We thank Dr Goldhamer for making explicit yet another probable factor related to relapse among schizophrenic patients. His insights regarding the Kafka-like consequences of depot preparations are most relevant as the number of longacting neuroleptics multiply internationally and their application encompasses increasingly large populations of schizophrenic patients. The thrust of Dr Goldhamer's argument is that depot preparations would significantly lower relapse in the first year after discharge relative to oral medications if the psychological devastation and social consequences secondary to forced compliance were to be negotiated psychotherapeutically.
We, too, believe that the dysphoria that might follow on forced compliance is likely to be at least an intervening variable that contributes to the relapse of some patients, although empirical evidence for this conclusion regarding schizophrenic patients generally is indirect. Dr Goldhamer, however, draws attention to the important interface between pharmacological and psychotherapeutic strategies in the treatment of schizophrenia, an area frequently
Hogarty GE, Schooler NR. Relapse in Schizophrenia-Reply. Arch Gen Psychiatry. 1981;38(7):843. doi:10.1001/archpsyc.1981.01780320123017