Carbamazepine in nonresponsive psychosis

Nonresponsive psychosis encompasses heterogeneous psychotics who are symptomatic despite adequate trials of neuroleptic medication. A proportion of those patients are schizophrenic. A second subgroup are symptomatic in that they have specific target features. The use of carbamazepine is discussed in the context of searching for active target symptoms and features that may imply its appropriate application as adjunctive medication in nonaffective, nonepileptic psychotics. Despite a dearth of studies in the literature, two studies, those of Neppe and of Klein, appear to be of theoretical relevance and are used as starting points to compare the other blind and nonblind literature available. It appears that carbamazepine is worthwhile in patients with some aggression and interpersonal difficulties who are refractory to neuroleptics alone and who exhibit instability and agitation. The role of temporal-lobe symptomatology and temporal-lobe foci is unclear, and the mechanism of action of carbamazepine is apparently not directly antipsychotic and may relate to an antikindling-like mechanism. The role of psychodynamics should not, however, be ignored. A great deal more research is required.