There are a number of studies suggesting that a subgroup of patients do very well off medication (see Bola, 2005), but it has been very difficult to define this subgroup, except that good prognosis factors predict good outcome groups. Most importantly, the available data do not indicate how the patients doing well off medication would be doing if they were on medication. The adverse effects of drugs would be avoided, and this is non-trivial for neuroleptic effects of many first-generation antipsychotics and for metabolic effects of many second-generation antipsychotics. The current paper does not address risk/benefit issues, but does report benefit to stable patients continuing antipsychotic drug treatment. This is important, and finding the drug and dose which minimize adverse effects is critical.

References:
Bola JR. Medication-Free Research in Early Episode Schizophrenia: Evidence of Long-Term Harm? Schizophr Bull. 2005 Oct 27. Abstract

View all comments by William Carpenter

I believe that the results of the CATIE study indirectly support the core principle of treatment, that is, it should be comprehensive, using a biopsychosocial approach. The large number of dropouts is but one example of the limitations of relying on antipsychotic medication alone in the treatment of schizophrenia. We know that psychosocial treatments enhance compliance and overall outcome. See, for example, the study that my colleagues and I conducted on relapse prevention in schizophrenia, which had a small number of dropouts over 18 months (Herz et al., 2000).

References:
Herz MI, Lamberti JS, Mintz J, Scott R, O'Dell SP, McCartan L, Nix G. A program for relapse prevention in schizophrenia: a controlled study. Arch Gen Psychiatry. 2000 Mar;57(3):277-83. Abstract

View all comments by Marvin Herz