No abstract

SUMMARYThis study surveyed all chronic schizophrenic patients from I 1 long-stay wards of a mental hospital. Patients were assessed on a variety of rating scales to assess clinical psychopathology and behaviour. Patients above the age of 65 years were studied in detail and also compared with those under that age living on the same wards. It was found that all the elderly schizophrenic patients in the sample had severe deficits in the form of residual negative symptoms and thought disorder. They had significantly fewer positive but more negative symptoms as compared to a younger sample on the same wards; there was no differences between the groups for affective symptoms or thought disorder. Although there were more males in the sample, no difference was found on any of the parameters between the two sexes. It was concluded that there are significant clinical differences in the 'elderly graduates' as compared to younger patients living in an identical environment; such findings could assist managers and administrators in the development of plans for other patients in this age group who are likely to be relocated from psychiatric hospitals in the near future or are already living in the community.

Twenty-four chronic schizophrenic long-stay hospital patients were identified, who had not received neuroleptic drugs for 8-30 (average 8 months) and met or exceeded a minimum criterion of severity of negative symptoms. They were randomly allocated to either sulpiride 200 mg twice daily or matching placebo, on a double-blind basis for 12 weeks. The results showed that low-dose sulpiride was significantly better than placebo in relation to improvements in negative symptoms. The changes in social behaviour were complex and not obviously related to symptom improvement; exhibited abnormal behaviour, a major factor in preventing successful return to the community, consistently improved only on the active drug.

SummaryDexamethasone suppresson test (DST) was administered to 26 chronic schizophrenic inpatients who were on stable doses of neuroleptics for over 3 months. Clinical assessments were made on the Brief Psychiatric Rating Scale (BPRS), the Manchester Scale (KGV) and the Scale for the Assessment of Negative Symptoms (SANS). Patients’ neuroleptic treatment was then stopped for 4 weeks and the clinical assessements and the DST repeated. Thirty two percent of the patients showed DST non-suppression which was mostly stable over the 4-week period of the study and was unaffected by the neuroleptic treatment. Contrary to some reports in the literature, the clinical rating scores (including those for depression and negative symptoms), in our patients, showed no relationship with the DST status. We suggest that the DST abnormality in chronic schizophrenies may result from two quite different mechanisms: one due to stress assoeiated with transient psychopathology such as agitation, anxiety, depression or psychotic perturbation which is transient, the other resulting from structural abnormalities in the brain and which remains stable over time.

References the earlier follow-up studies this appeared to mirror that seen in schizophrenic patients, although being more insidious and the personality disintegration being minimal, even after many years of follow-up. CORRESPONDENCE magnetic resonance, so that subtle differences in outcome can be detected.