Skip to main content
The BMJ logoLink to The BMJ
. 1990 Oct 13;301(6756):837–842. doi: 10.1136/bmj.301.6756.837

Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenic outpatients: clinical and social outcome at two years.

A G Jolley 1, S R Hirsch 1, E Morrison 1, A McRink 1, L Wilson 1
PMCID: PMC1663999  PMID: 2282421

Abstract

OBJECTIVE--To evaluate a novel approach to the prophylaxis of schizophrenic relapse characterised by administration of brief courses of neuroleptic for the earliest non-psychotic signs of relapse (prodromal symptoms). DESIGN--Two year follow up of subjects randomised, double blind, to receive either active (control group) or placebo (intermittent group) depot neuroleptic medication. Both groups received brief courses of oral neuroleptic when prodromal symptoms or relapse occurred. SETTING--Psychiatric outpatient department, Charing Cross Hospital, London. SUBJECTS--54 Stable patients in remission who met the American Psychiatric Association's DSM-III criteria for schizophrenia on the basis of case notes. MAIN OUTCOME MEASURES--Survival without relapse, survival without hospitalisation, point prevalence of extrapyramidal side effects and tardive dyskinesia, structured assessment of social functioning (social adjustment scale II), and frequency of prodromal symptoms. RESULTS--Of 19 relapses recorded over two years, 10 (53%) were preceded by non-psychotic prodromal signs. Survival rates for both relapse and hospitalisation were worse with intermittent treatment than continuous treatment over the two year follow up: 92% of controls and only 54% of patients given intermittent treatment survived the two year period without hospitalisation. Prolonged or frequent relapses as well as episodes of prodromal symptoms were more frequent with intermittent treatment. Lower scores for extrapyramidal side effects were recorded in the intermittent treatment group, but periodic assessments of social functioning failed to show any social advantages from this. CONCLUSION--The findings are at variance with a previous report of one year follow up in this cohort and attest to the superiority of continuous depot neuroleptic prophylaxis in preventing both psychotic and neurotic or dysphoric morbidity in schizophrenia.

Full text

PDF
837

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Carpenter W. T., Jr, Heinrichs D. W., Hanlon T. E. A comparative trial of pharmacologic strategies in schizophrenia. Am J Psychiatry. 1987 Nov;144(11):1466–1470. doi: 10.1176/ajp.144.11.1466. [DOI] [PubMed] [Google Scholar]
  2. Davis J. M. Comparative doses and costs of antipsychotic medication. Arch Gen Psychiatry. 1976 Jul;33(7):858–861. doi: 10.1001/archpsyc.1976.01770070088010. [DOI] [PubMed] [Google Scholar]
  3. Falloon I., Watt D. C., Shepherd M. The social outcome of patients in a trial of long-term continuation therapy in schizophrenia: pimozide vs. fluphenazine. Psychol Med. 1978 May;8(2):265–274. doi: 10.1017/s0033291700014318. [DOI] [PubMed] [Google Scholar]
  4. Glazer W. M., Aaronson H. S., Prusoff B. A., Williams D. H. Assessment of social adjustment in chronic ambulatory schizophrenics. J Nerv Ment Dis. 1980 Aug;168(8):493–497. doi: 10.1097/00005053-198008000-00008. [DOI] [PubMed] [Google Scholar]
  5. Herz M. I., Glazer W., Mirza M., Mostert M., Hafez H. Treating prodromal episodes to prevent relapse in schizophrenia. Br J Psychiatry Suppl. 1989 Jul;(5):123–127. [PubMed] [Google Scholar]
  6. Herz M. I., Szymanski H. V., Simon J. C. Intermittent medication for stable schizophrenic outpatients: an alternative to maintenance medication. Am J Psychiatry. 1982 Jul;139(7):918–922. doi: 10.1176/ajp.139.7.918. [DOI] [PubMed] [Google Scholar]
  7. Jolley A. G., Hirsch S. R., McRink A., Manchanda R. Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenic outpatients: clinical outcome at one year. BMJ. 1989 Apr 15;298(6679):985–990. doi: 10.1136/bmj.298.6679.985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Knights A., Okasha M. S., Salih M. A., Hirsch S. R. Depressive and extrapyramidal symptoms and clinical effects: a trial of fluphenazine versus flupenthixol in maintenance of schizophrenic out-patients. Br J Psychiatry. 1979 Dec;135:515–523. doi: 10.1192/bjp.135.6.515. [DOI] [PubMed] [Google Scholar]
  9. Van Putten T., May R. P. "Akinetic depression" in schizophrenia. Arch Gen Psychiatry. 1978 Sep;35(9):1101–1107. doi: 10.1001/archpsyc.1978.01770330075006. [DOI] [PubMed] [Google Scholar]
  10. Wistedt B., Jørgensen A., Wiles D. A depot neuroleptic withdrawal study. Plasma concentration of fluphenazine and flupenthixol and relapse frequency. Psychopharmacology (Berl) 1982;78(4):301–304. doi: 10.1007/BF00433729. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES