***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: Two types of schizophrenic patients , 27 with a high and 21 with a low energetic level , were treated for 3 weeks under double blind conditions with 16 ( 24 patients ) or 80 mg ( 24 patients ) haloperidol orally per day . The patients were rated by the ward psychiatrist as markedly or not markedly improved . Evaluation made by odds ratio comparison showed that ( 1 ) patients with a high energetic level ( plus-type patients ) improved with low doses whereas ( 2 ) patients with a low energetic level ( minus-type patients ) improved with high doses of haloperidol CONTEXT Although olanzapine has been widely adopted as a treatment of choice for schizophrenia , its long-term effectiveness and costs have not been evaluated in a controlled trial in comparison with a st and ard antipsychotic drug . OBJECTIVE To evaluate the effectiveness and cost impact of olanzapine compared with haloperidol in the treatment of schizophrenia . DESIGN AND SETTING Double-blind , r and omized controlled trial with r and omization conducted between June 1998 and June 2000 at 17 US Department of Veterans Affairs medical centers . PARTICIPANTS Three hundred nine patients with a Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition diagnosis of schizophrenia or schizoaffective disorder , serious symptoms , and serious dysfunction for the previous 2 years . Fifty-nine percent fully completed and 36 % partially completed follow-up assessment s. INTERVENTIONS Patients were r and omly assigned to receive flexibly dosed olanzapine , 5 to 20 mg/d , with prophylactic benztropine , 1 to 4 mg/d ( n = 159 ) ; or haloperidol , 5 to 20 mg/d ( n = 150 ) , for 12 months . MAIN OUTCOME MEASURES St and ardized measures of symptoms , quality of life , neurocognitive status , and adverse effects of medication . Veterans Affairs administrative data and interviews concerning non-VA service use were used to estimate costs from the perspective of the VA health care system and society as a whole ( ie , consumption of all re sources on behalf of these patients ) . RESULTS There were no significant differences between groups in study retention ; positive , negative , or total symptoms of schizophrenia ; quality of life ; or extrapyramidal symptoms .  Olanzapine was associated with reduced akathisia in the intention-to-treat analysis ( P<.001 ) and with lower symptoms of tardive dyskinesia in a secondary analysis including only observations during blinded treatment with study drug . Small but significant advantages were also observed on measures of memory and motor function . Olanzapine was also associated with more frequent reports of weight gain and significantly greater VA costs , ranging from 3000 dollars to 9000 dollars annually . Differences in societal costs were somewhat smaller and were not significant . CONCLUSION Olanzapine does not demonstrate advantages compared with haloperidol ( in combination with prophylactic benztropine ) in compliance , symptoms , extrapyramidal symptoms , or overall quality of life , and its benefits in reducing akathisia and improving cognition must be balanced with the problems of weight gain and higher cost Twenty acutely psychotic male psychiatric in patients were assigned to two groups and treated with high- and low-dose haloperidol using a rapid neuroleptization technique . A six-day maintenance phase followed . Both groups improved at one hour , one day , and seven days after starting treatment , and neither group differed as to degree or rapidity of symptom alleviation . Therefore , the results of the study do not give experimental support for the administration of high doses of haloperidol to young , acutely psychotic in patients with relatively good prognoses The efficacy of oral concentrate in the rapid tranquilization of 159 acutely disturbed patients in a psychiatric emergency service was evaluated . Patients were r and omly assigned to 1 of 10 treatment groups : 7 oral groups and 3 comparison intramuscular groups . Although intramuscular medication produced a faster response , concentrate also proved to be effective for rapid tranquilization . Side effects were benign and minimal . Age , sex , race , and diagnosis had no effect on outcome . The use of concentrate as a paradigm for treating acutely psychotic patients is discussed In a 12-weeks double-blind study high dosage versus st and ard dosage haloperidol therapy was evaluated in 23 male , chronic schizophrenic in patients . The patients were relatively treatment-resistant and , in spite of traditional neuroleptic medication , were characterized by a moderate to severe degree of illness . At the end of the trial the dose of haloperidol in the st and ard dosage group was 12–36 mg/day ( mean 15 ) , in the high dosage group 10–240 mg/day ( mean 103 ) . No significant difference in therapeutic effect was found between the two groups as measured by the Brief Psychiatric Rating Scale and global assessment . About half the patients in both groups improved during the trial . A greater incidence of side effects was noticed in the high dosage group than in the st and ard group , especially in the form of sedation ( 5 of 12 patients ) , aggressive episodes ( three patients ) , muscular weakness and tendency to fall ( two patients ) , and epileptic attacks ( one patient ) . The incidence of extrapyramidal phenomena showed fewer differences between the two groups . In addition , the high dosage group showed a temporary rise in serum alkaline phosphatase and serum aspartate-aminotransferase . There was a positive correlation between the dose of haloperidol and serum haloperidol , and between the haloperidol dose of up to 80 mg/day and serum prolactin . At higher doses prolactin response leveled off . Neither serum haloperidol nor serum prolactin showed any correlation to clinical response . It is concluded ( 1 ) that very high doses of haloperidol in only a few cases show any therapeutic advantage over haloperidol in st and ard doses ; ( 2 ) that high dosage treatment has a higher incidence of side effects ; and ( 3 ) that the serum concentrations of a given neuroleptic and of prolactin are of very limited value in the monitoring of neuroleptic treatment Due to large interindividual variabilities in kinetics of haloperidol ( HPDL ) , empirically adjusting the dose to achieve steady-state plasma levels ( Css ) is a time consuming process . We report a method to individualize doses to achieve the desired Css from the observed plasma level 24 hours after a single test dose . Twenty-eight acutely psychotic