Platelet monoamine oxidase (MAO) activity was significantly lower among 21 chronic schizophrenic patients, 19 of whom were receiving stable doses of antipsychotic medication, than among 16 control subjects. Poor ego functioning and poor outcome were significantly correlated with low MAO activity; current dose of major tranquilizer was negatively but not significantly correlated. The degree of psychopathology, rather than presence or absence of specific symptom constellations, was the significant characteristic of patients with low enzyme levels. This finding is in accordance with those of earlier studies of schizophrenic patients as well as with recent findings in nonschizophrenic samples.

Back to table of contents Previous article Next article ArticleNo Accessd-Amphetamine and SchizophreniaMORTIMER OSTOWMORTIMER OSTOWSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.140.4.517-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "d-Amphetamine and Schizophrenia." American Journal of Psychiatry, 140(4), pp. 517-a–518 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Register for access Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 140Issue 4 April 1983Pages 517-a-518 Metrics PDF download History Published online 1 April 2006 Published in print 1 April 1983

In this placebo-paired, double-blind study, 13 of 45 schizophrenic patients showed an acute improvement in schizophrenic symptoms following d-amphetamine infusion (20 mg). The 18 patients who worsened tended to have higher CSF 3-methoxy-4-hydroxyphenylglycol levels than did those who improved. d-Amphetamine blood levels and clinical descriptors of schizophrenic subgroups did not differentiate patients who improved from those who worsened; however, patients who improved had been significantly more psychotic before the infusion. Patients who worsened had been more psychotic than those who did not change. The authors suggest that those who did not change. The authors suggest that sensitivity to dopamine stimulation in schizophrenia is state-dependent rather than trait-dependent and that the simple, undirectional hypothesis of schizophrenia needs to be reformulated.

Thirteen schizophrenic patients underwent a d-amphetamine infusion while being treated with pimozide, an antipsychotic agent and a relatively specific dopamine (DA) blocker. Six patients who showed an acute increase in psychosis with d-amphetamine relapsed within 3 months after pimozide withdrawal. Of the seven patients who did not change in psychosis with d-amphetamine, six did not relapse after pimozide discontinuation (Fisher's exact test, p less than 0.005). Retrospectively, the psychosis-inducing effects of d-amphetamine were found to be predictive of psychotic exacerbation following subsequent pimozide withdrawal. Pimozide failed to block the psychotogenic effects of d-amphetamine in six patients indicating that other mechanisms besides DA may play a role in psychotic decompensation. The d-amphetamine infusion paradigm should be studied further to determine its clinical value for identifying which schizophrenic patients are at risk for relapse after discontinuation of neuroleptic treatment.

In ten of 30 schizophrenic patients treated with pimozide for five weeks, 20 mg of dextroamphetamine sulfate induced an increase in psychosis. The number of patients becoming more psychotic with the dextroamphetamine challenge was not significantly different from the number who worsened after dextroamphetamine challenge when pretreated with placebo. Half of the patients who showed a psychotic response to dextroamphetamine during placebo pretreatment responded to dextroamphetamine with an increase in psychosis after pimozide treatment. Dextroamphetamine induced a worsening in patients who had improved with pimozide. The stability of the preinfusion condition is more important to the type of response to dextroamphetamine than long-term pretreatment with a dopamine receptor blocker. The activation-euphoria response to dextroamphetamine was unaffected by pimozide pretreatment, which suggests that the changes in psychosis and activation may be regulated by different mechanisms. These findings question the postulated relationship between the antipsychotic drug response and dopamine receptor blockade.

Acute behavioral response to 20 mg of dextroamphetamine (intravenous) predicted fourth-week antipsychotic response to double-blind pimozide treatment. Patients whose psychotic condition improved with dextroamphetamine administration showed more antipsychotic response to pimozide therapy than those whose condition worsened or did not change. Multiple regression analysis indicated amphetamine-induced response predicted pimozide response after four weeks for fifth-week pimozide response was more accurately predicted by prepimozide psychosis ratings. Our study provides some evidence that mechanisms underlying early and late pimozide response are not necessarily identical. Because patients who did not respond to dextroamphetamine administration still improved with pimozide therapy, our data do not support the concept that schizophrenia can be divided into two groups (dopamine-sensitive or dopamine-insensitive) but, rather, that dopamine responsiveness changes over time. Clinical application is not warranted until studies with larger samples have replicated our findings.

