An open study was carried out on 36 therapy resistant aggressive schizophrenics. Patients were classified to two groups, the first receiving Carbamazepine (CZ), the second had Alprazolam (AZ) as an adjunct to their neuroleptics (NL). Assessment was made before and after two weeks, then six weeks after treatment, using I3rief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI).
Topographic EEG was done to all patients and in spite of non-specific changes and occasional focal abnormality, it has no relationship to the response to either CZ or AZ. The results showed significant improvement in CGI where AZ produced improvement in 57.9%, unchanged in 42.1%, and none of the cases became worse, while CZ showed 42.1%, 52.63%, and 5.27% respectively, but the differences were non significant. CZ showed better response in conceptual disorganization and unusual thoughts (p>O.O02), while AZ had a better response with hostility, suspiciousness, excitement (p>O.OOl), anxiety and depression (p>O.O3). Both drugs had a slight effect on motor retardation, withdrawal and blunted affect. The required maintenance treatment on NL was reduced by one third after four weeks of therapy with either CZ or AZ. The possible role of reducing kindling phenomena, increased Gabanergic activity and increasing NL plasma level are probable factors in ameliorating some symptoms and facilitating the response of the patients to their previous NL.
