The radioreceptor assay for the measurement of neuroleptic drugs in serum has been used to study the relationship between dose and serum level in schizophrenic patients receiving these drugs. The assay was found to be reproducible and capable of detecting neuroleptics in the sera of patients receiving a range of both oral and depot drugs, with the exception of trifluoperazine spansules. Linear correlations were obtained between daily dose and serum level for each drug both in individual patients on different doses and between patients on a stable dose. Extrapyramidal side effects were related to the serum neuroleptic level within, but not between, patients. The assay may be of use in clinical practice, including the assessment of compliance or poor response to neuroleptics.

This double-blind, placebo-controlled study investigated the effect of discontinuation of maintenance neuroleptic medication in chronic, long-stay schizophrenic patients who had been clinically stable for over 5 years, After 12 months, 75 per cent of the patients on placebo had relapsed as compared to 33 per cent on active medication and relapses in the placebo group occurred significantly earlier during the study; survival analysis revealed the differences to be statistically significant. No clear predictors of relapse could be identified, although patients who relapsed from either group were more likely to have had higher scores for anxiety symptoms and a lower serum prolactin level at baseline. It was concluded that even in older patients who have been chronically ill with prominent negative symptoms and living in a relatively undemanding environment on stable doses of neuroleptics, the risk of relapse remains unacceptably high after abrupt withdrawal of maintenance neuroleptic therapy.KEY WORDS-chronic schizophrenia, neuroleptic withdrawal, relapse, serum neuroleptic levels.

This study investigated the effects of transferring patients on combined depot and oral neuroleptics to a single depot preparation; a secondary objective was to assess the effects of transferring patients from one depot neuroleptic to another. It was found that, whereas transferring from one depot preparation (flupenthixol) to another (fluphenazine) had no clear disadvantage for the patients, changing over from a combined oral and depot (fluphenazine) regimen to equivalent doses of depot alone resulted in an unacceptably high rate of relapse. The reasons for this may relate to either the unique pharmacokinetics of these drugs or subtle qualitative differences between them. It is suggested that caution is necessary whenever attempts are made to rationalize polypharmacy in schizophrenic patients.

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