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November 1989

Alprazolam Augmentation of Antipsychotic Pharmacotherapy?

Author Affiliations

University of Cincinnati Department of Psychiatry Cincinnati, OH 45267-0559

Arch Gen Psychiatry. 1989;46(11):1052. doi:10.1001/archpsyc.1989.01810110094013

To the Editor.—  Wolkowitz et al1 reported on alprazolam augmentation of antipsychotic pharmacotherapy with fluphenazine hydrochloride in a sample of 12 schizophrenic patients. Although the authors were appropriately cautious about their conclusions, we wish to raise some problematic issues regarding their methodology and the results of the study.In their reported research design, the investigators did not include a baseline period with fluphenazine alone before placebo was added. Doing so, as demonstrated in Lingjaerde's2 larger study (n = 58) of estazolam, would have screened out responders to placebo and would have added validity to the findings by concentrating on the effect of alprazolam on those patients whose conditions failed to improve with placebo. Several instruments are available that measure the positive and negative symptoms of schizophrenia specifically. The Bunney-Hamburg Scale and the Brief Psychiatric Rating Scale (BPRS), which were employed by Wolkowitz et al,1 are not among them,

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