Showing papers in "Archives of General Psychiatry in 1983"

A Children's Global Assessment Scale (CGAS)

Abstract: • We evaluated the Children's Global Assessment Scale (CGAS), an adaptation of the Global Assessment Scale for adults. Our findings indicate that the CGAS can be a useful measure of overall severity of disturbance. It was found to be reliable between raters and across time. Moreover, it demonstrated both discriminant and concurrent validity. Given these favorable psychometric properties and its relative simplicity, the CGAS is recommended to both clinicians and researchers as a complement to syndrome-specific scales.

The Mini-Mental State Examination

Abstract: To the Editor.— In response (Archives1982;39:1443-1445) to a letter by Ganguli and Saul (Archives1982;39:1442-1443), Robins and Helzer noted that the Mini-Mental State Examination, 1 incorporated into the Diagnostic Interview Schedule (DIS) to assess cognitive impairment, had been reported by Folstein et al to differentiate between pseudodementia and true organic brain syndromes. We would like to make that statement more specific. The Mini-Mental State Examination was designed as a clinical method for grading cognitive impairment. It produces a score that can be used to follow the course of patients or as a case detection technique after cutoff scores are established. In a clinical psychiatric setting, a low Mini-Mental score can be associated with many disorders including mental retardation, delirium, manicdepressive disorder, and schizophrenia, as illustrated by Folstein et al in their pre- DSM-III article in 1975. 1,2 However, on a medical unit like the one from which Ganguli and

Predicting Response to Alcohol and Drug Abuse Treatments: Role of Psychiatric Severity

Abstract: Male alcoholics (n = 460) and drug addicts (n = 282) were evaluated at six-month follow-up after treatment in six rehabilitation programs. Initial analyses of the unstratified samples showed significant patient improvement, but no evidence of differential effectiveness from different treatments or from "matching" patients to treatments. The two samples were then divided into groups based on the number, duration, and intensity of their psychiatric symptoms at admission, ie, their overall "psychiatric severity." Patients with low psychiatric severity improved in every treatment program. Patients with high psychiatric severity showed virtually no improvement in any treatment. Patients with midrange psychiatric severity (60% of the samples) showed outcome differences from different treatments and especially from specific patient-program matches. These findings support the effectiveness and specificity of different substance abuse treatments, suggest methodologic reasons for the lack of similar findings in previous studies, and demonstrate the importance of psychiatric factors in substance abuse treatment.

Prediction of Suicide in Psychiatric Patients: Report of a Prospective Study

Abstract: A prospective research study attempted to identify persons who would subsequently commit or attempt suicide. The sample consisted of 4,800 patients who were consecutively admitted to the inpatient psychiatric service of a Veterans Administration hospital. They were examined and rated on a wide range of instruments and measures, including most of those previously reported as predictive of suicide. Many items were found to have positive and substantial correlations with subsequent suicides and/or suicide attempts. However, all attempts to identify specific subjects were unsuccessful, including use of individual items, factor scores, and a series of discriminant functions. Each trial missed many cases and identified far too many false positive cases to be workable. Identification of particular persons who will commit suicide is not currently feasible, because of the low sensitivity and specificity of available identification procedures and the low base rate of this behavior.

The well-being of chronic mental patients : Assessing their quality of life

Abstract: • The concept, "quality of life" (QOL), offers a broad perspective for assessing the needs and outcomes of chronic mental patients. In this survey of Los Angeles board-and-care homes, 278 randomly selected, mentally disabled residents evaluated their QOL in structured interviews based on a general QOL model. Life areas studied included living situation, family, social relations, leisure, work, safety, finances, and health. The model performed as well among these residents as among the general population, explaining 48% to 58% of the variance in global well-being. Adding patients' subjective QOL evaluations doubled the explanatory power of a model based only on personal characteristics and objective life conditions. Global well-being was most consistently associated with personal safety, social relations, finances, leisure, and health care variables. The study identifies methodological and service issues in need of further examination.

The Relationship of Personality to Affective Disorders: A Critical Review

Abstract: Although characterologic constellations such as obsessionalism, dependency, introversion, restricted social skills, and maladaptive self-attributions are popularly linked to the pathogenesis of depressive disorders, the evidence in support of this relationship remains modest. Indeed, many of these attributes may reflect state characteristics woven into the postdepressive personality. Current evidence is strongest for introversion as a possible premorbid trait in primary nonbipolar depressions. By contrast, driven, work-oriented obsessoid, extroverted, cyclothymic, and related dysthymic temperaments appear to be the precursors of bipolar disorders. Other personalities, while not necessarily pathogenic in affective disorders, nevertheless may modify the clinical expression of affective disorders and their prognosis.

