Staff perception on reduction of medication in patients with chronic schizophrenia

The value of maintenance neuroleptic therapy for patients with schizophrenia has been well documented (Kane, 1987; Soni et al 1992). There has been, however, a trend in recent years of prescribing higher than recommended doses of neuroleptics in the treatment of schizophrenia (Reardon et al, 1970). This is in agreement with the unconvincing evidence that higher doses of medication present additional benefits to people with chronic schizophrenia (Rifkin et al, 1991). The Royal College of Psychiatrists has issued a consensus statement advising caution in using high doses of neuro leptics (Thompson, 1994). In addition, recent reports have shown that clinical audit projects can result in the reduction of polypharmacy in patients with chronic schizophrenia in hospitals (Warner et al 1995). We report the findings of an exploratory study to assess staff perceptions in reducing the maintenance dose of neuroleptic medication in patients with chronic schizophrenia living in a long-stay hospital, before their discharge to community facilities. The study Ten in-patients with chronic schizophrenia, living in a 20-bed, long-stay ward and presenting a stable mental state over a period of one year were included in the study. Each was diagnosed as suffering from paranoid schizophrenia ac cording to DSM-III-R criteria (American Psychiatric Association, 1987), and had no secondary diagnosis. The other patients living in the same ward were excluded because four had serious forensic histories, three suffered from manic-depressive psychosis, two had personality disorders and one had learning disabilities. The patients included were all being prepared for resettlement into the community and had individually designed 'care plans' meeting their