Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-28T03:46:54.882Z Has data issue: false hasContentIssue false

III. Relapse Postponement or Relapse Prevention? The Implications for Long-term Outcome

Published online by Cambridge University Press:  29 January 2018

D. A. Curson*
Affiliation:
Bowden House Clinic, London Road, Harrow on the Hill, Middlesex H Al 3JL and Department of Psychiatry, Guy's Hospital Medical School, London
T. R. E. Barnes
Affiliation:
Department of Psychiatry, St George's Hospital Medical School, London
R. W. Bamber
Affiliation:
Department of Psychiatry, Guy's Hospital, London
S. D. Platt
Affiliation:
MRC Unit for Epidemiological Studies in Psychiatry, Royal Edinburgh Hospital, Edinburgh
S. R. Hirsch
Affiliation:
Charing Cross Hospital Medical School, London
J. C. Duffy
Affiliation:
Department of Statistics, University of Edinburgh, Edinburgh (From The Academic Unit for Clinical Psychopharmacology, Guy's Hospital Medical School, London)
*
Correspondence

Summary

The relapse and admission histories revealed a positive correlation between number of schizophrenic episodes and time on maintenance medication, probably reflecting severity of illness. Relapse rates after drug discontinuation rose to 45% within 13 months. There were no differences of predictive value between those relapsing on or off medication. The relationship between relapse rates, drug treatment, and social outcome is complex; antipsychotic drugs may postpone relapse, and frequent relapses might inhibit improvement in social performance long after florid symptoms have been controlled by medication.

Type
Long-term Depot Maintenance of Chronic Schizophrenic Out-patients: The Seven Year Follow-up of the Medical Research Council Fluphenazine/Placebo Trial
Copyright
Copyright © 1985 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ayd, F. J. (1961) A survey of drug-induced extra-pyramidal reactions. Journal of the American Medical Association, 175, 10541060.Google Scholar
Barnes, T. R. E. Milavich, G., Curson, D. A. & Platt, S. D. (1983) Use of the Social Behaviour Assessment Schedule (SBAS) in a trial of maintenance antipsychotic therapy in schizophrenic out-patients: pimozide versus fluphenazine. Social Psychiatry, 18, 193199.Google Scholar
Bennett, D. H. (1978) Community Psychiatry. British Journal of Psychiatry, 132, 209.Google Scholar
Blackwell, B. & Shepherd, M. (1968) Prophylactic lithium: another therapeutic myth? Examination of evidence to date. Lawet i, 968971.Google Scholar
Bleuler, M. (1974) The long-term course of the schizophrenic psychoses. Psychological Medicine, 4, 244254.Google Scholar
Brockingion, I. F., Kendell, R. E. & Leff, J. P. (1978) Definitions of schizophrenia: concordance and prediction of outcome. Psychological Medicine. 8, 387398.Google Scholar
Capstick, N. (1980) Long-term Fluphenazine decanoate maintenance requirements of chronic schizophrenic patients. Acta psychiatrica scandinavica. 61, 256262.Google Scholar
Carpenter, W. T., Bartko, J. J., Carpenter, C. L. & Strauss, J. L. (1976) Another view of schizophrenic sub-types. Archives of General Psychiatry. 33, 508516.Google Scholar
Cheadle, A. J., Freeman, H. L. & Korer, J. (1978) Chronic schizophrenic patients in the community. British Journal of Psychiatry, 132, 221227.Google Scholar
Cheadle, A. J. & Korer, J. R. (1979) A method for monitoring the care of schizophrenics in the community. British Journal of Psychiatry, 134, 412418.Google Scholar
Cheung, H. K. (1981) Schizophrenics fully remitted on neuroleptics for 3–5 years – to stop or continue drugs? British Journal of Psychiatry. 138, 490494.Google Scholar