Genetic Factors in Anxiety Disorders

Abstract: • We investigated genetic factors in the determination of anxiety disorders in a study of 32 monozygotic (MZ) and 53 dizygotic (DZ) adult same-sexed twins. The frequency of anxiety disorders was twice as high in MZ as in DZ co-twins of the total proband group, alike in the MZ and DZ co-twins of the generalized anxiety disorder proband group, and three times as high in MZ as in DZ co-twins of the other proband groups. Anxiety disorders with panic attacks were more than five times as frequent in MZ as in DZ co-twins in a combined group of probands with panic disorders and agoraphobia with panic attacks. For generalized anxiety disorder, genetic factors were not apparent, while genetic factors appear to influence the development of the other anxiety disorders, especially panic disorder and agoraphobia with panic attacks.

Empirical Study of Self-rated Defense Styles

Abstract: • A self-administered questionnaire that would indicate a person's perception of his or her habitual defensive style was constructed and tested. The hypotheses assessed were that defenses cluster so as to constitute "styles" and that these styles can be ranked as more or less adaptive. The sample comprised 98 psychiatric patients and 111 nonpatients. The tools used were (1) a questionnaire measure of self-appraisal of defensive style, (2) a questionnaire measure of ego adaptation, and (3) a sentence completion measure of ego development. The results, which argued strongly for the validity of a questionnaire measure of perceived defensive style, also showed that such defenses tend to cluster into styles that can be ranked on a developmental continuum, from "maladaptive action patterns," through "image-distorting" defenses, "selfsacrificing" defenses, and "adaptive" defenses.

A Family Study of Panic Disorder

Abstract: • In a family study of panic disorder, we collected data on 278 first-degree relatives of 41 probands with panic disorder and 262 relatives of 41 control probands. The morbidity risk for panic disorder was 17.3% in the first group, and an additional 7.4% were categorized as having probable panic disorder. Both rates were significantly higher than the respective rates in the control relatives, 1.8% and 0.4%. The risk of panic disorder in female subjects was twice that in male subjects. The rate of generalized anxiety disorder was the same in both groups of families. No other psychiatric disorders were increased in the families of patients with panic disorder. In a preliminary genetic analysis, we tested the single major locus and the multifactorial polygenic transmission models. Neither model was excluded by the data. We conclude that panic disorder is a familial disease that affects women twice as frequently as men and is not associated with an increased familial risk of other psychiatric conditions. Its method of transmission remains uncertain.

The predictive power of diagnostic tests and the effect of prevalence of illness

Abstract: • There is a great interest in the potential usefulness of biomedical tests in psychiatry, but basic statistical principles required for critical evaluation of their value remain poorly integrated into clinical thinking. We developed a useful scheme for organizing clinical test data so as to permit simple calculations of the sensitivity, specificity, and predictive power of medical tests. Some loss of predictive power is inherent in moving from artificial populations used for test development into more typical clinical settings, where prevalence is usually substantially lower.

The Validity of DSM-III Borderline Personality Disorder: A Phenomenologic, Family History, Treatment Response, and Long-term Follow-up Study

Abstract: • To test the validity of theDSM-IIIdiagnosis of borderline personality disorder (BPD), we examined the phenomenology, family history, treatment response, and four-to-seven-year long-term outcome of a cohort of 33 patients meetingDSM-IIIcriteria for BPD. We found that (1) BPD could be distinguished readily fromDSM-IIIschizophrenia; (2) BPD did not appear to represent "borderline affective disorder," although many patients displayed BPD and major affective disorder concomitantly; and (3) BPD could not be distinguished on any of the Indices from histrionic and antisocial personality disorders.

