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Adjunctive Medication in the Maintenance Treatment of Schizophrenia and its Conceptual Implications

Published online by Cambridge University Press:  06 August 2018

Samuel G. Siris
Samuel G. Siris*
Affiliation:
Adult Psychiatric Day Programs, Hillside Hospital Division of the Long Island Jewish Medical Center, and Professor of Psychiatry, Albert Einstein College of Medicine, 75–59 263rd Street, Glen Oaks, NY 11004, USA
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Abstract

Beyond the continuing use of neuroleptic medication, psychopharmacological treatment approaches during the maintenance phase of schizophrenia often involve adjunctive medication. Appropriate use of such ‘polypharmacy’ can be crucial to patients in achieving their optimal levels of symptom management and functional capacity, although the risks of side-effects and medication interactions must be weighed. This paper reviews the use of adjunctive anti-Parkinsonian medication, benzodiazepines, propranolol, antidepressants, lithium, and carbamazepine in this context. It also explores a strategy of identifying secondary syndromes in the longitudinal course of schizophrenia which can be approached psychopharmacologically.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 163 , Issue S22: The Psychopharmacology of Schizophrenia , December 1993 , pp. 66 - 78
Copyright
Copyright © 1993 The Royal College of Psychiatrists 

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References

Adler, L., Angrist, B., Peselow, E., et al (1986) A controlled assessment of propranolol in the treatment of neuroleptic-induced akathisia. British Journal of Psychiatry, 149, 42–45.CrossRefGoogle ScholarPubMed
Adler, L., Angrist, B., Peselow, E., et al (1987a) Noradrenergic mechanisms in akathisia: treatment with propranolol and clonidine. Psychopharmacology Bulletin, 23, 21–25.Google ScholarPubMed
Adler, L., Angrist, B., Peselow, E., et al (1987b) Clonidine in neuroleptic-induced akathisia. American Journal of Psychiatry, 144, 235–236.Google ScholarPubMed
Adler, L., Angrist, B., Fritz, P., et al (1991) Lack of efficacy of d-propranolol in neuroleptic-induced akathisia. Neuropsychopharmacology, 4, 109–115.Google ScholarPubMed
Allen, R. M. (1983) Role of amantadine in the management of neuroleptic-induced extrapyramidal syndromes: overview and pharmacology. Clinical Neuropharmacology, 6 (suppl. 1), 64–73.CrossRefGoogle ScholarPubMed
Ananth, J. & Lin, K. M. (1986) Propranolol in psychiatry: therapeutic uses and side effects. Neuropsychobiology, 15, 20–27.CrossRefGoogle ScholarPubMed
Angrist, B., Peselow, E., Rubinstein, M., et al (1982) Partial improvement in negative schizophrenic symptoms after amphetamine. Psychopharmacology, 78, 128–130.CrossRefGoogle ScholarPubMed
Arana, G. W., Ornstein, M. L., Kanter, F., et al (1986) The use of benzodiazepines for psychotic disorders: a literature review and preliminary clinical findings. Psychopharmacology Bulletin, 22, 77–87.Google ScholarPubMed
Arana, G. W., Goff, D. C., Baldessarini, R. J., et al (1988) Efficacy of anticholinergic prophylaxis for neuroleptic-induced acute dystonia. American Journal of Psychiatry, 145, 993–996.Google ScholarPubMed
Atre-Vaidya, N. & Taylor, M. A. (1989) Effectiveness of lithium in schizophrenia: Do we really have an answer? Journal of Clinical Psychiatry, 50, 170–173.Google ScholarPubMed
Bailey, E. V. & Stone, J. W. (1975) The mechanism of action of amantadine in Parkinsonism: a review. Archives of International Pharmacodynamic Therapy, 216, 246–262.Google Scholar
Baker, L. A., Cheng, L. Y. & Amara, I. B. (1983) The withdrawal of benztropine mesylate in chronic schizophrenic patients. British Journal of Psychiatry, 143, 584–590.CrossRefGoogle ScholarPubMed
Barbee, J. G., Mancuso, D. M., Freed, C. R., et al (1992) Alprazolam as a neuroleptic adjunct in the emergency treatment of schizophrenia. American Journal of Psychiatry, 149, 506–510.Google ScholarPubMed
