Paranoid Type Research Articles

Risperidone-induced sialorrhea responsive to biperiden treatment

Materials and methods The patient was an 18 year old female suffering from schizophrenia, paranoid type. She had no history of any medical condition. The onset of her psychiatric condition was at the age of 17. Due to low adherence, she had never taken any medications and had no previous hospitalizations. During her hospitalization, she was started on 1mg/ d lorazepam and 2mg/d risperidone (with a gradual increase up to 6mg/d on day 3, due to lack of response and progressive thought disorganization). On day 4 the patient exhibited hypersalivation and a concomitant mild speech disturbance. No signs of EPS where present except for mildly impaired postural reflexes that could be considered as a sign of imminent EPS. Subsequently, risperidone was tapered to 3mg/d along with oral biperiden 2mg/d resulting to full remission of hypersalivation by day 5.

Coping mechanisms evaluation in chronic schizophrenic patients

Background:Perceptual and thought distorsions that are observed in the acute episodes of schizophrenia make the adaptation to reality very difficult, but there are residual symptoms that interfere with coping in the interepisodic phases, also. There are specific coping strategies found by such patients in order to face the difficult challenges of hallucinations, delusions, attentional and memory deficits, but also the social stigma and negative symptoms, like isolation.Methods:We assessed 51 patients, 40 male and 11 female, mean age 39.8, diagnosed with chronic schizophrenia- paranoid (n=22), residual (n=14), catatonic (n=10) and disorganised (n=5) type, according to DSM -IV- TR criteria, in order to establish a correlation between main categories of coping mechanisms and the specific type of schizophrenia. Inclusion criteria: patients included in a cognitive- behavioural therapy and antipsychotic maintenance treatment for at least 4 weeks. Exclusion criteria: axis II comorbidity or severe somatic pathology that could modify patients coping strategies.Results:Patients with paranoid schizophrenia associated maladaptive coping strategies like alcoholism (36.3%) and aggression (27.2%), those with residual type presented more social withdrawal (71.4%) and self- harming (35.7%), while catatonic and disorganised schizophrenia cases had a high incidence of thought blocking (60% and 40%, respectively) and social isolation (60% in both groups).Conclusion:There are more frequent types of coping mechanisms in each form of schizophrenia. This is an important fact for focusing the psychotherapy approach on conversion to adaptative coping strategies, using techniques like verbal challenge and reality testing, reatributtion- enhancing methods, activities daily programming.

Psychosis in Parkinson's Disease: Phenomenology, Frequency, Risk Factors, and Current Understanding of Pathophysiologic Mechanisms

Psychosis in Parkinson's disease refers to a combination of hallucinations and delusions occurring with a clear sensorium and a chronic course. Hallucinations may involve several sensory modalities. Complex visual hallucinations are the most common type. "Minor" hallucinatory phenomena are frequently present and include visual illusions, passage hallucinations, and sense of presence. Insight may be lost in patients with cognitive impairment. Delusions of a paranoid type are more rare than hallucinations. Both hallucinations and delusions are more frequent in Parkinson's disease patients with dementia. Pathogenesis involves complex and probably multifactorial mechanisms, including pharmacologic (dopaminergic treatment and others) and disease-related factors.

Rhabdomyolysis associated with correction of hyponatremia and clozapine use in a patient with schizophrenia paranoid type

Rhabdomyolysis associated with correction of hyponatremia and clozapine use in a patient with schizophrenia paranoid type

Social cognition in “pure” delusional disorder

Introduction. Delusional disorders are characterised by monothematic, “encapsulated” and incorrigible false beliefs and misinterpretations of social signals. Due to the rarity of cases with “pure” delusional disorder (DD) in clinical settings most studies of social cognition in delusional patients have focused on patients with paranoid schizophrenia. In the present study we sought to examine emotion recognition, theory of mind abilities, and pragmatic language comprehension in patients with delusional disorder. Methods. Social cognition was assessed in 21 patients recruited over a 3‐year period who were diagnosed with delusional disorder, paranoid, erotomanic, or jealous type. In addition to an emotion recognition and theory of mind test battery, we included a novel German Proverb Test, which has been found indicative of subtle theory of mind deficits in schizophrenic patients. Executive functioning was assessed using the Wisconsin Card Sorting Test (WCST). Psychopathology was measured using the Positive and Negative Symptoms Scale (PANSS). Patients' task performance was compared to a group of 22 healthy control persons paralleled for verbal intelligence, education, and age. Results. Patients with DD made significantly more perseverative errors in the WCST, they performed more poorly on the theory of mind tasks and the proverb test, but were unimpaired in basic emotion recognition abilities relative to controls. When executive functioning was co‐varied out, the group differences in theory of mind disappeared, whereas the greater propensity of patients with DD to interpret proverbs literally remained significant. Conclusions. In “pure” DD the basic social cognitive abilities appear to be preserved. Difficulties in metaphorical speech comprehension and executive functioning could, however, indicate more subtle social cognitive deficits in these patients.

