posted on 2013-11-19, 00:00authored byM. Harrow, T. H. Jobe, R. N. Faull
Background. The prevailing standard of care in the field involves background assumptions about the importance of
prolonged use of antipsychotic medications for all schizophrenia (SZ) patients. However, do all SZ patients need
antipsychotics indefinitely ? Are there factors that help to identify which SZ patients can enter into prolonged periods
of recovery without antipsychotics ? This 20-year longitudinal research studied these issues.
Method. A total of 139 early young psychotic patients from the Chicago Follow-up Study, including 70 patients with
SZ syndromes and 69 with mood disorders, were assessed, prospectively, at the acute phase and then followed up
six times over the next 20 years. Patients were assessed with standardized instruments for major symptoms,
psychosocial functioning, personality, attitudinal variables, neurocognition and treatment.
Results. At each follow-up, 30–40% of SZ patients were no longer on antipsychotics. Starting at the 4.5-year
follow-ups and continuing thereafter, SZ patients not on antipsychotics for prolonged periods were significantly less
likely to be psychotic and experienced more periods of recovery ; they also had more favorable risk and protective
factors. SZ patients off antipsychotics for prolonged periods did not relapse more frequently.
Conclusions. The data indicate that not all SZ patients need treatment with antipsychotics continuously throughout
their lives. SZ patients not on antipsychotics for prolonged periods are a self-selected group with better internal
resources associated with greater resiliency. They have better prognostic factors, better pre-morbid developmental
achievements, less vulnerability to anxiety, better neurocognitive skills, less vulnerability to psychosis and experience
more periods of recovery.
Funding
This work was supported, in part, by United States
Public Health Service (USPHS) grants MH-26341 and
MH-068688 from the National Institute of Mental
Health, USA