Assessing Anhedonia in Psychiatric Patients: The Pleasure Scale

Abstract: In two studies of depressed, manic, schizophrenic, and normal subjects, a scale for measuring the intensity of subjects' pleasureable responses to normally emjoyable situations (the Pleasure Scale) evidenced good internal reliability and moderate agreement with the Chapman Anhedonia Scale and Indexes of depressive symptom severity. Only the depressed patients showed extremely anhedonic responses. Although more than half the depressed patients evidenced pleasure scores in the normal range, about 185 of them seemed more anhedonic than any norma subject. A mixture analysis resolved depressed patient scores into two distinct distributions: a normal-range distribution (88% of depressives) and an extremely anhedonic distribution (12%). The findings provide some support for the existence of a qualitatively distinct subtype of major depression that has been variously defined an "endogenomorphic" or "melancholic."

Psychotherapy for Opiate Addicts: Does It Help?

Abstract: • Opiate addicts beginning a new treatment episode on a methadone maintenance program were offered random assignment to drug counseling alone or to counseling plus six months of either supportive-expressive psychotherapy or cognitive-behavioral psychotherapy. Sixty percent of patients meeting the study criteria expressed an interest and 60% of these actually became engaged. One hundred ten subjects completed the study intake procedure and kept three or more appointments within the first six weeks of the project. Measures including standardized psychological tests, independent observer ratings, and continuous records of licit and illicit drug use were done at baseline and seven-month follow-up. All three treatment groups showed significant improvement, but patients receiving the additional psychotherapies showed improvement in more areas and to a greater degree than those who received counseling alone, and with less use of medication. More than a third of opiate addicts in our treatment program thus both were interested in professional psychotherapy and apparently benefitted from it. Certain administrative procedures appear necessary to maximize the chances that psychotherapy can be used effectively with drug-addicted patients. (Arch Gen Psychiatry1983;40:639-645)

Parental 'affectionless control' as an antecedent to adult depression. A risk factor delineated.

Abstract: The view that depressives perceive themselves as having been exposed to an insufficiency of parental care and to parental overprotection was confirmed in a case-control study of 125 neurotic depressives, using a subjective measure of perceived parental characteristics, the Parental Bonding Instrument (PBI). An interaction effect was noted, with the depressives scoring the same-sexed parent more deviantly. A discriminant analysis established that low parental care scale scores were the best discriminators, with raw care scores of less than 10 being highly sensitive in discriminating depressives from controls. Sixty-seven percent of the patients and 37% of the controls scored one or both parents to the "affectionless control" (low care--high protection) PBI quadrant, representing a relative risk of 3.4. It is concluded that the PBI delineates and quantifies a risk factor to certain grades of depressive experience.

Obsessive-compulsive disorder. A double-blind trial of clomipramine and clorgyline.

Abstract: Patients with obsessive-compulsive disorder who met DSM-III criteria and who had been ill for at least one year were studied in a double-blind, randomized, crossover comparison of the tricyclic antidepressant clomipramine hydrochloride and the monoamine oxidase inhibitor clorgyline hydrochloride. No significant improvement was evident after four weeks of treatment with placebo prior to the crossover study. Treatment with clomipramine was associated with significant improvement after both four and six weeks in measures of obsessions, anxiety, and depression. Antiobsessional responses to clomipramine did not depend on presence of depression. Improvement was correlated with plasma concentrations of clomipramine, but not with the plasma concentrations of any of its metabolites. No significant improvement was evident for the entire group with clorgyline treatment, although the conditions of individual patients did respond to the drug.

Reliability of DSM-III Anxiety Disorder Categories Using a New Structured Interview

Abstract: • The reliability ofDSM-IIIanxiety disorder diagnoses was determined using a new structured interview, the Anxiety Disorders Interview Schedule (ADIS). Two interviewers examined 60 consecutive outpatients at an anxiety disorders clinic and assigned primary and secondary diagnoses based on the ADIS. TheKstatistic, calculated on the basis of perfect matches on primary diagnoses, indicated good agreement for anxiety, affective, and adjustment disorders, as well as for the specific anxiety disorder categories of agoraphobia, panic, social phobia, and obsessive-compulsive disorder, but not for generalized anxiety disorder. We evaluated the causes for diagnostic disagreement, particularly in relation to the difficult differentiation between generalized anxiety disorder and other anxiety disorders.

Cognitive Loss and Recovery in Long-term Alcohol Abusers

Abstract: • The nature of the memory and visuospatial defects associated with chronic alcoholism, and the recovery of these functions, were investigated in a large group of alcoholic men and well-matched nonalcoholic controls. Both young and old alcoholics displayed significant impairments on tasks requiring the learning of novel associations and the holding of information in memory over longer delay intervals. The recovery of cognitive skills was found to depend on the length of abstinence and the particular behavioral functions examined. Whereas psychomotor skills and short-term memory improved significantly with prolonged abstinence, long-term memory was impaired even after seven years of continuous sobriety. We propose that recovery of short-term memory reflects reestablishment of cortical functioning, while the persistent long-term memory defect indicates more permanent damage to diencephalic structures.

