June 1992

Long-term Outcome in Chronic Schizophrenia-Reply

Author Affiliations

Maryland Psychiatric Research Center University of Maryland School of Medicine PO Box 21247 Baltimore, MD 21228
Bethesda, Md
New Haven, Conn

Arch Gen Psychiatry. 1992;49(6):503. doi:10.1001/archpsyc.1992.01820060083016

In Reply. —  We appreciate the careful review of our article1 by Schwartz and colleagues. They raise several important points. First, they suggest that our patient group is most representative of neuroleptic treatmentresistant schizophrenia described by Kane et al2 and that, therefore, our results are generalizable only to this rather narrow spectrum of schizophrenia. Semantic issues contribute to ambiguity regarding this point. Most of our patients were not literally "treatment-resistant" because they clearly became much more symptomatic during drug-free intervals and clearly improved once neuroleptic therapy was restarted3,4 The cohort of treatment-resistant patients studied by Kane et al were characteristically "back-ward." chronically institutionalized patients. Patients in our sample were largely living in the community before index hospitalization at the National Institute of Mental Health and, therefore, not as ill. Perhaps the most accurate term to describe our cohort is "partially neuroleptic responsive." While we agree with Schwartz and

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