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Long-term Outcome in Chronic Schizophrenia-Reply

Alan Breier, MD; Judith L. Schreiber, MSW; Janyce Dyer, MSN; David Pickar, MD
Arch Gen Psychiatry. 1992;49(6):503. doi:10.1001/archpsyc.1992.01820060083016.
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In Reply. —  We appreciate the careful review of our article1 by Schwartz and colleagues. They raise several important points. First, they suggest that our patient group is most representative of neuroleptic treatmentresistant schizophrenia described by Kane et al2 and that, therefore, our results are generalizable only to this rather narrow spectrum of schizophrenia. Semantic issues contribute to ambiguity regarding this point. Most of our patients were not literally "treatment-resistant" because they clearly became much more symptomatic during drug-free intervals and clearly improved once neuroleptic therapy was restarted3,4 The cohort of treatment-resistant patients studied by Kane et al were characteristically "back-ward." chronically institutionalized patients. Patients in our sample were largely living in the community before index hospitalization at the National Institute of Mental Health and, therefore, not as ill. Perhaps the most accurate term to describe our cohort is "partially neuroleptic responsive." While we agree with Schwartz and


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