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We describe a 62-year-old patient with a chronic delusional disorder who presented with severely matted hair ("plica polonica"). Until the late 19th century such dreadlocks were considered as cause, consequence and treatment of mental disease. The historical development of "plica polonica" is briefly reviewed as an example of early and once popular psychiatric disease concepts.

A group of 82 nonselected patients with the leading symptom "anxiety" as part of psychoreactive disturbances was included in a study comparing the effectiveness of fluspirilene and bromazepam. The results of an earlier pilot study showing on the whole the superiority of fluspirilene versus bromazepam was confirmed. The absence of significant side-effects under either medication seems to indicate, that the administration of the low-dose long-acting neuroleptic might be a preferable alternative to tranquilizers, especially in patients, in whom a danger of misuse cannot be excluded.

Today, Fluspirilene 1.5 mg i.m. (Imap 1,5 mg), is used to treat psychosomatic conditions, anxiety states and psychogenic disorders. The present article reports on clinical studies involving these indications. The efficacy of Fluspirilene 1.5 mg i.m. was demonstrated in patients with functional organic complaints, autonomic emotional symptom complexes, patients with anxiety, patients with functional heart complaints, and patients with functional gynaecological disorders. The results of a controlled study of 1.5 mg Fluspirilene i.m. and 6 mg Bromazepam are discussed. Forty-five patients from a neurologist's practice participated, all of whom had been classified as treatment-requiring patients with neurotic anxiety, on the basis of the physician's diagnosis and psychometric examination. Treatment lasted 42 days. The clinical assessment by the physician revealed that 1.5 mg Fluspirilene i.m. is significantly more effective than Bromazepam. The psychometric findings showed that patients with marked somatic anxiety treated with Fluspirilene showed greater improvement as expressed in a reduction in anxiety, lightening of mood, and increased activity, as compared with Bromazepam.

The paper reports on an open study of flupirilene administration in ten previously untreated female outpatients with paranoid symptomatology who were of advanced age. In eight of the ten patients who had been included in the 12-week study the authors observed a remission particularly of delusion dynamics, delusional intuitions, delusional perceptions, and restlessness as well as excitment. The therapy failed in two patients. Preexisting cerebro-organic impairments deteriorated partly, whereas vegetative and extrapyramidal side effects were of only moderate intensity. Hence, fluspirilene proved to be a depot neuroleptic with good antipsychotic effect in outpatient treatment of paranoid psychoses of patients of advanced age. However, especially in patients of advanced age. However, especially patients with preorganic brain syndrome, the obviously sedating and retarding effects of this drug must be taken into account, since they may contribute to further disturbance of the impaired cerebral function.

Over a period of 7 to 12 weeks we studied 3 series of 274 patients with depressive and somatic complaints treated with the long-acting neuroleptic fluspirilene in a dosage of 1-1.5 mg weekly. By means of various rating scales it was compared to diazepam in regard to its tranquilizing effects. Fluspirilene showed good activating and antidepressive qualities, which were superior to those of diazepam, whereas somatic complaints responded equally well to both drugs. The indications for a long-acting tranquilizer with the advantage of a controllable application are being discussed.

Over a period of 8 weeks we compared the tranquilizing effects of the longterm neuroleptic Fluspirilene to those of Diazepam in a series of 28 patients. Both drugs showed good effects on somatization, anxiety and depressive mood. Fluspirilene, however, proved to be the more mood elevating and more activating agent without being hypnotic. The indications for both drugs are being discussed emphazising the new therapeutic perspectives of a long acting tranquilizer.

Fluspirilene (Trademark Imap) is a depot neuroleptic agent for i.m. injection known for several years. Since it is well tolerated, has substance-specific repository properties and rarely leads to extrapyramidal motorial side effects, it has proved itself efficient for the in- and outpatient treatment of psychoses. Recently however, an extension of its indication has been advocated (as a "weak tranquilizer") to unspecific anxiety and agitation states as well as functional/neurasthenic syndromes. According to our observations, administration of the drug over several weeks in these cases frequently leads to depressive syndromes. Based on three case studies, this paper illustrates the problems involving administration of 1,5 mg Imap in functional/neurasthenic syndromes and discusses the occasional necessity of antidepressive therapy following discontinuation of the neuroleptic medication.

The authors report clinical experience from therapy with Orap-Janssen and Orap-Richter from 1968 to 1974. Excellent tolerance makes Orap particularly suitable for long-term maintenance therapy in schizophrenic psychoses. The evaluation is based on observations in 91 patients.

The clinical profile and side-effects of perphenazin-enanthate and fluspirilene were compared in 45 female chronic schizophrenic patients. 100 mg perphenazin-enanthate fortnightly or 8 mg fluspirilene weekly were administered. During the four months' period the psychopathological and somatic symptoms were evaluated by means of the AMP-system and the self-evaluation scale PD-S (v. Zerssen). A covariance analysis was carried out covering 12 AMP syndromes and 6 PD-S factors. The antipsychotic effect of both drugs was similar concerning the paranoid, the hallucinatory-desintegrative and the catatonic syndromes. A significant difference with regard to perphenazin-enanthate was found in the AMP-syndromes of hostility, hypochondria, and autonomic symptoms. Neither drug induced any depression. In the self-rating scale, the factors anxiousness and depressivity were also significantly lower in the perphenazin-enanthate regime. The patients under perphenazin-enanthate required a smaller amount of antiparkinsonian drugs. The more pronounced sedative effect of perphenazin-enanthate can be recommended in hostile and restless schizophrenic patients, whereas fluspirilene should be given to inactive autistic patients.

In recent years, depot neuroleptics have gained in importance in the outpatient treatment of chronic schizophrenics. These neuroleptics make drug therapy safer than before, thus improving the prerequisites for socio-therapeutic and rehabilitative measures. The present study analyses the ranking and value of this kind of treatment in the management of outpatients. A random sample of 80 schizophrenics treated as outpatients, by a psychiatric university clinic working on a sectorial basis was examined for the purpose of this study. Treatment results, problems of indication, limitations of therapeutic possibilities using depot neuroleptics, as well as constellative conditions under which therapy was discontinued, are discussed.