Two-year follow-up of the patients included in the WHO International Pilot Study of Schizophrenia

Over 90% of the 1202 patients investigated in the 9 centres collaborating in the International Pilot Study of Schizophrenia were traced 2 years after the initial examination and on the average over 75% of them were re-examined, using standardized instruments and methods. Results indicate that patients diagnosed as schizophrenic on the basis of standardized assessments and clearly specified diagnostic criteria demonstrated very marked variations of course and outcome over a 2-year period. Schizophrenic patients in the centres in developing countries had considerably better course and outcome than schizophrenic patients in the centres in developed countrie

The International Pilot Study of Schizophrenia: five-year follow-up findings

A five-year follow-up of the patients initially included in the International Pilot Study of Schizophrenia was conducted in eight of the nine centres. Adequate information was obtained for 807 patients, representing 76% of the initial cohort. Clinical and social outcomes were significantly better for patients in Agra and Ibadan than for those in the centres in developed countries. In Cali, only social outcome was significantly bette

Schizophrenia succeeded by affective illness: catamnestic study and statistical enquiry

On the basis of data derived from a long-term follow-up of 12 cases and a 2-year follow-up of the International Pilot Study of Schizophrenia it is suggested that some patients with remitting schizophrenic illnesses can subsequently present clear-cut affective disorders. The implications of these findings are discusse

Symptom profiles of psychiatric disorders based on graded disease classes: an illustration using data from the WHO International Pilot Study of Schizophrenia

The Grade of Membership (GoM) model is a classification procedure which allows a person to be a member of more than one diagnostic class. It simultaneously quantifies the degrees of membership in classes while generating the discrete symptom profiles or ‘pure types' describing classes. The model was applied to the symptomatology, history, and follow-up of 1065 cases in the WHO International Pilot Study of Schizophrenia. The model produced an eight diagnostic class or ‘pure type' solution, of which five were related to the diagnostic concepts of schizophrenia and paranoid disorder, two types were affective disorders, and one asymptomatic type. A subtype of paranoid schizophreniform disorder found primarily in developing countries was identified. There was a strong association between pure types and the original clinical and computer generated (CATEGO) diagnoses. A GoM based psychiatric classification might more clearly identify core disease processes than conventional classification models by filtering the confounding effects of individual heterogeneity from pure type definition

The Sertindole Safety Survey: A retrospective analysis under a named patient use programme in Europe

<p>Abstract</p> <p>Background</p> <p>After sertindole's suspension, health authorities established a specific named-patient use (NPU) programme in order to supply sertindole to patients who did not respond to or did not tolerate alternative treatments. This programme provided the possibility of prospectively following an exhaustive cohort of patients treated with sertindole after its suspension. A survey was performed to assess sertindole's modalities of prescription, assess and document any serious adverse events (SAEs), and assess the mortality rate within the NPU cohort.</p> <p>Methods</p> <p>The study comprised a survey of sertindole-treated patients in eleven European countries. All patients treated with sertindole within the NPU programme were eligible for the study.</p> <p>Results</p> <p>1,432 patients were included in the study. The reason for sertindole prescription was lack of efficacy (approximately 50%) or adverse events (approximately 20%) of other antipsychotic treatments. The mean sertindole dose was 13.4 mg daily. Lack of efficacy and adverse events were reported as reasons for sertindole discontinuation.</p> <p>A total of 97 SAEs were recorded, including ten fatal outcomes, which occurred during the study period or within thirty days after sertindole discontinuation. The all-cause mortality rate was 0.51 per 100 Person-Years of Exposure (95% Poisson confidence interval: 0.23–0.97). QTc prolongation was reported in 15 patients (1.05% of total patients), being a rate of 0.85 per 100 Person-Years of Exposure [95% CI: 0.48–1.41].</p> <p>Conclusion</p> <p>Although prescribing and supplying sertindole were subject to administrative constraints, a significant number of patients were treated with sertindole, thus supporting the need for sertindole in specific cases.</p> <p>Trial registration number</p> <p>Not applicable.</p

Psychiatry, Objectivity and Realism about Value

Many of the current debates about validity in psychiatry and psychology are predicated on the unexpected failure to validate commonly used diagnostic categories. The recognition of this failure has resulted in, what Thomas Kuhn calls, a period of extraordinary science in which validation problems are given increased weight, alternatives are proposed, methodologies are debated, and philosophical and historical analyses are seen as more relevant than usual. In this important new book in the IPPP series, a group of leading thinkers in psychiatry, psychology, and philosophy offer alternative perspectives that address both the scientific and clinical aspects of psychiatric validation, emphasizing throughout their philosophical and historical considerations

TREC-Rio trial: a randomised controlled trial for rapid tranquillisation for agitated patients in emergency psychiatric rooms [ISRCTN44153243]

Agitated or violent patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians and clinical practice all differ. Systematic reviews show that all relevant studies are small and none are likely to have adequate power to show true differences between treatments. Worldwide, current treatment is not based on evidence from randomised trials. In Brazil, the combination haloperidol-promethazine is frequently used, but no studies involving this mix exist. TREC-Rio (Tranquilização Rápida-Ensaio Clínico [Translation: Rapid Tranquillisation-Clinical Trial]) will compare midazolam with haloperidol-promethazine mix for treatment of agitated patients in emergency psychiatric rooms of Rio de Janeiro, Brazil. TREC-Rio is a randomised, controlled, pragmatic and open study. Primary measure of outcome is tranquillisation at 20 minutes but effects on other measures of morbidity will also be assessed. TREC-Rio will involve the collaboration of as many health care professionals based in four psychiatric emergency rooms of Rio as possible. Because the design of this trial does not substantially complicate clinical management, and in several aspects simplifies it, the study can be large, and treatments used in everyday practice can be evaluated

The Relationship Between IQ, Memory, Executive Function, and Processing Speed in Recent-Onset Psychosis: 1-Year Stability and Clinical Outcome

Studies commonly report poor performance in psychotic patients compared with controls on tasks testing a range of cognitive functions, but, because current IQ is often not matched between these groups, it is difficult to determine whether this represents a generalized deficit or specific abnormalities. Fifty-three first-episode psychosis patients and 53 healthy controls, one-to-one matched for sex, age, and full-scale current IQ, were compared on Wechsler Adult Intelligence Scale (WAIS) subtests representing indices of perceptual organization, verbal comprehension, processing speed, and working memory as well as other tests of executive function and episodic memory. The groups showed an equivalent pattern of performance on all WAIS subtests except digit symbol processing speed, on which the patients were significantly worse. Patients were also worse on measures where performance correlated with digit symbol score, namely working and verbal memory tasks. Standardized residual scores for each subtest were calculated for each patient using the difference between their actual subtest score and a predicted subtest score based on their full-scale IQ and the performance of controls. Scaled scores and residual scores were examined for relationships with clinical measures. Digit symbol–scaled score was significantly correlated with concurrent negative syndrome score at baseline, and digit symbol residual score significantly predicted residual negative symptoms at 1-year follow-up. In summary, our comparison of patients and controls precisely matched for IQ revealed that processing speed was attenuated in recent-onset schizophrenia, contributed significantly to working and episodic memory deficits, and was a prognostic factor for poor outcome at 1 year