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April 1989

Ethics of Drug Discontinuation Studies in Schizophrenia-Reply

Author Affiliations

Department of Psychiatry Hillside Hospital Long Island Jewish Medical Center PO Box 38 Glen Oaks, NY 11004

Arch Gen Psychiatry. 1989;46(4):387. doi:10.1001/archpsyc.1989.0181004009321

In Reply.—  Chandler suggests that neuroleptic discontinuation studies in patients with schizophrenia are unethical. Though this point of view is understandable, we believe it is not warranted and does not reflect a comprehensive understanding of the relevant issues. The efficacy of neuroleptics in schizophrenia is proved but is limited by several factors, perhaps most significantly by the capacity of neuroleptics to cause tardive dyskinesia. In addition, there is marked variability in the course of illness among schizophrenic patients.1 This is evident in the maintenance treatment literature, which shows that many patients (approximately 30%) relapse despite receiving neuroleptic medication, while neuroleptics can be withdrawn from other patients for many months and in some cases for years without relapse.2,3 Standard maintenance medication treatment strategies, though they are indisputably effective in group comparisons, may be quite inefficient in addressing the treatment requirements of the individual patient. This has prompted the targeted

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