Loren R. Mosher

Treatment of acute psychosis without neuroleptics: two-year outcomes from the Soteria project.

The Soteria project (1971–1983) compared residential treatment in the community and minimal use of antipsychotic medication with “usual” hospital treatment for patients with early episode schizophrenia spectrum psychosis. Newly diagnosed DSM-II schizophrenia subjects were assigned consecutively (1971 to 1976, N = 79) or randomly (1976 to 1979, N = 100) to the hospital or Soteria and followed for 2 years. Admission diagnoses were subsequently converted to DSM-IV schizophrenia and schizophreniform disorder. Multivariate analyses evaluated hypotheses of equal or better outcomes in Soteria on eight individual outcome measures and a composite outcome scale in three ways: for endpoint subjects (N = 160), for completing subjects (N = 129), and for completing subjects corrected for differential attrition (N = 129). Endpoint subjects exhibited small to medium effect size trends favoring experimental treatment. Completing subjects had significantly better composite outcomes of a medium effect size at Soteria (+.47 SD, p = .03). Completing subjects with schizophrenia exhibited a large effect size benefit with Soteria treatment (+.81 SD, p = .02), particularly in domains of psychopathology, work, and social functioning. Soteria treatment resulted in better 2-year outcomes for patients with newly diagnosed schizophrenia spectrum psychoses, particularly for completing subjects and for those with schizophrenia. In addition, only 58% of Soteria subjects received antipsychotic medications during the follow-up period, and only 19% were continuously maintained on antipsychotic medications.

Family studies of MZ twins discordant for schizophrenia: neurological findings.

Over the past six years the Section on Twin and Sibling Studies, NIMH, has conducted intensive studies of 16 families with MZ twins discordant for schizophrenia. In addition, 3 families in which both twins were schizophrenic and 4 with no known psychiatric illness have been similarly investigated. Each family is admitted to the Clinical Center, NIH, for two weeks of multi-disciplinary investigation. In the hope of shedding light on the question of neurologic findings in schizophrenic patients and their role in this disorder, detailed neurological examinations are performed on the twins by two neurologists. Patients with gross neurologic disturbance are screened out by our selection criteria. The examiners are therefore explicitly seeking minor deviations in neurologic status, rather than patterns of symptoms and signs leading to a specific neurologic diagnosis. Given this context, the neurologists recorded substantial numbers of signs. Yet, in none of the twins was there sufficient evidence to warrant a neurologic diagnosis. The pairs of neurologic reports were subjected to a variety of procedures, in an attempt to quantify the results. For example, 11 of the first 13 index schizophrenic twins, as compared with 1 of 13 cotwin controls, were rated as having “probable” or “definite” neurologic abnormality, based upon the senior authors analysis of the number and type of signs recorded and the degree of agreement between the examiners. Significant group differences on number of signs reported were found between schizophrenics and nonschizophrenics, schizophrenic indexes and their cotwin controls, and schizophrenics and normals. In contrast, there were no significant group differences in the number of signs found between the nonschizophrenic cotwin controls and the normal twins.