and intrapatient variations, and the newness and lack of complete comparability of the quantitative methodologies. Within these limitations, there are a number of studies that are fairly consistent in showing a half-life of disappearance from the plasma of CPZ and/or metabolites in the range of a few to several hours. This would usually mean that most of the drug and metabolites are cleared from the plasma in a few days after drug discontinuation. Urinary studies are related less directly than blood studies to desired clinical effects. Under steady-state conditions in various studies, 43 to 63 per cent of a daily therapeutic dose of CPZ can be recovered in the urine in 24 hours. After drug discontinuation, urinary drug and/or metabolites in most studies last from about 3 to 18 days, with sometimes minimal or trace amounts after this. The clinical studies show a continuation of therapeutic benefits for up to 6 months and longer in some studies, but there are a number of studies showing placebo (withdrawn) groups deteriorating significantly more than continued drug groups much before this, even as early as 1 to 2 weeks off drug. This examination of the literature tends toward a duration of substantial pharmacological (therapeutic) action of CPZ of no more than a few days after drug discontinuation. For a small number of patients, clinical deterioration begins about the same time, whereas in many others, clinical improvement lasts weeks or months. Some of this latter continuation of improvement is likely not due to CPZ and/or metabolites currently active. There do remain many unanswered questions regarding the persistence of minute amounts of CPZ and/or metabolites in storage and possibly at active sites, and whether or not in some patients this makes a significant contribution.

The hypothesis that chlorpromazine (CPZ) has the effect in visual information processing of protecting the short term memory visual trace by serving to filter or habituate stimuli following an initial stimulus was tested in 40 normal college students. The method involved the tachistoscopic presentation of paired, successive 3 x 2 consonant arrays, separated by a 200-millisecond interval, with instructions to report either the first or the second array, in a double blind repeated measurement design in which Ss served as their own placebo controls and a single dose of 50 milligrams of CPZ was administered. Under the particular conditions obtaining in this investigation, the results do not support the hypothesis, but suggest that when ipsimodal, isomorphic distraction follows an initial relevant stimulus, CPZ tends to reduce STM span. The results do afford partial support for the hypothesis that CPZ has the effect of delaying the processing (coding) of visual information. A CPZ mechanism of action on response criteria in deciding the relevance of stimuli is advanced and related to clinical effects of CPZ in acute schizophrenics.

The basic strategy being proposed is one of studying the time-course of antipsychotic drug effects upon performance measures in parallel with the timecourse of drug effects upon the symptoms of schizophrenia, general morbidity and ward behavior. Critical for the productivity of this strategy is the inclusion of performance measures that reflect functioning in psychological processes—e.g., attention, perception etc., in which schizophrenic-specific deficit or deviance has been demonstrated and which may be presumed to mediate symptom formation. Promising candidates for inclusion in a battery of performance measures under these criteria are those reflecting functioning in the information-processing sequence, i. e., in sensory-attentional-perceptual-cognitive processes. Given this approach, the examination of relationships between patterns of change at the level of deficit performance and of symptomatology, has the potentiality of disclosing both mechanisms of drug action and critical mediating mechanisms of schizophrenic disorder.

"It was hypothesized that schizophrenics producing several M percepts would show greater tendency to inhibit overt motor response than a comparable group which produced few M. Similarly schizophrenics with introversive experience--types were expected to show more motor inhibition and less spontaneous gross motor activity during a waiting period than extratensive S's." In general, these hypotheses were supported by data obtained from 50 hospitalized male schizophrenics. 23 references. (PsycINFO Database Record (c) 2006 APA, all rights reserved)