Acute Treatment of Schizophrenia

William C. Wirshing,M.D., Donna Ames Wirshing, M.D., Stephen R. Marder, M.D., and Theodore Van Putten, M.D.
UCLA School of Medicine and West Los Angeles Veterans Affairs Medical Center
11301 Wilshire Blvd. (B-151H)
Los Angeles, CA 90073 USA
Tel (310) 824-3162
Fax (310) 312-0572


1. American Psychiatric Association. DSM-III: Diagnostic and statistical manual of mental disorders, 3rd ed. Washington, DC: The American Psychiatric Association, 1980.

2. Ames D, Wirshing WC, Marder SM, Yuwiler A, Brammer GL. Fluoxetine and haloperidol stabilized schizophrenics. New Research Programs & Abstracts, May 1993, NR 66,76. APA 146th Annual Meeting, San Francisco.

3. Atsmon A, Blum I, Wijsenbeek H, Maoz B, Steiner M, Ziegelman G. The short-term effects of adrenergic-blocking agents in a small group of psychotic patients: Preliminary clinical observations. Psychiatr Neurol Neurochir 1970;74:251-258.

4. Baldessarini RJ, Katz B, Cotton P. Dissimilar dosing with high-potency and low-potency neuroleptics. Am J Psychiatry 1984;141:748-752.

5. Biederman J, Lerner Y, Belmaker RH. Combination of lithium carbonate and haloperidol in schizo-affective disorder: A controlled study. Arch Gen Psychiatry 1979;36:327-333.

6. Bollen CA, De Cuyper H, Eneman M, Malfroid M, Peuskens J, Heylen S. Risperidone versus haloperidol in the treatment of chronic schizophrenic inpatients: A multicentre double-blind comparative study. Acta Psychiatr Scand 1992;85:295-305.

7. Brizer DA, Hartman N, Sweeney J, Millman RB. Effect of methadone plus neuroleptics on treatment-resistant chronic paranoid schizophrenia. Am J Psychiatry 1985;142:1106-1107.

8. Brody D, Adler LA, Kim T et al. Effects of buspirone in seven schizophrenic subjects. J Clin Psychopharmacol 1990;10:68-69.

9. Davis, JM, Casper, R. Antipsychotic drugs: Clinical pharmacology and therapeutic use. Drugs 1977;14:260-282.

10. Davis JM, Schaffer CB, Killian GA, Kinard C, Cahn C. Important issues in the drug treatment of schizophrenia. Schizophr Bull 1980;6:70-87.

11. Diamond R. Drugs and the quality of life: The patient's point of view. J Clin Psychiatry 1985;42:636-637.

12. Donlon PT, Hopkin JT, Tupin JP, Wicks JJ, Wahba M, Meadow A. Haloperidol for acute schizophrenic patients: An evaluation of three oral regimens. Arch Gen Psychiatry 1980;37:691-695.

13. Donlon PT, Meadow A, Tupin JP, Wahba M. High versus standard dosage fluphenazine HCl in acute schizophrenia. J Clin Psychiatry 1978;39:800-804.

14. Drake RE, Ehrich J. Suicide attempts associated with akathisia. Am J Psychiatry 1985;142:499-501.

15. Ericksen SE, Hurt SW, Chang S, Davis JM. Haloperidol dose, plasma levels, and clinical response: A double-blind study. Psychopharmacol Bull 1978;14:15-16.

16. Fouks L. Originalite et specificite de la fluphenazine. In: Proceedings of the Fifth International Congress of Neuropsychopharmacology, Washington, DC. Amsterdam, Excerpta Medica Foundation, International Congress Series No. 192, 1967;1128-1134.

17. Goff DG, Brotman AW, Waites M, McCormick S. Trial of fluoxetine added to neuroleptics for treatment resistant schizophrenic patients. Am J Psychiatry 1990;147:492-494.

18. Gold MS, Donabedian RK, Dillard M Jr, Slobetz FW, Riordan CE, Kleber HD. Antipsychotic effect of opiate agonists. Lancet 1977;2:398-399.

19. Gundlach R, Engelhardt DM, Hankoff L, Paley H, Rudorfer L, Bird E. A double-blind outpatient study of diazepam (Valium) and placebo. Psychopharmacology 1966;9:81-92.

20. Hakola HP, Laulumaa VA. Carbamazepine in treatment of violent schizophrenics. Lancet 1982;1:1358.

21. Haase HJ. Extrapyramidal modification of fine movements—A "conditio sine qua non" of the fundamental therapeutic action of neuroleptic drugs. In: Bordeleau JM, ed. Systeme extrapyramidal et neuroleptiques. Montreal, Quebec, Canada: Editions Psychiatriques, 1961;329-353.

