CHRONIC SCHIZOPHRENIA—A PSYCHOPHARMACOLOGICAL APROACH1

Our work suggests that the Leonhard classification system holds much pron.ise as a framework for future neurological development. One might speculate along biochemical lines that the nonsystematic subpopulation of schizophrenics may suffer from altered dopamine β-hydroxylase activity which results in an excess of dopamine, This would eeplain why this class responds so well to dopamine receptor blocking agent when other patient do not. One might also speculate tint we are dealing with a number of diseases-each with different courses and progressing to different end states, but all with common pattern during the acute stage, e.g., increased dopamine levels or receptor sensitivity levels. This is probably why the acute stage can usually be controlled by the administration of a dopamine receptor blocking agent. A further speculation concerns the catatonic patient- who had begun to respond to psychosocial and milieu treatment prior to the introduction of neuroleptics. This particular group of patients do not seem to benefit from prophylactic treatment with neuroleptics. If, by activating a patient, catecholamines are released, it is hypothesized that the Catatonics are a completely separate subpopulation-not just clinically-but also biochemically. Completely different types of drugs may be helpful for the different schizophrenic subpopulations. Among the various substances, propranolol should be considered. Obviously, this drug will not be effective in all schizophrenics; but there arc certain types of patients who respond to β-blockers. There is also increasing evidence that clordine (which stimulates alpha-adrenergic receptors) may also have an effect on certain schizophrenics The most recent findings is that cholecystokinin-thought for Some time to be an exclusively peripheral substance-appears to be present in the brain and available in the form of ceulotide, a neuropeptide which is a dopamine agonist. This susbtance, also, seems to be effective in the treatment of certain schizophrenics. Chronic schizophrenia requires re-evaluation and it should be recognized that different drugs are effective in different types of patients. There is renewed interest in the various schizophrenic conditions and their end states. We must hope that the pharmacologists, provided with sufficient information, will search for new drugs with differentiated activities that will meaningfully influence the end states of schizophrenic disorders and/or prevent their development.