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Life Events and Schizophrenic Relapse after Withdrawal of Medication

  • Joseph Ventura (a1), Keith H. Nuechterlein (a1), Jean Pederson Hardesty (a1) and Michael Gitlin (a1)


Research with schizophrenic out-patients has shown that antipsychotic medication reduces relapse rates. This protective factor may operate partially by raising the threshold for relapse in the face of environmental stressors such as life events and high levels of familial expressed emotion. A prospective, longitudinal design was employed in the monthly collection of life-events data with 23 recent-onset schizophrenic out-patients. In a between-subjects ANOVA, a significantly higher frequency of independent life events was found in the month prior to a relapse for ten patients on medication, as compared with the analogous month for 13 drug-free patients. These findings suggest that neuroleptic medication may produce a prophylactic effect by raising a patient's threshold of vulnerability to relapse.


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UCLA Department of Psychiatry and Biobehavioral Sciences, 300 Medical Plaza, Suite 2200, Los Angeles, CA90024-6968, USA


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American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
Birley, J. L. T. & Brown, G. W. (1970) Crisis and life changes preceding the onset or relapse of acute schizophrenia. British Journal of Psychiatry, 116, 327333.
Brown, G. W. & Birley, J. L. T. (1968) Crisis and life change and the onset of schizophrenia. Journal of Health and Social Behavior, 9, 203214.
Brown, G. W. & Wing, J. K. (1972) Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry, 121, 241258.
Brown, G. W. & Harris, T. (1978) Social Origins of Depression. New York: Free Press.
Curson, D. A., Barnes, T. R. E., Bamber, R. W., et al (1985) Long-term maintenance of chronic schizophrenic out-patients: the seven-year follow-up of the Medical Research Council fluphenazine/placebo trial. British Journal of Psychiatry, 146, 464480.
Day, R., Nielsen, J. A., Korten, A., et al (1987) Stressful life events preceding the acute onset of schizophrenia: a cross-national study from the World Health Organization. Culture, Medicine and Psychiatry, 11, 123205.
Dohrenwend, B. S., Krasnoff, L., Askenasy, A. R., et al (1978) Exemplification of a method for scaling life events: the PERI life events scale. Journal of Health and Social Behavior, 19, 205229.
Goldstein, M. J. (1987) Psychosocial issues. Schizophrenia Bulletin, 13, 157171.
Hogarty, G. E., Goldberg, S. C., Schooler, N. R., et al (1974) Drug and sociotherapy in the aftercare of schizophrenic patients: II. Two-year relapse rates. Archives of General Psychiatry, 31, 603608.
Hogarty, G. E. & Ulrich, R. F. (1977) Temporal effects of drug and placebo in delaying relapse in schizophrenic outpatients. Archives of General Psychiatry, 34, 297301.
Jacobs, S. & Myers, J. (1976) Recent life events and acute schizophrenic psychosis: a controlled study. Journal of Nervous and Mental Disease, 162, 7587.
Kanner, A. D., Coyne, J. C., Schaefer, C., et al (1981) Comparison of two modes of stress measurement: daily hassles and uplifts versus major life events. Journal of Behavioral Medicine, 4, 139.
Leff, J. P. (1987a) A model of schizophrenic vulnerability to environmental factors. In Search for the Causes of Schizophrenia (eds H. Häfner, W. F. Gattaz & W. Janzarik), pp. 317320. Berlin: Springer-Verlag.
Leff, J. P. (1987b) The influence of life events and relatives' Expressed Emotion on the course of schizophrenia. In Psychopathology: An International Perspective (eds D. Magnusson & A. Öhman), pp. 5976. New York: Academic Press.
Leff, J. P., Hirsch, S. R., Gaind, R., et al (1973) Life events and maintenance therapy in schizophrenic relapse. British Journal of Psychiatry, 123, 659660.
Leff, J. P., Kuipers, L., Berkowitz, R., et al (1983) Life events, relatives' Expressed Emotion and maintenance neuroleptics in schizophrenic relapse. Psychological Medicine, 13, 799806.
Lukoff, D., Nuechterlein, K. H. & Ventura, J. (1986) Manual for the Expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin, 12, 594602.
Nuechterlein, K. H. (1987) Vulnerability models for schizophrenia: state of the art. In Search for the Causes of Schizophrenia (eds H. Häfner, W. F. Gattaz & W. Janzarik), pp. 297316. Berlin: Springer-Verlag.
Nuechterlein, K. H. & Dawson, M. E. (1984) A heuristic vulnerability/stress model of schizophrenia episodes. Schizophrenia Bulletin, 10, 300312.
Nuechterlein, K. H., Snyder, K. S., Dawson, M. E., et al (1986) Expressed Emotion, fixed-dose fluphenazine decanoate maintenance, and relapse in recent-onset schizophrenia. Psychopharmacology Bulletin, 22, 633639.
Nuechterlein, K. H., Dawson, M. E., Ventura, J., et al (1991) Testing vulnerability models: stability of potential vulnerability indicators across clinical state. In Search for the Causes of Schizophrenia, vol. 2 (eds H. Häfner & W. F. Gattaz), pp. 177191. Heidelberg: Springer-Verlag.
Overall, J. E. & Gorham, D. R. (1962) The brief psychiatric rating scale. Psychological Reports, 10, 799812.
Spitzer, R. L., Endicott, J. & Robbins, E. (1978) Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry, 35, 773782.
Vaughn, C. E. & Leff, J. P. (1976) The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry, 129, 125137.
Vaughn, C. E., Snyder, K. S., Jones, S., et al (1984) Family factors in schizophrenic relapse: a California replication of the British research on Expressed Emotion. Archives of General Psychiatry, 41, 11691177.
Ventura, J., Nuechterlein, K. H., Lukoff, D., et al (1989) A prospective study of stressful life events and schizophrenic relapse. Journal of Abnormal Psychology, 98, 407411.
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and CATEGO Program. London: Cambridge University Press.
Zubin, J. & Spring, B. (1977) Vulnerability–a new view of schizophrenia. Journal of Abnormal Psychology, 86, 103126.


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Life Events and Schizophrenic Relapse after Withdrawal of Medication

  • Joseph Ventura (a1), Keith H. Nuechterlein (a1), Jean Pederson Hardesty (a1) and Michael Gitlin (a1)
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