22. Hirschowitz J, Casper R, Garver DL. Lithium response in good prognosis schizophrenia. Am J Psychiatry 1980;137:916-920.

23. Hollister LE, Bennett JL, Kimbell I Jr, Savage C, Overall JE. Diazepam in newly admitted schizophrenics. Dis Nerv Syst 1963;746-750.

24. Ital T, Keskiner A, Heinemann L et al. Treatment of resistant schizophrenics with extreme high dosage fluphenazine. Psychosomatics 1970;11:496-499.

25. Jimerson DC, Van Kammen DP, Post RM, Docherty JP, Bunney WE Jr. Diazepam in schizophrenia: Preliminary double-blind trial. Am J Psychiatry 1982;139:489-491.

26. Kane JM, Honigfeld G, Singer J, Meltzer HY. Clozapine for the treatment-resistant schizophrenic: A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988;45:789-796.

27. Karson CN, Weinberger DR, Bigelow L, Wyatt RJ. Clonazepam treatment of chronic schizophrenia: Negative results in a double-blind, placebo-controlled trial. Am J Psychiatry 1982;139:1627-1628.

28. Keckich WA. Neuroleptics. Violence as a manifestation of akathisia. JAMA 1978;240:2185.

29. Keepers GA, Clappison VJ, Casey DE. Initial anticholinergic prophylaxis for neuroleptic-induced extrapyramidal syndromes. Arch Gen Psychiatry 1983;40:1113-1117.

30. Kellner R, Wilson RM, Muldawer MD, Pathak D. Anxiety in schizophrenia: Responses to chlordiazepoxide in an intensive design study. Arch Gen Psychiatry 1975;32:1246-1254.

31. Khantzian EJ, Mack JE, Schatzberg AF. Heroin use as an attempt to cope: Clinical observations. Am J Psychiatry 1974;131:160-164.

32. Kidron R, Auerbuch I, Klein E, Belmaker RH. Carbamazepine-induced reduction of blood levels of haloperidol in chronic schizophrenia. Biol Psychiatry 1985;20:219-222.

33. Klein E, Bental E, Lerer B, Belmaker RH. Carbamazepine and haloperidol v placebo and haloperidol in excited psychoses. Arch Gen Psychiatry 1984;4l:165-170.

34. Levinson DF, Simpson GM, Singh H et al. Fluphenazine dose, clinical response, and extrapyramidal symptoms during acute treatment. Arch Gen Psychiatry 1990;47:761-768.

35. Lingjaerde O. Effect of the benzodiazepine derivative estazolam in patients with auditory hallucinations: A multicentre double-blind, cross-over study. Acta Psychiatr Scand 1982;65:339-354.

36. Lindstrom LH, Persson E. Propranolol in chronic schizophrenia: Controlled study in neuroleptic-treated patients. Br J Psychiatry 1980;137:126-130.

37. Luchins DL. Carbamazepine in violent non-epileptic schizophrenics. Psychopharmacol Bull 1984;20:569-571.

38. Marder SR. Risperidone: Clinical development: North American results. Clin Neuropharmacol 1992;15(suppl. 1):92A-93A.

39. Marder SR, Van Putten T, Mintz J et al. Costs and benefits of two doses of fluphenazine. Arch Gen Psychiatry 1984;41:1025-1029.

40. McEvoy JP, Hogarty G, Steingard S. Optimal dose of neuroleptic in acute schizophrenia: A controlled study of the neuroleptic threshold and higher haloperidol dose. Arch Gen Psychiatry 1991;48:739-745.

41. Myers DH, Campbell PL, Cocks NM, Flowerdew JA, Muir A. A trial of propranolol in chronic schizophrenia. Br J Psychiatry 1981;139:118-121.

42. Neborsky R, Janowsky D, Munson E, Depry D. Rapid treatment of acute psychotic symptoms with high and low dose haloperidol. Arch Gen Psychiatry 1981;38:195-199.

43. Neppe VM. Carbamazepine in nonresponsive psychosis. J Clin Psychiatry 1988;49 (Suppl):22-28.

44. Overall JE, Gorham DR. The Brief Psychiatric Rating Sale. Psychol Rep 1962;10:799-812.

45. Peet M, Middlemiss DN, Yates RA. Pharmacokinetic interaction between propranolol and chlorpromazine in schizophrenic patients, Lancet 1980;2:978.

