Suspension therapy in acute schizophrenia. Clinical and neuroendocrine/biochemical effects of abrupt discontinuation of neuroleptic medication.

Abstract

22 acutely schizophrenic patients with partial remission under standard haloperidol therapy (reduction in BPRS total score by 50% or less) were included in this prospective study. There was a significant correlation between the BPRS total score or the BPRS factors Anxiety/depression and Anergia and extrapyramidal side effects at the end of the 3-week neuroleptic treatment phase. In these patients abrupt discontinuation of neuroleptic medication (suspension therapy) brings about a significant further reduction in BPRS total scores together with a favorable effect on the BPRS factors Anxiety/depression, Anergia and Thought disturbance. There was a trend towards low serum prolactin values before neuroleptic discontinuation being linked with a favorable effect of subsequent suspension therapy. Urinary dopamine and homovanillic acid excretion before neuroleptic discontinuation did not predict the clinical suspension effect. Thus peripheral neuroendocrine and biochemical effects of haloperidol-induced dopamine blockade and their changes after discontinuation of neuroleptic medication seem not to be linked with the clinical effect of suspension therapy in acute schizophrenia. There was, however, a significant relationship between low urinary epinephrine, norepinephrine, vanillylmandelic acid and cortisol excretion before suspension therapy and a favorable suspension effect. On the other hand, the more pronounced a nonspecific stress constellation (catecholamines, cortisol) was in patients with an unsatisfactory remission under neuroleptics, the less favorable was the clinical effect of suspension therapy. Until now, the treatment courses of suspension therapy have been evaluated in 43 schizophrenic patients. According to both clinical aspects and observer rating, three types of therapeutic suspension effects have been distinguished in one-third of the cases respectively; none (at best temporary remission, no improvement in the overall treatment situation); partial (substantial remission, neuroleptic medication resumed for therapeutic reasons), and favorable (almost complete remission, neuroleptic medication resumed for prophylactic reasons).