Premorbid Adjustment, Paranoid Status, and Patterns of Response to Phenothiazine in Acute Schizophrenia

Abstract

Schizophrenia research has long been plagued by a variety of methodological problems, including, for example, lack of clear diagnostic criteria, psychopathologic heterogeneity within any sample of patients labeled "schizophrenic," and the effect of institutionallzation on experimental results. With the Introduction of the major tranquillzing agents In the early 1950's, schizophrenia research was further complicated. While a boon to patients, these widely used drugs have proven a bane to many investigators, whose experimental results have often been confounded by drug effects. Drug withdrawal during the period of study would seem to be a logical solution to this problem, but unfortunately the phenothiazines are excreted in significant amounts for some time following withdrawal-especially if the patient had been receiving drugs over a prolonged period. Moreover, drug withdrawal may result in severely disruptive behavior, making the conduct of research even more difficult. In an effort to circumvent these problems, Dr. Goldstein chose to study "the behavioral actions of phenothiazines" on schizophrenics; i.e., what are schizophrenics on drugs like? and how do they differ from those on placebo? In the research reported below, he attempted to deal with the complicating factor of previous drug intake by separately analyzing data for patients whose urine showed low or high levels of phenothiazine at admission. In the personal essay on page 38, Dr. Ban discusses several methodological "double binds" he has encountered In clinical psychopharmacological research. Together, the two authors highlight a number of important problems in schizophrenia research.-The Editors. 'Clinical ratings were not obtained in the first study.