The relationship of demographic, clinical, and outcome variables to neuroleptic treatment requirements

A retrospective study of 61 acute schizophrenic patients examined whether any demographic, clinical, and outcome characteristics distinguished patients who improved with placebo or low dosages of antipsychotics (PLD patients) from patients who required high conventional dosages of antipsychotics (HCD patients). Patients in the PLD group (n=30) and HCD group (n=31) were similar in overall level of psychopathology at admission. Prominent excitement and certain somatic and auditory hallucinations were significantly more frequent in the HCD patients. PLD patients were more likely to be female, were hospitalized more rapidly after the onset of psychosis, and were more often first admissions. Although paranoid symptoms and premorbid schizoid personality did not differentiate the two groups, nonschizoid patients who were nonparanoid tended to be in the PLD group while nonschizoid patients who were paranoid tended to be in the HCD group. PLD patients were less psychotic at discharge, remained out of the hospital for longer periods, and had fewer rehospitalizations. These results confirm other reports of better outcome for patients successfully treated without medication. PLD patients were also functionng better as family members 1 year after discharge. Further research is indicated to improve the prediction of which acute psychotic patients will respond without medication or to low dose neuroleptic treatment and to determine if these predictions are generalized to other treatment settings.