Concentrations of monoamine metabolites and chlorpromazine in cerebrospinal fluid for prediction of therapeutic response in psychotic patients treated with neuroleptic drugs.

Concentrations of the major monoaminergic transmitter metabolites HVA, MOPEG and 5-HIAA were determined in the cerebrospinal fluid (CSF) of untreated schizophrenic patients. Patients with aberrated concentrations of 5-HIAA and HVA in CSF had schizophrenia in their families in a frequency significantly higher than that of patients with normal concentrations. These results may indicate the existence of a subgroup of schizophrenic patients having a family disposition for the disorder and an aberrated transmission from central serotonin and dopamine neurons. In young healthy volunteers, aberrated monoamine metabolite concentrations in CSF were also related significantly to a history of psychiatric morbidity in the family. In psychotic patients treated with chlorpromazine significant correlations were obtained between therapeutic outcome on the one hand, and both biochemical effects related to central monoamine metabolism and chlorpromazine concentrations in the CSF on the other hand. Patients with chlorpromazine concentrations above 1 ng/ml in CSF or 40 ng/ml in plasma responded more favourably than patients with concentrations below those levels. The results indicate that biochemical and pharmacokinetic data may be of value for diagnostic classification and prediction of therapeutic outcome in drug-treated schizophrenic patients.