Since the beginning of the neuroleptics in 1952, French psychiatrists
have proposed a classification of neuroleptics, taking into account th
e pharmacological and therapeutic differences between these drugs. The
y distinguished 3 different clinical effects of neuroleptics: sedative
effects, effects on the positive symptoms of schizophrenia and effect
s on the negative symptoms. The effect of some neuroleptics on negativ
e symptoms is recognized by the international community, which conside
rs clozapine to be effective. In France, in most cases, the indication
of clozapine is still refractory paranoid schizophrenia. The effect o
f this atypical neuroleptic on other types of schizophrenic patient is
not well known. Remoxipride appears to be as effective in treating ps
ychotic symptoms and to have fewer side effects than haloperidol. Remo
xipride is effective for both positive and negative symptoms. Loxapine
has been prescribed in France since 1980. Its pharmacological profile
is close to that of clozapine: it has dopamine (D-2), histamine (H-1)
, serotonin (5-HT2) and adrenergic (alpha(1))-blocking activities. Its
best indication seems to be paranoid schizophrenia, although some dat
a suggest bipolar action. The bipolar action of some new neuroleptics
is illustrated by amisulpride, a substitute benzamide derivative. The
originality of this molecule lies in its two opposite actions at two d
istinct doses. Doses of 600-1200 mg/day are effective against positive
symptoms; 50-150 mg/day improves negative symptoms. This latter effec
t could be mediated by activation of the dopamine system. Risperidone
binds to 5-HT2, D-2, alpha(1), and H-1 receptors. At a daily dose of 5
mg, risperidone would probably act on both negative and positive symp
toms, inducing fewer extrapyramidal symptoms than classical neurolepti
cs. Carpipramine is neither antidepressant nor neuroleptic; carpiprami
ne is a specific 5-HT2 antagonist and is the only known disinhibitor d
rug. The St. Anne Hospital School, following Deniker, recommends its u
se for hebephrenic patients. Amineptine is a very potent dopaminergic
antidepressant that can be effective on negative symptoms such as loss
of affect and anergia. All the drugs are empirically prescribed. Thei
r use would be justified by a serotonin and/or dopamine hypothesis of
schizophrenia.