SUSPENSION THERAPY IN ACUTE SCHIZOPHRENIA - CLINICAL AND NEUROENDOCRINE BIOCHEMICAL EFFECTS OF ABRUPT DISCONTINUATION OF NEUROLEPTIC MEDICATION

22 acutely schizophrenic patients with partial remission under standar d haloperidol therapy (reduction in BPRS total score by 50% or less) w ere included in this prospective study. There was a significant correl ation between the BPRS total score or the BPRS factors Anxiety/depress ion and Anergia and extrapyramidal side effects at the end of the 3-we ek neuroleptic treatment phase. In these patients abrupt discontinuati on of neuroleptic medication (suspension therapy) brings about a signi ficant further reduction in BPRS total scores together with a favorabl e effect on the BPRS factors Anxiety/depression, Anergia and Thought d isturbance. There was a trend towards low serum prolactin values befor e neuroleptic discontinuation being linked with a favorable effect of subsequent suspension therapy. Urinary dopamine and homovanillic acid excretion before neuroleptic discontinuation did not predict the clini cal suspension effect. Thus peripheral neuroendocrine and biochemical effects of haloperidol-induced dopamine blockade and their changes aft er discontinuation of neuroleptic medication seem not to be linked wit h the clinical effect of suspension therapy in acute schizophrenia. Th ere was, however, a significant relationship between low urinary epine phrine, norepinephrine, vanillylmandelic acid and cortisol excretion b efore suspension therapy and a favorable suspension effect. On the oth er hand, the more pronounced a nonspecific stress constellation (catec holamines, cortisol) was in patients with an unsatisfactory remission under neuroleptics, the less favorable was the clinical effect of susp ension therapy. Until now, the treatment courses of suspension therapy have been evaluated in 43 schizophrenic patients. According to both c linical aspects and observer rating, three types of therapeutic suspen sion effects have been distinguished in one-third of the cases respect ively: none (at best temporary remission, no improvement in the overal l treatment situation); partial (substantial remission, neuroleptic me dication resumed for therapeutic reasons), and favorable (almost compl ete remission, neuroleptic medication resumed for prophylactic reasons ).