In the treatment of chronic schizophrenia, there are risks associated with both neuroleptic maintenance (eg, tardive dyskinesia) and neuroleptic withdrawal (eg, psychotic exacerbation or relapse). We reviewed 66 studies on neuroleptic withdrawal involving 4365 patients with schizophrenia. The mean cumulative relapse rate was 53% in patients withdrawn from neuroleptic therapy and 16% in those maintained on neuroleptic therapy over a mean follow-up period of 9.7 months. The relapse rate was positively associated with length of follow-up. Predictors of relapse reported in individual studies included younger age, higher baseline neuroleptic dosage, and shorter length of hospitalization. Adverse effects of neuroleptic withdrawal other than relapse were usually mild and transient. The risk-benefit ratio of neuroleptic maintenance vs withdrawal should be assessed carefully in individual patients. A slow taper to the lowest effective dosage may be the preferred strategy in many patients.From the

Normal volunteers (28 women), 20-45 years old, completed tests of visuospatial ability, verbal fluency, and language lateralization, and the midsagittal surface areas of the splenium, isthmus, midregion, and genu of the corpus callosum were measured from inversion recovery magnetic resonance images. Multivariate statistics were used to analyze patterns of correlations. Verbal fluency correlated positively with the area of the splenium and with the area of a posterior callosal factor defined largely by the splenium. The posterior callosum, particularly the splenium, also correlated negatively with language lateralization. There were no other consistent brain-behavior relationships. These results are relevant to understanding factors involved in the development of cognitive characteristics that show sex differences and to understanding the neural basis of language lateralization and verbal abilities.

Confirmatory factor analysis was used to examine a proposed factor structure of a comprehensive neuropsychological battery used to study patients with schizophrenia and related psychotic disorders (n = 209). An a priori six-factor model and five nested models were evaluated successively, using maximum likelihood confirmatory factor analysis. In all multifactor models, the factors were significantly intercorrelated. A six-factor model with two pairs of correlated errors fit the neuropsychological data significantly better than competing models with fewer factors. The six factors included verbal crystallized, attention/working memory, verbal episodic memory, speed of information processing, visual episodic memory, and reasoning/problem solving. Severity of negative symptoms was significantly associated with worse performance on attention/working memory and verbal crystallized factors, but positive symptoms, depression, and a summary measure of psychopathology were not significantly related to neuropsychological performance. Impairment on a performance-based measure of functional capacity was significantly related to all neuropsychological factors. A simultaneous confirmatory factor analysis using the original sample and a group of healthy subjects (n = 131) demonstrated that the six-factor model of cognition was generalizable and applied equally well to both groups.

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