A non-neuroleptic treatment for schizophrenia: analysis of the two-year postdischarge risk of relapse

Abstract

The efficacy of antipsychotic drug maintenance in reducing the risk of relapse among previously hospitalized schizophrenic patients has been well documented. However, data from an ongoing study comparing two cohorts of young first admission schizophrenics--one receiving neuroleptic-oriented treatment on the wards of a community mental health center (CMHC), the other an intensive interpersonal approach in a small homelike facility in the community (Soteria House)--raise questions about the routine use of neuroleptics with this population. Our questioning of this practice is based on data analyzed from these two cohorts by means of the life table, a statistical technique appropriate for longitudinal studies. Data are presented in two ways: (1) The overall effectiveness of the two independent treatment programs (Soteria, N = 32, vs. CMHC, N = 36) is compared in terms of the probabilities of not being readmitted over the 2-year postdischarge interval. (2) Analyses that look at the influence of the original treatment setting and postdischarge antipsychotic drug status on readmission rates are presented. Program comparisons reveal Soteria patients to have a consistently higher survival rate than CMHC patients throughout 2 years postdischarge. At 12 months postdischarge, the cumulative probability of remaining well (no readmissions) significantly favors the Soteria patients (p less than .05, Mantel chi2). The overall results of the Soteria program were achieved despite the fact that all CMHC patients received neuroleptics during their original inpatient stays and about 50 percent were maintained on neuroleptics up to the point of readmission or study termination, whereas only 10 percent of Soteria subjects were treated with or maintained on neuroleptics. The survival rates by postdischarge drug status and program affiliation show the Soteria no-drug group to have the highest proportion of survivors at almost every interval throughout 24 months, the CMHC drug-maintained group to have the lowest survival rate, and the CMHC unmaintained group to be surviving at a rate generally comparable to the Soteria no-drug group.