Schizophrenia: promising drug ... and infectious clues.

Risperidone, an antipsychotic drug approved for use in the United States beginning this year, often diminishes hallucinations, delusions, apathy and other symptoms of schizophrenia while avoiding some of the harmful and dangerous side effects caused by other antipsychotics, according to a study published in the June American Journal of Psychiatry.

In an 8-week trial, people hospitalized for schizophrenia improved substantially more on a moderate daily dose of risperidone than on either a higher daily dose of a standard antipsychotic drug, haloperidol, or an inactive placebo pill, contend psychiatrist Stephen R. Marder of the West Los Angeles Veterans Affairs Medical Center and psychopharmacologist Richard C. Meibach of the Janssen Research Foundation in Titusville, N.J. The foundation is a division of the company that markets risperidone in the United States.

Risperidone produced few tics or movement disorders, a serious problem in users of haloperidol and chemically related drugs, the researchers note. The new medication also caused no potentially fatal breakdowns in the body's immune system, an occasional reaction to the recently approved antipsychotic drug clozapine (SN: 5/23/87, p.324). However, longer studies must establish whether risperidone eventually produces such effects, Marder and Meibach note.

A total of 388 schizophrenic patients hospitalized at 20 medical centers participated in the study Similar evidence for risperidone's superiority over haloperidol and placebo emerged last year from a multicenter study in Canada.

Risperidone blocks entry points on brain cells for two chemical messengers, dopamine and serotonin. The way in which it eases schizophrenia remains unclear, however.

Another new antipsychotic medication, remoxipride, also shows promise and may become available in the United States later this year. "There is now more optimism and effort in antipsychotic drug development than at any time in history," writes John M. Kane, a psychiatrist at Long Island Jewish-Hillside Medical Center in Glen Oaks, N.Y., in an accompanying editorial.

Researchers should examine whether schizophrenic patients given these new drugs show an enhanced response to various rehabilitation services, remarks psychologist Nina R. Schooler of the University of Pittsburgh.

. . . and infectious clues

A growing number of scientists suspect that schizophrenia stems from a derailing of brain development early in life. In support of this view, researchers found that an unusually large number of adult schizophrenics in Helsinki, Finland, were in the second trimester of fetal development during the 1957 worldwide influenza epidemic (SN: 9/19/87, p.180).

The same link between the 1957 epidemic and a second-trimester risk of schizophrenia has since been noted in England, Wales, and several other countries.

Preliminary data now suggest that medically documented influenza infections occurred frequently in Helsinki women who gave birth to children later afflicted with schizophrenia, report Sarnoff A. Mednick, a psychologist at the University of Southern California in Los Angeles, and his colleagues.

Mednick's group located prenatal clinic files for 25 of 71 schizophrenia patients in the Helsinki sample. Of the 15 individuals exposed to the epidemic in the second trimester, 13 had mothers who definitely contracted influenza at that time. Of 10 patients exposed in the first or third trimesters, 2 had mothers with recorded influenza infections.

The pattern observed in this small sample requires confirmation in other populations, the scientists note in the current Schizophrenia Bulletin (vol. 20, no. 2).