In de praktijk zijn de effecten van clozapine en risperidon vergeleken bij schizofrene patiënten die onvoldoende reageren op klassieke antipsychotica. Van de 25 op clozapine ingestelde patiënten gebruikte 63 procent na een half jaar nog medicatie. Bij driekwart van deze groep wend naast goede effecten op hallucinaties en wanen ook een gunstig effect op negatieve symptomen geconstateerd. Van de 25 op risperidon ingestelde patiënten gebruikte na een half jaar nog 54 procent medicatie. In tegenstelling tot tie clozapine-gebruikers werd er bij hen nauwelijks een duurzaam effect op negatieve symptomen gevonden. Wel werden relatief weinig bijwerkingen gemeld. Gezien de resultaten van dit onderzoek wordt een kritische houding ten aanzien van het gebruik van nieuwe antipsychotica aanbevolen.

With the introduction of major tranquillizers more than three decades ago symptom rating scales were soon accepted as the method of evaluating their clinical effects. The Mini-compendium is a collection of rating scales for measuring outcome of antianxiety drugs, antidepressants, antimanics, and anti-psychotics. The scales have been selected by their “cash values”, i.e. the scales most frequently used for the respective dimensions. These scales have been further developed in terms of strict item definitions. The simple sum of the individual scale items has been considered as a sufficient statistic if they fulfilled latent structure analysis of shared phenomenology.

Schizophrenia is a neurobiological developmental disorder of basic neuro-integrative functions, resulting in failures of cognitive selfregulation. Neurophysiological and psychophysiological dysfunctions should be considered in connection with the ubiquitous cognitive dysfunctions. Schizophrenic patients have problems with the integration of information, resulting in deficits of perceptual organization, and in ‘metacognitive’ deficits of executive functions in the area of behavior and experience. The biological basis of these cognitive functions is in the frontal cortex, but the primary dysfunction seems to be a subcortical one. Negative symptoms can be understood as a secondary exhaustion mechanism, and partly as an adaptive process, corresponding with energetic deficits in information processing. Psychophysiological studies of regional cerebral blood flow, positron emission tomography, electrophysiological recordings and measures of eye tracking point to frontal dysfunction and hypoactivation in patients with negative symptoms. This agrees well with the results of cognitive studies. Psychophysiologists and cognitive psychologists are studying different aspects of the same systems disorder.

Severe schizophrenics as a group show subtle abnormalities of cerebral structure. Cerebral ventricular enlargement is the best replicated finding, and this tends to be associated with impairment of neuropsychological performance. The idea that these abnormalities have a neurodevelopmental origin gains indirect support from the, admittedly less consistent, evidence of abnormalities of cerebral asymmetry and of neuronal migration in adult schizophrenics, as well as from the behavioural, psychomotor, and cognitive impairments reported in preschizophrenic children. However, the relationship between childhood and adult neuropsychological and brain structural findings has not been proven, and we do not know whether only some schizophrenics have a developmental origin, or whether patients differ only in the degree of developmental impairment that they show.

To answer the question if it is possible for specific psychiatric illnesses to influence the thyroxine-concentration, a group of 376 patients admitted to a psychiatric hospital was studied retrospectively.

13.5% had an elevated thyroxine-concentration and only 0.6% had a low concentration.

Of the group of 145 men, 22.8% was found to have an elevated thyroxine-concentration. In the group of 196 women we found 6.6% to be elevated. A low thyroxine was found in only 0.5% of the women and 0.7% of the men.

In the group with an elevated thyroxine the psychiatric diagnoses of schizophrenia and psychotic disorders NOS are more common (19.6% and 17.4% respectively) than in the group with a normal thyroxine (4.4% and 6.5% respectively).

A concise review is given of the importance of the atypical antipsychotic drugs clozapine, sulpiride, remoxipride and raclopride. Both the concept of atypicality and the pharmacological profile of these compounds is discussed. The newly developed atypical antipsychotic remoxipride has been studied in several double blind studies. In virtually all of these studies a reduced propensity for the induction of extrapyramidal symptoms was found.

These findings implicate that atypical antipsychotics may also not induce tardive dyskinesia. In addition to the treatment of acute schizophrenia, these compounds might be of use in the treatment of treatment resistent schizophrenia (clozapine), tardive dyskinesia and psychosis during the course of Parkinson's disease.

Neuropeptides are endogenous substances present in nerve cells and involved in nervous system functions. Neuropeptides are synthetized in large precursor proteins and several are formed in the same precursor. Neuropeptides affect learning and memory processes, social, sexual and maternal behavior, pain and addiction, body temperature, food and water intake e.a. In addition, neuropeptides possess trophic influences on the nervous system, neuroleptic-like andpsychostimulant-like activities. Disturbances in classical neurotransmitter activity as found in Parkinson's disease, psychoses, and dementia, may also be caused by disturbances in neuropeptide activity. In fact, alterations in the concentration of a number of neuropeptides in schizophrenia, depression, and dementia have been found.

Much work has been done during the last decade on the influence of neuropeptides in schizophrenia, autism, depression, and in various disorders associated with memory disturbances. These studies concern neuropeptides related to adrenocorticotropic hormone (ACTH) and melanocyte stimulating hormone (MSH), vasopressin- and endorphin-type neuropeptides, thyrotropic releasing hormone (TRH), and the C-terminal part of oxytocin Pro-Leu-Gly-NH2 (PLG). Several of these exert positive effects but in not more than 25% the response is clinically relevant. This may have to do with the severity of the disease and its chronicity. The modest effects may also be caused by the poor bioavailability of peptides and insufficient pharmacotherapeutic experience regarding dose, and duration of treatment.

Over the past 25 years much effort has been put into the research of the relationship between neuropsychiatric disorders and the concentrations of CSF-monoamine metabolites. Most of this research has beenfocused on the relation between CSF-concentrations of 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) and specific symptomatological entities, particularly schizophrenia, Alzheimer's dementia and endogenous depression. It appeared that specific relations between diseases and CSF-concentrations of monoamine metabolites cannot be longer maintained and that a more functional psychopathology should be considered as the future research strategy.