Successful Switch to Olanzapine after Rhabdomyolysis Caused by Water Intoxication and Clozapine Use

We report on a case of rhabdomyolysis induced by the correction of hyponatremia after psychogenic polydipsia and clozapine use, where the switch to a high dose of olanzapine resulted in the non-recurrence of rhabdomyolysis. The 46-year-old patient with the diagnosis of schizophrenia paranoid type, who had been on clozapine treatment for the previous 4 years, was admitted with the symptoms of generalized seizure and vomiting, and as severe hyponatremia was proved, its correction with the parallel use of clozapine treatment was done. CK concentrations increased to 48 120 U/L without any symptom of neuroleptic malignant syndrome. To prevent acute renal insufficiency, high-volume alkaline diuresis was initiated and clozapine was tapered and stopped. On the day 12 of treatment, olanzapine was started and was elevated to 30 mg/day. CK concentration began to fall returning to the normal concentration on day 20. Six months after the switch to olanzapine no recurrence of rhabdomyolysis was detected; clinical and laboratory findings were normal. We suggest that after a benzodiazepine-type antipychotic-induced rhabdomyolysis, a switch to another atypical antipsychotic can be a cautious clinical strategy.

Neuropsychological profile of a patient with Fregoli syndrome

Case Report The Fregoli syndrome consists in the delusional conviction that an individual (usually a persecutor, but not always) assumes the guise of persons that the patient meets; it falls into the general category of delusional misidentification syndromes. These syndromes have been repeatedly associated with structural or functional cerebral abnormalities, and an association with impaired facial recognition has been observed in some cases. In the present study we present the neuropsychological profile of a female patient with schizophrenia, paranoid type, who manifested Fregoli syndrome.

Cerebral information processing in personality disorders: I. Intensity dependence of auditory evoked potentials

Patients with personality disorders such as the histrionic type exaggerate their responses when receiving external social or environmental stimuli. We speculated that they might also show an augmenting pattern of the auditory evoked potential N1–P2 component in response to stimuli with increasing levels of intensity, a response pattern that is thought to be inversely correlated with cerebral serotonin (5-HT) activity. To test this hypothesis, we collected auditory evoked potentials in 191 patients with personality disorders (19 patients with the paranoid type, 12 schizoid, 14 schizotypal, 18 antisocial, 15 borderline, 13 histrionic, 17 narcissistic, 25 avoidant, 30 dependent and 28 obsessive-compulsive) and 26 healthy volunteers. Their personality traits were measured using the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). Compared with healthy subjects and other patient groups, the histrionic group scored higher on the basic traits Affective Instability, Stimulus Seeking, Rejection and Narcissism, and on the higher traits Emotional Dysregulation and Dissocial, than the other groups, and the schizoid group scored lower on most of the DAPP-BQ basic and higher traits. In addition, the histrionic group showed steeper amplitude/stimulus intensity function (ASF) slopes at three midline scalp electrodes than the healthy controls or the other patient groups. The ASF slopes were not correlated with any DAPP-BQ traits in the total sample of 217 subjects. However, the DAPP-BQ basic trait Rejection was positively correlated with the ASF slopes at all three electrode sites in the histrionic group. The increased intensity dependence of the auditory N1–P2 component might indicate that cerebral 5-HT neuronal activity is, on average, weak in the histrionic patients.