Back to table of contents Previous article Next article ArticleNo AccessMore on Thiazide-Induced HypercalcemiaNORMAN M. BACHER, KENNETH L. MANILOW, and HARVEY A. LEWISNORMAN M. BACHERSearch for more papers by this author, KENNETH L. MANILOWSearch for more papers by this author, and HARVEY A. LEWISSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.138.4.534-cAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "More on Thiazide-Induced Hypercalcemia." American Journal of Psychiatry, 138(4), pp. 534-c–535 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byRisk of Hypercalcemia in Blacks Taking Hydrochlorothiazide and Vitamin DThe American Journal of Medicine, Vol. 127, No. 8 Volume 138Issue 4 April 1981Pages 534-c-535 Metrics PDF download History Published online 1 April 2006 Published in print 1 April 1981

Emergency psychiatric services provide essential care. Their utilization may also be assumed to reflect the health care needs of a population. The authors observed trends in an emergency psychiatric service over a 17-year period by comparing 400 randomly selected patient visits in 1977 with date from 1960 and 1970. They found a decrease in the number of patients seeking treatment, decreased patient age and socioeconomic status, increased use by men, increased night visits, little change in diagnostic categories, and a striking increase in hospitalization since 1970. These data support the importance of assessing trends in emergency psychiatric services over time to ensure that they meet the needs of the population being served.

Acute behavioral changes following a 20 mg i.v. d-amphetamine predicted the small antipsychotic and antidepressant effects of the third week of lithium treatment in schizophrenic patients. Multivariate regression models accounted for 95% of the variance predicting the antipsychotic effects and for 89% of the variance predicting the antidepressant effects in postpsychotic depressed patients. The greater the increases in the d-amphetamine-induced changes in the thought disorder cluster of the Brief Psychiatric Rating Scale, the greater the antipsychotic effects of lithium. The data suggest that the modest behavioral changes observed with lithium in schizophrenia are most likely drug-induced.

Some tricyclic antidepressants have been reported to inhibit monoamine oxidase (MAO) activity in vitro in addition to blocking the reuptake of norepinephrine and/or serotonin. While the inhibition of MAO is reversible, platelet MAO activity in depressed patients responding to amitriptyline treatment has been reported to be reduced after drug treatment. In a reverse design, we measured platelet MAO activity and drug levels in patients chronically being treated with amitriptyline and again 2 and 4 weeks after stopping the medication. Although tricyclic drug concentrations were initially within the therapeutic range and undetectable on placebo treatment, platelet MAO activities were unchanged.

The dopamine hypothesis of schizophrenia claims that increased dopamine activity underlies psychotic behavior. This hypothesis gets major support from the reported d-amphetamine-induced worsening of psychosis, because amphetamine increases dopamine activity in the brain. Dopamine receptor supersensitivity has been shown to be present in animals during the postneuroleptic period. In this study the postulated relationships between psychotic decompensation as observed after d-amphetamine infusion and the dopamine receptor supersensitivity expected to be present during the neuroleptic withdrawal period were examined. Twenty milligrams of d-amphetamine administered intravenously did not cause a stronger psychotogenic effect in 12 schizophrenic patients. One week after discontinuation of pimozide treatment, the d-amphetamine-induced change as indicated by the Brief Psychiatric Rating Scale (BPRS) paranoid disturbance cluster score, was not significantly different from the response to a similar infusion during the drug-free state. Unexpectedly, the increase in the BPRS mannerisms and posturing item and in the pulse rate response to d-amphetamine were decreased. These results raise questions about the role of dopamine in d-amphetamine effects and suggest postneuroleptic dopamine receptor subsensitivity. They challenge a simple dopamine hypothesis of schizophrenia.

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The authors found that plasma luteinizing hormone (LH), prolactin, and testosterone were initially normal in nine acutely psychotic males with schizophrenia or schizo-affective disorder; follicle-stimulating hormone (FSH) was normal in eight of the nine. When patients were treated with pimozide, a relatively specific dopamine receptor blocker, there were statistically significant declines in FSH and LH, although levels remained within normal limits. Prolactin rose significantly, but testosterone did not change. The observed reductions in FSH and LH concentrations are consistent with the hypotheses that dopamine and/or prolactin play a role in gonadotropin secretion. The maintenance of normal levels of gonadotropins and testosterone, however, suggests that these patients possessed relatively normal hypothalamic-pituitary-gonadal axis function before and during a course of neuroleptic treatment.

The authors observed that many psychotic patients on a clinical/research ward incorporated various aspects of research organization into their own evolving intrapsychic structures. This process had either beneficial or deleterious clinical effects, depending on the attributes of the research and the specific mental functions to which these attributes became attached. The observations resulted in the development of a set of recommendations for maximizing the therapeutic usefulness of this phenomenon and minimizing its countertherapeutic drawbacks.

In a sample of 22 psychotic schizophrenic patients, eight improved substantially during a 30-day drug-free period. The drug-free improver group differed from the nonimprover group in demonstrating a later age of onset, briefer psychotic episodes, shorter hospitalizations, and better prognostic scores on the Phillips Scale, Strauss-Carpenter Modified Prognostic Scale, and the Vaillant Scale. After drug withdrawal, drug-free improvers frequently demonstrated further improvement when treated with doses of neuroleptic drugs that were substantially lower than the clinically recommended doses. The authors raise the question as to whether the drug-free improvers may represent a subgroup of schizophrenic patients who are being overtreated presently by standard neuroleptic practice.