patients , after up to 2 weeks of inhospital drug washout , received a 15-mg oral " test " dose of HPDL and 24- and 48-hour plasma levels were measured . They were then r and omly assigned to empirically determined doses of HPDL ( 2 , 4 , or 10 mg b.i.d . ) to achieve a low , medium , or high Css . The 24-hour plasma level after the test dose , the final Css , and the dose required to achieve that Css were analyzed by a linear regression model . The log Css in terms of the log dose revealed a strong linear relationship ( R2 = .78 , n = 28 ) , which was further improved by the addition of the 24-hour log plasma level ( R2 = .87 ) OBJECTIVE This multicenter , double-blind , placebo-controlled study evaluated the efficacy and safety of three doses of sertindole ( 12 , 20 , and 24 mg/day ) and haloperidol ( 4 , 8 , and 16 mg/day ) in the treatment of psychotic symptoms for 497 hospitalized patients with schizophrenia . METHOD The patients were r and omly assigned to one of the medication groups and received treatment for 8 weeks . Changes in Positive and Negative Syndrome Scale , Scale for the Assessment of Negative Symptoms , Brief Psychiatric Rating Scale , and Clinical Global Impression scores were used as evaluations of treatment efficacy . Three rating scales were used to assess extrapyramidal symptoms as well as the occurrence of adverse events and the use of medications related to extrapyramidal symptoms . RESULTS Both sertindole and haloperidol were comparably effective in the treatment of psychosis , and all dose levels were significantly more effective than placebo . For the treatment of negative symptoms , only sertindole , 20 mg/day , was significantly more effective than placebo . For all extrapyramidal symptom measures , sertindole was clinical ly and statistically indistinguishable from placebo , and rates of extrapyramidal symptoms were not dose related . All dose levels of haloperidol produced significantly more extrapyramidal symptoms than placebo or sertindole .  Adverse events associated with sertindole treatment were mild in severity . CONCLUSIONS Sertindole is a new antipsychotic agent effective for the treatment of both the positive and negative symptoms of schizophrenia , with motor side effects that are indistinguishable from those associated with placebo High doses of antipsychotic medications are sometimes prescribed in clinical practice , although the efficacy and safety of such treatment have not been established . The purpose of this study was to determine whether high-dose , long-term antipsychotic treatment prescribed on the basis of clinical judgment can be justified . Patients who were receiving high doses of haloperidol were screened , and those patients whose plasma levels were at least 15 ng/mL were r and omly assigned to an experimental group ( N = 11 ) or to a control group ( N = 12 ) . The experimental group underwent a dose reduction to achieve the target plasma level of 10 ng/mL. The reduction was gradual over a period of 12 weeks . The control group treatment was maintained at the original level . Both groups were then followed up for another 16 weeks , during which the plasma levels of haloperidol were kept constant . The study used double-blind procedures . Both groups showed an average slight symptom reduction . There was no significant difference in the severity of symptoms between the two groups at any time point . The dose reduction had no apparent adverse effects . Thus , the results of this study did not provide justification for high-dose , long-term antipsychotic treatment . However , these results must be interpreted with caution because the sample studied here was small and biased The objective of this study was twofold : ( 1 ) to describe the effects of risperidone on the quantitative electroencephalogram ( EEG ) in schizophrenic patients and ( 2 ) to explore the relationships between EEG changes and clinical improvement . The subjects were nine male schizophrenic patients participating in a placebo-controlled , double-blind clinical trial ( duration , 9 weeks ) aim ed to assess the effects of risperidone . The EEG effects of risperidone were compared with those of haloperidol .  Nine haloperidol patients were selected from a separate treatment study that had a similar design and selection criteria and used identical EEG methods . We found that risperidone treatment induced widespread changes in interhemispheric power asymmetry . Furthermore , overall clinical improvement was related to two EEG measures : ( 1 ) absolute power changes in the beta frequency b and and ( 2 ) power asymmetry in the theta and delta b and s. Both relationships were most expressed in the anterior areas . The first relationship could not be linked to any specific cluster of behavioral symptoms . The second relationship was linked to improvements of affective symptoms and hostility-suspiciousness . The relationships observed in the risperidone group could not be detected in the haloperidol-treated patients . We hypothesized that the first relationship is attributable to an interaction between the serotonergic and dopaminergic system ; the second relationship was associated with serotonergic mechanisms This study examined depressive symptoms in acute schizophrenic episodes and their relationship to neuroleptic treatment .  Sixty-three depressed and 62 non-depressed acutely exacerbated schizophrenic patients were evaluated with the Brief Psychiatric Rating Scale , the Scale for the Assessment of Positive Symptoms , the Simpson-Angus Extrapyramidal Scale , and the Hamilton Rating Scale for Depression . Subjects were then r and omly assigned to different haloperidol plasma levels and followed for 3 weeks . Overall , depression improved with treatment of the acute psychosis , but a positive association between extrapyramidal side effects and depressive symptoms emerged over time . Depressive symptoms tended to be positively related to haloperidol plasma levels . The results suggest that depressive symptoms in schizophrenia are heterogeneous in origin ; while neuroleptics can ameliorate depressive symptoms inherent in the acute schizophrenic episode , they can also contribute to depression 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 The apparent rationale for the popular use of high doses of 
    Output:
    
It would be underst and able , however , if clinicians were cautious in prescribing doses in excess of 7.5 mg/day of haloperidol to a person with uncomplicated acute schizophrenia , and if people with schizophrenia were equally reticent to take greater doses .