Sir
We were impressed by the results with Divalproex combined with olanzapine or risperidone in patients with an acute exacerbation of schizophrenia. One of us (MBI) runs a locked, male-only, ten-bedded, psychiatric intensive care unit, and often uses the combination of sodium valproate (mean dose, 1200–2000 mg per day in divided doses) and atypical antipsychotic drug. We are currently engaged in an open label study in the unit to try to analyze individual predictors of response to antipsychotic medication. Patients give informed consent to the use of the data when they have the capacity to do so. The study is ongoing, with annual interim reports. The unit has a combination of forensic patients waiting for placement in high security and they are not included in the analysis. The patients are detained against their will under the UK Mental Health Act (1983). The patients may appeal against detention through independent Mental Health Review Tribunals as well as to the board of managers of the hospital. Patients are transferred to an ‘open’ psychiatric ward if they are settled enough to be managed in such a setting, or the appeal tribunal so directs. Of 57 patients admitted to my unit over the past year, 30 male patients with a diagnosis of schizophrenia (ICD-10) consented to take part in the study. We used the Brief Psychiatric Rating Scale (BPRS, Overall JE and Gorham DR (1988). Psychopharmacol Bull 24: 97–99), and the Temperament & Character Inventory (TCI-240, Cloninger R (1987). Arch. Gen Psychiatry 44: 573–588) instruments in the assessment. We tabulate the results as follows:
