A ONE-YEAR PROSPECTIVE-STUDY OF THE EFFECT OF LIFE EVENTS AND MEDICATION IN THE ETIOLOGY OF SCHIZOPHRENIC RELAPSE

Background. We set out to determine whether and to what degree life ev ents independent of illness increase the risk of relapse in schizophre nia following withdrawal from medication in the previous 6 months, eit her by triggering a relapse in the following 4 weeks or by acting cumu latively over time. Method. Seventy-one patients fulfilling DSM-III-R criteria for schizophrenia with chronic illness were followed for 48 w eeks and assessed on the LEDS scale. Half were treated with regular ne uroleptic medication and half had been recently withdrawn from medicat ion. A subgroup was randomised double-blind to treatment or placebo. R esults. A proportional hazards regression model showed that life event s made a significant cumulative contribution over time (P < 0.05) to t he risks of relapse and that ceasing medication made an independent co ntribution. The risk of relapse increased in proportion to the number of life events but no interaction between medication status and events could be detected, i.e. life events were not more closely associated with relapse on medication than off medication. For those of the sampl e exposed to the mean rate of life events during the study period, it was estimated that 23% of the relapse risk could be attributed to life events, and for those with twice the mean rate of events, 41%. In con trast, patients who continued on regular medication had 80% less risk of relapse than those who had been withdrawn from medication either by choice or under double-blind controlled conditions. Conclusion. A con tribution of life events to the risk of relapse in schizophrenia was c onfirmed by this study but the hypothesis that life events trigger rel apse was not supported, nor was the hypothesis that life events are mo re relevant to relapse in patients on maintenance medication than in p atients off medication.