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.
Bola
John R
JR
Department of Social Work, University of Southern California, MRF-222, Los Angeles, California 90089-0411, USA.
Mosher
Loren R
LR
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004637:Emergency Services, Psychiatric; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008884:Milieu Therapy / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D018579:Patient Selection; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D012107:Research Design; D012114:Residential Treatment / Q000379:methods; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*; D012960:Socioenvironmental Therapy / Q000379:methods*; D016896:Treatment Outcome
D014150:Antipsychotic Agents