Panic Disorder and Major Depression: Increased Risk of Depression, Alcoholism, Panic, and Phobic Disorders in Families of Depressed Probands With Panic Disorder

Abstract: • In a large, case-control family study of depression, 77 (58%) of 133 depressed probands displayed anxiety symptoms that met DSM-III criteria for agoraphobia, panic disorder, or generalized anxiety disorder. In two thirds of these 77 cases, these symptoms were associated with depressive episodes. In a previous study, the lifetime rate of major depression and anxiety disorders among first-degree family members of probands with major depression plus an anxiety disorder was found to be significantly increased regardless of when the anxiety symptoms occurred. In this study we analyzed our data according to the specific anxiety disorders observed. Major depression plus panic disorder in probands was associated with a marked increase in risk in relatives for a number of psychiatric disorders; relatives were more than twice as likely to have major depression, panic disorder, phobia, and/or alcoholism than the relatives of probands with major depression without any anxiety disorder. These results indicate that the relationship between major depression and anxiety disorders requires further study.

Dexamethasone suppression tests in antidepressant treatment of melancholia. The process of normalization and test-retest reproducibility.

Abstract: • Pilot studies suggest that changes in response to the dexamethasone suppression test (DST) in melancholic patients receiving antidepressants might represent a laboratory marker of clinical progress. We performed weekly DSTs in 31 hospitalized patients with major depressive disorder, primary and endogenous subtypes, during drug-free and subsequent treatment periods. Most nonsuppressors had progressive normalization of DST responses in conjunction with clinical improvement, DST normalization usually preceded or coincided with good clinical response, and failure to normalize was often associated with poorer clinical outcome. Occasional patients with baseline dexamethasone suppression become nonsuppressive after withdrawal from medication, but the DST has no apparent value as a serial marker in patients with welldocumented normal DST findings. Our results extend the construct validity of the DST as a state-related marker in nonsuppressors and suggest future clinical applications.

Treatment of Phobias: I. Comparison of Imipramine Hydrochloride and Placebo

Abstract: • In a controlled-outcome study of phobias, 218 adult phobic patients (147 women and 71 men) received a course of 26 weekly treatment sessions that consisted of behavior therapy (BT) and imipramine hydrochloride, BT and placebo, or supportive psychotherapy and imipramine. The BT consisted of systematic desensitization using fantasy and assertiveness training. Patients were classified as agoraphobic, mixed phobic, or simple phobic. Although the conditions of most patients in each group showed moderate to marked improvement, the effects of imipramine were significantly superior to those of placebo in patients with spontaneous panic attacks, ie, patients with agoraphobia or mixed phobia. In patients with simple phobia, who do not experience spontaneous panic, there was not a significant difference between imipramine and placebo. This study clearly distinguished those phobic patients who experienced spontaneous panic from those who did not in terms of pharmacologic benefit.

A Naturalistic Assessment of the Motor Activity of Hyperactive Boys: I. Comparison With Normal Controls

Abstract: The motor activity of hyperactive and normal boys was studied in 12 age- and classroom-matched pairs. Activity was measured continuously for a one-week period with a portable solid-state monitor. Hyperactives exhibited generally higher levels of motor activity than normal controls regardless of the time of day, including during sleep and on weekends. In a situation-by-situation analysis, hyperactives were most consistently and significantly more active than the controls during structured school activities. Little evidence was found, however, to support the hypothesis that hyperactivity is simply an artifact of the structure and attentional demands of a given setting. Pervasive increases in simple motor behavior are a clear attribute of hyperactive behavior and distinguished hyperactives from controls as well as did a standardized measure of attention.

Brain function in psychiatric disorders. III. Regional cerebral blood flow in unmedicated schizophrenics.

