To the Editor.—
Breier et al1.recently reported deterioration in chronic schizophrenic patients followed up for an average of 6 years after admission to a National Institute of Mental Health research ward. The patients were more symptomatic on followup, and 78% had had a psychotic relapse during the follow-up period. We believe that methodologic problems limiting interpretation of these findings should have been subjected to greater scrutiny, as this study could be employed to shape policy regarding allocation of increasingly scarce and expensive public resources for the treatment of schizophrenia.First, the authors are inconsistent in their approach to the impact of sampling bias on generalizability of their findings. Nearly all patients were referred from community-based inpatient and outpatient facilities "for improvement of symptom control and functional capacity" because they still had "residual positive and negative symptoms." Elsewhere, the authors describe these patients as having illnesses that continued "without remission"
Schwartz F, Terkelsen KG, Smith TE. Long-term Outcome in Chronic Schizophrenia. Arch Gen Psychiatry. 1992;49(6):502. doi:10.1001/archpsyc.1992.01820060082015