Purpose: While initial treatment of early episode schizophrenia spectrum disorders with antipsychotic medications has become standard clinical practice, it is not clear that this type of treatment results in beneficial long-term outcomes. The Soteria project (1971-1983) compared residential treatment in the community with minimal use of antipsychotic medication to “usual” hospital treatment for individuals with early episode schizophrenia spectrum psychosis. This study reports combined 2-year outcomes for two cohorts of subjects. Method: Newly diagnosed schizophrenia subjects were assigned consecutively (N=79) or randomly (N=100) to the hospital or Soteria and followed for two years. Admission diagnoses were subsequently converted to DSM-IV schizophrenia and schizophreniform disorder. Multivariate analyses evaluate 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). Results: Endpoint subjects exhibited small to medium effect size trends favoring experimental treatment. Completing subjects had significantly better composite outcomes of a medium effect size in Soteria (+0.47 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. Implications: Soteria treatment resulted in better two-year outcomes for newly diagnosed schizophrenia spectrum psychoses, particularly for completing individuals and for those with schizophrenia. In addition, 43 percent of Soteria subjects did not receive any antipsychotic medications during the follow-up period, and only 19 percent were continuously maintained on antipsychotics. This suggests that an initial psychosocial intervention combined with a short-term trial of psychosocial treatment without the immediate use of antipsychotic medications may both improve long-term outcomes and reduce medication dependence. Similar results have been found in recent European quasi-experimental studies (Ciompi et al., 1992; Lehtinen et al., 2000) as well as in earlier American random assignment studies (Rappaport et al., 1978; Schooler et al., 1967). [A more detailed review of this evidence is provided in the accompanying abstract submission: ‘Medication-free research in early episode schizophrenia: Evidence of harm?'] Social workers, with specialized training in establishing and maintaining therapeutic relationships, may be best able to provide such specialized treatment in early episode schizophrenia.

This research received National Institute of Mental Health grant support.

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