title: Less is more Redux: Scheduled intermittent dosing to protect/prevent cognitive deterioration in schizophrenia.
abstract: We propose a strategy of scheduled intermittent dosing in place of daily administration of antipsychotic medications for the treatment of patients with schizophrenia. Intermittent (extended) dosing has already been demonstrated to be at least equally effective as daily administration of antipsychotic medications. It is increasingly appreciated that remission of positive symptoms is not the same as recovery: a resumption of a productive and socially gratifying life. Our field has focused on positive symptoms to the exclusion of cognitive deterioration and emotional blunting. Dopamine is the primary neurotransmitter responsible for the accumulation and processing of new information as well as the expression of emotions modulated via the nucleus accumbens. Data suggests that patients receiving less accumulated antipsychotic agents do better over the years in achieving meaningful recoveries. In addition to clinical improvement, there is the financial benefit in giving less medication, which is often costly, over several decades. Finally, there is the possibility, albeit not yet demonstrated, that less accumulated antipsychotic agents might reduce the occurrence of significant weight gain, the metabolic syndrome, with its accompanying medical complications which not only impacts the quality of life and life expectancy of those who suffer from it, but also increases the financial burden to society.
authors.affiliation: Harvard Medical School, Dept. of Psychiatry, Laboratory of Clinical and Experimental Psychopathology, John C Corrigan Mental Health Center, 49 Hillside Street, Fall River, MA 02720, United States. Electronic address: roger.boshes@dmh.state.ma.us.
authors.forename: R A
authors.initials: RA
authors.lastname: Boshes
authors.affiliation: Harvard Medical School, Dept. of Psychiatry, Laboratory of Clinical and Experimental Psychopathology, John C Corrigan Mental Health Center, 49 Hillside Street, Fall River, MA 02720, United States; Mass Gen Hosp Outpatient Psych, 15 Parkman St # Wac, Boston, MA 02114, United States.
authors.forename: T C
authors.initials: TC
authors.lastname: Manschreck
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D003072:Cognition Disorders / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control; D018450:Disease Progression; D004298:Dopamine / Q000502:physiology; D018492:Dopamine Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D006801:Humans; D011954:Receptors, Dopamine / Q000187:drug effects; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy*; D012565:Schizophrenic Psychology
chemical_list: D014150:Antipsychotic Agents; D018492:Dopamine Antagonists; D011954:Receptors, Dopamine; D004298:Dopamine