Benzodiazepines in the Treatment of Schizophrenia: A Review and Reappraisal

Objective: Benzodiazepines, either alone or added to neuroleptics, have been studied extensively as treatments for schizophrenia, but no consensus regarding their efficacy has been reached. The authors review the double-blind trials in the literature and relate the findings to the neurobiology ofbenzodiazepine actions. Method: The clinical review included all double-blind studies through 1 989 that could be identified by means of Index Medicus and computer-assisted searches and by the cross-referencing ofarticles. The findings from the 1 4 studies of benzodiazepines used alone and the 1 6 studies of adjunctive therapy are presented separately. Results: The studies reviewed suggest that 1) response is highly van-able, and about one-third to one-halfofpatients improve; 2) benzodiazepines are potentially most useful as adjuncts to neuroleptics in the acute management of psychotic agitation, although actual antipsychotic effects have also been observed in some patients; 3) relatively higher doses of benzodiazepines may be associated with better response; and 4) therapeutic effects, when seen, develop rapidly but diminish after several weeks in some patients. The authors explore the neurobiological bases of benzodiazepine action, which presumably un-denlie their efficacy in schizophrenia and may help explain the variability of response. &amp