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Objective: Subtypologies of schizophrenia based on cross-sectional criteria, such as the nomenclature of the DSMs, have not been successful in identifying valid diagnostic subgroups among patients with schizophrenia. A subtypology that uses criteria to classify individuals on the basis of longitudinal deficits in self-care may identify a more valid subgroup of schizophrenic patients., Method: This study describes the clinical characteristics of a group of schizophrenic patients identified on the basis of a longitudinal criterion: at least 5 years of continuous and complete dependence on others for obtaining and maintaining the basic necessities of life, including food, clothing, and shelter., Results: Sixty-one "Kraepelinian" schizophrenic inpatients, when compared to 80 non-Kraepelinian schizophrenic inpatients who were similar in years of illness, age, and education, demonstrated more severe negative symptoms and more severe formal thought disorder; yet the severity of their delusions, hallucinations, and bizarre behavior did not differ significantly. None of the Kraepelinian patients and eight non-Kraepelinian patients met DSM-III-R criteria for schizoaffective disorder., Conclusions: Data from this replication study suggest that Kraepelinian schizophrenic patients, identified on the basis of a longitudinal course characterized by severe dysfunctions in self-care, may represent an alternative, and possibly more valid, method of subtyping schizophrenia.

Objective: This study sought to characterize a subset of patients with DSM-III schizophrenia or schizophreniform disorder who respond to lithium., Method: Sixty-six psychotic patients were given a systematic therapeutic trial of lithium alone. Differences in demographic characteristics, symptoms, and family history of psychotic disorders between the responders and nonresponders to lithium were explored., Results: Responders and nonresponders did not differ significantly in age, duration of illness, length of current episode, distribution of RDC and DSM-III diagnoses, or number of positive symptoms. However, the responders to lithium (N = 10) exhibited a paucity of negative symptoms and an absence of familial schizophrenic spectrum disorders., Conclusions: These preliminary results suggest the possibility of pretreatment identification of psychotic patients for whom neuroleptic medication could be avoided by therapeutic intervention with lithium alone.

Objective: The authors' goal was to determine whether higher doses of haloperidol improve antipsychotic response., Method: During a 2-week, double-blind, randomized fixed-dose study, 24 psychotic patients were given 4, 10, or 40 mg/day of haloperidol., Results: No clinically relevant difference between groups in favor of the higher antipsychotic doses could be detected., Conclusions: Doses of 4 mg/day of haloperidol appear to be as effective as higher doses in the treatment of psychosis.

CSF homovanillic acid (HVA) levels reflecting central dopamine release and apomorphine-stimulated human growth hormone (HGH) secretion reflecting central dopamine receptor activity were concomitantly determined in 20 schizophrenic patients. There was a strong negative correlation between HVA and HGH levels: high dopamine release was associated with lower HGH responses to dopamine receptor activation by apomorphine. Studies are reviewed which suggest that the presently observed relationship reflects release-mediated down-regulation of central D2 receptors, the dopamine receptor subtype associated with the antipsychotic properties of neuroleptic medication.

The authors describe the first five patients enrolled in an open clinical trial of clonazepam as a maintenance treatment in lithium-refractory bipolar disorder. All patients relapsed quickly after taking clonazepam (one within 2 weeks and four within 10-15 weeks), and the study was prematurely terminated. The results cast doubt over the usefulness of clonazepam as a prophylaxis in lithium-resistant bipolar patients who have histories of psychotic mania or delusional depression.

The authors previously found a high correlation between lithium response and clinical diagnostic criteria in a subgroup of schizophrenic-like patients who responded favorably to lithium therapy. In the present study the authors extend this research by using biological markers to predict and identify such patients. They examined growth hormone (GH) response to apomorphine administration and the in vitro lithium ratio in 31 patients before and after a 2-week lithium trial. Peak GH levels (greater than or equal to 20 ng/ml) and lithium ratios (greater than or equal to .39) were correlated with a positive response to lithium therapy. The authors discuss 1) the use of these two biological markers to predict the success of lithium therapy in schizophrenia and 2) biological abnormalities characteristic of lithium-responsive schizophrenic patients.

Conflicting reports concerning cholinomimetic-induced reduction of schizophrenic symptoms prompted the authors to study such changes in schizophrenic symptoms following physostigmine infusions in subgroups of patients with schizophrenic-like illness. These subgroups were defined by the presence or absence of antipsychotic response during a 2-week trial of lithium alone after physostigmine infusion. Patients who showed significant but temporary improvement in their thinking disturbance on serial Brief Psychiatric Rating Scale scores following physostigmine infusion subsequently responded to lithium; patients who failed to improve following physostigmine also failed to respond to lithium. The authors suggest that some schizophrenic-like illnesses may be biologically similar to mania both with respect to physostigmine and lithium-induced changes in symptomatology.

The authors report the results of a 2-week lithium trial using 31 patients meeting Research Diagnostic Criteria for schizophrenia or schizoaffective disorder who were also diagnosed according to DSM-III criteria. One-third of the patients showed reduction of their schizophrenic-like symptoms during the lithium trial. Seven of the 9 responders (78%) met DSM-III criteria not for schizophrenia but for a schizophreniform disorder. Such patients also met McCabe and associates' criteria for good prognosis schizophrenia. This study lends further support to the growing body of evidence which suggests that schizophreniform disorder and good prognosis schizophrenia may be affective disorders with atypical schizophrenic-like features. The authors cautiously suggest that a lithium trial may be indicated in this subgroup of patients.