CONCLUSIONS The data indicate that after the acute phase certain specific subgroups of patients with schizophrenia have an increased probability of going off antipsychotics for prolonged periods and opting out of the mental health caregiving system and indicate the characteristics of this particular subgroup are. Posthospital treatment is important for most patients with schizophrenia. The controlled trials data on clinic populations of patients suggest that among the patients with schizophrenia who stay in clinic treatment settings for years after the acute phase there is increased risk of relapse when going off antipsychotics. However, the current data suggest that for the select subgroup of patients with schizophrenia who are not in clinic settings, who have gone off antipsychotics and did not immediately relapse, and stayed off them for a period of time, a surprising number experienced periods of recovery and continued to function well for a considerable period without antipsychotics. Clearly, the present longitudinal data suggest that not all patients with schizophrenia need to use antipsychotic medications continuously throughout their lives. It is not known how the off medication schizophrenia patients experiencing periods of recovery, and those experiencing difficulties in functioning, would have been functioning had they been receiving medications, and from the present study one is not able to make definitive causal inferences about the treatment factors affecting outcome. However, knowledge by clinical workers of which factors are associated with greater chances of success can be helpful in treatment decisions for patients with schizophrenia who express an interest in going off antipsychotics.
The data, collected over a 15-year period, reveal factors that are protective and indicate which patients are more likely (but not certain) to function adequately if they choose to leave treatment. These factors, which were identified prospectively (e.g., the prognostic and developmental data were collected and scored many years earlier, at index hospitalization), and increase the probability of success when off antipsychotics, include 2 different prognostic indices and 2 different person- ality scales. For those schizophrenia patients who are func- tioning better for a period who, by themselves, show an interest in coming off antipsychotic medications and also show evidence of inner resources (or earlier favorable prog- nostic features and good developmental achievements), the data suggest that some or many will succeed for a period. Periods or intervals of recovery are dependent on multiple internal characteristics of the patient, and on external factors and treatment, rather than only one factor, and prediction can be made with moderate rather than perfect probability, as in most other areas of medicine and many areas of biology.