Purpose: In early episode schizophrenia spectrum disorders, antipsychotic treatment is nearly universal. This study uses meta-analysis techniques to integrate evidence addressing the questions of whether: (a) initial medication treatment results in long-term benefits to clients, and (b) if short periods of medication-free research in early episode schizophrenia result in demonstrable long-term harm to human subjects. Method: Studies were included if a majority of subjects had a first or second schizophrenia spectrum, used a quasi-experimental or random assignment design in which at least one group received standard antipsychotic medications and one group a time-limited trial without antipsychotic treatment, with a minimum of one-year results. Effect-sizes were calculated and combined using standard meta-analytic procedures. Results: Only 7 studies with 745 subjects met inclusion criteria and were available for analysis. Individual study effects ranged from r = –0.21 to r = 0.14, producing a weighted mean effect size estimate of r = –0.11, suggesting a small effect size advantage for non-drug treatment. However, this effect was not statistically different from zero (SE=.081, Z= -1.358, n.s., fixed effects 95% CI: -.27, .05), indicating inadequate evidence to conclude that either initial antipsychotic treatment or its absence exhibits a long-term advantage. Implications: Good-quality evidence suggests a small but not statistically significant advantage for an initial trial without antipsychotic medications in early episode schizophrenia spectrum disorders. The evidence does not support a conclusion of long-term harm resulting from short-term postponement of medications. Initial medication-free trial periods also resulted in a reduction in the proportion of clients receiving long-term medication maintenance treatment. The long-standing presumption of long-term benefit from initial antipsychotic treatment in early schizophrenia is not solidly founded on evidence from controlled studies. Therefore, an ethical prohibition of carefully conducted early-episode schizophrenia research involving a short non-antipsychotic medication trial period on grounds of ‘withholding proven treatment' is untenable. The divergence of these results with popular belief and current clinical practice underscores the importance of social work's active participation in the ‘critical community' of science (Popper, 1965 (1963)). Recent evidence has substantiated concerns for the introduction of bias through pharmaceutical company sponsorship of medical research (e.g., Berkelman, Li, & Gross, 2003). Removing bias from mental health knowledge requires a willingness to rigorously assess fundamental assumptions combined with a commitment to developing best client-centered treatments (Bola, 2003).

References Berkelman, J. E., Li, Y., & Gross, C. P. (2003). Scope and impact of financial conflicts of interest in biomedical research. Journal of the American Medical Association, 289(4), 454-465. Bola, J. R. (2003). Integrity and bias in academic psychiatry. The British Journal of Psychiatry, 185(5), 464. Popper, K. R. (1965 (1963)). Conjectures and refutations: The growth of scientific knowledge. New York: Basic Books.