Abstract: • Regional cerebral blood flow (rCBF) was measured during resting baseline and the performance of a verbal and a spatial task in 19 unmedicated schizophrenics and 19 matched controls. Abnormalities in rCBF were evident in schizophrenics both for resting and activated measures. Resting flows were higher in the left hemisphere for schizophrenics, supporting the hypothesis of left hemispheric overactivation. This effect was stronger in the more severely disturbed patients. The pattern of rCBF changes during activation with the verbal and spatial tasks was also different in schizophrenics. Laterality of flow changes further supported the hypothesis of left hemispheric overactivation. Furthermore, whereas normals had greater increase in flow for the spatial than the verbal task, schizophrenics showed the reverse pattern. This effect also was more pronounced in the severely disturbed patients. Comparison with an earlier sample of medicated schizophrenics suggested that neuroleptics restore symmetry of resting flows before they produce symptomatic relief. Medication did not affect the abnormalities in pattern of rCBF changes during activation with cognitive tasks.

CSF and Urinary Biogenic Amines and Metabolites in Depression and Mania: A Controlled, Univariate Analysis

Abstract: • Levels of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) in the CSF, and norepinephrine (NE), epinephrine (E), vanillylmandelic acid, normetanephrine, metanephrine, and MHPG in the urine, were measured in 151 hospitalized patients with affective disorders and in 80 healthy controls following a two-week drug-free period. Unipolar and bipolar depressed subjects differed only in NE and E levels. Compared with controls, depressed subjects had higher CSF MHPG levels, women had higher 5-HIAA levels, and men had lower HVA levels. All urinary metabolites were elevated in depression and mania, with the exception of MHPG. The patterns of NE-E differences discriminated among the forms of affective disorders. These data suggest an imbalance of monoamine transmission in depression, characterized by the hyperactive sympathetic nervous system and adrenal medulla. However, MHPG may not be the measure of choice to reflect this imbalance, necessitating measurement of total body monoamine output.

Family history of suicide.

Abstract: Among 243 patients with a family history of suicide, almost half (118 [48.6%]) had attempted suicide, more than half (137 [56.4%]) had a depressive disorder, and more than a third (84 [34.6%]) had recurrent affective disorder. These 243 patients with a family history of suicide were compared with 5,602 patients with no family history of suicide. A family history of suicide was found to significantly increase the risk for an attempt at suicide in patients with a wide variety of diagnoses: schizophrenia, unipolar and bipolar affective disorders, depressive neurosis, and personality disorders.

Lithium carbonate augmentation of antidepressant treatment. An effective prescription for treatment-refractory depression.

Abstract: To assess whether lithium carbonate augments antidepressant effects of long-term antidepressant treatment in non-responding patients, 15 treatment-refractory patients were studied using a placebo-controlled, double-blind design. After at least 21 days of antidepressant drug therapy, and while continuing to receive the same daily dose of antidepressant drug, eight patients received lithium carbonate and seven received placebo. In comparison with placebo, lithium carbonate produced a small but statistically significant improvement in the mean daily nursing ratings of depression during the first two days of treatment. The beneficial effects of lithium carbonate were more variable during the next four days, but by the seventh through 12th day of the trial, the drug produced a significant and clinically meaningful improvement. When the seven placebo-treated patients received active lithium carbonate on the 13th day of the study, their rate of improvement was similar to that of the eight patients who had received active lithium carbonate initially. This augmentation of the anti-depressant effect was seen in patients treated with desipramine hydrochloride, amitriptyline hydrochloride, or mianserin hydrochloride. Although in five of the 15 patients, the improvement appeared as early as 24 to 48 hours after the first lithium carbonate dose, the remaining patients did not show a clear improvement until approximately five to eight days later. We concluded that lithium carbonate does augment the antidepressant effect when added to the long-term antidepressant treatment of nonresponding patients.

Personality and Depression: Empirical Findings

Abstract: The Clinical Studies of the National Institute of Mental Health--Clinical Research Branch Collaborative Program on the Psychobiology of Depression offer an opportunity to clarify the relationship between personality and depression. Thirty-one female patients with primary nonbipolar major depressive disorder were assessed diagnostically using the Schedule for Affective Disorders and Schizophrenia and completed a battery of standard self-report personality inventories when they were completely symptom free. Their personality scale scores were compared with those of female relatives who had recovered from the same type of disorder, those of female relatives with no history of psychiatric illness, and published scale norms. Compared with the normal population, both groups of recovered depressives were introverted, submissive, and passive, with increased interpersonal dependency but normal emotional strength. Comparison to never-ill relatives yielded similar results except that the never-ill relatives had scores reflecting extraordinary emotional strength.

