Fluphenazine treatment in the psychotic child: clinical-evoked potential correlations.

Abstract The efficacy of fluphenazine in the treatment of the adult schizophrenic patient is widely acknowledged. It displays a wide safety margin and was found to have an excellent antipsychotic effect, especially in a high dosage range, 19, 22, 46 without producing toxicity or marked extrapyramidal side effects. 7, 25 The drug's dual mode of action—there is a stimulatory component, more prevalent in low dosages, and an inhibitory component that is more pronounced in the higher dosage range—widens its therapeutic spectrum. 13 The introduction of depot forms (fluphenazine enanthate and decanoate) has facilitated the management of the patient to a great extent. 6, 16–18 Finally, the drug's effect on the central nervous system (CNS) has also been documented extensively by means of visual and computer-analyzed awake EEG studies, 1, 2, 10, 13, 51 all-night sleep EEG studies, 14 and evoked potential investigations. 30 However, in sharp contrast to the ample knowledge we have about the fluphenazine effects on the adult psychotic patient, the information about its action in the psychotic child is rather scarce. While it is often assumed that a drug's mode of action in the adult patient is quite similar to that in children, recent investigations involving amphetamine, for instance, proved otherwise: while in adults amphetamine induces a significant latency decrease in the evoked potential, which is associated with a stimulatory effect in behavior, in hyperkinetic children a significant latency increase can be observed which is accompanied by the well-known clinical “paradoxical” tranquilizing effect. 41 Thus, in order to fill this vacuum of information about the mode of action of fluphenazine on the clinical symptomatology and brain activity in the psychotic child, the present study was carried out with a special interest in the relationship between clinical changes and alterations in the visual evoked potential (VEP) during treatment.