Cooper, J. E., Kendell, R. E., Gurland, B. J., Sharpe, L., Copeland, J. R. M. & Simon, R. (1972) Psychiatric Diagnosis in New York and London. London: Oxford University Press.Google Scholar
Crumpton, N. (1968) The role of drugs in maintaining patients in the community. In: Treatment of Mental Disorders in the Community. (ed. Daniel, G. R. & Freeman, H. L.). London: Bailliere Tindall.Google Scholar
Curson, D. A. (1980) Current trends in the medical treatment of schizophrenia. In: Current Trends in Treatment in Psychiatry, (ed. Tennent, T. G.). London: Pitman Medical.Google Scholar
Daniel, G. R. (1968) Social and economic effects of long-acting phenothiazines. British Journal of Social Psychiatry, 2, 167169.Google Scholar
Davis, J. M. (1975) Overview: Maintenance therapy in psychiatry: I. Schizophrenia. American Journal of Psychiatry. 132, 12371245.Google Scholar
Davis, J. M. (1976) Recent developments in the drug treatment of schizophrenia. American Journal of Psychiatry, 133, 2, 208214.Google Scholar
Dencker, S. J. Leep, M. & Malm, U. (1980) Do schizophrenics well-adapted in the community need neuroleptics? A depot neuroleptic withdrawal study. Acta Psychiatrica Scandinavica 279, (suppl) 6476.Google Scholar
Denham, J. & Adamson, L. (1971) The contribution of fluphenazine enanthate and decanoate in the prevention of readmission of schizophrenic patients. Acta psychiatrica scandinavica, 47, 420.Google Scholar
Englehardt, D. M. & Freedman, N. (1970) Maintenance drug therapy: schizophrenic patients in the community. In Social Psychiatry Vol 1. Ed. Kiev, Avi. London: Routledgc & Kegan Paul.Google Scholar
Falloon, I., Watt, D. C. & Shepherd, M. (1978) A comparative trial of pimozide and fluphenazine decanoate in continuation therapy of schizophrenia. Psychological Medicine. 8, 5970.Google Scholar
Forrest, A. D. & Hay, A. J. (1973) The Schizophrenias: operational definition. British Journal of Medical Psychology, 46, 337346.Google Scholar
Freeman, H. L. (1983) Concepts of community psychiatry. British Journal of Hospital Medicine, 30, 2 9096.Google Scholar
Freeman, H. L. Cheadle, A. J. & Korer, J. R. (1979) A method for monitoring the treatment of schizophrenia in the community. British Journal of Psychiatry, 134, 412416.Google Scholar
Gardos, G. & Cole, J. O. (1976) Maintenance antipsychotic therapy: is the cure worse than the disease? American Journal of Psychiatry, 133, 3236.Google Scholar
Goldberg, D. (1974) Principles of rehabilitation. Comprehensive Psychiatry, 15, 237248.Google Scholar
Hay, A. J. & Forrest, A. D. (1972) The diagnosis of schizophrenia and paranoid psychosis: an attempt at classification. British Journal of Medical Psychology, 45, 233241.Google Scholar
Helmchen, H. & Hippius, H. (1967) Depressive Syndrome im Verlauf neuroleptischer Therapie. Nervenarzt, 38, 445461.Google Scholar
Hirsch, S. R. (1980) Current trends in the medical treatment of schizophrenia. In Current Trends in Treatment in Psychiatry (ed. Tennent, T. G.). London: Pitman Medical.Google Scholar
Hirsch, S. R. Gaind, R., Rohde, P. D., Stevens, B. C. & Wing, J. K. (1973) Out-patient maintenance of chronic schizophrenic patients with long-acting fluphenazine: Double-blind placebo trial. British Medical Journal, i, 633637.Google Scholar
Hogarty, G., Goldberg, S., Schoder, N. & Ulrich, R. (1974) Drug and sociotherapy in the after-care of schizophrenic patients. II Two year relapse rates. Archives of General Psychiatry, 31, 603609.Google Scholar