Barnes, T. R. E. (1989) A rating scale for drug-induced akathisia. British Journal of Psychiatry, 154, 672–676.Google Scholar
Barnes, T. R. E. (1990) Comment on the WHO consensus statement. British Journal of Psychiatry, 156, 413–414.CrossRefGoogle ScholarPubMed
Barnes, T. R., Curson, D. A., Liddle, P. F., et al (1989) The nature and prevalence of depression in chronic schizophrenic inpatients. British Journal of Psychiatry, 154, 486–491.CrossRefGoogle Scholar
Bartels, S. J. & Drake, R. E. (1988) Depressive symptoms in schizophrenia: comprehensive differential diagnosis. Comprehensive Psychiatry, 29, 467–483.CrossRefGoogle ScholarPubMed
Bergen, J., Kitchin, R. & Berry, G. (1992) Predictors of the course of tardive dyskinesia in patients receiving neuroleptics. Biological Psychiatry, 32, 580–594.CrossRefGoogle ScholarPubMed
Berlant, J. L. (1987) One more look at propranolol for the treatment of refractory schizophrenia. Schizophrenia Bulletin, 13, 705–714.CrossRefGoogle Scholar
Bermanzohn, P. C. & Siris, S. G. (1992) Akinesia: a syndrome common to Parkinsonism, retarded depression, and negative symptoms. Comprehensive Psychiatry, 33, 221–232.CrossRefGoogle ScholarPubMed
Bodkin, J. A. (1990) Emerging uses for high potency benzodiazepines in psychotic disorders. Journal of Clinical Psychiatry, 51 (suppl.), 41–46.Google ScholarPubMed
Bond, W. S. (1986) Psychiatric indications for clonidine: the neuropharmacologic and clinical basis. Journal of Clinical Psychopharmacology, 6, 81–87.Google Scholar
Brenner, R. & Shopsin, B. (1980) The use of monoamine oxidase inhibitors in schizophrenia. Biological Psychiatry, 15, 633–647.Google ScholarPubMed
Bucci, L. (1987) The negative symptoms of schizophrenia and the monoamine oxidase inhibitors. Psychopharmacology, 91, 104–108.Google Scholar
Calev, A. (1983) Anticholinergic drugs and memory. British Journal of Psychiatry, 143, 422–423.Google Scholar
Carlsson, A. (1988) The current status of the dopamine hypothesis of schizophrenia. Neuropsychopharmacology, 1, 179–186.Google Scholar
Carmen, J. S., Bigelow, L. B. & Wyatt, R. J. (1981) Lithium combined with neuroleptics in chronic schizophrenic and schizoaffective patients. Journal of Clinical Psychiatry, 42, 124–128.Google Scholar
Carpenter, W. T. Jr, Stephens, J. H., Rey, A. C., et al (1982) Early intervention vs. continued pharmacotherapy of schizophrenia. Psychopharmacology Bulletin, 18, 21–23.Google Scholar
Carpenter, W. T. Jr, Heinrichs, D. W. & Alphs, L. D. (1985) Treatment of negative symptoms. Schizophrenia Bulletin, 11, 440–452.CrossRefGoogle ScholarPubMed
Carpenter, W. T. Jr, Kurz, R., Kirkpatrick, B., et al (1991) Carbamazepine maintenance treatment in outpatient schizophrenics. Archives of General Psychiatry, 48, 69–72.CrossRefGoogle ScholarPubMed
Cesarec, Z. & Nyman, A. K. (1985) Differential response to amphetamine in schizophrenia. Acta Psychiatrica Scandinavica, 71, 523–538.Google Scholar
Chien, C. P., DiMascio, A. & Cole, J. D. (1974) Antiparkinson agents and depot phenothiazines. American Journal of Psychiatry, 131, 86–90.CrossRefGoogle Scholar
Chouinard, G., Annabal, L., Ross-Chouinard, A., et al (1988) A five-year prospective longitudinal study of tardive dyskinesia: factors predicting appearance of new cases. Journal of Clinical Psychopharmacology, 8, 21S–26S.CrossRefGoogle Scholar
Christison, G. W., Kirch, D. G. & Wyatt, R. J. (1991) When symptoms persist: choosing among alternative somatic treatments for schizophrenia. Schizophrenia Bulletin, 17, 217–240.Google Scholar
Cohen, W. J. & Cohen, N. H. (1974) Lithium carbonate, haloperidol and irreversible brain damage. Journal of the American Medical Association, 230, 1283–1287.Google Scholar
Cooper, T. B. (1987) Pharmacokinetics of lithium. In Psychopharmacology: the Third Generation of Progress (ed. Meltzer, H. Y.), pp. 1365–1375. New York: Raven Press.Google Scholar
