Of 49 schizophrenicpatientsfollowed up 12 monthsafter their first admissionto hospital, onlyabout 45% had experiencedno relapseand had no schizophrenicsymptoms;a poorer outcome was moreoften found in Feighnerpositivethan Feighnernegativeschizophrenic patients. The patients' overall level of unemployment had more than doubled to 51 %. In patients whose acute episodesrespondedto treatment, pimozidetaken once weekly as maintenance therapy was as effective as intramuscularflupenthixol decanoate, but tardive dyskinesiaappeared in two patients receivingweekly pimozide;the repeat psy chometric assessmentat 12 months found modest improvements, i.e. no evidence of intellectual decline, in Matrices, Block Design, and Digit Copying tests. Forty per cent of relativesstillshowed significantpsychological distress,which correlatedwith patients' schizophrenicsymptoms, and the relatives' socialfunctioningremainedpoorerthan that of a normal community sample.

From an original cohort of 471 admissions of male schizophrenics (260 individuals) to Leverndale Hospital, Glasgow, in the years 1967-70 inclusive, 39 patients were found who in December 1973 had become long-term residents by virtue of over three years' stay. These patients were followed up two years later, when it was found that 33 remained. Three had died and two had been discharged, though one was later admitted elsewhere. Those remaining had an average age 45-4 years, and an average duration of illness of 15 years. The patients are considered in terms of their clinical state, management problems, accommodation, occupational grade, and social circumstances. It is concluded that they represent a hard cord and that very few of them are likely to be suitable for such alternative forms of care as are at present available.

Of 49 schizophrenic patients followed up 2 years after their first admission to hospital, 37% were well, 47% had been readmitted to hospital at some time over the 2 years, and 38% showed schizophrenic symptoms at follow-up. A poor outcome at 2 years was associated with male sex, poor outcome after the first 5 weeks of the first admission, negative schizophrenic symptoms on first admission, and a diagnosis of definite or probable schizophrenia using the Feighner criteria. Only 23% were in employment. A small double-blind discontinuation study of maintenance antipsychotic medication during the second year found more relapses in those switched to placebo medication. Repeat psychometric assessment at 2 years confirmed modest improvements found at 12 months; that is, there was no evidence of intellectual decline. Relatives showed no more psychosocial distress than that found in a normal community sample; what distress there was correlated with patients' schizophrenic symptoms.

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This is the first comparative double blind study of remoxipride. Sixty-one patients with acute schizophrenia received either remoxipride (75-375 mg daily) or thioridazine (150-750 mg daily) for 6 weeks. There was no statistically significant between-drug difference in improvement in mental state, as measured by the Brief Psychiatric Rating Scale, although the trend favoured thioridazine; global assessment of illness severity at the last rating also favoured thioridazine. Sedation, anticholinergic effects, autonomic dysfunction and weight gain were significantly more common in patients receiving thioridazine. Both drugs produced few extrapyramidal effects, but both produced cardiovascular changes in two patients; neither drug produced significant abnormalities in laboratory tests.