Descriptive approaches to subtyping schizophrenia use symptoms, signs, and functioning characteristics as diagnostic criteria. Such approaches often appear superficially to be obvious, simple, and atheoretical; in reality, however, there are many ways in which descriptive data can be selected and organized to subtype patients. This report describes these various approaches. Selection of diagnostic criteria can focus primarily either on cross-sectional or longitudinal characteristics of patients. Alternative ways of organizing descriptive data include typological and dimensional approaches and two increasingly common complex models, multiaxial and hierarchical subtyping. Examples and implications of these alternative approaches are described, and methods for choosing among them are suggested.

Back to table of contents Previous article Next article ARTICLESNo AccessChronic Amitriptyline ToxicityEarl L. Giller Jr., M.D., PH.D., Donald S. Bialos, M.D., John P. Docherty, M.D., Peter Jatlow, M.D., Laurie Harkness, M.S.W.Earl L. Giller Jr.Dr. Giller is Psychiatry Research Coordinator, Dr. Bialos is Staff Psychiatrist, and Ms. Harkness is Associate in Research, Psychiatry Service, West Haven Veterans Administration Hospital, West Spring St., West Haven, Conn. 06516. Dr. Giller is also Assistant Professor of Psychiatry, Yale University School of Medicine, where Dr. Bialos is Assistant Clinical Professor of Psychiatry, Dr. Docherty is Assistant Professor of Psychiatry, and Dr. Jatlow is Professor of Laboratory Medicine. Dr. Docherty is also Director of Education, Yale Psychiatric Institute.Search for more papers by this author, M.D., PH.D., Donald S. BialosDr. Giller is Psychiatry Research Coordinator, Dr. Bialos is Staff Psychiatrist, and Ms. Harkness is Associate in Research, Psychiatry Service, West Haven Veterans Administration Hospital, West Spring St., West Haven, Conn. 06516. Dr. Giller is also Assistant Professor of Psychiatry, Yale University School of Medicine, where Dr. Bialos is Assistant Clinical Professor of Psychiatry, Dr. Docherty is Assistant Professor of Psychiatry, and Dr. Jatlow is Professor of Laboratory Medicine. Dr. Docherty is also Director of Education, Yale Psychiatric Institute.Search for more papers by this author, M.D., John P. DochertyDr. Giller is Psychiatry Research Coordinator, Dr. Bialos is Staff Psychiatrist, and Ms. Harkness is Associate in Research, Psychiatry Service, West Haven Veterans Administration Hospital, West Spring St., West Haven, Conn. 06516. Dr. Giller is also Assistant Professor of Psychiatry, Yale University School of Medicine, where Dr. Bialos is Assistant Clinical Professor of Psychiatry, Dr. Docherty is Assistant Professor of Psychiatry, and Dr. Jatlow is Professor of Laboratory Medicine. Dr. Docherty is also Director of Education, Yale Psychiatric Institute.Search for more papers by this author, M.D., Peter JatlowDr. Giller is Psychiatry Research Coordinator, Dr. Bialos is Staff Psychiatrist, and Ms. Harkness is Associate in Research, Psychiatry Service, West Haven Veterans Administration Hospital, West Spring St., West Haven, Conn. 06516. Dr. Giller is also Assistant Professor of Psychiatry, Yale University School of Medicine, where Dr. Bialos is Assistant Clinical Professor of Psychiatry, Dr. Docherty is Assistant Professor of Psychiatry, and Dr. Jatlow is Professor of Laboratory Medicine. Dr. Docherty is also Director of Education, Yale Psychiatric Institute.Search for more papers by this author, M.D., Laurie HarknessDr. Giller is Psychiatry Research Coordinator, Dr. Bialos is Staff Psychiatrist, and Ms. Harkness is Associate in Research, Psychiatry Service, West Haven Veterans Administration Hospital, West Spring St., West Haven, Conn. 06516. Dr. Giller is also Assistant Professor of Psychiatry, Yale University School of Medicine, where Dr. Bialos is Assistant Clinical Professor of Psychiatry, Dr. Docherty is Assistant Professor of Psychiatry, and Dr. Jatlow is Professor of Laboratory Medicine. Dr. Docherty is also Director of Education, Yale Psychiatric Institute.Search for more papers by this author, M.S.W.Published Online:24 Apr 2020https://doi.org/10.1176/ajp.1979.136.4a.458AboutSectionsView articleAbstractPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleAbstract Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 136Issue 4A April 1979Pages 458-459 Metrics PDF download History Received 4 December 1978 Accepted 15 January 1979 Published online 24 April 2020 Published in print 1 April 1979