Crawshaw, J. A. & Mullen, P. E. (1984) A study of benzhexol abuse. British Journal of Psychiatry, 145, 300–303.CrossRefGoogle ScholarPubMed
Csernansky, J. G., Lombrozo, L., Gulevich, G. O., et al (1984) Treatment of negative schizophrenic symptoms with alprazolam: a preliminary open-label study. Journal of Clinical Psychopharmacology, 4, 349–352.CrossRefGoogle ScholarPubMed
Csernansky, J. G., Riney, S. J., Lombrozo, L., et al (1988) Double-blind comparison of alprazolam, diazepam, and placebo for the treatment of negative schizophrenic symptoms. Archives of General Psychiatry, 45, 655–659.Google Scholar
Cutler, J. & Siris, S. G. (1991) ‘Panic-like’ symptomatology in schizophrenic and schizoaffective patients with post-psychotic depression: observations and implications. Comprehensive Psychiatry, 32, 465–473.CrossRefGoogle Scholar
Davis, J. M. (1975) Overview: maintenance therapy in psychiatry –I. Schizophrenia. American Journal of Psychiatry, 132, 1237–1245.Google ScholarPubMed
Davis, K. L., Kahn, R. S., Ko, G., et al (1991) Dopamine in schizophrenia: a review and reconceptualization. American Journal of Psychiatry, 148, 1474–1486.Google Scholar
Delva, N. J. & Letemendia, F. J. J. (1982) Lithium treatment in schizophrenia and schizoaffective disorders. British Journal of Psychiatry, 141, 387–400.CrossRefGoogle Scholar
Dilsaver, S. C. (1988) Antimuscarinic agents as substances of abuse: a review. Journal of Clinical Psychopharmacology, 8, 14–22.CrossRefGoogle ScholarPubMed
Dixon, L., Weiden, P. J., Frances, A. J., et al (1989) Alprazolam intolerance in stable schizophrenic outpatients. Psychopharmacology Bulletin, 25, 213–214.Google Scholar
Donaldson, S. R., Gelenberg, A. J. & Baldessarini, R. J. (1983) The pharmacologic treatment of schizophrenia: a progress report. Schizophrenia Bulletin, 9, 504–527.CrossRefGoogle ScholarPubMed
Dose, M., Apelt, S. & Emrich, H. M. (1987) Carbamezepine as an adjunct of antipsychotic therapy. Psychiatry Research, 22, 303–310.CrossRefGoogle Scholar
Douyon, R., Angrist, B., Peselow, E., et al (1989) Neuroleptic augmentation with alprazolam: clinical effects and pharmacokinetic correlates. American Journal of Psychiatry, 146, 231–234.Google Scholar
Dubin, W. R., Weiss, K. J. & Dorn, J. M. (1986) Pharmacotherapy of psychiatric emergencies. Journal of Clinical Psychopharmacology, 6, 210–222.CrossRefGoogle ScholarPubMed
Dumon, J.-P., Catteau, J., Lanvin, F., et al (1992) Randomized, double-blind, crossover, placebo-controlled comparison of propranolol and betaxolol in the treatment of neuroleptic-induced akathisia. American Journal of Psychiatry, 149, 647–650.Google Scholar
Fayen, M., Goldman, M. B., Moulthrop, M. A., et al (1988) Differential memory function with dopaminergic versus anticholinergic treatment of drug-induced extrapyramidal symptoms. American Journal of Psychiatry, 145, 483–486.Google Scholar
Fleischhacker, W. W., Roth, S. D. & Kane, J. M. (1990) The pharmacologic treatment of neuroleptic-induced akathisia. Journal of Clinical Psychopharmacology, 10, 12–21.Google Scholar
Galdi, J., Rieder, R. O., Silber, D., et al (1981) Genetic factors in the response to neuroleptics in schizophrenia: a pharmacogenetic study. Psychological Medicine, 11, 713–728.CrossRefGoogle Scholar
Group for the Advancement of Psychiatry (GAP) (1992) Beyond Symptom Suppression: Improving the Long-Term Outcomes of Schizophrenia. Washington, DC: American Psychiatric Press.Google Scholar
Garza-Trevino, E. S., Hollister, L. E., Overall, J. E., et al (1989) Efficacy of combinations of intramuscular antipsychotics and sedative hypnotics for control of psychotic agitation. American Journal of Psychiatry, 146, 1598–1601.Google Scholar
Gelenberg, A. J. (1987) Treating extrapyramidal reactions: some current issues. Journal of Clinical Psychiatry, 48 (suppl.), 24–27.Google Scholar
