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A One Year Prospective Study of the Effect of Life Events and Medication in the Aetiology of Schizophrenic Relapse

Published online by Cambridge University Press:  02 January 2018

Steven Hirsch ,
Jo Bowen ,
Javad Emami ,
Philip Cramer ,
Anthony Jolley ,
Camilla Haw  and
Mark Dickinson
Steven Hirsch*
Affiliation:
Department of Psychiatry, Charing Cross & Westminster Medical School
Jo Bowen
Affiliation:
Chelsea and Westminster Hospital, 369 Fulham Road, London SW10
Javad Emami
Affiliation:
Department of Public Health and Epidemiology, Charing Cross & Westminster Medical School
Philip Cramer
Affiliation:
Ealing Mental Health Unit, Uxbridge Road, Southall
Anthony Jolley
Affiliation:
Charing Cross Hospital, Fulham Palace Road, London W6
Camilla Haw
Affiliation:
Academic Department of Psychiatry, Horton Hospital, Long Grove Road, Epsom, Surrey
Mark Dickinson
Affiliation:
Harpersbury Hospital
*
Professor Hirsch, Department of Psychiatry, Charing Cross & Westminster Medical School, 24 St Dunstan's Road, London W6 8RF
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Abstract

Background

We set out to determine whether and to what degree life events independent of illness increase the risk of relapse in schizophrenia following withdrawal from medication in the previous 6 months, either by triggering a relapse in the following 4 weeks or by acting cumulatively over time.

Method

Seventy-one patients fulfilling DSM–III–R criteria for schizophrenia with chronic illness were followed for 48 weeks and assessed on the LEDS scale. Half were treated with regular neuroleptic medication and half had been recently withdrawn from medication. A subgroup was randomised double-blind to treatment or placebo.

Results

A proportional hazards regression model showed that life events made a significant cumulative contribution over time (P < 0.05) to the risks of relapse and that ceasing medication made an independent contribution. The risk of relapse increased in proportion to the number of life events but no interaction between medication status and events could be detected, i.e. life events were not more closely associated with relapse on medication than off medication. For those of the sample exposed to the mean rate of life events during the study period, it was estimated that 23% of the relapse risk could be attributed to life events, and for those with twice the mean rate of events, 41%. In contrast, patients who continued on regular medication had 80% less risk of relapse than those who had been withdrawn from medication either by choice or under double-blind controlled conditions.

Conclusion

A contribution of life events to the risk of relapse in schizophrenia was confirmed by this study but the hypothesis that life events trigger relapse was not supported, nor was the hypothesis that life events are more relevant to relapse in patients on maintenance medication than in patients off medication.

Type
Papers
Information
The British Journal of Psychiatry , Volume 168 , Issue 1 , January 1996 , pp. 49 - 56
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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