Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-17T07:36:20.476Z Has data issue: false hasContentIssue false

Methodological and Design Issues in Clinical Trials of New Neuroleptics: an Overview

Published online by Cambridge University Press:  06 August 2018

A. George Awad*
Affiliation:
University of Toronto; The Wellesley Hospital, Toronto; Department of Psychiatry, The Wellesley Hospital, 160 Wellesley Street East, Toronto, Ontario M4Y 1J3, Canada

Abstract

The recent development of new neuroleptics that differ from the conventional neuroleptics in both mechanism of action and side-effects profile has introduced problems in their clinical assessment, and highlighted ongoing issues in the design and methodology of clinical trials. These issues are broadly grouped and discussed as follows: sampling problems and selection of patients; design issues; problems in measurement; ensuring compliance; recognition of extrapharmacological issues; and statistical models. For patients to benefit from the development of new neuroleptics, clinical settings have to be prepared for testing their efficacy and safety without too much delay in well designed clinical trials.

Type
Research Article
Copyright
Copyright © 1993 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Awad, A. G. (1989) Drug therapy in schizophrenia – variability of outcome and prediction of response. Canadian Journal of Psychiatry, 34, 711720.CrossRefGoogle ScholarPubMed
Awad, A. G. (1992) Quality of life of schizophrenics on medications – implications for clinical trials of new neuroleptics. Hospital and Community Psychiatry, 43, 262265.Google Scholar
Awad, A. G. & Hogan, T. P. (1985) Early treatment events and prediction of response to neuroleptics in schizophrenia. Progress in Neuropsychopharmacology and Biological Psychiatry, 9, 583585.CrossRefGoogle ScholarPubMed
Awad, A. G. & Hogan, T. P. (1988) Diagnostic criteria as a predictor of drug response in schizophrenia. Medical Science Research, 16, 199200.Google Scholar
Blackwell, B. (1982) Treatment compliance. In Treatment of Mental Disorders (eds Greist, J. H., Jefferson, J. W. & Spitzer, R. L.), pp. 510516. Oxford: Oxford University Press.Google Scholar
Carpenter, W. T., Strauss, J. S. & Bartko, J. J. (1973) A flexible system for the diagnosis of schizophrenia: report from WHO International Pilot Study of Schizophrenia. Science, 182, 12751278.CrossRefGoogle ScholarPubMed
Davidhizar, R. E. (1985) Can clients with schizophrenia describe feelings and beliefs about taking medications? Journal of Advanced Nursing, 10, 469473.CrossRefGoogle Scholar
Davis, J. M., Schaffer, C. B., Killian, G. A., et al (1980) Important issues in the drug treatment of schizophrenics. Schizophrenia Bulletin, 6, 7078.CrossRefGoogle Scholar
deLeon, J., Wilson, W. H. & Simpson, G. M. (1989) Measurement of negative symptoms in schizophrenia. Psychiatric Developments, 3, 211234.Google Scholar
Ellgring, H. (1989) Facial expression as a behavioural indicator of emotional status. Pharmacopsychiatry, 22, 2328.CrossRefGoogle Scholar
Feighner, J. P., Robbins, E., Guze, S. B., et al (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 5763.CrossRefGoogle ScholarPubMed
Fenton, W. S. & McGlashan, T. H. (1992) Testing systems for assessment of negative symptoms in schizophrenia. Archives of General Psychiatry, 49, 179184 CrossRefGoogle ScholarPubMed
Gaebel, W. (1989) Treatment course clinical and neurobiological correlates of negative symptoms – towards an integrative model of schizophrenia. Schizophrenia Research, 2, 62.CrossRefGoogle Scholar
Goldberg, S. C., Schooler, N. R., Davidson, E. M., et al (1966) Sex and race difference in response to drug treatment among schizophrenics. Psychopharmacologia, 9, 3147.CrossRefGoogle ScholarPubMed
Helzer, B. S. & Coryell, W. (1983) More on DSM III: how consistent are precise criteria? Biological Psychiatry, 18, 12011203.Google ScholarPubMed
