Sleeplessness in acute and chronic schizophrenia — Response to haloperidol and anti-Parkinsonism agents

Ten acute and seven chronic schizophrenics were longitudinally investigated in two separate double-blind studies. In both studies, after a washout and settling in period of two or more weeks, the patients were placed on placebo for about a month and then on individualized dosages of haloperidol for four months. During the haloperidol periods, the acute patients received two three-week courses of benztropine and the chronic patients, a single two-week course of trihexyphenidyl. The anti-Parkinsonism drugs were given non-blind. Nine times every night, the patients were rated for sleeplessness, and once every week they were rated for psychopathology.The results indicated that marked, predominantly early night sleeplessness was present in the patients studied. The acute subjects were more sleepless than the chronics but the pattern of sleeplessness was similar. The degree of sleeplessness seemed related to total psychopathology, hallucinations and thought disorder. No relationship was found with affective symptoms. Haloperidol reduced sleeplessness promptly and had the effect of normalizing sleep in these patients. Concurrently used anti-Parkinsonism medication seemed to have the opposite effect in chronic patients. These data did not support the notion that haloperidol was a stimulating neuroleptic, and the general distinction made between activating and sedative neuroleptics was questioned. It was suggested that the stimulating effect noticed with some neuroleptics may be attributable to the anti-Parkinsonism drugs often used with them.