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A retrospective review of neuroleptic dosages over a five-year period in 19 chronic schizophrenic patients revealed that the majority (85 percent) had either consistent yearly increases or decreases in dosage, although clinical status remained unchanged. The authors present differences in adverse effects between the two groups and discuss the implications of their findings for the concepts of neuroleptic drug tolerance and supersensitivity psychosis.

An ongoing screening program using pharmacists to detect tardive dyskinesia (TD) was developed, and a pharmacy-based prevalence survey of TD in chronic hospitalized psychiatric patients was undertaken to determine the extent of abnormal involuntary movements. The results show that older patients and women in particular are at higher risk for developing abnormal movements. Higher doses of neuroleptics were used in non-TD patients, indicating a possible masking effect caused by these drugs. By using a standardized rating method such as the Abnormal Involuntary Movement Scale, pharmacists can and should be utilized in the surveillance of TD.

The Ward Atmosphere Scale was used to assess the development of a therapeutic milieu in a clinical ward converted to a research unit at a state psychiatric hospital. The designated ward had been considered a “problem ward” with low staff moral, a high incidence of violence by patients, and high incidence of injuries to patients and staff. The scale was administered to patients and staff on two occasions. The results of the first administration were presented to staff, and from these consultation sessions, a therapeutic milieu developed. The scale was readministered 3 mo. after the implementation of the therapeutic milieu. Significant improvements were seen in staff's perception of the ward environment, incidence of patients' assaults, and staff use of seclusion and restraints.

Six treatment-resistant schizophrenic patients were given a ten-week single-blind trial of carbamazepine. Treatment resistance was determined on the basis of documented failure to respond to treatment with at least three neuroleptic drugs from two different chemical classes. The adjunctive use of carbamazepine resulted in a significant improvement of the negative symptoms of schizophrenia. These symptoms are often poorly responsive to conventional antipsychotic drugs. Therefore, controlled studies should be performed to further assess the possible efficacy of carbamazepine in schizophrenia.