Gelenberg, A. J., Van Putten, T., Lavori, P. W., et al (1989) Anticholinergic effects on memory: benztropine versus amantadine. Journal of Clinical Psychopharmacology, 9, 180–185.CrossRefGoogle ScholarPubMed
Gerbino, L., Oleshanky, M. & Gershon, S. (1978) Clinical use and mode of action of lithium. In Psychopharmacology: a Generation of Progress (eds Lipton, M. A., DiMascio, A. & Killam, K. F.), pp. 1261–1275. New York: Raven Press.Google Scholar
Gerlach, J. & Casey, D. (1988) Tardive dyskinesia. Acta Psychiatrica Scandinavica, 77, 369–378.CrossRefGoogle ScholarPubMed
Goff, D. C., Brotman, A. W., Waites, M., et al (1990) Trial of fluoxetine added to neuroleptics for treatment-resistant schizophrenic patients. American Journal of Psychiatry, 147, 492–494.Google Scholar
Goldstein, M. J., Rodnick, E. H., Evans, J. R., et al (1978) Drug and family therapy in the aftercare of acute schizophrenics. Archives of General Psychiatry, 35, 1169–1177.CrossRefGoogle ScholarPubMed
Hakola, H. P. A. & Laulumaa, V. A. (1982) Carbamazepine in treatment of violent schizophrenics. Lancet, i, 1358.Google Scholar
Heh, C. W. C., Sramek, J., Herrera, J., et al (1988) Exacerbation of psychosis after discontinuation of carbamazepine treatment. American Journal of Psychiatry, 145, 878–879.Google Scholar
Herz, M. I., Szymanski, H. V. & Simon, J. C. (1982) Intermittent medication for stable schizophrenic outpatients: an alternative maintenance medication. American Journal of Psychiatry, 139, 918–922.Google Scholar
Herz, M. I., Glazer, W. M., Mostert, M. A., et al (1991) Intermittent vs maintenance medication in schizophrenia: two-year results. Archives of General Psychiatry, 48, 333–339.Google Scholar
Hirsch, S. R., Jolley, A. G., Barnes, T. R. E., et al (1989) Dysphoric and depressive symptoms in chronic schizophrenia. Schizophrenia Research, 2, 259–264.CrossRefGoogle ScholarPubMed
Hitri, A., Craft, R. B., Fallon, J., et al (1987) Serum neuroleptic and anticholinergic activity in relationship to cognitive toxicity of antiparkinsonian agents in schizophrenic patients. Psychopharmacology Bulletin, 23, 33–37.Google Scholar
Hogarty, G. E., Anderson, C. M., Reiss, D. J. et al (1986) Family psychoeducational, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia: I. One-year effects of a controlled study on relapse and expressed emotion. Archives of General Psychiatry, 43, 633–642.Google Scholar
House, A., Bostock, J. & Cooper, J. (1987) Depressive syndromes in the year following onset of a first schizophrenic illness. British Journal of Psychiatry, 151, 773–779.Google Scholar
Irwin, M., Sullivan, G. & Van Putten, T. (1988) Propranolol as a primary treatment of neuroleptic-induced akathisia. Hillside Journal of Clinical Psychiatry, 10, 244–250.Google Scholar
Johnson, J. M. (1984) Psychiatric uses of antiadrenergic and adrenergic blocking drugs. Journal of Nervous and Mental Disease, 172, 123–132.CrossRefGoogle ScholarPubMed
Johnson, D. A. W. (1988) The significance of depression in the prediction of relapse in chronic schizophrenia. British Journal of Psychiatry, 152, 320–323.CrossRefGoogle ScholarPubMed
Kahn, J. P., Puertollano, M. A., Schane, M. D. et al (1988) Adjunctive alprazolam for schizophrenia with panic anxiety: clinical observation and pathogenetic implications. American Journal of Psychiatry, 145, 742–744.Google Scholar
Kahn, E. M. Schulz, S. C., Perel, J. M., et al (1990) Change in haloperidol level due to carbamazepine – a complicating factor in combined medication for schizophrenia. Journal of Clinical Psychopharmacology, 10, 54–57.CrossRefGoogle ScholarPubMed
Kane, J. M. (1990) Treatment programme and long-term outcome in chronic schizophrenia. Acta Psychiatrica Scandinavica, 82 (suppl. 358), 151–157.CrossRefGoogle Scholar
Kane, J. M., Rifkin, A., Woerner, M., et al (1983) Low dose neuroleptic treatment of outpatient schizophrenics: I. Preliminary results for relapse rates. Archives of General Psychiatry, 40, 893–896.Google Scholar
