Neuropsychological prediction of treatment response and outcome in schizophrenia

  • R. M. Bilder
  • J. A. Bates


Despite decades of experience using antipsychotic medications, we still have a very limited capacity to predict who among our patients will benefit, how much they will benefit, and the extent to which they are likely to suffer disabling side effects from treatment. The contributions to this volume reflect increasing insight into a range of factors that may influence treatment response and outcome, but it is ironic that we can repeat the lament of Philip May and his colleagues in that the situation today has advanced little since 1964 (May 1966, May et al. 1976). Investigators continue to comment that the best predictor of antipsychotic treatment response is a prior history of response to the same treatment (May and Goldberg 1978, Awad 1989). In the era when only “typical” neuroleptic treatments were available, this lack of predictive power may have made less difference to clinicians, but the rapid development of new antipsychotic agents prompts a need to enhance our capacity to predict who will benefit, and who may be at increased risk from different treatments. One goal for current research is determining how neuropsychological (NP) methods may help both in the prediction and the definition of outcome. The key advantages of neuropsychology in these contexts include: (a) the possibility that NP methods may distinguish reliably between reversible state effects and more persistent trait effects; and (b) the possibility that NP methods may offer more valid indices of integrity or compromise within the specific functional brain systems that are the targets of antipsychotic drug treatments. To the extent that NP indices of specific neuropsychopharmacologic system functions can be validated, there are new opportunities to develop targeted treatment strategies, which could include rational selection of treatments based on NP profiles, and titration of ongoing treatments using changes in NP function as the key dependent measures.


Reaction Time Measure Fluphenazine Decanoate Antipsychotic Drug Treatment Target Treatment Strategy Island Jewish Medical 
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Copyright information

© Springer-Verlag Wien 1994

Authors and Affiliations

  • R. M. Bilder
    • 1
  • J. A. Bates
    • 2
  1. 1.Hillside Hospital DivisionLong Island Jewish Medical CenterGlen OaksUSA
  2. 2.Long Island CampusAlbert Einstein College of MedicineUSA

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