Bromocriptine for "negative" schizophrenia

The hypothesis that the pathophysiology of negative symptoms in schizophrenia may involve relative hypoactivity of central dopaminergic neurotransmission prompts the exploration of dopamine agonist strategies in the treatment of this condition. Although the use of dopamine agonists in otherwise unmedicated schizophrenic patients often leads to the exacerbation of psychosis, trials of dopamine agonists in combination with neuroleptic agents warrant investigation. We therefore report on open clinical experience involving six patients with chronic negative symptoms of schizophrenia, maintained on neuroleptic medication, who appeared to have favorable responses to the addition of moderate doses of bromocriptine (10 to 20 mg/d orally in divided doses). One particular factor that makes these trials potentially informative is that five of the six patients had failed to respond to standard treatments with anticholinergic antiparkinsonian medication before the bromocriptine trial, making it unlikely that the bromocriptine had its effect purely by counteracting neuroleptic-induced akinesia. A trial of bromocriptine under these circumstances has never been reported. A second unique feature of this report concerns the lengthy period of follow-up. Adjunctive bromocriptine was continued for a total of 27 patient-years in the six individuals, with maintenance of favorable course and minimal incidence of psychotic exacerbation.