Conventional high-dose antipsychotics tend to result in more side effects, negative
symptoms and dysphoria, and at the same time lower the cognitive function which is
already impaired in most schizophrenics. Florid psychotic symptoms, negative symptoms
and cognitive impairment greatly impede psychosocial performance and eventual
reintegration int society. The reduction of symptom and the improvement of cognitive
funtions and social skills are therefore central to the psychiatric rehabilitation process.
The purpose of this study was to evaluate the dose-reduction effects of antipsychotics
more than 1,500mg equivalent of chlorpromazine. Fifty-one chronic schizophrenics who
maintained high-does antipsychotics for more than three months were randomly
assigned to two groups : 20 patients comprised the dose-maintaining group and 31
patients made the dose-reduction group. Over a sixteen weekperiod Positive and
Negative Syndrome Scale(PANSS), Extrapyramidal Symptom(EPS), Nurses' Observation
Scale for Inpatient Evaluation(NOSIE-30), Continuous Performance Test(CPT), Quality of
Life(QOL), and haloperidol/reduced haloperidol blood levels were determined at the base
line and after 2, 4, 6, 8, 12, 16 weeks to evaluate the dose reduction effects of
high-dose antipsychotics. The results were as follows:
1) Dose-reduction is highly effective in reducing positive and negative symptoms, and
general psychopathology. Effects were most prominent at 8, 12, 16 weeks. Among the
dose reduction group, positive symptoms in positive symptom group and negative
symptoms in negative symptom group were more reduced.
2) Extrapyramidal symptoms showed no significant difference between two groups. But
EPS was reduced time after time within two groups.
3) Hit rates of Continuous Performance Test, which indicate attentional capacity,
increased significantly after dose reduction.
4) Haloperidol and reduced haloperidol blood levels decreased until the 4th week, after
which they were constant.
5) Total scores of Nurses' Observation Scale for Inpatient Evaluation were unchanged
between the two groups. But among the indices, social interest and personal neatness
were improved in the dose-reduction group and retardation was aggrevated in the
dose-maintaining group.
6) Total quality of life scores were unchanged between two groups. But in the dose
maintaining group, satisfaction scores of attention, autonomy, and interpersonal
relationship decreased progressively.
These findings suggest that the dose reduction of antipsychotics for chronic
schizophrenics on programs of high-dose antipsychotics were effective. Dose reduction
should therefore be implemanted to spread the rehabilitation and improve quality of life
for chronic schizophrenics.
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