Hogarty, G. Ulrich, R. F., Mussare, F. & Aristigueta, N. (1976) Drug discontinuation among long-term successfully maintained schizophrenic outpatients. Diseases of the Nervous System, 57, 494500.Google Scholar
Hollister, L. (1978) “Psychopharmacology”. In: Schizophrenia, Science and Practice. Ch. 5. (ed. Shershaw, J.). Cambridge, Mass: Harvard University Press.Google Scholar
Johnson, D. A. W. (1976) The expectation of outcome for maintenance therapy in chronic schizophrenia. British Journal of Psychiatry, 128, 246250.Google Scholar
Johnson, D. A. W. (1978) Prevalence and treatment of drug induced extrapyramidal symptoms. British Journal of Psychiatry, 132, 2730.Google Scholar
Johnson, D. A. W. (1979a) Further observations on the duration of depot neuroleptic maintenance therapy in schizophrenia. British Journal of Psychiatry, 135, 524530.Google Scholar
Johnson, D. A. W. (1979b) Clinical considerations in the use of depot neuroleptics for the treatment of schizophrenia; In: Management of Schizophrenia: Biological and Sociological Aspects, (ed. Van Praag, H. M.). Assen: Van Gorcum.Google Scholar
Johnson, D. A. W. (1981) Studies of depressive symptoms in schizophrenia. British Journal of Psychiatry, 139, 89101.Google Scholar
Johnson, D. A. W. (1982) Haloperidol decanoate and the treatment of chronic schizophrenia. In Therapeutics Today Vol. 2. (ed. Johnson, D. A. W.). New York: Adis Press.Google Scholar
Johnson, D. A. W. & Freeman, H. L. (1972) The long-acting tranquillizers. Practitioner, 208, 395402.Google Scholar
Johnson, D. A. W. (1973) Drug defaulting by patients on long-acting phenothiazines. Psychological Medicine, 3, 115119.Google Scholar
Jus, A., Pineau, R., Lachance, R., Pelchat, G., Jus, K., Pirks, P. & Villeneuve, R. (1976) Epidemiology of tardive dyskinesia. Part 1 Diseases of the Nervous System, 37, 210214.Google Scholar
Kane, J. M. (1981) Low dose neuroleptics in outpatient schizophrenics. In 3rd World Congress of Biological Psychiatry, Stockholm, S181.Google Scholar
Kane, J. M. Rikkin, A., Ouitkin, F., Nayak, D. & Saraf, K. (1979) Low dose fluphenazine decanoate in maintenance treatment of schizophrenia. Psychiatry Research, 1, 341345.Google Scholar
Kennedy, P. F., Hershon, H. I. & McGuire, R. G. (1971) Extrapvramidal disorders after prolonged phenothiazine therapy. British Journal of Psychiatry, 118, 509518.Google Scholar
Kidger, T., Barnes, T. R. E. Trauer, T. & Taylor, P. J. (1980) Sub-syndromes of tardive dyskinesia. Psychological Medicine, 10, 513520.CrossRefGoogle ScholarPubMed
Knights, A., Okasha, M. S., Salih, M. A. & Hirsch, S. R. (1979) A trial of Fluphenazine versus flupenthixol in maintenance of schizophrenic outpatients. British Journal of Psychiatry, 135, 515523.Google Scholar
Knights, A. & Hirsch, S. R. (1981) “Revealed” depression and drug treatment for schizophrenia. Archives of General Psychiatry, 38, 806811.Google Scholar
Kraepelin, E. (1919) “Dementia praecox and paraphrenia” (Trans R. M. Barclay from 8th Edition of “Psychiatrie“ Barth, Leipzig) Edinburgh: Livingstone.Google Scholar
Leff, J. P. & Wing, J. K. (1971) Trial of maintenance therapy in schizophrenia. British Medical Journal, 3, 559604.Google Scholar
Light, R. J. & Margolin, B. H. (1971) An analysis of variance for categorical data. Journal of the American Statistical Association, 66, 534544.Google Scholar
Margolin, B. H. & Light, R.J. (1974) An analysis of variance for categorical data II. Journal of the American Statistical Association, 69, 755764.Google Scholar
Markowe, M., Steinert, J. & Heyworth-Davis, F. (1967) Insulin and chlorpromazine in schizophrenia: A ten year comparative survey. British Journal of Psychiatry, 113, 11011106.Google Scholar
