Am J Psychiatry 1994; 151:379-384
Copyright © 1994 by American Psychiatric Association
Noradrenergic activity and prediction of psychotic relapse following haloperidol withdrawal in schizophrenia
DP van Kammen, H Agren, JK Yao, DT O'Connor, J Gurklis and JL Peters
Highland Drive VA Medical Center, Pittsburgh, PA 15206.
OBJECTIVE: The purpose of this study was to develop a model based on the
authors' previous studies to identify which neuroleptic-treated
schizophrenic patients are at risk of early relapse following drug
withdrawal. METHOD: Clinical and CSF monoamine-related variables obtained
for 50 male haloperidol-treated, schizophrenic patients were used in a
logistic regression model to identify those who relapsed (N = 24) within 6
weeks after placebo substitution and those who did not (N = 26). RESULTS:
The oral dose of haloperidol, weight, CSF norepinephrine,
3-methoxy-4-hydroxyphenylglycol and chromogranin A-like immunoreactivity,
and the anxiety and paranoia subscale ratings of the Brief Psychiatric
Rating Scale produced a model that correctly predicted 18 relapsers and 21
nonrelapsers. By including the interactions of paranoia subscale by CSF
norepinephrine and anxiety by CSF norepinephrine, the model correctly
identified 20 relapsers and 23 nonrelapsers with a sensitivity and
specificity of 83% and 88%, respectively. CONCLUSIONS: Increased
noradrenergic activity during chronic dopamine blockade may be an episode
marker and may predict relapse within 6 weeks following haloperidol
withdrawal in schizophrenia. Effective relapse prediction models have
important practical implications for the treatment of schizophrenia and the
understanding of the psychotic relapse process.
