Abstract

Neuroleptic Drug Treatment of Schizophrenia: The State of
the Confusion

Forwarded by Ron Thompson

A selective review of research reports published during the
last five years in leading psychiatric journals and touching
on basic aspects of the use and evaluation of neuroleptic
drugs suggests that the enterprise of drug treatment of
schizophrenia is conceptually and clinically -- though not
economically -- bankrupt.  although new drugs spur hope and
reinforce the dominant treatment paradigm, evidence is
presented in this article that 1) psychopharmacologists do
not know what is the optimal dose of the most widely-used
neuroleptics; 2) that the rate of "nonresponse" to
neuroleptic treatment is much higher than generally
admitted; 3) that toxic effects are routinely misdiagnosed;
4) that prescribing guidelines may have no impact on actual
prescription patterns; 5) that claims that the popular
"atypical" neuroleptic clozapine is free of extrapyramidal
symptoms are _completely_ false; and finally 6) that
penetration of the double-blind in studies of the
effectiveness of psychotropics over placebos may be a common
occurrence.  In light of these findings, it is argued that
the field is in crisis and that major, paradigmatic change
is _absolutely_ necessary.

Requests for reprints should be sent to David Cohen, PhD,
Groupe de recherche sur les aspects sociaux de la prevention
(GRASP), Universite de Montreal, CP 6128, succ A, Montreal
QC, CANADA, H3C 3J7.

December 1993