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A path-analytical approach to differentiate between direct and indirect drug effects on negative symptoms in schizophrenic patients

A re-evaluation of the North American risperidone study

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Abstract

The hypothesis that differences in drug effects of risperidone and haloperidol on negative symptoms in schizophrenia are secondary to effects on positive, extrapyramidal, and depressive symptoms was investigated by means of an analysis of the data from the USA-Canada risperidone double-blind randomized clinical trial of 523 chronic schizophrenic patients. Regression analyses in the total sample and within treatment groups confirmed a strong relationship between changes in negative symptoms and the other variables studied (R2=0.50−0.51,p<0.001). Only depressive symptoms did not contribute significantly to these results (p>0.10). Path analysis showed that the greater mean change (p<0.05) of negative symptoms with risperidone compared to haloperidol could not be fully explained by correlations with favourable effects on positive and extrapyramidal symptoms. The relationship between shift in extrapyramidal symptoms and shift in negative symptoms failed to reach statistical significance; however, there was a clear tendency in the expected direction in both treatment groups.

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References

  • American Psychiatric Association (ed) (1987) Diagnostic and statistical manual of mental disorders. 3rd edition, revised. American Psychiatric Association, Washington

    Google Scholar 

  • Andreasen NC (1989) The Scale for the Assessment of Negative Symptoms (SANS): conceptual and theoretical foundations. Br J Psychiatry 155, Suppl 7:49–52

    Google Scholar 

  • Breier A, Buchanan R, Kirkpatrick B, Davis O, Irish D, Summerfelt A, Carpenter W (1994) Effects of lozapine on positive and negative symptoms in outpatients with schizophrenia. Am J Psychiatry 145:578–583

    Google Scholar 

  • Carpenter WT, Heinrichs DW, Alphs LD (1985) Treatment of negative symptoms. Schizophr Bull 11:440–452

    Google Scholar 

  • Carpenter WT, Heinrichs DW, Wagman AMI (1988) Deficit and nondeficit forms of schizophrenia: the concept. Am J Psychiatry 145:578–583

    Google Scholar 

  • Chouinard G, Ross-Chouinard A, Annable L, Jones BD (1980) The Extrapyramidal Symptom Rating Scale. Can J Neurol Sci 7:233

    Google Scholar 

  • Chouinard G, Jones BD, Remington G et al. (1993) A Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients. J Clin Psychopharmacol 13:25–40

    Google Scholar 

  • Hoffman WF, Labs SM, Casey DE (1987) Neuroleptic-induced parkinsonism in older schizophrenics. Biol Psychiatry 22:427–439

    Google Scholar 

  • Janssen Research Foundation (ed) (1991) A randomized, doubleblind, multicenter trial of risperidone in the treatment of chronic schizophrenia. Clinical research report (RIS-Int-3), November 1991. Janssen, Piscataway, New Jersey/USA

    Google Scholar 

  • Kammen DP van, Hommer DW, Malas KL (1987) Effect of pimozide on positive and negative symptoms in schizophrenic patients: Are negative symptoms state dependent? Neuropsychobiology 18:113–117

    Google Scholar 

  • Kay SR, Opler LA, Fiszbein A (1987) Positive and Negative Syndrome Scale (PANSS). Rating Manual. Social and Behavioral Documents. San Rafael, CA

    Google Scholar 

  • Marder SR, Meibach RC (1994) Risperidone in the treatment of schizophrenia. Am J Psychiatry 13:25–40

    Google Scholar 

  • Meltzer HY (1985) Dopamine and negative symptoms in schizophrenia: critique of the type I–II hypothesis. In: Alpert M (ed) Controversies in schizophrenia. Guilford, New York, pp 110–136

    Google Scholar 

  • Miller DD, Perry PJ, Cadoret RJ, Andreasen NC (1994) Clozapine's effect on negative symptoms in treatment-refractory schizophrenics. Compr Psychiatry 35:8–15

    Google Scholar 

  • Möller H-J (1993) Neuroleptic treatment of negative symptoms in schizophrenic patients. Efficay problems and methodological difficulties. Eur Neuropsychopharmacol 3:1–11

    Google Scholar 

  • Möller H-J, van Praag HM, Aufdembrinke B et al. (1994) Negative symptoms in schizophrenia: considerations for clinical trials. Working group on negative symptoms in schizophrenia. Psychopharmacology 115:221–228

    Google Scholar 

  • Overall JE, Gorham DE (1961) Brief Psychiatric Rating Scale. Psychol Rep 10:799–812

    Google Scholar 

  • Overall J, Klett CJ (1972) Applied multivariate analysis. McGraw-Hill, New York

    Google Scholar 

  • Prosser ES, Csernansky JG, Kaplan H, Thiemann S, Becker T, Hollister LE (1987) Depression, parkinsonian symptoms, and negative symptoms in schizophrenics treated with neuroleptics. J Nerv Ment Dis 175:100–105

    Google Scholar 

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Möller, HJ., Müller, H., Borison, R.L. et al. A path-analytical approach to differentiate between direct and indirect drug effects on negative symptoms in schizophrenic patients. Eur Arch Psychiatry Clin Nuerosci 245, 45–49 (1995). https://doi.org/10.1007/BF02191543

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  • DOI: https://doi.org/10.1007/BF02191543

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