Galantamine for Treatment-Resistant Schizophrenia

Mr. A was a 28-year-old man with persistent auditory hallucinations and persecutory delusions who had been given repeated placement in the community, but these efforts had failed because of frequent episodes of agitation, threatening behavior, and destruction of property that seemed to be driven by paranoia and his hearing “voices.” Galantamine was introduced and brought to an oral dose of 8 mg b.i.d. over 2 weeks. The episodes of agitation disappeared, and Mr. A became more capable of sustained routine conversation in which he could rationally evaluate his psychopathology. After an additional 2 weeks of treatment, he was successfully placed in a group home, where he has continued to do well for 2 months.

Mr. B was a 53-year-old man with profoundly disorganized thoughts and poor self-care, including wearing multiple layers of clothing inside out and backward. He repeatedly wandered away from the group home where he had been placed. Galantamine treatment was initiated and brought to an oral dose of 12 mg b.i.d. Mr. B’s thoughts became more organized. He wore his clothes correctly and was more social with staff and other patients. Staff at the group home report that since returning there, he no longer wanders away and, in fact, signs out when taking local walks. He remains more social and has maintained clearly improved dressing and hygiene.