46. Povan N, Yagcioglu V, Itil M, et al: High and very high dose fluphenazine in the treatment of chronic psychosis. In: Cerletti A, Bore FD, eds. The present status of psychotropic drugs, pharmacological and clinical aspects. Proceedings of the Sixth International Congress of the Collegium Internationale Neuropsychopharmacologicum, Tarrangona, Spain, April 1968. Amsterdam, Excerpta Medica Foundacion, International Congress Series, No. 180, 1969;495-497.

47. Pugh CR, Steinert J, Priest RG. Propranolol in schizophrenia: A double blind, placebo controlled trial of propranolol as an adjunct to neuroleptic medication. Br J Psychiatry 1983;143:151-155.

48. Quitkin F, Rifkin A, Klein DF. Very high dosage versus standard dosage fluphenazine in schizophrenia: A double-blind study of non-chronic treatment refractory patients. Arch Gen Psychiatry 1975;32:1276-1281.

49. Reardon GT, Riflkin A, Schwartz A, Myerson A, Siris SH. Changing pattern of neuroleptic dosage over a decade. Am J Psychiatry 1989;146:726-729.

50. Rifkin A, Doddi S, Karagi B, Borenstein M, Wachpress M. Dosage of haloperidol for schizophrenia. Arch Gen Psychiatry 1991;48:166-170.

51. Rifkin A, Quitkin F, Carrillo C, et al: Very high dose fluphenazine for nonchronic treatment-refractory patients. Arch Gen Psychiatry 1971;25:398-403.

52. Rifkin A, Siris S: Drug treatment of acute schizophrenia. In: Meltzer HY, ed. Psychopharmacology: The third generation of progress. New York: Raven Press, 1987;1095-1101.

53. Salzman C. The use of ECT in the treatment of schizophrenia. Am J Psychiatry 1980;137:1032-1041.

54. Simpson GM, Varga E, Haber EJ. Psychotic exacerbations produced by neuroleptics. Dis Nerv Syst 1976;37:367-369.

55. Siris SG, Bermanzohn PC, Gonzalez A, Mason SE, White CV, Shuwall MA. Use of antidepressants for negative symptoms in a subset of schizophrenic patients. Psychopharmacol Bull 1991;27:331-335.

56. Small JG, Kellams JJ, Milstein V, Moore J. Placebo-controlled study of lithium combined with neuroleptics in chronic schizophrenic patients. Am J Psychiatry 1975;132:1315-1317.

57. Spitzer RL, Endicott J, Robbins E. Research Diagnostic Criteria: Rationale and reliablility. Arch Gen Psychiatry 1978;35:773-782.

58. Sramek J, Herrera J, Costa J, Heh C, Tran-Johnson T, Simpson G. A carbamazepine trial in chronic, treatment-refractory schizophrenia. Am J Psychiatry 1988;145:748-750.

59. Teicher MH, Baldessanni RJ. Selection of neuroleptic dosage. Arch Gen Psychiatry 1985;42:636-637.

60. Van Putten T. Why do schizophrenic patients refuse to take their drugs? Arch Gen Psychiatry 1974;31:67-72.

61. Van Putten T, Marder SR, Mintz J. A controlled dose comparison of haloperidol in newly admitted schizophrenic patients. Arch Gen Psychiatry 1990;47:754-758.

62. Van Putten T, Marder SR, Mintz J, Poland RE. Haloperidol plasma levels and clinical response: A therapeutic window relationship. Am J Psychiatry 1992;49:500-505.

63. Van Putten T, Marder SR, Wirshing WC, Aravagiri M, Chabert N. Neuroleptic plasma levels. Schizophr Bull 1991;17:197-216.

64. Volavka J, Cooper T, Czobor P, et al. Haloperidol blood levels and clinical effects. Arch Gen Psychiatry 1992;49:354-361.

65. Wijsenbeck H, Steiner M, Goldberg SC. Trifluoperazine: A comparison between regular and high doses. Psychopharmacologia 1974;36:147-150.

66. Wirshing WC, Van Putten T, Marder SR. Clinical consequences of akinesia and akathisia. Res Clin Forums 1993;15:31-43.

67. Woerner MG, Mannuza S, Kane JM. Anchoring the BPRS: An aid to improved reliability. Psychopharmacol Bull 1988;24:112-117.

68. Yorkston NJ, Zaki SA, Pitcher DR, Gruzelier JH, Hollander D, Sergeant HGS. Propranolol as an adjunct to the treatment of schizophrenia. Lancet 1977;2:575-578.

Back to Chapter

published 2000