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Treatment of Acute Psychosis Without Neuroleptics: Two-Year Outcomes From the Soteria Project

BOLA, JOHN R. Ph.D.1; MOSHER, LOREN R. M.D.2

The Journal of Nervous and Mental Disease: April 2003 - Volume 191 - Issue 4 - p 219-229
doi: 10.1097/01.NMD.0000061148.84257.F9
ARTICLE

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.

1Department of Social Work, University of Southern California, MRF-222, Los Angeles, California 90089-0411. Send reprint requests to Dr. Bola.

2Soteria Associates, San Diego, California.

This research was supported by grants from the National Institute of Mental Health.

Presented in part at the World Psychiatric Association’s International Congress in Madrid, Spain, October 2, 2001.

The authors thank Leonard S. Miller, Ph.D., UC Berkeley, and Jim Mintz, Ph.D., UCLA, for their help with statistical consultations, and John M. Davis, M.D., University of Illinois, for critique of an earlier version of this manuscript.

© 2003 Lippincott Williams & Wilkins, Inc.