Changes in Schizophrenic Psychopathology and Ward Behaviour as a Function of Phenothiazine Treatment

¹ Research Psychologist, Psychopharmacology Service Center, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
² Assistant Director of Psychiatry, Massachusetts Mental Health Center, and Clinical Associate in Psychiatry, Harvard Medical School.
³ Chief, Psychopharmacology Service Center, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland

This study attempted to determine which of a wide variety of schizophrenic symptoms and behaviours could be favourably influenced by phenothiazine treatment. The following results were obtained:

1. Phenothiazine treatment significantly improved patients more than placebo on overall measures of clinical state and in 14 of 21 relatively independent measures of schizophrenic manifestations.

2. Examination of the effects on symptoms shows that the clinical effects of drug treatment go far beyond those suggested by the term "tranquillizer". In addition to change in excitement and anxiety, there is a reduction in symptoms such as apathy and motor retardation.

3. Significant improvement occurred on placebo, and varied in amount among the symptoms measured.

4. Most symptoms not showing a drug-placebo difference showed significant improvement on placebo. The lack of a drug-placebo difference does not indicate little improvement but usually indicates equally great improvement under both drug and placebo treatment conditions.

5. There is one group of symptoms in which there was no improvement except on drug treatment. These are:

Irritability

Slowed Speech and Movements

Hebephrenic Symptoms

Self Care

Indifference to Environment

These symptoms correspond to a limited extent to what Bleuler has called "fundamental" symptoms.

6. The profiles of improvement due to placebo and due to drug are qualitatively different. It is, therefore, incorrect to conclude that drugs merely induce a quantitative increase of placebo effect. Instead there seems to be evidence for a qualitatively different action of drugs in addition to a quantitative action.

7. Patients who did not manifest a particular symptom before treatment were more likely to develop the symptom on placebo than on drug. Not only do drugs produce a reduction in patients' symptoms present before treatment, but they also appear to prevent the development of symptoms originally not present.

This article has been cited by other articles:

				H. E. Spohn, R. B. Lacoursiere, K. Thompson, and L. Coyne Phenothiazine Effects on Psychological and Psychophysiological Dysfunction in Chronic Schizophrenics Arch Gen Psychiatry, June 1, 1977; 34(6): 633 - 644. [Abstract] [PDF]

				L. L. Judd, M. J. Goldstein, E. H. Rodnick, and N. L.P. Jackson Jr. Phenothiazine Effects in Good Premorbid Schizophrenics Divided Into Paranoid-Nonparanoid Status Arch Gen Psychiatry, August 1, 1973; 29(2): 207 - 211. [Abstract] [PDF]

				M. L. Clark, W. K. Huber, K. D. Charalampous, E. A. Serafetinides, W. Trousdale, and J. P. Colmore Drug Treatment in Newly Admitted Schizophrenic Patients Arch Gen Psychiatry, November 1, 1971; 25(5): 404 - 409. [Abstract] [PDF]