PREDICTING DURATION OF CLINICAL STABILITY FOLLOWING HALOPERIDOL WITHDRAWAL IN SCHIZOPHRENIC-PATIENTS

Although chronic maintenance antipsychotic drug treatment is the most effective way of preventing relapse in schizophrenic patients, it is n ot very successful. A considerable number of patients relapse on medic ation, and many others do not take their medications as prescribed aft er leaving the hospital. Unfortunately, clinicians are not able to ide ntify how long patients will remain clinically stable after drug disco ntinuation. To develop a model consisting of behavioral and monoaminer gic variables to identify the risk of symptom exacerbation, we obtaine d in the week prior to haloperidol discontinuation global behavioral r atings and cerebrospinal fluid (CSF) values for monoamine metabolites in a sample of 109 DSM-III-R schizophrenic patients. Patients were fol lowed until specific criteria for increases in psychosis were met for up to 1 year and then returned to antipsychotic drug treatment. Cox re gression analysis identified predictors of the survival function, of t he probability of relapse at a given time drug free. The best model in dicated that increased psychosis, decreased anxiety, and increased CSF homovanillic acid (HVA) to 5-hydroxyinfoleacetic acid (5-HIAA) ratio, and decreased CSF 3-methoxy-4-hydroxyphenylglycol (MHPG) prior to hal operidol withdrawal were associated with early increases in psychosis. Our study indicates that it is possible to identify those patients wh o are more likely to remain clinically stable without medication. When the model is validated, it will help clinicians assess the relapse ri sk over time, lower doses in treatment-resistant patients, and possibl y determine the optimal time for aftercare visits following hospital d ischarge.