An investigation of the dihydropyrimidinase-like 2 (DPYSL2) gene in schizophrenia: genetic association study and expression analysis

Several linkage studies support a susceptibility locus for schizophrenia on chromosome 8p21-22. In this study, we investigated a gene mapping to 8p21, dihydropyrimidinase-like 2 (DPYSL2). DPYSL2 plays an important role in axonal formation and dysfunction of DPYSL2 may result in neurodevelopmental abnormalities. In previous studies, the expression of the gene has been shown to display alteration in the brain of schizophrenia patients compared with those of healthy controls. Recently, Nakata and colleagues found polymorphisms in the 3'-end of DPYSL2 to be associated with schizophrenia, especially the paranoid type, in a Japanese population. In this study, we genotyped four SNPs in DPYSL2 in 2552 Chinese Han specimens. Case-control and TDT analyses were performed to detect association of DPYSL2 with schizophrenia. However, no allele, genotype or haplotype association was found. We investigated the expression of DPYSL2 in 29 schizophrenia patients and 54 healthy controls using quantitative real-time PCR and no difference was found between the two groups. In a comparative allele-specific expression test, we used two SNPs as markers. Only a small proportion of heterozygotes revealed a significant difference (>20%) in allele representation. The results indicated the mRNA level did not contribute mainly in the altered expression of the gene in schizophrenia patients. Although our results provided no evidence for DPYSL2 itself as a susceptibility gene for schizophrenia, recent findings have indicated that DPYSL2 may interact with other candidate genes for schizophrenia and be worthy of further studies.

Psychological Effects of (S)-Ketamine and N,N-Dimethyltryptamine (DMT): A Double-Blind, Cross-Over Study in Healthy Volunteers

Pharmacological challenges with hallucinogens are used as models for psychosis in experimental research. The state induced by glutamate antagonists such as phencyclidine (PCP) is often considered as a more appropriate model of psychosis than the state induced by serotonergic hallucinogens such as lysergic acid diethylamide (LSD), psilocybin and N,N-dimethyltryptamine (DMT). However, so far, the psychological profiles of the two types of hallucinogenic drugs have never been studied directly in an experimental within-subject design. Fifteen healthy volunteers were included in a double-blind, cross-over study with two doses of the serotonin 5-HT2A agonist DMT and the glutamate N-methyl-D-aspartate (NMDA) antagonist (S)-ketamine. Data are reported for nine subjects who completed both experimental days with both doses of the two drugs. The intensity of global psychological effects was similar for DMT and (S)-ketamine. However, phenomena resembling positive symptoms of schizophrenia, particularly positive formal thought disorder and inappropriate affect, were stronger after DMT. Phenomena resembling negative symptoms of schizophrenia, attention deficits, body perception disturbances and catatonia-like motor phenomena were stronger after (S)-ketamine. The present study suggests that the NMDA antagonist model of psychosis is not overall superior to the serotonin 5-HT2A agonist model. Rather, the two classes of drugs tend to model different aspects or types of schizophrenia. The NMDA antagonist state may be an appropriate model for psychoses with prominent negative and possibly also catatonic features, while the 5-HT2A agonist state may be a better model for psychoses of the paranoid type.

Annonce du diagnostic de schizophrénie au sein d’un service de psychiatrie de secteur

Resume L’annonce du diagnostic de schizophrenie aux patients atteints de cette maladie est en France un sujet d’actualite. L’evolution des pratiques cliniques, une meilleure efficacite des moyens therapeutiques et un droit a l’information plus exigeant des patients en sont les principaux facteurs. En effet, si cette annonce est de pratique courante dans les pays anglo-saxons, et notamment aux Etats-Unis ou la legislation influence de facon predominante l’information faite au malade, les medecins francais se montrent reticents sur l’interet d’une telle annonce. La schizophrenie demeure une pathologie heterogene marquee par un polymorphisme clinique. Le pronostic reste neanmoins classiquement reserve, avec une evolution le plus souvent synonyme de chronicite. Le caractere potentiellement deficitaire de l’evolution classe cette affection parmi les troubles psychiatriques les plus invalidants. La revue de la litterature a ce sujet est pauvre concernant les etudes methodologiques et peu de donnees ont jusqu’ici ete publiees en France sur le niveau d’information des patients schizophrenes et leurs besoins en ce domaine, a l’exception de l’enquete de Bayle et al. La litterature est essentiellement constituee de reflexions sur les aspects medico-legaux et legislatifs ainsi que d’enquetes aupres de confreres medecins sur l’annonce diagnostique. En se basant sur ces donnees et notre experience clinique, nous avons institue dans notre service un protocole d’information au sujet de la schizophrenie. Cette procedure se deroule en 3 phases sur une periode d’un mois, en accord avec le desir du patient d’etre informe sur sa maladie. Les aspects cliniques, etiologiques et therapeutiques de la maladie sont abordes au cours de cette procedure. L’amelioration clinique constatee notamment aux scores des echelles d’evaluation (BPRS et CGI et les scores aux echelles EVA infirmiers) ne peut bien entendu etre imputee a la procedure d’information du diagnostic, les patients ayant beneficie d’un traitement antipsychotique pendant leur hospitalisation. L’observance aux traitements sur la duree de 2 ans est egalement assez satisfaisante. Cette procedure, elaboree sous forme d’entretiens semi-structures regroupes en un cahier « d’annonce diagnostique » mis a la disposition des medecins et de l’equipe, a probablement aide les soignants a donner l’information dans un cadre preetabli. De plus, il a ete propose aux patients ayant beneficie de l’annonce diagnostique de participer a 2 groupes de psychoeducation sur la maladie et les medicaments. Les familles des patients ayant connaissance du diagnostic, pouvaient participer a un groupe specifique dont le but est la connaissance de la maladie et d’ameliorer les communications entre la famille et le malade. Bien que ces premieres observations constatees au cours de cette procedure d’annonce soient encourageantes, elles necessitent d’etre confirmees par l’elargissement du nombre de patients concernes et au long cours. La plupart des auteurs soulignent l’interet d’une annonce diagnostique au cours des 2 premieres annees de la maladie, afin d’ameliorer le pronostic et en raison de meilleures capacites d’insight. Aussi a-t-il ete mis en place dans notre service un suivi sur 2 ans des patients ayant beneficie de cette annonce pour evaluer a long terme le benefice ou non de l’annonce diagnostique sur la compliance et la qualite de vie de ces patients. Cette demarche presente plusieurs interets : elle repond a une ethique de l’information, elle permet une comprehension de la maladie. L’annonce diagnostique s’inscrit sur le mode du partenariat, dans un processus dynamique et psychoeducatif ou le patient et son entourage sont des partenaires eclaires.

