Recovery From Schizophrenia: Psychiatry And Political Economy

226 TREATMENTschizophrenia into good-and poor-prognosis cases (using a scale devised by LesliePhillips). The patients were randomly assigned to treatment with a placebo or astandard antipsychotic drug soon after admission. After three weeks of treatmentthe poor-prognosis patients appeared to benefit from taking active medication.The good-prognosis patients, however, did better if they were taking placebo—they improved more rapidly and were discharged sooner. This finding wasparticularly true for non-paranoid, good-prognosis patients. 19 The researchersuncovered a similar pattern of response when they repeated their study with anew sample of 24 males with good-prognosis schizophrenia—neuroleptic drugsfailed to benefit the non-paranoid, good-prognosis patients in three weeks oftreatment. 20 Unfortunately, no long-term follow-up of the patients in either ofthese studies was done.Interestingly enough, this research group obtained analogous findings whenthey compared the effect of high versus low doses of standard antipsychotic drugstreatment on a group of 104 young people with acute schizophrenia. The goodprognosispatients—particularly males—showed a negligible rate of relapse andhad fewer symptoms at the end of six months on the lower dose of medication. 21Rappaport and associatesEighty young males with acute schizophrenia admitted to Agnews State Hospitalin California were randomly assigned on admission to chlorpromazine or placebotreatment by Maurice Rappaport and his co-workers. After discharge from thehospital the patients were treated with or without active medication depending,presumably, on their clinical condition and their compliance with thepsychiatrist’s recommendation. Patients who did well on placebo treatment inhospital tended to be treated without medication after leaving hospital and tohave had good-prognosis schizophrenia and a history of good functioning beforeadmission. Placebo treatment failures were likely to be given active medicationafter discharge. At three-year follow-up the patients who took a placebo inhospital and were off medication as out-patients showed the greatest clinicalimprovement and the lowest levels of pathology and functional disturbance. Theyalso had the lowest rate of rehospitalization:The superiority of the placebo/no medication group to the chlorpromazine/no-medication category is particularly worth noting, although part of thisdifference in outcome may be due to there being a greater proportion of goodprognosispatients in the former group. The authors of the study conclude: