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Thomas A. Ban: Schizophrenia. A Psychopharmacological Approach

Thomas A. Ban:  Schizophrenia. A Psychopharmacological Approach.
Charles C. Thomas, Springfield, 1972. (134 pages)

Presented by Thomas A. Ban

INFORMATION ON CONTENTS: This monograph is divided into five chapters including Introduction (chapter 1), Drugs (chapter 2), Patients (chapter 3), Schizophrenias (chapter 4),   and Concluding Remarks (chapter 5). They are preceded by a Preface and Acknowledgments, and followed by a Bibliography, and two Indexes (Authors and Subjects). In Chapter 1 (Introduction), a brief, enthusiastic account is given for the introduction of chlorpromazine, the first neuroleptic, in the treatment of schizophrenia around the world, from 1952 to 1955. In Chapter 2 (Drugs), the neuroleptics, introduced in the treatment of schizophrenia during the 18 subsequent years and their clinical effects are discussed. During these years the number of neuroleptics rapidly grew and by 1970, there were over 20 neuroleptics in clinical use, with more or less equal overall therapeutic efficacy but without any clearly defined differential therapeutic indications.

In Chapter 3 (Patients), the emphasis shifts from drugs, to the effect of neuroleptics on Patients. Thus, information is presented on the effects of neuroleptic treatment on psychiatric hospitalization (population changes, duration of hospital stay, prevention of hospitalization) and on the behavior of patients in hospital; the effects of neuroleptics are compared to other available treatments (psychotherapies, physical therapies) for schizophrenia; and the changes affected by neuroleptics on the different psychiatric syndromes and psychopathological symptoms encountered in schizophrenic patients, are discussed. A special section is dedicated to the characterization of schizophrenic patients in the community, the primary site of treatment after the introduction of neuroleptics.

Finally, in Chapter 4 (Schizophrenias), the effects of neuroleptics on the schizophrenias are examined. In view of the pharmacological heterogeneity of responsiveness and the recognition that a patient refractory to treatment with one drug, may respond to another, the possibility is raised of using pharmacological responsiveness for classifying patients. However, attempts for grouping patients in a clinically meaningful way on the basis of their pharmacological responsiveness, have invariably failed. The same applies to the testing of biochemical hypotheses of schizophrenia which have emerged during the 1960s and’70s, such as anomalies of tryptophan metabolism, phenylalanine metabolism and transmethylation.

The monograph concludes with the sobering statement that in spite of all the changes which have been encountered during the two decades after the introduction of chlorpromazine, schizophrenia in all civilized countries have remained a major public health problem; neuroleptics have helped but did not cure schizophrenic patients. Yet, the introduction of neuroleptics brought about a new way of thinking about schizophrenia that has generated testable biochemical hypotheses about the pathomechanism of the illness.

AUTHOR’S COMMENTS: This monograph is an expansion of my Hoffman - LaRoche Lecture at the Clarke Institute of Psychiatry, presented on January 15, 1971. It is also available in Japanese in Hayime Kazamatsuri’s translation.

 

Thomas A. Ban

May 29, 2014