Dysphoric response to neuroleptic treatment in schizophrenia: its relationship to autonomic arousal and prognosis.

Longitudinal pharmacotherapeutic data from 58 schizophrenic patients suggest that the emergence of a dysphoric state, characterized by a combination of anxiety, depression, and accusatoriness, early in the course of neuroleptic treatment augurs poor therapeutic outcome and is associated with an unfavorable prognostic classification and a tendency for autonomic arousal to increase with treatment from a drug-free base line somewhat higher than normal. These associations particularly characterized the nonparanoid schizophrenics with nuclear prognostic classification and poor short-term as well as long-term therapeutic outcome; they did not apply to the paranoids. The dysphoric response was unrelated to base-line dysphoria or to the extrapyramidal reactions to neuroleptic medication, and seemed to reflect some basic biological differences between the poor prognosis nonparanoid, the good prognosis nonparanoid, and the paranoid schizophrenics.