Kane, J. M., Woerner, M. & Lieberman, J. (1988) Tardive dyskinesia: prevalence, incidence, and risk factors. Journal of Clinical Psychopharmacology, 8, 52S–56S.CrossRefGoogle ScholarPubMed
Karson, C. N., Weinberger, D. R., Bigelow, L., et al (1982) Clonazepam treatment of chronic schizophrenia: negative results in a double-blind, placebo-controlled trial. American Journal of Psychiatry, 139, 1627–1628.Google Scholar
Kellner, R., Wilson, R. M. Muldawer, M. D., et al (1975) Anxiety in schizophrenia: the responses to chlordiazepoxide in an intensive design study. Archives of General Psychiatry, 32, 1246–1254.Google Scholar
Kidron, R., Averbuch, I., Klein, E., et al (1985) Carbamazepine-induced reduction of blood levels of haloperidol in chronic schizophrenia. Biological Psychiatry, 20, 219–222.CrossRefGoogle ScholarPubMed
Klein, E., Bental, E., Lerer, B., et al (1984) Carbamazepine and haloperidol v. placebo and haloperidol in excited psychoses: a controlled study. Archives of General Psychiatry, 41, 165–170.CrossRefGoogle ScholarPubMed
Kragh-Sorensen, P., Borga, O., Garle, M., et al (1977) Effect of simultaneous treatment with low doses of perphenazine on plasma and urine concentrations of nortriptyline and 10-hydroxynortriptyline. European Journal of Clinical Pharmacology, 11, 479–483.CrossRefGoogle ScholarPubMed
Kramer, M. S., Gorkin, R. A., DiJohnson, C., et al (1988) Propranolol in the treatment of neuroleptic-induced akathisia (NIA) in schizophrenics: a double-blind, placebo-controlled study. Biological Psychiatry, 24, 823–827.Google Scholar
Kramer, M. S., Vogel, W. H., DiJohnson, C., et al (1989) Antidepressants in ‘depressed’ schizophrenic inpatients: a controlled trial. Archives of General Psychiatry, 46, 922–928.CrossRefGoogle ScholarPubMed
Kutcher, S., Williamson, P., Mackenzie, S., et al (1989) Successful clonazepam treatment of neuroleptic-induced akathisia in older adolescents and young adults: a double-blind, placebo-controlled study. Journal of Clinical Psychopharmacology, 9, 403–406.CrossRefGoogle Scholar
Lader, M. (1988) Beta-adrenoceptor antagonists in neuropsychiatry: an update. Journal of Clinical Psychiatry, 49, 213–223.Google Scholar
Lake, C. R., Casey, D. E. McEvoy, J. P., et al (1986) Anticholinergic prophylaxis in young adults treated with neuroleptic drugs. Psychopharmacology Bulletin, 22, 981–984.Google ScholarPubMed
Lavin, M. R., & Rifkin, A. (1991a) Prophylactic antiparkinson drug use: I. Initial prophylaxis and prevention of extrapyramidal side effects. Journal of Clinical Pharmacology, 31, 763–768.Google Scholar
Lavin, M. R., & Rifkin, A. (1991b) Prophylactic antiparkinson drug use: II. Withdrawal after long-term maintenance therapy. Journal of Clinical Pharmacology, 31, 769–777.Google Scholar
Leff, J., Tress, K. & Edwards, B. (1988) The clinical course of depressive symptoms in schizophrenia. Schizophrenia Research, 1, 25–30.CrossRefGoogle ScholarPubMed
Lerner, Y., Mintzer, Y. & Schestatzky, M. (1988) Lithium combined with haloperidol in schizophrenic patients. British Journal of Psychiatry, 153, 359–362.Google Scholar
Levi-Minzi, S., Bermanzohn, P. C. & Siris, S. G. (1991) Bromocriptine for ‘negative’ schizophrenia. Comprehensive Psychiatry, 32, 210–216.Google Scholar
Lipinski, J. F., Keck, P. E. & McElroy, S. L. (1988) Beta-adrenergic antagonists in psychosis: Is improvement due to treatment of neuroleptic-induced akathisia? Journal of Clinical Psychopharmacology, 8, 409–416.Google ScholarPubMed
Loga, S., Curry, S., & Lader, M. (1975) Interactions of orphenadrine and phenobarbitone with chlorpromazine: plasma concentration and effects in man. British Journal of Clinical Pharmacology, 2, 197–208.Google Scholar
Luchins, D. J. (1984) Carbamazepine in violent non-epileptic schizophrenics. Psychopharmacology Bulletin, 20, 569–571.Google ScholarPubMed
