Psychotic relapse and maintenance therapy in paranoid schizophrenia: a 15 year follow up

In spite of numerous reports on a 1 to 2 year maintenance neuroleptic treat ment of schizophrenia, there is little systematic information on decade-lon g maintenance therapy. We conducted a retrospective study in fifty outpatie nts with paranoid schizophrenia who have been seen at our clinic for a dura tion of 15 years or more since their first psychotic episodes. Relapse rate within 2, 5, 10, and 15 years from remission of the first psychotic episod e were 52, 60, 86, and 90%, respectively. However, the incidence of relapse decreased with time. This decrease was accounted for by the decrease of re lapse observed when off drug. Conversely, the incidence of relapse occurred on drug remained unchanged. The average maintenance dose 15 years after re mission of the first psychotic episode was 5.41 +/- 7.28 mg/d (haloperidol equivalents: mean +/- SD). The maintenance dose correlated significantly wi th the number of relapses and total duration of psychotic episodes. These r esults suggest that maintenance treatment remained effective for decades, a lthough it did not ameliorate the liability to relapse itself. Repeated rel apse may be associated with requirement for a higher neuroleptic dose for r elapse prevention.