Differences in the nature of relapse and subsequent inpatient course between medication-compliant and noncompliant...

Two subgroups of relapsed and rehospitalized schizophrenic patients were separated on the basis of preadmission compliance or noncompliance with prescribed antipsychotic medications. Noncompliant patients had a gradual onset of episode with prominent psychotic features, required involuntary commitment, and remained in hospital longer. Compliant patients had a rapid onset of symptoms with prominent affective features (anxiety and depression) which were frequently associated with environmental stressors independent of the patient. Compliant patients were usually voluntary admissions and recovered quickly with minimal or no change in their antipsychotic pharmacotherapy. The pathogenesis of relapse among drug-compliant patients remains unknown, but likely includes aspects of environmental stress, an emergent affective syndrome, and, to some less clear extent, akinesia and akathisia. Implications for the inpatient and community treatment of these patients are discussed.