La récidive dans l'homicide pathologique. Étude descriptive et analytique de douze observations

This descriptive and analytic study concerns 12 men who committed homicide recidivism and were under compulsion admitted to the maximum-security hospital for insane in Cadillac, near Bordeaux, between 1 st January 1990 and 1 st January 2005. These patients murdered 17 victims at their first crimes and 18 during the following homicides. There are 6 cases of schizophrenia (50%) usually of paranoid type, 2 cases of persistent delusional disorder (17%), 2 cases of moderate mental retardation (17%), respectively one case of schizo-affective disorder and of pervasive developmental disorder (8%). Mean age for the first crime is 28,2 years (SD 9,8; range 14–42) and 37,8 years for the second (SD 12; range 23–64). Mean interval between criminal events (2 to 5 homicides by patient) is 8,9 years (SD 8,6; range 0–28). Most of the 35 victims are not family relatives (83%) but the murderer knew them before (74%). One third of homicide recidivism occurs against another patient during hospitalisation (4 cases) or against another prisoner in jail (2 cases). The act of homicide often seems to be impulsive and very violent. The weapon used is frequently the one that just comes to hand at the time. Criminal background and acts of violence linked to murders, especially assault and battery (75%) and attempted murder (50%), are frequent in lifetime. Three patients have committed at least one attempted murder before the first homicide. Clinician and expert knowledge of previous psychiatric, legal and violent criminal history of these patients is essential in prevention of recidivism.

Tardive Nocturnal Akathisia Due to Clozapine Treatment

In the following case report we present a 43-year-old male patient diagnosed with schizophrenia, paranoid type, who exhibited nocturnal tardive akathisia or pseydoakathisia approximately one year after being treated with clozapine 300 mg per day. Because of the low occurrence of akathisia due to clozapine, the episodes of restlessness were at first considered as a sign of worsening of the patient's psychopathology. Since the patient was resistant to other antipsychotic agents, clozapine was reinitiated. A week later, the patient once again exhibited episodes of restlessness. This time, the episodes were diagnosed as akathisia and the patient was treated with biperidene and lorazepam, while he had already been on propanolol for cardiovascular reasons. The episodes continued without any change in frequency or severity. Therefore, treatment with clozapine was discontinued and the patient was started on a new regimen with ziprasidone. Three days later, the episodes that caused distress to the patient resolved. Thus, it is possible that apart from episodes of acute akathisia, episodes of tardive akathisia or pseydoakathisia can also occur in patients treated with atypical antipsychotics.

