Regarding "Forced treatment is not a panacea" (Jan. 7), I agree with the authors' opinion that caution should be exercised in mandating enforced medication. However, their version of Dr. Thomas Insel's opinion on a rather small, 100 patient study is somewhat misleading.
In the aforementioned study, about 100 patients who were in their first episode of schizophrenia were treated with antipsychotic medication remitted. They continued on medication for 6 months, then they were randomly assigned to continuation medication or to medication dose reduction/discontinuation. After 18 months, the study demonstrated that twice as many relapses occurred with the discontinuation strategy and that the discontinuation strategy demonstrated no advantage in functional outcome. After seven years, the discontinuation strategy demonstrated twice the recovery rate of the maintenance treatment group.
It is important to note that the patients were first-episode patients. Dose reduction/discontinuation resulted in increased relapse for the first 18 months. However, after 7 years this strategy was correlated with twice the recovery rate.
So we should be cautious in generalizing the results of first-episode patients to patients with chronic schizophrenia and multiple relapses. The enforced medication debate largely concerns the latter group.
Dr. Lawrence Adler, Baltimore
The writer is a clinical assistant professor of psychiatry at the University of Maryland School of Medicine.