Manos, N., Gkiouzepas, J. & Logothetis, J. (1981a) The need for continuous use of antiparkinsonian medication with chronic schizophrenic patients receiving long-term neuroleptic therapy. American Journal of Psychiatry, 138, 184–188.Google Scholar
Manos, N., Gkiouzepas, J., Tzotzoras, T., et al (19816) Gradual withdrawal of antiparkinson medication in chronic schizophrenics: Any better than the abrupt? Journal of Nervous and Mental Disease, 169, 659–661.Google Scholar
Marder, S. R., Van Putten, T., Mintz, J., et al (1987) Lowand conventional-dose maintenance therapy with fluphenazine decanoate: two year outcome. Archives of General Psychiatry, 44, 518–521.CrossRefGoogle Scholar
McEvoy, J. P. (1987) A double-blind crossover comparison of antiparkinson drug therapy: amantadine versus anticholinergics in 90 normal volunteers, with emphasis on differential effects on memory function. Journal of Clinical Psychiatry, 48 (suppl.), 20–23.Google ScholarPubMed
McEvoy, J. P. & Freter, S. (1989) The dose-response relationship for memory impairment by anticholinergic drugs. Comprehensive Psychiatry, 30, 135–138.CrossRefGoogle ScholarPubMed
McGlashan, T. H. & Carpenter, W. T. Jr (1976) Postpsychotic depression in schizophrenia. Archives of General Psychiatry, 33, 231–239.Google Scholar
McGorry, P. D., Chanen, A., McCarthy, E., et al (1991) Posttraumatic stress disorder following recent-onset psychosis: an unrecognized postpsychotic syndrome. Journal of Nervous and Mental Disease, 179, 253–258.Google Scholar
Meltzer, H. Y. (1985) Dopamine and negative symptoms in schizophrenia: critique of the type I—II hypothesis. In Controversies in Schizophrenia (ed. Alpert, M.), pp. 110–136. New York: Guilford Press.Google Scholar
Meltzer, H. Y., Sommers, A. A. & Luchins, D. J. (1986) The effect of neuroleptics and other psychotropic drugs on negative symptoms in schizophrenia. Journal of Clinical Pscyhopharmacology, 6, 329–338.Google Scholar
Miller, F. & Menninger, J. (1987) Lithium–neuroleptic neurotoxicity is dose dependent. Journal of Clinical Psychopharmacology, 7, 89–91.CrossRefGoogle ScholarPubMed
Modell, J. G., Tandon, R. & Beresford, T. P. (1989) Dopaminergic activity of the antimuscarinic antiparkinsonian agents. Journal of Clinical Psychopharmacology, 9, 347–351.Google Scholar
Nelson, J. C. & Jatlow, P. I. (1980) Neuroleptic effect on desipramine steady-state plasma concentrations. American Journal of Psychiatry, 137, 1232–1234.Google Scholar
Neppe, V. M. (1983) Carbamazepine as adjunctive treatment in nonepileptic chronic inpatients with EEG temporal lobe abnormalities. Journal of Clinical Psychiatry, 44, 326–331.Google ScholarPubMed
Nestelbaum, Z., Siris, S. G., Rifkin, A., et al (1986) Exacerbation of schizophrenia associated with amantadine. American Journal of Psychiatry, 143, 1170–1171.Google Scholar
Nuechterlein, K. H. & Dawson, M. E. (1984) A heuristic vulnerability/stress model of schizophrenic episodes. Schizophrenia Bulletin, 10, 300–312.Google Scholar
Okuma, T., Yamashita, I., Takahashi, R., et al (1989) A double-blind study of adjunctive carbamazepine versus placebo on excited states of schizophrenic and schizoaffective disorders. Acta Psychiatrica Scandinavica, 80, 250–259.Google Scholar
Pato, C. N., Wolkowitz, O. M., Rapaport, M., et al (1989) Benzodiazepine augmentation of neuroleptic treatment in patients with schizophrenia. Psychopharmacology Bulletin, 25, 263–266.Google ScholarPubMed
Perlick, D., Stastny, P., Katz, I., et al (1986) Memory deficits and anticholinergic levels in chronic schizophrenia. American Journal of Psychiatry, 143, 230–232.Google Scholar
Potamianos, G. & Kellet, J. M. (1982) Anticholinergic drugs and memory: the effect of benzhexol on memory in a group of geriatric patients. British Journal of Psychiatry, 140, 470–472 Google Scholar
Prusoff, B. A., Williams, D. H., Weissman, M. M., et al (1979) Treatment of secondary depression in schizophrenia. Archives of General Psychiatry, 36, 569–575.Google Scholar
