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April 1989

Ethics of Drug Discontinuation Studies in Schizophrenia

Author Affiliations

Department of Psychiatry Iowa City Veterans Administration Hospital Iowa City, IA 52242

Arch Gen Psychiatry. 1989;46(4):387. doi:10.1001/archpsyc.1989.0181004009320

To the Editor.—  I would like to register an ethical objection to the methodology used in the report by Lieberman et al1 regarding the prediction of relapse in schizophrenia. Briefly, their methods involved discontinuing antipsychotic medication in stable schizophrenics for up to one year and observing them for signs of relapse to judge the efficacy of a methylphenidate challenge in predicting relapse. While I would not have had any qualms about such a study in 1958, the situation is quite different in 1988. Few findings have been as well documented in medicine as the efficacy of antipsychotics in preventing relapse in schizophrenia.2,3 An investigator thus can be quite certain that discontinuing antipsychotics for up to a year will lead to relapse in most patients. This in fact was true in this study, in which only three of 39 patients did not relapse over a one-year period.One must