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 treatment of schizophrenia, there is little systematic information on decade-long maintenance therapy. We conducted a retrospective study in fifty outpatients with paranoid schizophrenia who have been seen at our clinic for a duration 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 episode were 52, 60, 86, and 90%, respectively. However, the incidence of relapse decreased with time. This decrease was accounted for by the decrease of relapse observed when off drug. Conversely, the incidence of relapse occurred on drug remained unchanged. The average maintenance dose 15 years after remission of the first psychotic episode was 5.41 +/- 7.28 mg/d (haloperidol equivalents: mean +/- SD). The maintenance dose correlated significantly with the number of relapses and total duration of psychotic episodes. These results suggest that maintenance treatment remained effective for decades, although it did not ameliorate the liability to relapse itself. Repeated relapse may be associated with requirement for a higher neuroleptic dose for relapse prevention.