Hogan, T. P., Awad, A. G. & Eastwood, M. R. (1983) A self-report scale predictive of drug compliance in schizophrenia: reliability and discriminative ability. Psychological Medicine, 13, 177183.CrossRefGoogle Scholar
Hogan, T. P., Awad, A. G. (1992) Subjective response to neuroleptics and outcome in schizophrenia: a re-examination comparing two measures. Psychological Medicine, 22, 347352.CrossRefGoogle ScholarPubMed
Hogarty, G. D., Goldberg, S. C., Schooler, N. R., et al (1974) Drug and sociotherapy in the after care of schizophrenic patients – II. Two year relapse rate. Archives of General Psychiatry, 31, 603608.CrossRefGoogle Scholar
Judd, L. L., Goldstein, M. J., Rodnick, E. H., et al (1973) Phenothiazine effects in good premorbid schizophrenics divided into paranoid–non paranoid status. Archives of General Psychiatry, 29, 207211.CrossRefGoogle Scholar
Kane, J. (1989) The current status of neuroleptic therapy. Journal of Clinical Psychiatry, 50, 322328.Google ScholarPubMed
Kane, J., Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment-resistant schizophrenic. Archives of General Psychiatry, 45, 789796.CrossRefGoogle ScholarPubMed
Kraemer, H. C., Pruyn, J. P., Gibbons, R. D., et al (1987) Methodology in psychiatric research. Archives of General Psychiatry, 44, 11001106.CrossRefGoogle ScholarPubMed
Kramer, J., Mattson, R., Prevey, M. L., et al (1989) How often is medication taken as prescribed? A novel assessment technique. Journal of American Medical Association, 261, 32733277.CrossRefGoogle Scholar
Kruger, H. P. (1989) Hidden chronemics – a hidden dimension of speech: theoretical background, measurement and clinical validity. Pharmacopsychiatry, 22, 512.CrossRefGoogle ScholarPubMed
Lapierre, Y. D., Ancill, R., Awad, A. G., et al (1992) A dose-finding study with remoxipride in the acute treatment of schizophrenic patients. Journal of Psychiatry and Neuroscience, 17, 135145.Google ScholarPubMed
Leff, J. P. & Wing, J. K. (1971) Trial maintenance therapy in schizophrenia. British Medical Journal, ii, 599603.CrossRefGoogle Scholar
Lucchelli, P. E., Borghi, C. & Fuccella, L. M. (1990) Multicentre Clinical Trials. Milan: Società di Scienze Farmacologicne Applicate.Google Scholar
Manchanda, R. & Hirsch, S. R. (1986) Does propranolol have an antipsychotic effect? A placebo-controlled study in acute schizophrenia. British Journal of Psychiatry, 148, 701707.CrossRefGoogle ScholarPubMed
Prien, R. F., Levine, J. & Switalsky, R. N. (1977) Discontinuation of chemotherapy for chronic schizophrenics. Hospital and Community Psychiatry, 22, 49.Google Scholar
Rappaport, M., Hopkins, K. H., Hall, K., et al (1978) Are there schizophrenics for whom drugs may be unnecessary or contra-indicated? International Pharmacopsychiatry, 13, 100111.CrossRefGoogle ScholarPubMed
Sackett, D. L. & Haynes, R. B. (1976) Compliance with Therapeutic Regimes. Baltimore: John Hopkins University Press.Google Scholar
Sarwer-Foner, G. J. (1963) On the mechanism of action of neuroleptic drugs: a theoretical psychodynamic explanation. Recent Advances in Biological Psychiatry, 6, 217232.Google ScholarPubMed
Seeman, M. V. (1983) Interaction of sex, age and neuroleptic dose. Comprehensive Psychiatry, 24, 125128.CrossRefGoogle ScholarPubMed
Snaith, R. P. (1991) Measurement in psychiatry. British Journal of Psychiatry, 159, 7882.CrossRefGoogle ScholarPubMed
Spitzer, R., Endicott, J. & Robins, E. (1985) Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders (2nd edn). New York: Biometric Research, New York State Psychiatric Institute.Google Scholar
Van Putten, T. & May, P. R. A. (1978) Subjective response as a predictor of outcome in pharmacotherapy. Archives of General Psychiatry, 35, 447480.CrossRefGoogle ScholarPubMed
Van Putten, T. & May, P. R. A., Marder, S. R., et al (1981) Subjective response to antipsychotic drugs. Archives of General Psychiatry, 38, 187190.CrossRefGoogle ScholarPubMed
Wolkowitz, O. M., Bartko, J. J. & Pickar, D. (1990) Drug trials and heterogeneity in schizophrenia: the mean is not the end. Biological Psychiatry, 28, 10211025.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.