Response to Neuroleptic Drugs as a Device for Classifying Schizophrenia

Abstract

Although schizophrenic patients are routinely treated with neuroleptic medication, the diversity in response to such treatment is noteworthy; some patients are exquisitely responsive to neuroleptic treatment, while others are clearly resistant. The authors examine the hypothesis that neuroleptic-responsive and neuroleptic-resistant patients have different illnesses by considering the following issues: the reliability of the distinction between neuroleptic responsiveness and resistance; the consistency in neuroleptic responsiveness over time; the association between neuroleptic responsiveness and other clinical features; and the neuroleptics' therapeutic action. On the basis of the data available and on theoretical and historical grounds, the distinction between neuroleptic-responsive and neuroleptic-resistant patients warrants application in both clinical and research settings.

Pre-morbid asociality in neuroleptic-resistant and neuroleptic-responsive schizophrenia

“…This study provides additional evidence for the hypothesis that neuroleptic-responsivity may be a valid means of subtyping schizophrenia, as previously suggested by Brown & Herz (1989), and supported by the differential effect of typical neuroleptics of clozapine on neuroleptic-resistant schizophrenia (Kane et al 1988).…”

The depolarization block hypothesis of neuroleptic action: implications for the etiology and treatment of schizophrenia

“…Although the relevance of extracellular DA to the positive symptoms of schizophrenia is unclear, this observation may provide insight into why clozapine may be particularly effective in alleviating the negative symptoms of schizophrenia (Kane et aI., 1988;Meltzer, 1989). Prominent negative symptoms are often associated with: (1) a higher probability of damage to the cortex, amygdala, or hippocampus (Alpert et aI., 1978;Meltzer, 1984;Van Kammen et aI., 1986;, (2) lower initial levels of HVA (Lindstrom, 1985;Van Kammen et aI., 1983), (3) attenuated HVA response to acute neuroleptic administration (Bowers et aI., 1984(Bowers et aI., , 1989Van Kammen et aI., 1986), and (4) diminished thera-peutic response to treatment with classical antipsychotic drugs (Brown and Herz, 1989). However, one type of treatment that appears to be effective in controlling negative symptoms is the administration of DA agonists, such as apomorphine (Tamminga et al, 1978), L-DOPA (Gerlach andLuhdorf, 1975;Meltzer et al, 1986), or amphetamine (An grist et al, 1980).…”

More harm than good: The case against using antipsychotic drugs to prevent severe mental illness

“…If the results of these studies are successful in crude terms -if the participants who are treated experience fewer psychotic episodes at follow-up than those who do not -the pressure to use this kind of treatment in clinical services may prove almost irresistible. Despite evidence that some psychiatric patients fail to respond to antipsychotic medication (Brown & Herz, 1989;Kinon et al, 1993), and that some do better with psychosocial support on its own (Warner, 1985), drug treatment is already considered the first line intervention for patients who have already developed a psychotic disorder, and it is rare to find patients who have been offered an alternative. The use of these drugs in the prevention of psychosis will increase the market for antipsychotics dramatically, and is sure to be encouraged by the pharmaceutical industry.…”