Neuroleptics and Diagnostic Heterogeneity in Relation to Drug Evaluation

  • F.-A. Wiesel
Conference paper
Part of the Psychopharmacology Series book series (PSYCHOPHARM, volume 10)

Abstract

The opinion that schizophrenia is a heterogenous disease goes back to E. Bleuler who in his monograph Dementia Praecox oder Gruppe der Schizofrenien (Bleuler 1911) proposed the term schizophrenia in his psychopathological descriptions of patients with dementia praecox. In his textbook Lehrbuch der Psychiatrie he writes: “Wenn wir auch eine naturliche innere Einteilung noch nicht machen konnen, so erscheint uns die Schizophrenie doch nicht als eine Krankheit im engeren Sinne, sondern als eine Krankheitsgruppe, etwa analog der Gruppe der Organischen, die in Paralyse, senile Formen usw. Zerfällt. Man sollte deswegen eigentlich von Schizophrenien in der Mehrzahl sprechen” (Since we cannot divide schizophrenia on objective grounds, schizophrenia seems not to be one disease, but rather a group of disorders, more like the organic psychoses - paralysis, dementia. One should conceive of schizophrenia in plural.) (Bleuler 1916) However, in previous research most investigators have conceived schizophrenia as a uniform disease with Kraepelin’s subtypes, i. e., catatonic, paranoid, and hebephrenic schizophrenia. Over the years several different diagnostic systems have been developed and used in schizophrenia research. This means that different criteria for selection of patients in research have been used, suggesting that quite different patient categories have been studied. Thus Brockington et al. (1978), using 10 diagnostic systems in the study of 119 psychotic patients, found that the number of patients with a diagnosis of schizophrenia ranged between 4% and 45%.

