Evaluation of penfluridol in hospitalised chronic schizophrenic.
Department of Psychiatry, Govt. Mental Hospital, Madras.
Department of Psychiatry, Govt. Mental Hospital, Madras.
Thirty chronic schizophrenic patients completed 12 week treatment with a single weekly dose of 20 mg penfluridol, a new long acting oral neuroleptic. The patients were evaluated by using modified rating scale. Significant reduction in scores was demonstrated in 15 out of 26 symptom variables. Few side effects were reported which were easily controlled by conventional antiparkinson agents. Laboratory investigations remained within normal limits.
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Vaidyalingam N. Evaluation of penfluridol in hospitalised chronic schizophrenic. J Postgrad Med 1990;36:100-3
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Vaidyalingam N. Evaluation of penfluridol in hospitalised chronic schizophrenic. J Postgrad Med [serial online] 1990 [cited 2022 May 17 ];36:100-3
Available from: https://www.jpgmonline.com/text.asp?1990/36/2/100/865
Since the introduction of chlorpromazine, the neuroleptics have proved very valuable in the management of schizophrenia and their daily administration in preventing schizophrenic patients from relapsing1. However, patients on maintenance therapy who take neuroleptic drugs irregularly are particularly at high risk of psychotic decompensation3. Discontinuation of drugs and taking them irregularly and in sub-therapeutic doses are some of the major causes of relapse5. Successful maintenance drug treatment of chronic schizophrenia is often limited by patient's non-compliance stemming from the illness itself, and the necessity of daily and often multiple daily drug ingestion.
This problem has led to the search for longer acting drugs. The depot injectable preparations of fluphenazine are often fraught with drawbacks since many patients resent the painful injection which is repeated month after month. This has led to the search for long acting orally administered neuroleptic, resulting in the discovery and use of diphenylbutyl piperidine group of drugs, which are long acting oral neuroleptics. Of these the longest acting one is penfluridol6,7. Studies have shown that penfluridol safely controls schizophrenic symptoms when administered on a weekly basis8.
The present study was undertaken to evaluate efficacy and safety of penfluridol in hospitalised chronic schizophrenics.
The study was carried out in Government Mental Hospital, Madras. The patients selected for the trial were chronic schizophrenics in the age group of 20-40 years, suffering from the disease a little over than two years. Most of these patients had one or more previous hospital admission.
Patients who showed any evidence of mental retardation, intellectual deterioration, severe depression, extreme suspiciousness and with any obvious physical disease were excluded from the trial.
Thirty-four patients were selected for the trial. All the patients were admitted in Government Mental Hospital and the trial was conducted for a period of 12 weeks as an inpatient open study. Detailed physical examination was performed on each patient along with haematological and biochemical investigations (i.e. haemogram, liver function tests, kidney function tests, blood urea, fasting blood sugar) at the beginning of the study. During the first week, all the previous drugs were stopped and patients were observed for basic assessment of mental condition. The mental status of the patient was evaluated by using a Modified Rating Scale (MRS) with 25 variables which is a combination of the Brief Psychiatric Rating Scale (BPRS) and items derived from the scales devised by Hamilton et al4 Wing10, Venables and O'Connor9 at the initiation of drug trial. Penfluridol tablet in the dose of 20 mg was then given orally once a week by the nurse. The behaviour of the patient was assessed and the patients were rated according to the above mentioned scale.
For next 12 weeks, the patients were observed for any side effects.
All the investigations were repeated at the end of the trial.
Of 34 patients, 30 patients completed the trial. Final analysis of the results was done at the end of 12 weeks. Table 1 shows the improvements in the symptoms as rated on various scales at the end of 12 weeks as compared to initial.
In 10 patients the side effects viz. fatigue, muscular restlessness, tremor, rigidity, dystonia, excessive salivation, lack of facial expression and parkinsonian gait were observed. The side effects appeared on 3rd or 4th day after starting the drug. The side effects when present were easily controlled by conventional antiparkinson agents.
Laboratory investigations done at the end of the trial did not reveal any abnormality as compared to basal levels.
It is known that a single drug cannot control or ameliorate all the symptoms of chronic schizophrenia. Penfluridol seems to be effective in controlling some of the symptoms of chronic schizophrenia. In the present study a fixed dose of 20 mg once a week was used. It is claimed by Gallant et a12 that upto maximum of 160 mg with the increased dose more symptoms may probably be brought under control. In the present study, the drug did not alter significantly the thought disturbance, though the American authors claim good results in this area. Other symptoms which were refractory are animosity, belligerance and violent behaviour.
However, present study confirms penfluridol to be safe and effective (20 mg orally) for maintenance therapy in schizophrenia. The advantage is that patients can avoid the discomfort of daily oral medication and fortnightly injection. This helps family members to supervise the medication regimens in a better way. All these factors would more successful maintenance drug treat-contribute to better compliance and a ment of chronic schizophrenics.
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