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Long-term morbidity associated with delayed treatment of first admission schizophrenic patients: a re-analysis of the Camarillo State Hospital data.

Wyatt RJ, Green MF, and Tuma AH (1997).

Psychological Medicine 27: 261-268.

This study found that patients with schizophrenia who were not treated with antipsychotic medications during their first admission were doing worse at followup than patients who had initially been treated with antipsychotic medications; both groups had been released from the hospital within six months. The study thus suggests that early treatment with antipsychotic medications both decreases the immediate morbidity associated with schizophrenia, and prevents detrimental changes possibly related to prolonged untreated psychosis.

The authors conducted a retrospective analysis of records from the Camarillo State Hospital study, which was conducted by Philip May and colleagues in the late 1950s and early 1960s, a time when the issue of whether there were immediate benefits from antipsychotic medications were still being debated. That study randomly assigned first-episode patients with schizophrenia to one of five treatment groups: milieu therapy alone, psychotherapy alone, ECT, antipsychotic medications alone, and antipsychotic medications plus psychotherapy.

This study re-examined some of these data, reasoning that those first-episode patients initially treated with milieu- or psychotherapy alone who were stable enough to be discharged from the hospital within six months might be considered to have a spontaneously remitting form of schizophrenia, and thus be expected to do well on followup. Patients were thus divided into two groups: those who had initially been treated with antipsychotic medications (the antipsychotic medications as well as the antipsychotic medications plus psychotherapy groups) and those who had initially been treated without antipsychotic medications (milieu- and psychotherapy alone groups); data from patients initially treated with ECT were not analyzed. Because patients in the study by May and colleagues who had not been discharged within six months were often reassigned to different treatment groups, the authors chose six months as the cutoff date for defining spontaneously remitting patients. Out of 89 patients given either milieu- or psychotherapy alone, 25 were discharged within six months. In contrast, 71 of 91 patients given antipsychotic medications were discharged in the same time period. Today, this improved immediate outcome from antipsychotic medication is, of course, well documented.

These patients were followed for two years after their initial discharge. The study found that, by the second year of followup, those patients initially treated with antipsychotic medications required significantly fewer rehospitalization days than the group of initially non-medicated patients. And, although in the first year of followup the initially medicated patients required significantly more medication in chlorpromazine equivalents, this was not true by the second year of followup.

In order to assess patients’ continued ability to function, 11 patients from each group were matched for age, educational status at first admission, race, and gender, and their Global Assessment of Functioning (GAF) scores were estimated over a period of six to seven years following discharge. Again, those patients initially treated with antipsychotic medications were found to be functioning at a significantly higher level, as measured by GAF scores, than patients initially not treated with antipsychotic medications.

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