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Correlation With Psychosis and Response to Neuroleptic Treatment

David Pickar, MD; Rodrigo Labarca, MD; Allen R. Doran, MD; Owen M. Wolkowitz, MD; Alec Roy, MB; Alan Breier, MD; Markku Linnoila, MD, PhD; Steven M. Paul, MD

Arch Gen Psychiatry. 1986;43(7):669-676.

Abstract
• The plasma levels of homovanillic acid (HVA), a major circulating dopamine (DA) metabolite, were measured in schizophrenic patients during five weeks each of double-blind placebo-controlled neuroleptic treatment (N =16) and withdrawal (N =11). Both neuroleptic treatment and withdrawal were associated with time-dependent changes in the plasma levels of HVA; treatment was associated with decreases and withdrawal with increases. The levels of plasma HVA measured longitudinally during both conditions were highly correlated with psychosis ratings. Moreover, changes in individual mean weekly levels of plasma HVA were predictive of treatment response, including changes in both positive and negative symptoms of schizophrenia. These data are consistent with the suggestion that the mechanisms of action of antipsychotic drugs involve, in addition to short-term DA receptor blockade, a slowly developing decrease in presynaptic DA activity.

Author Affiliations
From the Section on Clinical Studies, Clinical Neuroscience Branch, National Institute of Mental Health (Drs Pickar, Labarca, Doran, Wolkowitz, Roy, Breier, and Paul), and the National Institute on Alcohol Abuse and Alcoholism, Laboratory of Clinical Studies (Dr Linnoila), Bethesda, Md.

Footnotes
Accepted for publication Sept 6, 1985.

Reprint requests to Section on Clinical Studies, Clinical Neuroscience Branch, National Institute of Mental Health, Bldg 10, Room 4N214, 9000 Rockville Pike, Bethesda, MD 20892-1000 (Dr Pickar).

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