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Classification of neuroleptic drugs - lack of relationship to effect on negative symptoms in schizophrenia

Published online by Cambridge University Press:  28 April 2020

Svein G. Dahl
Svein G. Dahl*
Affiliation:
Institute of Medical Biology, University of Tromsø, P.O. Box 977, N-9001Tromsø, Norway
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Summary

There is both pharmacological and clinical support for a classification of the schizophrenic syndrome into negative and positive subtypes. For neuroleptics that act upon both types of symptoms, it appears that lower doses are required for treatment of negative than for positive symptoms. Successful drug treatment of negative symptoms may therefore depend upon the choice of a correct dosage for the individual patient. Due to variation in pharamacokinetic parameters, similar doses of a neuroleptic drug may result in different plasma levels in individual patients, especially after oral medication. Pharmacokinetic variations, if not under proper control, may easily disguise a concentration-dependent relationship, such as the effects of a neuroleptic drug upon negative and positive symptoms. In drug treatment of negative symptoms it may therefore be an advantage to individualize the doses as a function of plasma drug level measurements, when available. No general relationship has been demonstrated between the chemical properties or pharmacodynamics of neuroleptic drugs and their potential to act upon negative symptoms. Also, the drugs which have been demonstrated to have an “energizing” effect have widely different pharmacokinetic properties. A chemical or pharmacological classification of neuroleptics therefore does not seem to give any information about their possible efficacy in treating negative symptoms in schizophrenia.

Résumé

Résumé

Les données pharmacologiques et cliniques sont en faveur d’une classification du syndrome schizophrénique en sous types négatifs et positifs. Les neuroleptiques agissant sur les deux types de symptômes semblent nécessiter pour les symptômes négatifs des doses inférieures à celles qu'il convient d’utiliser pour traiter les symptômes positifs. Le succès du traitement médicamenteux des symptômes négatifs peut très bien dépendre du choix d’une posologie adaptée au cas individuel. En raison de la variation des paramètres pharmacocinétiques, des posologies équivalentes de neuroleptiques peuvent correspondre à des taux plasmatiques différents selon les individus, en particulier lors de traitements par voie orale. Les variations pharmacocinétiques, lorsqu’elles ne sont pas convenablement controlées, peuvent facilement provoquer à notre insu une notion qui serait liée à la concentration comme c’est le cas pour les effets d’un neuroleptique sur les symptômes négatifs et positifs. Dans le traitement médicamenteux des symptômes négatifs, il est parfois utile de déterminer la posologie à partir de la mesure des concentrations plasmatiques du produit, lorsque cela est réalisable. Aucune relation généralisable n’a été démontrée entre les propriétés chimiques ou pharmacocinétiques des médicaments neuroleptiques et leur efficacité potentielle sur les symptômes négatifs. Les produits pour lesquels l’effet désinhibiteur a été démontré ont des propriétés pharmacocinétiques très différentes. Une classification chimique ou pharmacologique des neuroleptiques ne semble donc pas rendre compte de l'efficacité de ces produits sur les symptômes négatifs de la schizophrénie.

Keywords

SchizophreniaNegative SymptomsNeurolepticsPlasma Drug LevelsPharmacological ClassificationPharmacokineticsMolecular structuresSchizophrénieSymptômes négatifsNeuroleptiquesConcentrations plasmatiques des produitsClassification pharmacologiquePharmacocinétiqueStructures moléculaires
Type
Research Article
Information
Psychiatry and Psychobiology , Volume 2 , Issue 4 , 1987 , pp. 289 - 294
Copyright
Copyright © European Psychiatric Association 1987

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