Pullen, G. P., Best, N. R. & Maguire, J. (1984) Anticholinergic drug abuse: A common problem? British Medical Journal, 289, 612–613.Google Scholar
Reynolds, G. P. (1989) Beyond the dopamine hypothesis: the neurochemical pathology of schizophrenia. British Journal of Psychiatry, 155, 305–316.CrossRefGoogle ScholarPubMed
Rifkin, A., Quitkin, F. & Klein, D. F. (1975) Akinesia: a poorly recognized drug-induced extrapyramidal behaviour disorder. Archives of General Psychiatry, 32, 672–674.Google Scholar
Rifkin, A., Quitkin, F., Kane, J., et al (1978) Are prophylactic antiparkinsonian drugs necessary? A controlled study of procyclidine withdrawal. Archives of General Psychiatry, 35, 483–489.Google Scholar
Roberts, K. & Vass, N. (1986) Schneiderian first-rank symptoms caused by benzodiazepine withdrawal. British Journal of Psychiatry, 148, 593–594.Google Scholar
Sachdev, P. & Lonergan, C. (1991) The present status of akathisia. Journal of Nervous and Mental Disease, 179, 381–391.Google Scholar
Salzman, C., Green, A. I., Rodriguez-Villa, F., et al (1986) Benzodiazepines combined with neuroleptics for management of severe disruptive behavior. Psychosomatics, 27 (suppl.), 17–21.Google Scholar
Sandberg, L. & Siris, S. G. (1987) ‘Panic disorder’ in schizophrenia: a case report. Journal of Nervous and Mental Diseases, 175, 627–628.CrossRefGoogle Scholar
Silver, H. & Nassar, A. (1992) Fluvoxamine improves negative symptoms in treated chronic schizophrenia: an add-on double-blind, placebo-controlled study. Biological Psychiatry, 31, 698–704.CrossRefGoogle ScholarPubMed
Simpson, G. M., Cooper, T. B., Bark, N., et al (1980) Effect of antiparkinsonian medications on plasma levels of chlorpromazine. Archives of General Psychiatry, 37, 205–208.CrossRefGoogle ScholarPubMed
Siris, S. G. (1985) Akathisia and ‘acting out”. Journal of Clinical Psychiatry, 46, 395–397.Google Scholar
Siris, S. G. (1987) Akinesia and post-psychotic depression: a difficult differential diagnosis. Journal of Clinical Psychiatry, 48, 240–243.Google Scholar
Siris, S. G. (1988) Implications of normal brain development for pathogenesis of schizophrenia (letter). Archives of General Psychiatry, 45, 1055.Google Scholar
Siris, S. G. (1990) Pharmacological treatment of substance-abusing schizophrenic patients. Schizophrenia Bulletin, 16, 111–122.CrossRefGoogle ScholarPubMed
Siris, S. G. (1991) Diagnosis of secondary depression in schizophrenia: implications for DSM–IV. Schizophrenia Bulletin, 17, 75–98.Google Scholar
Siris, S. G., Cooper, T. B., Rifkin, A. E., et al (1982) Plasma imipramine concentrations in patients receiving concomitant fluphenazine decanoate. American Journal of Psychiatry, 139, 104–106.Google ScholarPubMed
Siris, S. G., Morgan, V., Fagerstrom, R., et al (1987) Adjunctive imipramine in the treatment of post-psychotic depression: a controlled trial. Archives of General Psychiatry, 44, 533–539.CrossRefGoogle Scholar
Siris, S. G., Adan, F., Cohen, M., et al (1988) Post-psychotic depression and negative symptoms: an investigation of syndromal overlap. American Journal of Psychiatry, 145, 1532–1537.Google Scholar
Siris, S. G., Aronson, A. & Sellew, A. P. (1989a) Imipramineresponsive panic-like symptomatology in schizophrenia. Biological Psychiatry, 25, 485–488.CrossRefGoogle ScholarPubMed
Siris, S. G., Cutler, J., Owen, K., et al (1989b) Controlled trial of adjunctive imipramine maintenance in schizophrenic patients with remitted post-psychotic depressions. American Journal of Psychiatry, 146, 1495–1497.Google Scholar
Siris, S. G., Bermanzohn, P. C., Gonzalez, A., et al (1991) The use of antidepressants for negative symptoms in a subset of schizophrenic patients. Psychopharmacology Bulletin, 27, 331–335.Google Scholar
Siris, S. G., Bermanzohn, P. C., Mason, S. E., et al (1993) Maintenance imipramine therapy for secondary depression in schizophrenia. Archives of General Psychiatry (in press).Google Scholar
