Comparative analysis of the action of butyrylperazine at Manhattan State Hospital and the University Psychiatric Clinic at Erlangen

Étude Comparative de la Butapérazine et de la Prochlorpérazine Chez le Schizophrène Chronique

A comparative double-blind trial of butaperazine and prochlorperazine was carried out in 40 chronic schizophrenic patients. Subjects were matched in 20 pairs according to sex, age, duration of hospitalization, staff, ward and score on the B.P.R.S. Drugs were randomly allocated within each pair of patients and their effects evaluated according to the B.P.R.S. Posology was progressively increased up to 200 mg. daily but remained always equal for all patients. Results were analysed by non-parametric statistics for the B.P.R.S. and by an χ2 test for the global evaluation.

Butaperazine and prochlorperazine showed a significant therapeutic efficacy throughout the twelve-week period. At the fourth and tenth week, prochlorperazine was significantly superior to butaperazine. However, at the twelfth week there was no significant difference in the efficacy of both drugs, as measured by the B.P.R.S. and the global evaluation. Beyond 100 mg. daily of both drugs a plateau was reached which higher doses did not influence.

Side effects made their appearance sooner with butaperazine but at the end of the trial the frequency of side effects was comparable with both drugs.

A highly significant positive correlation between raters adds weight to our results*.

Neuroleptic drugs in the treatment of acute psychosis: how much do we really know?

The efficacy of neuroleptic antipsychotic drugs has been well demonstrated and neuroleptics are the standard treatment of acute psychosis. However, important aspects of neuroleptic treatment, including course of response, optimal doses, and mechanism of action, remain poorly studied or controversial. Placebo-controlled studies of the onset of the response of acute psychosis to neuroleptics are few and yield conflicting results. Studies of the relationship of doses and blood levels to the therapeutic effects of neuroleptics suggest that the optimal range of doses and levels is narrow and that commonly used doses are too high. Finally, studies of the mechanism of action of neuroleptics suggest that the dopamine hypothesis is based on unsupported assumptions concerning drug effects, drug distribution, and effective doses of drug. Alternative hypotheses, that the antipsychotic effects of the neuroleptics are mediated, at least in part, through alpha 1-adrenergic or serotonin 5-HT2 receptor antagonism, are reviewed. The evidence regarding these issues and controversies is discussed, and specific approaches to increase our understanding and enhance our use of the neuroleptics are suggested.

Multiculturalism and Canadian psychiatry: opportunities and challenges

In this lecture, the writer calls the attention of Canadian psychiatrists to the unparalleled opportunities the national policy of multiculturalism has for clinical and research activities. Using illustrations from three important fields in psychiatry--epidemiology, psychopharmacology and psychotherapy, he points out the roles socio-cultural factors play in generating ethnic differences which deserve to be given serious scientific attention for both the understanding of causative factors and the treatment of mental disorders. He emphasizes that medical universalism and ethnocentricism have no place in Canadian psychiatry, and that the next phase of Canadian psychiatry should focus on cultural relevancy based on cultural relativism and equal participation of all cultures and ethnic groups.

Ethnicity and psychopharmacology

In clinical studies and cross-national surveys, cultural or ethnic factors have been found to be significant determinants in patients' responses to psychotropic medication. Dosage requirements and the potential for toxic reactions might differ amongst racial and ethnic groups. In this paper, the authors review the relevant literature and examine pharmacodynamic, pharmacokinetic and cultural-psychological factors, all of which could be responsible for such ethnic variations.

Desipramine pharmacokinetics in Chinese and Caucasian volunteers

In order to better define the role of pharmacokinetic variation in reported cross-ethnic differences in dosing patterns of some psychoactive drugs, single dose kinetics of the tricyclic antidepressant desipramine (DMI) were studied in 14 Chinese and 16 Caucasian healthy volunteers. DMI and 2-OH-DMI concentrations were assayed with h.p.l.c. in serial plasma and 24 h urine samples over 5 days following an oral 100 mg dose of DMI. Mean total clearance of DMI ( CLDMI ) from plasma was significantly (P less than 0.05) higher in the Caucasians (123 +/- 57 l/h) than in the Chinese (73.5 +/- 38.8 l/h). There was no significant difference in the apparent clearance of DMI by hydroxylation, fraction of dose metabolized to the hydroxy metabolite, DMI t1/2 or plasma protein binding between the two groups. Trimodal distribution of CLDMI was found, with 4/14 (29%) Chinese demonstrating slow CL (less than 33 l/h) and 4/16 (25%) Caucasians rapid CL (greater than 195 l/h). Correcting CL values for the greater mean weight of the Caucasians did not alter the pattern of distribution. CLDMI did not correlate with body weight. Although environmental factors cannot be ruled out, these results are consistent with genetically based differences in hepatic metabolism, probably affecting pathways in addition to hydroxylation, and suggest that 30% of Orientals would be at risk for toxicity from routine doses of tricyclics or similarly metabolized drugs.

Drug-induced tardive dyskinesia

Drug-induced tardive dyskinesia, which occurs in the course of long-term administration of psychotropic drugs, especially neuroleptics, and persists for years even after drug removal, began to be reported in the late 1950s. Since then, more than 100 investigations on this subjects have been described. And it is estimated that 10 to 30 percent of long-term hospitalized psychiatric patients in Europe and North America exhibit tardive dyskinesia, whereas 5 to 20 percent of patients exhibit this syndrome in Japan. These findings suggest that the manifestation of tardive dyskinesia will become a serious problem in the investigation of psychotropic drug treatment. The author presents a review of the symptomatology, etiological factors, differential diagnosis, prognosis, and management of this syndrome. Results of the author's studies in the cross-national survey and on the reversibility of tardive dyskinesia are also described. In connection with biochemical theory of the etiology of tardive dyskinesia, a variety of therapeutic investigations have been carried out, but no successful therapy could be found among them. Therefore, the author stresses that the early diagnosis of dyskinetic symptoms, possible removal of responsible drugs, and preventive care in daily psychotropic drug treatment are regarded as extremely important in the management of this syndrome.

Comparative analysis of persistent dyskinesias of long-term usage with neuroleptics in France and in Japan

The prevalence of tardive dyskinesia was studied in two psychiatric hospitals, one in France (Hopital psychiatrique de Bassens) and the other in Japan (Inogashire Hospital). Twenty-four of 131 patients in Bassens exhibited this disorder, and 22 of 123 patients in Inogashira. No difference was observed between the prevalence of both hospitals. Higher incidence in older age and a marked coexistence of chronic brain disorders were common characteristics of the patients affected by this disorder in both hospitals. All cases in France and in Japan presented a typical oral dyskinesia, but in general the symptoms in France were less intermittent and more pronounced than those in Japan. There existed a considerable contrast of the psychotropic medications between the two hospitals, which seemed to be related not to the prevalence, but to the severity of the symptoms.