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Solomon C. Goldberg, PhD; Nina R. Schooler, PhD; Gerard E. Hogarty, MSW; Margaret Roper, MA

Arch Gen Psychiatry. 1977;34(2):171-184.

Abstract
• Despite the established efficacy of neuroleptics for maintaining schizophrenics in the community, there are data suggesting that those with very good prognostic signs may do as well without drugs. In testing this, we find no evidence that patients with good signs are not in need of drugs; instead they profit most from drug treatment. Patients who benefit little (1) are men whose families were disrupted earlier in their lives, (2) live alone or with extended families whose attitudes toward the study are not positive, and (3) are irregular in taking their medication. The practical implication is that the drug nonresponder can be helped by some means to ensure regularity of medication taking, such as a visiting nurse or long-acting medication. A second research question is whether major role therapy (MRT, a combination of social casework and vocational rehabilitation) can lengthen the time until relapse. Major role therapy affected time to relapse in a disordinal manner; asymptomatic patients benefited from MRT, while in patients with greater symptom severity MRT—surprisingly—hastened relapse. It is hypothesized that symptomatic patients are suffering from an inability to manage an expanded and enriched cognitive field; MRT, a therapy that urges the patient to become more responsible and to expand his horizons, may actually induce a state with which the patient cannot cope. It is recommended that a therapy such as MRT be deferred until the patient is essentially asymptomatic.

Author Affiliations
From the Psychopharmacology Research Branch, National Institute of Mental Health, Rockville, Md (Drs Goldberg and Schooler and Ms Roper); and the Western Psychiatric Institute and Clinic, Department of Psychiatry, School of Medicine, University of Pittsburgh (Mr Hogarty).

Footnotes
Accepted for publication June 16, 1976.

Reprint requests to 5600 Fishers Lane, Rockville, MD 20852 (Dr Goldberg).

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