Keywords

Depression Dopamine Tyrosine Dementia Schizophrenia 

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References

  1. Alfredsson G, Wiesel F-A (1990) Relationships between clinical effects and monoamine metabolites and amino acids in sulpiride-treated schizophrenic patients. Psychopharmacology (Berl) 101: 324–331CrossRefGoogle Scholar
  2. Andreasen NC (1982) Negative symptoms in schizophrenia. Arch Gen Psychiatry 39: 784–788PubMedGoogle Scholar
  3. Angst J, Stassen HH, Woggon B (1989) Effect of neuroleptics on positive and negative symptoms and the deficit state. Psychopharmacology (Berl) 99: S41–S46CrossRefGoogle Scholar
  4. Bleuler E (1911) Dementia praecox oder Gruppe der Schizophrenien. Deuticke, LeipzigGoogle Scholar
  5. Bleuler E (1916) Lehrbuch der Psychiatrie. Springer, BerlinGoogle Scholar
  6. Bowers MB Jr, Swiger ME, Jatlow PI, Hoffman FJ, Giocoechea N (1986) Early neuroleptic response in psychotic men and women: correlation with plasma HVA and HMPG. Compr Psychiatry 27: 181–185PubMedCrossRefGoogle Scholar
  7. Brockington IF, Kendell RE, Leff JP (1978) Definitions of schizophrenia: concordance and prediction of outcome. Psychol Med 8: 387–398PubMedCrossRefGoogle Scholar
  8. Carlsson M, Carlsson A (1990) Schizophrenia: a subcortical neurotransmitter imbalance syndrome? Schizophr Bull 16 (3): 425–432PubMedGoogle Scholar
  9. Chang W-H, Chen T-Y, Lee C-F, Hung J-C, Hu W-H, Yeh E-K (1988) Plasma homovanillic acid levels and subtyping of schizophrenia. Psychiatry Res 23: 239–244PubMedCrossRefGoogle Scholar
  10. Cheramy A, Romo R, Godeheu C, Baruch P, Glowinski J (1986) In vivo presynaptic control of dopamine release in the cat caudate nucleus-II. Facilitatory or inhibitory influence of Lxglutamate. Neuroscience 19: 1081–1090PubMedCrossRefGoogle Scholar
  11. Crow TJ (1980) Molecular pathology of schizophrenia: more than one disease process? Br Med J 66–68Google Scholar
  12. Farde L, Wiesel F-A, Halldin C, Sedvall G (1988) Central D2-dopamine receptor occupancy in schizophrenic patients treated with antipsychotic drugs. Arch Gen Psychiatry 45: 71–76PubMedGoogle Scholar
  13. Farde L, Wiesel F-A, Stone-Elander S, Halldin C, Nordström A-L, Hall H, Sedvall G (1990) D2-Dopamine receptors in neuroleptic-naive schizophrenic patients - a PET- study with (11C)raclopride. Arch Gen Psychiatry 47: 213–219PubMedGoogle Scholar
  14. Fonnum F (1984) Glutamate: a neurotransmitter in mammalian brain. J Neurochem 42: 1–11PubMedCrossRefGoogle Scholar
  15. Gattaz WF, Kohlmeyer K, Gasser T (1990) Computer tomographic studies in schizophrenia. In: Häfner H, Gattaz WF (eds) Search for the causes of schizophrenia, vol 2. Springer, Berlin Heidelberg New York, pp 242–256CrossRefGoogle Scholar
  16. Hagenfeldt L, Venizelos N, Bjerkenstedt L, Wiesel F-A (1987) Decreased tyrosine transport in fibroblasts from schizophrenic patients. Life Sci 41: 2749–2757PubMedCrossRefGoogle Scholar
  17. Johnstone EC, Crow TJ, Frith CD, Husband J, Kreel L (1976) Cerebral ventricular size and cognitive impairment in chronic schizophrenia. Lancet 2: 924–926PubMedCrossRefGoogle Scholar
  18. Kane J, Honigfeld G, Singer J, Meltzer H, Clozaril Collaborative Study Group (1988) Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 45: 789–796PubMedGoogle Scholar
  19. Kay SR, Singh MM (1989) The positive-negative distinction in drug-free schizophrenic patients. Arch Gen Psychiatry 46: 711–718PubMedGoogle Scholar
  20. Keks NA, Copolov DL, Kulkarni J, Mackie B, Singh BS, McGorry P, Rubin RT, Hassett A, McLaughlin M, van Riel R (1990) Basal and haloperidol-stimulated prolactin in neuroleptic-free men with schizophrenia defined by 11 diagnostic systems. Biol Psychiatry 27: 1203–1215PubMedCrossRefGoogle Scholar
  21. Kennedy JL, Giuffra LA, Moises HW, Cavalli-Sforza LL, Pakstis AJ, Kidd JR, Castiglione CM, Sjögren B, Wetterberg L, Kidd KK (1988) Evidence against linkage of schizophrenia to markers on chromosome 5 in a northern Swedish pedigree. Nature 336: 167–170PubMedCrossRefGoogle Scholar
  22. Kornhuber HH, Kornhuber I, Kim JS, Kornhuber ME (1984) Zur biochemischen Theorie der Schizophrenic (A biochemical theory of schizophrenia). Nervenarzt 55: 602–606PubMedGoogle Scholar
  23. McDermott BE, Sautter FJ, Garver DL (1991) Heterogeneity of schizophrenia: relationship to latency of neuroleptic response. Psychiatry Res 37: 97–103PubMedCrossRefGoogle Scholar
  24. Roberts PJ, McBean GJ, Sharif NA, Thomas EM (1982) Striatal glutamatergic function: modifications following specific lesions. Brain Res 235: 83–91PubMedCrossRefGoogle Scholar
  25. Sherrington R, Brynjolfsson J, Petursson H, Potter M, Dudleston K, Barraclough B, Wasmuth J, Dobbs M, Gurling H (1988) Localization of a susceptibility locus for schizophrenia on chromosome 5. Nature 336: 164–167PubMedCrossRefGoogle Scholar
  26. Strauss JS, Gift TE (1977) Choosing an approach for diagnosing schizophrenia. Arch Gen Psychiat 34: 1248–1253Google Scholar
  27. Weinberger DR (1990) Brain anatomy in schizophrenia. Discussion. In: Häfner H, Gattaz WV (eds) Search for the causes of schizophrenia, vol 2. Springer, Berlin, Heidelberg New York, pp 275–281CrossRefGoogle Scholar
  28. Wiesel F-A (1989) Positron-emission tomography in psychiatry. Psychiatr Dev 1: 19–47Google Scholar
  29. Wiesel F-A, Farde L, Nordström A-L, Sedvall G (1990) Central D1- and D2 receptor occupancy during antipsychotic drug treatment. Proc NeuroPsychopharmacol Biol Psychiatry 14: 759–767CrossRefGoogle Scholar
  30. Wiesel F-A, Blomqvist G, Venizelos N, Bjerkenstedt L, Halldin C, Hagenfeldt L, Sjögren I (1991) Altered transport of tyrosine across the blood brain barrier in patients with schizophrenia. Biol Psychiatry 2: 337–340Google Scholar
  31. Wik G, Wiesel F-A, Sjögren I, Blomqvist G, Greitz T, Stone-Elander S (1989) Effects of sulpiride and chlorpromazine on regional cerebral glucose metabolism in schizophrenic patients as determined by positron emission tomography. Psychopharmacology (Berl) 97: 309–318CrossRefGoogle Scholar
  32. Wolkin A, Barouche F, Wolf AP, Rotrosen J, Fowler JS, Shiue C-Y, Cooper TB, Brodie JD (1989) Dopamine blockade and clinical response: evidence for two biological subgroups of schizophrenia. Am J Psychiatry 146: 905–908PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • F.-A. Wiesel
    • 1
  1. 1.Department of PsychiatryUppsala UniversityUppsalaSweden

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