Small, J. G., Kellams, J. J., Milstein, V., et al (1975) A placebo controlled study of lithium combined with neuroleptics in chronic schizophrenic patients. American Journal of Psychiatry, 132, 1315–1317.Google Scholar
Spohn, H. E. & Strauss, M. E. (1989) Relation of neuroleptic and anticholinergic medication to cognitive functions in schizophrenia. Journal of Abnormal Psychology, 98, 367–380.Google Scholar
Stampfer, H. G. (1990) ‘Negative symptoms': a cumulative trauma stress disorder? Australian and New Zealand Journal of Psychiatry, 24, 516–528.Google Scholar
Strauss, M. E., Reynolds, K. S., Jayaram, G., et al (1990) Effects of anticholinergic medication on memory in schizophrenia. Schizophrenia Research, 3, 127–129.Google Scholar
Stroebel, C. F., Szarek, B. I. & Glueck, B. C. (1984) Use of clomipramine in treatment of obsessive–compulsive symptomatology. Journal of Clinical Psychopharmacology, 4, 98–100.Google Scholar
Tandon, R. & Greden, J. F. (1989) Cholinergic hyperactivity and negative schizophrenic symptoms. Archives of General Psychiatry, 46, 745–753.Google Scholar
Tune, L. & Coyle, J. T. (1980) Serum levels of anticholinergic drugs in the treatment of acute extrapyramidal side effects. Archives of General Psychiatry, 37, 293–297.Google Scholar
Tune, L. E., Strauss, M. E., Lew, M. F., et al (1982) Serum levels of anticholinergic drugs and impaired recent memory in chronic schizophrenic patients. American Journal of Psychiatry, 139, 1460–1462.Google Scholar
van Kammen, D. P. & Boronow, J. J. (1988) Dextroamphetamine diminishes negative symptoms in schizophrenia. International Clinical Psychopharmacology, 3, 111–121.CrossRefGoogle ScholarPubMed
Van Putten, T. (1975) The many faces of akathisia. Comprehensive Psychiatry, 16, 43–47.Google Scholar
Van Putten, T. & May, P. R. A. (1978) ‘Akinetic depression’ in schizophrenia. Archives of General Psychiatry, 35, 1101–1107.Google Scholar
Van Putten, T. & Marder, S. R. (1987) Behavioral toxicity of antipsychotic drugs. Journal of Clinical Psychiatry, 48 (9, suppl.), 13–19.Google Scholar
Weinberger, D. R. (1987) Implications of normal brain development for the pathogenesis of schizophrenia. Archives of General Psychiatry, 44, 660–669.Google Scholar
Wells, B. G., Marken, P. A., Rickman, L. A., et al (1989) Characterizing anticholinergic abuse in community mental health. Journal of Clinical Psychopharmacology, 9, 431–435.Google Scholar
Wise, R. A. (1982) Neuroleptics and operant behaviour: the anhedonia hypothesis. Behavioral and Brain Sciences, 5, 39–87.CrossRefGoogle Scholar
Wolkowitz, O. M., Breier, A., Doran, A., et al (1988) Alprazolam augmentation of the antipsychotic effects of fluphenazine in schizophrenic patients: preliminary results. Archives of General Psychiatry, 45, 664–671.CrossRefGoogle ScholarPubMed
Wolkowitz, O. M. & Pickar, D. (1991) Benzodiazepines in the treatment of schizophrenia: a review and reappraisal. American Journal of Psychiatry, 148, 714–726.Google Scholar
Wolkowitz, O. M., Turetsky, N., Reus, V. I., et al (1992) Benzodiazepine augmentation of neuroleptics in treatment-resistant schizophrenia. Psychopharmacology Bulletin, 28, 291–295.Google ScholarPubMed
World Health Organization (1990) Prophylactic use of anticholinergics in patients on long-term neuroleptic treatment: a consensus statement. British Journal of Psychiatry, 156, 412.Google Scholar
Yassa, R. & Dupont, D. (1983) Carbamazepine in the treatment of aggressive behavior in schizophrenic patients: a case report. Canadian Journal of Psychiatry, 28, 566–568.Google Scholar
Zemlan, F. P., Hirschowitz, J., Sautter, F. J., et al (1984) Impact of lithium therapy of core psychotic symptoms of schizophrenia. British Journal of Psychiatry, 144, 64–69.CrossRefGoogle ScholarPubMed
Zubin, J. & Spring, B. (1977) Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology, 86, 103–126.Google Scholar
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