Mindham, R. I., Gaind, R. & Anstee, B. H. (1972) Comparison of orphenadrine and placebo on the control of phenothiazine-induced parkinsonism. Psychological Medicine, 2, 406413.CrossRefGoogle ScholarPubMed
Nie, N. H., Hull, C. H., Jenkins, J. G., Steinbrenner, K. & Bent, D. H. (1975) Statistical Package for the Social Sciences (SPSS) 2nd ed. New York: McGraw Hill.Google Scholar
Oldham, A. J. (1969) Community Psychiatry in London: A three year analysis. British Journal of Psychiatry, 115, 465.Google Scholar
Pasamanick, B., Scarpitti, F. R., Lefton, M., Dinitz, S., Wernert, J. J. & McPheeters, H. (1964) Home vs. hospital care for schizophrenics. Journal of the American Medical Association, 187, 177181.Google Scholar
Platt, S., Weyman, A., Hirsch, S. R. & Hewett, S. (1980) The Social Behaviour assessment Schedule (SBAS): Rationale, Contents, scoring and reliability of a new interview schedule. Social Psychiatry, 15, 4355.Google Scholar
Platt, S. Hirsch, S. & Weyman, A. (1983) Social Behaviour Assessment Schedule (SBAS) Third Edition. Windsor: NFER-Nelson.Google Scholar
Rasmussen, O. S. (1970) Fluphenazine enanthate in sesame oil: a depot preparation. Acta Psychiatrica Scandinavica, 46, 311357.Google Scholar
Rifkin, A., Ouiticin, F. & Klein, D. F. (1975) A poorly-recognised drug-induced extrapyramidal behavioural disorder. Archives of General Psychiatry, 32, 672674.Google Scholar
Rifkin, A., Ouiticin, F. & Rabiner, C. J. (1977) Fluphenazine decanoate, fluphenazine hydrochloride, and placebo in remitted schziophrenics. Relapse rates after one year. Archives of General Psychiatry, 34, 4347.Google Scholar
Shakow, D. (1977) On doing research in Schizophrenia. Psychological Issues, 10, 155207.Google Scholar
Stevens, B. C. (1973) Role of Fluphenazine decanoate in lessening the burden of chronic schizophrenics in the community. Psychological Medicine, 3, 141158.Google Scholar
Sturt, E., Wykes, T. & Creer, C. (1982) 1. Demographic, social, and clinical characteristics of the sample. In Psychological Medicine, Supplement 2.Google Scholar
Strauss, J. S. & Carpenter, W. T. (1972) The prediction of outcome in schizophrenia: characteristics of outcome. Archives of General Psychiatry, 27, 739746.Google Scholar
Strauss, J. S. & Carpenter, W. T. (1974) Characteristic symptoms and outcome in schizophrenia. Archives of General Psychiatry, 30, 429434.Google Scholar
Strauss, J. S. & Carpenter, W. T. (1977) Prediction of outcome in schizophrenia. Archives of General Psychiatry, 34, 159163.Google Scholar
van Praag, H. M. (1976) About the impossible concept of schizophrenia. Comprehensive Psychiatry, 17, 481497.Google Scholar
van Putten, T. & May, P. R. A. (1978) “Akinetic” depression in schizophrenia. Archives of General Psychiatry, 35, 11011107.Google Scholar
Vaughn, C. E. & Leff, J. P. (1976) The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry, 129, 125137.Google Scholar
Wing, J. K. (1961) A simple and reliable sub-classification of chronic schizophrenia. Journal of Mental Science, 107, 862875.Google Scholar
Wing, J. K. & Brown, G. W. (1970) Institutionalism and Schizophrenia. Cambridge: Cambridge University Press.Google Scholar
Wing, J. K. Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
Wistedt, B. (1981) A depot neuroleptic withdrawal study. Acta Psychiatrica Scandinavica, 64, 6584.Google Scholar
World Health Organisation (1973) The International Pilot Study of Schizophrenia. Volume 1 Geneva: WHO.Google Scholar
World Health Organisation (1980) Changing Patterns in Mental Health Care. Copenhagen: WHO.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.