***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Differents protocol es therapeutiques et differents  dosages de neuroleptiques chez des Abstract Nine VA Medical Centers are participating in a 2-year double-blind placebo controlled study of antioxidant  treatment for tardive dyskinesia ( TD ) conducted by the Department of Veteran Affairs Cooperative Studies Program . One of the principal outcome measures of this study is the score derived from the instrumental assessment of upper extremity dyskinesia . Dyskinetic h and movements are quantified by assessing the variability associated with steady-state isometric force generated by the patient . In the present report , we describe the training procedures and results of a multi-center reliability assessment of this procedure . Data from nine study centers comprising 45 individual patients with six trials each ( three from left h and and three from right h and ) were reanalyzed by an independent investigator and the results were subjected to reliability assessment . For the statistic of interest ( average coefficient of variation over trials 2 and 3 for each h and , then take the larger of these two values ) , we found very high intraclass correlation coefficients for reliability over all patients across sites ( ICC = 0.995 ) . We also calculated the reliability of the measures across trials within patient for each combination of h and ( right , left , dominant ) , rater group ( site , control ) , and trials set ( all three , trials 2 and 3 ) . For a given h and and trial set , the reliability of the site raters was similar to that of the control . This study demonstrates that instrumental measures for the assessment of dyskinesia are reliable and can be implemented in multi-center studies with minimal training The attempt in one hospital to model a drug study after the NIMH nine-hospital collaborative study result ed in a useful modification in which relatively small numbers of newly admitted , acutely exacerbated chronic schizophrenic patients were studied for a period of four weeks . Statistically significant drug : placebo differences were easily detected on most psychiatric and behavioral variables , but not on the psychological performance tasks used . The overall design appears to be suitable for sequential analysis and might provide the basis for an early screening program for antipsychotic drugs in which very small numbers of subjects would be required for relatively short periods of observation . A possible differential drug response favoring thioridazine over chlorpromazine hydrochloride and fluphenazine hydrochloride on several variables was not statistically significant A double-blind withdrawal trial in 41 chronic schizophrenic out patients was carried out during 6 months . Depot neuroleptics ( fluphenazine decanoate or flupenthixol decanoate ) were compared with placebo to evaluate clinical and neurological effects during continued therapy and during withdrawal . The drugs were significantly more effective than placebo in preventing relapse and rehospitalization . In the placebo group 62 % relapsed compared to 27 % in the drug group . There was a weak and nonsignificant tendency to a higher relapse frequency in the flupenthixol group compared to the fluphenazine group . After withdrawal for 6 months , plasma levels for fluphenazine were detectable . Plasma levels for flupenthixol  were not detectable after 9 weeks of withdrawal . The differences in the plasma levels may possibly explain the difference in relapse rate between the two depot neuroleptics . Furthermore , it was found that the patients who relapsed during fluphenazine treatment had a significantly lower plasma level of the drug than patients who did not relapse during treatment . The results from this study provide some information on the therapeutic levels of fluphenazine and flupenthixol in schizophrenic patients OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate A double-blind , placebo-controlled trial was carried out to determine the value of maintenance therapy with phenothiazines in a population of out patients who had recently recovered from an acute episode of schizophrenia . The drug was shown to be significantly more effective than the placebo in preventing relapse . The relationship of the trial patients to the population from which they were selected was defined in terms of clinical , historical , and social data . Maintenance therapy seems of little value in patients with a good prognosis and in the severely ill , but it is of value in the indeterminate group between these two extremes Anticholinergic antiparkinson drugs administered orally at st and ard clinical ly prescribed doses impaired new memory acquisition and mood in normal volunteer subjects , based on tests of free recall , recognition memory , and time production , self-rating of memory function , and an evaluation of mood states .  Elderly subjects were more severely impaired than were young adults .  Amantadine did not impair new memory acquisition , and on self-report measures , it was significantly better tolerated than were anticholinergics . Among patients being treated for psychotic illness , there are two groups in which an effort to avoid anticholinergic therapy is especially worthwhile because of the severe consequences of memory dysfunction . These individuals are young neuroleptic-responsive patients who are in an early stage of their disease and elderly patients . For these two groups , amantadine should be considered as the initial mode of treatment , with low-dose anticholinergics being used for those patients who do not achieve adequate relief from extrapyramidal side effects with amantadine BACKGROUND The efficacy of low doses of certain neuroleptics in improving negative symptoms is still controversial . This study assessed the efficacy of amisulpride , a benzamide which increases dopaminergic transmission at low doses via presynaptic dopamine receptor blockade , on negative symptoms of schizophrenia . METHOD The study was design ed as a parallel-group , double-blind , placebo-controlled trial . Patients had to fulfil DSM-III criteria for schizophrenia , And reasen 's criteria for negative schizophrenia , and to have a total score of at least 75 on the SANS ; those treated with neuroleptics or antidepressants underwent a six-week placebo wash-out . One hundred and four in- patients were r and omly assigned to amisulpride 100 mg/d , amisulpride 300 mg/d , or placebo  for six weeks ; 85 patients completed the study . RESULTS Both amisulpride doses were significantly more effective than placebo on the primary evaluation criterion ( SANS total score , MANOVA P < 0.02 ) . No significant changes were found in positive symptoms or in extrapyramidal symptoms . CONCLUSIONS Negative symptoms can be improved by low doses of amisulpride , favouring the hypothesis of dopaminergic hypofunction as one of the causes of negative symptoms Plasma homovanillic acid ( HVA ) levels were measured hourly for a 24-hour period in 10 patients with schizophrenia during treatment with placebo and fluphenazine .  Ten age- and sex-matched normal volunteers were similarly studied . Diet and activity were carefully controlled and monitored in both patients and controls . A circadian rhythm of the plasma HVA level was found in controls with a nadir in the afternoon and peak values in the early morning hours ; when the patients were free from drugs , they showed a similar rhythm with lower amplitudes . Fluphenazine treatment significantly reduced the plasma concentrations of HVA and abolished the 24-hour rhythm . These data suggest that a 24-hour rhythm of the plasma HVA level exists in humans and that the amplitude of this rhythm may be less pronounced in patients with schizophrenia . Treatment with neuroleptic drugs reduces both the absolute levels and the normal circadian rhythm of the plasma HVA level The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . A double-blind cross-over trial comparing oral fluphenazine and fluphenazine enanthate in 43 chronic in-patient male schizophrenics showed that both were efficacious . On the total score assessment  fluphenazine was statistically superior to fluphenazine enanthate , but the overall clinical impression showed a slight superiority for fluphenazine enanthate . Fewer patients needed anti-parkinson medication during the trial period . Patients were as adequately controlled as they had been before the trial on a variety of phenothiazines . The results are discussed , and important factors , such as the certainty that the patients are receiving their medication with the long-acting injection and the saving of time for overworked nursing staff , are stressed The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas A study of anti‐Parkinsonism agents in prolonged phenothiazine therapy seeks to clarify some anecdotal misconceptions . Antiparkinsonian agents do not appear to affect the therapeutic efficiency of phenothiazines , nor does using them on a “ dem and ” basis increase the problems of control of parkinsonian side effects .  Older patients , however , appear to require the extended usage of antiparkinsonian agents rather more than some studies would suggest . Sustained release antiparkinsonian agents may yet further simplify the management of schizophrenia BACKGROUND There are cl aims that the extra costs of atypical ( second-generation ) antipsychotic drugs over conventional ( first-generation ) drugs are offset by improved health-related quality of life . AIMS To determine the relative costs and value of treatment with conventional or atypical antipsychotics in people with schizophrenia . METHOD Cost-effectiveness acceptability analysis integrated clinical and economic r and omised controlled trial data of conventional and atypical antipsychotics in routine practice . RESULTS Conventional antipsychotics had lower costs and higher quality -adjusted life-years ( QALYs ) than atypical antipsychotics and were more than 50 % likely to be cost-effective . CONCLUSIONS The primary and sensitivity analyses indicated that conventional antipsychotics may be cost-saving and associated with a gain in QALYs compared with atypical antipsychotics In a simple remitted , nonpsychotic schizophrenics , the relapse rate within one year was significantly higher for those patients taking placebo as opposed to those taking fluphenazine hydrochloride orally or fluphenazine decanoate . There were no differences in relapse rates between the two active drugs , but there were significantly more terminations due to toxicity from fluphenazine decanoate than from pluphenazine given orally , entirely due to the fact that in 35 % of patients receiving fluphenazine decanoate , severe akinesia developed Based on a double blind cross-over study , it was determined that schizophrenic patients who have more high frequency fast activity and a lesser degree of alpha and slow waves in computerized EEG before the treatment have a better therapeutic outcome to the major tranquilizer ( neuroleptic ) treatment . The correlation between pretreatment high frequency computer EEG measurements and better therapeutic outcome reached the level of statistical significance . “ Therapy resistant ” schizophrenic patients were characterized by a lesser degree of very fast beta activity , more alpha waves and slow waves , higher amplitudes in computer EEG , and a lesser degree of acute ( florid ) psychotic symptomatology but more “ negative ” symptoms such as motor retardation 
    Output:
    
The findings in this review confirm much that clinicians and recipients of care already know , but they provide quantification to support clinical impression .
Fluphenazine 's global position as an effective treatment for psychoses is not threatened by the outcome of this review .
However , fluphenazine is an imperfect treatment and if accessible , other inexpensive drugs less associated with adverse effects may be an equally effective choice for people with schizophrenia