TREATMENT OF NEGATIVE SYMPTOMS IN SCHIZOPHRENIA AND SCHIZOAFFECTIVE DISORDER BY SELEGILINE AUGMENTATION OF ANTIPSYCHOTIC MEDICATION - A PILOT-STUDY EXAMINING THE ROLE OF DOPAMINE

It has been suggested that schizophrenic negative symptoms may be mani festations of regionally deficient CNS dopaminergic activity. We sough t to test this hypothesis by openly treating patients on chronic antip sychotic medication who showed prominent negative symptoms with low-do se selegiline (5 mg b.i.d.), a monoamine oxidase-B inhibitor that sele ctively enhances dopaminergic activity. Twenty-one patients meeting DS M-III-R criteria for chronic schizophrenia (N = 14) or schizoaffective disorder (N = 7) with prominent negative symptoms were studied. Subje cts had been kept at their current antipsychotic and antiparkinsonian medication dose levels for at least a month before the study, which wa s continued unchanged throughout the trial. Over 6 weeks of selegiline treatment, a 34.7% reduction in negative symptoms was demonstrated on the Scale for the Assessment of Negative Symptoms. There were also re ductions in depressive symptoms (21-item Hamilton Depression Scale dro pped 36.8%) and extra-pyramidal symptoms (Simpson-Angus Extrapyramidal Symptom Scale scores dropped 27.7%), but no change was observed in th e severity of positive symptoms as measured by the Brief Psychiatric R ating Scale. Global clinical improvement was demonstrated, with mean C linical Global Impressions Scale score rising 17.6%. These findings su pport the hypothesis that negative symptoms, as well as extrapyramidal symptoms and certain depressive symptoms, may be manifestations of re gionally deficient dopaminergic activity.