The association of the HLA in patients with schizophrenia, schizoaffective disorder, and in their biological relatives

To determine the association of the HLA in 50 patients with schizophrenia, schizoaffective disorder, 48 healthy controls, 41 biological relatives without psychiatric disease, and 48 biological relatives with mood disorder, the HLA genotype at the class I and class II were determined. The subjects were interviewed by structured diagnostic criteria categorized according to DSM-IV, axis I, (SCID-IV). Significant positive association was found with HLA-B*15 in patients, family with humor disorder and without mental disorder ( p = 0.003) and negative association of the HLA-B*35 in relatives without psychiatric disease ( p = 0.03). The HLA-B*15 frequency was significantly increased in a subgroup of patients with age at onset in the early 20s, lower educational achievement, occupational disability, chronically ill, more paranoid type. These findings suggest the existence of some involvement of an immunogenetic mechanism in a subgroup of schizophrenic, schizoaffective patients, and biological relatives.

Aripiprazole Reduces Alcohol Use

Dear Editor: Few pharmacotherapy options exist for the treatment of alcohol dependence. Recent reports suggest that newer atypical antipsychotic medications may reduce alcohol craving and use when prescribed to patients with alcohol abuse or dependence (1). Aripiprazole, a new atypical antipsychotic, has partial dopamine agonist and antagonist effects (2). Since dopamine stimulation in the nucleus accumbens has been suggested to cause addictive behaviour, aripiprazole's partial dopamine agonist effects in this area of the brain may reduce this behaviour (3). We present a case wherein aripiprazole reduced alcohol craving and use. Case Report Mr S is white, aged 39 years, and diagnosed with schizophrenia, paranoid type, according to DSM-IV criteria. He received outpatient psychiatric treatment with psychotherapy and pharmacotherapy (olanzapinc 20 mg daily). He continued to experience delusions of reference and periodic auditory hallucinations. His Brief Psychiatric Rating Scale (BPRS) score was 31. Mr S also met the DSM-IV diagnostic criteria for alcohol dependence, which started at age 18 years with an occasional beer and progressed to his drinking a 12-pack daily. He denied any medical problems, but admitted to problems with employment and relationships caused by his alcohol use. Despite several attempts to quit, including treatment in 2 substance use treatment programs, he relapsed repeatedly. His current use amounted to 6 cans of beer daily. He refused to attend any addiction program, including Alcoholics Anonymous. He also suffered from glaucoma. During treatment, he discovered through the Internet that olanzapine might exacerbate glaucoma, which led him to stop olanzapine on his own. At his next meeting, his psychiatrist discussed several options, including the newer atypical antipsychotic, aripiprazole. Mr S finally agreed to try this medication, which has limited anticholinergic effects and therefore might not worsen glaucoma. Aripiprazole was started at 10 mg initially and increased to 20 mg daily over 2 months. During follow-up, Mr S reported reduced psychotic symptoms (his BPRS score decreased to 23). He stopped daily drinking and reported decreased alcohol craving (his Pennsylvania Craving Scale score decreased from 27 to 5; his Self-Report Likert Craving Scale score decreased from 7 to 3; and his Addiction Severity Index score for alcohol decreased from 6 to 2). His only reported side effect was increased anxiety, which resolved within a week. Discussion Approximately 50% of patients with schizophrenia abuse alcohol and (or) drugs. …

New Onset of Diabetes Mellitus With Ziprasidone

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Sir: To the best of our knowledge, only 1 case has been reported in the literature of diabetes and pancreatitis associated with the use of ziprasidone.1 This report describes a case of diabetes mellitus in a patient treated with ziprasidone. Case report. Mr. A, a 36-year-old Spanish man, had a DSM-IV diagnosis of schizophrenia paranoid type, first diagnosed in 1986.†‹

Recognition of facial expression and visual P300 in schizophrenic patients: Differences between paranoid type patients and non‐paranoid patients

This study compared the effects of facial affective stimuli on visual event-related potentials (ERP) in schizophrenic patients and healthy subjects using photographs of babies depicting sadness (crying face), neutrality (neutral face), and pleasure (smiling face). Visual ERP were recorded using an oddball paradigm in 32 schizophrenic patients (16 paranoid type and 16 non-paranoid patients) and 32 age-matched healthy subjects. The P300 amplitude, latency, and the subject's reaction time were recorded. The P300 amplitude when viewing a photograph of a smiling baby was the smallest registered of three photographs for healthy subjects and paranoid type patients with successively greater amplitudes for neutrality and sadness. However, the P300 amplitude was the smallest while viewing crying photographs and was the largest while viewing a smiling photograph for non-paranoid patients. These results suggest that the P300 amplitude is influenced by viewing emotionally moving facial expressions and that the effect is different for different subtypes of schizophrenia. These differences may reflect differences in information processing resulted from emotional influences caused by visual-affective stimuli.

