[The syndromes of oculogyric crisis and paroxysmal perceptual alteration in chronic schizophrenic patients--a clinical inquiry into their pathophysiology].

The syndromes of oculogyric crisis (OGC) and paroxysmal perceptual alteration (PPA) in chronic schizophrenics have been investigated. The perceptual symptoms of PPA are characterized by hypersensitivity of perception, psychedelic experience (brightening of colors, sharpening of contrast, visual distortion, etc.) and a disorder of somatic schema (one feels that one is floating, one's extremities are pulled and elongated, etc.). PPA in chronic schizophrenics occurs abruptly mainly in the evening, often precipitated by fatigue. During the attack patients also suffer from mood and thought alteration (anxiety, agitation, depressive mood and inability to distract their thought from one thing), but they are aware that symptoms of PPA are not real and apprehensive about them. The attack ceases gradually and spontaneously while the patient rests or sleeps. The syndrome of OGC occurs in a similar fashion as in PPA; the attack occurs mainly in the evening and is also associated with a variety of transient mood and thought disturbances similar to those in PPA. Four cases have been described in this study, who experienced both PPA and OGC simultaneously. Among 223 schizophrenic patients admitted to our hospital between April 1987 and September 1988, 18 cases with OGC, 5 cases with PPA, and 4 cases with both PPA and OGC were found. The mean +/- SD dose of neuroleptics (chlorpromazine equivalent) at the latest occurrence of these syndromes was 761 +/- 470 mg (N = 22, ranging from 195 to 2010 mg) for OGC and 773 +/- 587 mg (N = 9, ranging from 227 to 2010 mg) for PPA. The appearance of OGC in cases with 195 mg or more dose (chlorpromazine equivalent) of neuroleptics of OGC in cases with with 195 mg or more dose (chlorpromazine equivalent) of neuroleptics (NLP) is significantly higher (p less than 0.05) than that in cases with less than 195 mg of NLP. Similarly, the appearance of PPA in cases with 277 mg or more dose of NLP was higher (p less than 0.1) than that in cases with less than 277 mg of NLP. In paranoid schizophrenic patients the incidences of OGC and PPA were significantly lower (p less than 0.001 and p less than 0.05, respectively) than those in other types of schizophrenics. In disorganized schizophrenic patients the incidence of PPA was significantly lower (p less than 0.01) than those in undifferentiated, residual and schizoaffective types.(ABSTRACT TRUNCATED AT 400 WORDS)