Symptom checklist syndromes in the general population. Correlations with psychotherapeutic drug use.

Abstract: • Using symptom checklists administered on a large scale by survey interviewers in the 1979 National Survey of Psychotherapeutic Drug Use, we developed a method for classifying survey respondents by syndromes. These syndromes had symptoms and other characteristics consistent with their DSM-III diagnostic counterparts and showed one-year prevalence rates in accord with available epidemiologic data: Major Depression, 5.1%; Agoraphobia-Panic, 1.2%; Other Phobia, 2.3%; and Generalized Anxiety, 6.4%. However, the anxietyrelated syndromes occurred less frequently than clinical lore might suggest. The data showed a very low rate of antidepressant use and a higher rate of antianxiety agent use among Major Depressives (11% and 23%) and Agoraphobics (8% and 55%). Also noteworthy were the infrequent use of antianxiety agents among respondents with Generalized Anxiety (27%) and the low frequency of both antianxiety (19%) and antidepressant (3%) drug use among persons with high distress who did not qualify for any syndrome. These findings suggest that the majority of persons with serious psychiatric disorders still do not receive treatment or the most appropriate treatment.

Brain electrical activity mapping (BEAM) in schizophrenic patients.

Abstract: • A new topographic approach, brain electrical activity mapping, summarizes EEG and evoked potential data as color maps. Eleven drug-free and 14 medicated schizophrenic patients and 11 normal controls were studied with this technique. Compared with controls, both schizophrenic groups had more slow activity (delta, 0 to 3.5 Hz), greatest in frontal regions, and more fast activity (beta, 20 to 31.5 Hz) in postcentral regions. Both schizophrenic groups were different from controls late in the visual evoked potential and in the middle of the auditory evoked potential. Overall, using multivariate discriminant analysis, a very significant group separation effect was found, and retrospective classification was 95% successful in discriminating both schizophrenic groups from controls. To estimate the ability of our features to assign subjects prospectively to control or patient groups, we employed "jackknifing," which resulted in overall classification success rates of 84.0% for medicated schizophrenic patients v controls and 81.8% for drug-free schizophrenic patients v controls.

Lithium Carbonate Addition in Tricyclic Antidepressant—Resistant Unipolar Depression: Correlations With the Neurobiologic Actions of Tricyclic Antidepressant Drugs and Lithium Ion on the Serotonin System

Abstract: • Preliminary reports suggested that the addition of lithium carbonate to the regimen of patients treated with, but not responding to, a tricyclic antidepressant (TCA) drug can induce a rapid alleviation of depression. We examined the effect of lithium carbonate addition in 39 patients with unipolar depression whose conditions were not improved by at least three weeks' TCA drug administration. In 30 of 42 observations, lithium carbonate brought about a greater than 50% improvement within 48 hours. In a second study, the effects of lithium carbonate addition were compared in five amitriptyline hydrochloride—pretreated and five placebo-pretreated patients who showed no improvement after a three-week treatment. All five patients receiving amitriptyline showed a greater than 50% improvement 48 hours after lithium carbonate addition, whereas only one patient in the placebo group showed a marked response. In a third study the effect of lithium carbonate withdrawal was studied in nine TCA-resistant patients who had shown a marked improvement 48 hours after lithium addition. Only five of these patients had a relapse five days after lithium discontinuation. Since animal studies have shown that TCA drugs sensitize forebrain neurons to serotonin and that lithium enhances the activity of serotonin-containing neurons, we propose that the antidepressant effect of lithium addition in TCA-resistant patients might be mediated by enhancing serotonin neurotransmission.

Low-dose neuroleptic treatment of outpatient schizophrenics. I. Preliminary results for relapse rates.

Abstract: • In an attempt to begin to establish minimum effective dosage requirements for the maintenance treatment of schizophrenia, we undertook a double-blind comparison of low-dose fluphenazine decanoate (1.25 to 5.0 mg/2 wk) with the standard-dose regimen (12.5 to 50.0 mg/2 wk) in outpatient schizophrenics. For the first 126 patients studied, cumulative relapse rates at one year for the low dose were 56% and for the standard dose 7%, a significant difference. Despite the fact that very little dyskinetic symptomatology developed in the sample as a whole, the low-dose treatment appeared to have a significant advantage in producing fewer early signs of tardive dyskinesia. Severity of relapse and total cumulative dosage were also considered.