Characteristics of schizophrenic patients with a history of suicide attempt

OBJECTIVEThe aim of this study was to evaluate the suicide attempt history among schizophrenic patients and compare their sociodemographic and clinical characteristics with schizophrenic patients without a history of suicide attempt.METHODSixty schizophrenic patients according to DSM-IV criteria were included in the study. Half of the patients were in acute phase and receiving inpatient treatment, while the other half were in stable phase and outpatients. The sample was subdivided into two subsamples according to the presence/absence of lifetime suicidal attempts.RESULTSHistory of suicide attempt was found in 27 (45%) of the patients. The rate of having suicidal ideation, depression, paranoid type schizophrenia and first-degree relatives with psychiatric disorder was high among the group with suicide attempt history. Depression and insight scores were high and PANSS Negative symptoms subscale score was low among the patients with suicide attempt history. There were no significant differences between the two groups according to the scores of PANSS Positive symptoms and General Psychopathology subscales.CONCLUSIONThe high rate of suicide attempt history in our sample suggests that risk of suicide has to be determined and protective measures have to be taken while planning inpatient and outpatient treatment of these patients. Suicide attempt history is a risk factor for suicide ideation and is also related to depressive symptoms and high insight score and low negative symptoms score.

Degré d'organisation du crime de parricide pathologique : mode opératoire, profil criminologique. À propos de 42 observations

This descriptive study concerns 42 men who committed parricide and were admitted under compulsion to the maximum-security hospital for dangerous insane patients in Cadillac, near Bordeaux, between 1963 and 2003. Mean age was 29.9 years. Most were single, living with their parents and had no profession. There were 35 cases of schizophrenia (83.3%) usually of paranoid type, six cases of persistent delusional disorder (14.3%) and one case of substance-induced psychotic disorder (2.4%). The disorder had lasted in general from 1 to 5 years (40.5%) or in some for more than 10 years (33.3%). Auditory hallucinations were frequent and the delusions were mostly of the persecution or influence type. The act of homicide often seemed to be an emotional reaction of defence, with no apparent motive, impulsive, very violent and committed within the family household. The weapon used was frequently the one that just came to hand at the time. The modus operandi of the crime was as follows: totally disorganized in 30 cases (71.4%), mixed in nine (21.4%) and moderately organized in three (7.1%). There was no real difference between schizophrenics and paranoiacs regarding degree of organization of the crime. Typological analysis of the acting out revealed that most of the crimes were of the behavioural type: aggressive, affective, expressive. The 49 victims were in decreasing order the mother (49.0%), the father (40.8%) and the grandparents (10.2%). Mean age of the victims was 61.8 years. While homicide is usually described as occurring in a paroxystic state of delusion and sudden emotion, many psychotic express a former feeling of relational blockage, being stifled, frustration, failure and persecutory homicidal hate towards the future victim. The forensic consequences are then envisaged with frequent application of the former article 64 or the present article 122-1 of the French Criminal Code.

Serum prolactin levels in unmedicated first-episode and recurrent schizophrenia patients: a possible marker for the disease's subtypes

Various studies indicate that we must consider schizophrenia not as a single disease but as several distinct etiological processes that give rise to characteristic symptoms. In the current study, we aimed to examine prolactin serum levels in unmedicated first-episode and recurrent schizophrenic patients. The prolactin levels were compared among the different schizophrenia subtypes, i.e. paranoid, schizoaffective and disorganized. Prolactin serum samples were assessed on the morning after the admission in 48 first-episode and 38 recurrent unmedicated hospitalized schizophrenia patients. Two psychiatrists made the diagnosis without knowledge of laboratory results and completed the rating scales. Despite all prolactin levels being within or close to the normal range, we found significant differences in prolactin serum levels among schizophrenia subtype patients: the lowest values were for the paranoid type, intermediate for the schizoaffective and the highest for the disorganized patients. The results seem to indicate a pronounced hyperdopaminergic activity in paranoid schizophrenia, suggesting differences in dopaminergic tone between the schizophrenia subtypes, and support the clinical and the neuropsychological individuality of disease subtypes. There were no significant differences in prolactin serum levels of the schizophrenia subtypes between the first-episode and the recurrent patients. It appears that there are constant patterns of dopamine bioactivity in acutely psychotic unmedicated schizophrenia patients, whether the patients are first admitted or recurrent.