Outpatient Maintenance of Chronic Schizophrenic Patients with Long-acting Fluphenazine: Double-blind Placebo

Hirsch, Steven R.; Gaind, R.; Rohde, Peter; Stevens, Barbara C.; Wing, J. K.

doi:10.1136/bmj.1.5854.633

Cited by 252 publications

(77 citation statements)

References 10 publications

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“…Only a third (5/15) of the studies employing relapse defined this in terms of clinical deterioration of specific florid schizophrenic phenomenology (Falloon et al 1978;Hirsch et al 1973;Kane et al 1979;Leff & Wing, 1971;Rifkin et al 1977). The definition in one study employed the term 'psychotic' rather than 'schizophrenic', but this appeared to be a purely semantic distinction (Kane et al 1979).…”

Section: (C) Clinical Deterioration: Specificmentioning

confidence: 99%

“…Other studies have employed independent assessment of social functioning at relapse and have restricted the definition of relapse to clinical outcome (Abuzzahab & Zimmerman, 1980;Clark et al 1975;Falloon et al 1978;Hirsch et al 1973;Hogarty et al 1973;Linn et al 1979;O'Brien et al 1972;Schooler et al 1980).…”

Section: (D) Change Of Management Requiring Terminationmentioning

confidence: 99%

“…To answer questions concerning overall morbidity, schizophrenic and affective episodes may be combined but, in addition, separate analyses are recommended. Crucial questions such as whether neuroleptic drugs, especially intramuscular fluphenazine, may contribute to an excess of depression while controlling schizophrenia can only be resolved in this manner (Hirsch et al 1973;Falloon et al 1978;Schooler et al 1980).…”

Section: (B) Clinical Deterioration: Non-specificmentioning

confidence: 99%

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Relapse in schizophrenia: a review of the concept and its definitions

Falloon¹,

Marshall²,

Boyd³

et al. 1983

Psychol. Med.

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The increasingly rigorous attention paid to the diagnosis of schizophrenia has not yet been extended to the development of reliable and valid criteria for describing the course of the illness. Over the past two decades the concept of 'relapse' has become the pre-eminent measure of the success of community treatment programmes of schizophrenia. However, to date there has been little effort to examine this measure critically, or to develop other measures to reflect the wide range of clinical outcome in schizophrenia. This issue is not new. Kraepelin has been faulted for his lack of clarity in discussing the association between the diagnosis of dementia praecox and a poor clinical outcome (WHO, 1975). Stressing that 'the general course of dementia praecox is very variable', he outlined several typical courses of the illness, all of which proceeded to terminal dementia (Kraepelin, 1919). He recognized the lack of specifically defined outcome criteria, citing reports showing recovery rates varying from 0 to 25%.Although Kraepelin remained sceptical that full recovery without any residual defect was possible, Meyer (1922) contended that functional recovery was possible and proposed that, in many cases, schizophrenia could be regarded as episodic, with relapses representing fresh attacks of the disease. Kraepelin acknowledged that 'more than half exhibit marked improvement', but noted that these recoveries 'give way sooner or later to a relapse'. In support of his thesis of incomplete remission, he observed that subsequent relapses almost always consisted of symptoms similar to those presented in the original episode. This consistency of symptom patterns was also reported by Bleuler (1911), who supported the notion that complete restoration of premorbid mental health was a rarity. Bleuler cautioned against attributing much significance to published reports regarding 'cure' rates, not only because of the subjective nature of such determinations, but also because of' the varying conditions of admission and relapse for each institution', which often play a greater role in defining discharge status than objective changes in psychopathology.Concern about the natural course of schizophrenia led these pioneers to focus discussion more upon the definition of remission, than its counterpart, relapse. Although concern regarding the course of the illness has continued (Vaillant, 1964;Huber et al. 1981), little attention has been paid to this matter in studies investigating the effectiveness of clinical interventions. With the advent of newer pharmacological and psychosocial interventions, emphasis has shifted to factors surrounding clinical exacerbation after the patient has been discharged from the hospital in a state of partial or complete clinical remission. The effectiveness of community aftercare has been measured in terms of failure to sustain these 'remissions' and, more often than not, by readmission of the patient to hospital. The latter is primarily a social intervention which, although usually associated with symptom e...

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Section: (C) Clinical Deterioration: Specificmentioning

confidence: 99%

Section: (D) Change Of Management Requiring Terminationmentioning

confidence: 99%

Section: (B) Clinical Deterioration: Non-specificmentioning

confidence: 99%

See 1 more Smart Citation

Relapse in schizophrenia: a review of the concept and its definitions

Falloon¹,

Marshall²,

Boyd³

et al. 1983

Psychol. Med.

View full text Add to dashboard Cite

show abstract

“…Had they been designed as such, the random allocation of patients to drug or placebo would have ensured that the groups were matched for level of EE and amount of face to Letemendia & Harris (1967) and Hirsch et al (1973). Both were trials of maintenance phenothiazine treatment in chronic schizophrenia, but whereas the former was carried out on patients living in hospital the latter was concerned with patients in the community.…”

Section: Jp Leff Institute Of Psychiatry Londonmentioning

confidence: 99%

Assessment of drugs in schizophrenia.

Leff¹

1976

Brit J Clinical Pharma

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“…Fluphenazine enanthate ('Moditen') for injection at monthly or more frequent intervals for the treatment of schizophrenia was introduced about 20 years ago, and shown in controlled trials to be beneficial in pre venting relapse (Hirsch et al, 1973). Such depot treat ment has become widespread as a part of the care of patients in the community.…”

mentioning

confidence: 99%