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Clinical Outcome of a Two-Year Longitudinal Study

Ian R. H. Falloon, MD; Jeffery L. Boyd, PhD; Christine W. McGill, MSW; Malcolm Williamson, PhD; Javad Razani, MD; Howard B. Moss, MD; Alexander M. Gilderman, PharmD; George M. Simpson, MD

Arch Gen Psychiatry. 1985;42(9):887-896.

Abstract
• Environmental stress may contribute to the clinical morbidity of established cases of schizophrenia treated with optimal neuroleptic drugs. A family-based approach that aimed to enhance the problem-solving capacity of the index patient and his family caregivers was compared with a patientoriented approach of similar intensity over a two-year period. Thirty-six patients who returned to stressful parental households after florid episodes of schizophrenia (CATEGO and DSM-III) were stabilized with optimal neuroleptics before being randomly assigned to family or individual therapy in a comprehensive community management program. After nine months, family-managed patients had fewer exacerbations of schizophrenia, lower ratings of schizophrenic psychopathology, fewer hospital admissions, and a trend toward lower deficit symptoms and reduced neuroleptic dosage. This reduced clinical morbidity was sustained throughout the second year of less intensive follow-up. The relative efficacy of the family approach in this clinical management study did not appear to be due to prognostic factors, rater bias, stressful life events, or the effectiveness of pharmacotherapy. Definitive tests of these findings with respect to efficacy require further well-designed studies.

Author Affiliations
From the Schools of Medicine (Drs Falloon, Boyd, Williamson, Razani, Moss, and Simpson and Ms McGill) and Pharmacy (Dr Gilderman), University of Southern California, Los Angeles; and Los Angeles County Department of Mental Health (Drs Falloon, Boyd, Razani, Moss, and Simpson and Ms McGill). