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Novel treatment strategies in schizophrenia
337
Schizophrenic and Neuroleptic Drugs Tuesday, 20 October 1992
Novel treatment strategies in schizophrenia
Rogue, Patrick and Rogue, Ariane C.It.S., BP 304, 67728 Hoerdt, France
A growing body of evidence conf'Lrms the implication of serotonin (5-HT) in the pathophysiology of schizophrenia, and clinical trials with 5-HT 2 antagonists have demonstrated their therapeutic potential especially in the management of negative symptoms (Axelsson et al., 1989). The role of dopamine is also essential, with seemingly an overactivity associated with positive symptoms and hypofunctioning in defect states (Davis et al. 1991). The frequent association between these two types of syndromes suggests that the combination of D 2 and 5-HT 2 receptor antagonists as a logical therapeutic strategy. We studied this possibility with the non-specific 5-HT 2 antagonist mianserin using an open add-on design. Chronic schizophrenic inpatients (DSM-HI-R) were equilibrated on a similar neuroleptic regimen. 30 to 90 mg mianserin was then given during 8 weeks (fixed 30 mg dose the fast week, 30 to 90 mg flexible dose the following weeks). The BPRS, SANS and SAPS were monitored weekly. The BQLS (Brief Quality of Life rating Scale (Rogue, 1991)) was also monitored in some cases. Analysis of the data for the patients who completed the trial (n - 14 to date) shows a significant decrease in the negative (p < 0.01) and global symptom ratings (p < 0.05). This was not due to an antidepressant type effect (no change in the BPRS-Overall depression subscale). Quality of life also significantly improved (p < 0.05). These preliminary results show the efficacy of mianserin in severe schizophrenia, and confirm the interest of combining 5HT 2 with D 2 antagonists in these patients. Data from an amplified sample will be discussed with respect to the role of serotonin and dopamine in schizophrenia. References
Axelsson, R., Nilsson, A., Christensson, E. and Bj6rk, A. (1991). Effect of amperozide in schizophrenia. Psychophannacol 104, 287-292. Davis, K.L., Kahn, R.S., Ko, G. and Davidson, M. (1991). Dopamine and schizophrenia revisited: A review and reeonceptualization. Am. J. Psychiatry 148, 1474-1486. Rogue, P. (1991). The Brief Quality of Life rating Scale. Inst. on H&CP Abstr. 43, 215.
Is the initial improvement a valid criterion for drug choice in acute schizophrenia?
Klimke, A., Klieser, E., Lehmann, E. and Miele, L. Psychiatric Hospital of the Heinrich-Heine-University Dasseldorf (Head: Prof. Dr. K. Heinrich), Germany Several investigators found that the initial improvement of acute schizophrenia after some days of neuroleptic treatment is
Schizophrenic and Neuroleptic Drugs Tuesday, 20 October 1992
Novel treatment strategies in schizophrenia
Rogue, Patrick and Rogue, Ariane C.It.S., BP 304, 67728 Hoerdt, France
A growing body of evidence conf'Lrms the implication of serotonin (5-HT) in the pathophysiology of schizophrenia, and clinical trials with 5-HT 2 antagonists have demonstrated their therapeutic potential especially in the management of negative symptoms (Axelsson et al., 1989). The role of dopamine is also essential, with seemingly an overactivity associated with positive symptoms and hypofunctioning in defect states (Davis et al. 1991). The frequent association between these two types of syndromes suggests that the combination of D 2 and 5-HT 2 receptor antagonists as a logical therapeutic strategy. We studied this possibility with the non-specific 5-HT 2 antagonist mianserin using an open add-on design. Chronic schizophrenic inpatients (DSM-HI-R) were equilibrated on a similar neuroleptic regimen. 30 to 90 mg mianserin was then given during 8 weeks (fixed 30 mg dose the fast week, 30 to 90 mg flexible dose the following weeks). The BPRS, SANS and SAPS were monitored weekly. The BQLS (Brief Quality of Life rating Scale (Rogue, 1991)) was also monitored in some cases. Analysis of the data for the patients who completed the trial (n - 14 to date) shows a significant decrease in the negative (p < 0.01) and global symptom ratings (p < 0.05). This was not due to an antidepressant type effect (no change in the BPRS-Overall depression subscale). Quality of life also significantly improved (p < 0.05). These preliminary results show the efficacy of mianserin in severe schizophrenia, and confirm the interest of combining 5HT 2 with D 2 antagonists in these patients. Data from an amplified sample will be discussed with respect to the role of serotonin and dopamine in schizophrenia. References
Axelsson, R., Nilsson, A., Christensson, E. and Bj6rk, A. (1991). Effect of amperozide in schizophrenia. Psychophannacol 104, 287-292. Davis, K.L., Kahn, R.S., Ko, G. and Davidson, M. (1991). Dopamine and schizophrenia revisited: A review and reeonceptualization. Am. J. Psychiatry 148, 1474-1486. Rogue, P. (1991). The Brief Quality of Life rating Scale. Inst. on H&CP Abstr. 43, 215.
Is the initial improvement a valid criterion for drug choice in acute schizophrenia?
Klimke, A., Klieser, E., Lehmann, E. and Miele, L. Psychiatric Hospital of the Heinrich-Heine-University Dasseldorf (Head: Prof. Dr. K. Heinrich), Germany Several investigators found that the initial improvement of acute schizophrenia after some days of neuroleptic treatment is