| Keywords | Schizophrenia, / Treatment-resistant, / Relapse, / Japanese version of Manchester Scale, / Criteria for refractory schizophrenia, / Plasma HVA, / Plasma HMPG, / Agranulocytosis |
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| Research Abstract |
Results in the investigation of treatment-resistant schizophrenia were as follows. (1) The reliability, internal structure and validity of the Japanese Version of the Manchester Scale (MS) were sufficiently high, and this scale was thought to be valuable. (2) The criteria of refractory schizophrenia were considered as follows ; (i) diagnosis of schizophrenia by ICD-10, (ii) continuous hospitalization for at least the past two years, (iii) Global Assessment Scale was 40 or less, (iv) item scores of marked or severe on at least three of the six MS items (flattened affect, psychomotor retardation, delusions, hallucinations, incoherence of speech, poverty of speech). (3) As the duration of the illness of schizophrenia became longer, incoherence of speech changed from a distinct symptom to a part of negative symptoms, and the symptoms complex of anxious-depressed symptomes and hallucinatory-delusional symptoms separated into independent symptoms. (4) Refractory schizophrenics had both sever
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e negative symptoms and severe positive symptoms, and they were treatment-resistance in spite of large dosage of antipsychotics. (5) Treatment-resistant schizophrenics showed poor improvement in positive symptoms during hospitalizaion, and they had not developed reductions in plasma HVA and MHPG levels. (6) There were high frequency of abnormalities in the hematological and blood chemical exzaminations in schizophrenic inpatients, and several unexopected medications caused these abnormalities. (7) Dryg induced agranulocytosis was not rare in the psychiatric field, the successful treatments of this side effect were the discontinuation of causal medications and the injection with granulocyte colony stimulating factor. (8) The forensic aspects of refractory psychosis were examined through the actual cases in the United Kingdom.
Results in the study of the relapse in schizophrenia were as follows. (1) The reduction of antipsychotic medication, not the psycho-social stresses, caused the relapse in schizophrenics during the reduction process. The increase in the score of anxious-depressed symptoms or the level of plasma MHPG resulted in relapse during the reduction process. (2) Several biological items at discharge related to the relapse in schizophrenia during one year follow-up. (3) Depot antipsychotic injection clearly decreased the rate of relapse or rehospitalization in schizophrenics, but did not influence their psycho-social function. Less
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