The chronic schizophrenic who is seclusive, withdrawn, anergic, apathetic, delusional and hallucinated still presents a great challenge to psychiatry. These are the patients who compose the majority of treatment failures with psyehotropic drugs. Very often tranquilizers alone will merely make the patient more withdrawn, more disinterested and lethargic, whereas psychic energizers, especially the monoamine oxidase (MAO) inhibitors, when used alone in this type of patient, will frequently cause an exacerbation of the psychotic symptoms, the patient becoming disturbed, irritable, aggressive, and responding more actively to delusions and hallucinations. Since these patients have delusions and hallucinations, they will need a tranquilizer with a strong antipsychotic (i.e., antidelusional and anti-hallucinatory) effect and a relatively weak sedative effect. Such tranquilizers may be found in the piperazine group of phenothiazine derivatives. However, in addition to an anti-delusional and anti-hallucinatory drug the patients may require an affective stimulant to overcome their autistic withdrawal and apathy. Since the treatment must be long-term, the stimulant cannot be one to which tolerance is developed, such as, the amphetamine derivatives. The MAO inhibitors are energizers which have a potent stimulating effect and which do not produce tolerance. Although this may cause an exacerbation of the symptoms of schizophrenia, this is less common when the MAO inhibitor is combined with a tranquilizer. At present our most effective treatment for the chronic, withdrawn, disinterested schizophrenic is a combination of an anti-psychotic tranquilizer and a MAO inhibitor.
The MAO inhibitors can be divided into hydrazines, such as, iproniazid (Marsilid), isocarboxazid (Marplan), phenelzine (Nardil) and nialamide (Niamid), and non-hydrazines, such as, tranylcypromine (Parnate), and pargyline (Eutony]). These MAO inhibitors differ from each other in the potency of their clinical actions, their speed of action, and the kind and