The Early Course of Schizophrenia and Long-term Maintenance Neuroleptic Therapy

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Abstract
IN THEIR computation of results across studies, Gilbert et al1 find a mean relapse rate of 53% for patients with schizophrenia participating in neuroleptic withdrawal periods in 29 studies that included matched neuroleptic withdrawal and neuroleptic maintenance groups, with average follow-up of about 10 months. The relapse rate for the matched medication maintenance groups is significantly lower, although 16% of these patients relapsed within the average follow-up period of 10 months despite continuous medication. These studies have in almost all cases involved patients who have been ill for many years, leaving unanswered many critical questions about continuous maintenance medication in the early course of a schizophrenic or schizophreniform illness. Because typical neuroleptic medications have substantial side effects, including the increasing possibility of persistent and potentially irreversible tardive dyskinesia with continued use, clinicians, patients, and their families often face very difficult decisions about long-term continuous maintenance medication in the initial