[Principles of chemotherapy of paranoid schizophrenia]

The pharmacological treatment for paranoid schizophrenia is based on antipsychotic drugs. Their actions is only suspensive but not curative. In 1980 Crow proposed a division of schizophrenia in two major syndromes, type 1 being characterized by prominent positive symptoms. Andreasen in 1982 suggested similar criteria for positive subtype. Many others have described schizophrenia subtypes over the years. The paranoid schizophrenia criteria are very close to Crow's type 1 criteria. Since chlorpromazine was synthetized in France in 1952, the French speaking psychiatrists have classified neuroleptics according to their therapeutic efficacy and their side effects. So Deniker and Ginestet categorized neuroleptics on the basis of their behavioural efficacy and distinguished sedative neuroleptics from anti-delusional neuroleptics and anti-autistic neuroleptics. French psychiatrists consider that there are qualitative differences between various neuroleptics. In USA, equivalent doses are established with chlorpromazine for many neuroleptic drugs, but equivalency doses are considered as crude at best by some, such as J.M. Kane. The typical neuroleptic treatment is reviewed: target symptoms, choice of drug, dosage, route of administration, combined medications, predictive clinical and biological parameters of response, duration of treatment. Failure to response to neuroleptic treatment is not uncommon. Some strategies are detailed for the treatment-resistant patients. Combination of neuroleptics like haloperidol + thioproperazine or haloperidol + trifluoperazine may be useful.(ABSTRACT TRUNCATED AT 250 WORDS)