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Prediction of Relapse in Schizophrenia
Jeffrey A. Lieberman, MD;
John M. Kane, MD;
Stavros Sarantakos, MD;
Dominick Gadaleta, MD;
Margaret Woerner, PhD;
Jose Alvir, DrPH;
Jorge Ramos-Lorenzi, MD
Arch Gen Psychiatry. 1987;44(7):597-603.
Abstract
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• Despite the proven efficacy of neuroleptic drugs in the acute and maintenance pharmacotherapy of schizophrenia, practical methods for identifying patients who require neuroleptic treatment to prevent relapse are lacking. This study evaluated the use of a methylphenidate challenge test to predict the outcome in 34 stable outpatients with schizophrenia receiving neuroleptic treatment. Patients received two infusions, one of methylphenidate and one of placebo, in randomized order one week apart while receiving neuroleptic treatment and again three weeks after drug withdrawal. Behavioral, cardiovascular, and neurologic responses were evaluated before and after infusion under double-blind conditions. Patients were then followed up without medication for 52 weeks or until symptom recurrence. The results indicate that specific measures, including behavioral response to methylphenidate, presence of tardive dyskinesia, and, under specific pharmacologic conditions, tardive dyskinesia, blink-rate, and pulse-rate responses to methylphenidate, are associated with time and propensity to relapse following neuroleptic withdrawal. These measures may be potentially useful in the identification of candidates for neuroleptic withdrawal and/or dosage-reduction treatment strategies.
Author Affiliations
From the Department of Psychiatry, Hillside Hospital, Long Island Jewish Medical Center, Glen Oaks, NY; and the Department of Psychiatry, State University of New York at Stony Brook (Drs Lieberman, Kane, and Sarantakos).
Footnotes
Accepted for publication Jan 29, 1987.
Read before the 139th Annual Meeting of the American Psychiatric Association, Washington, DC, May 15, 1986.
Reprint requests to Hillside Hospital, Long Island Jewish Medical Center, PO Box 38, Glen Oaks, NY 11004 (Dr Lieberman).
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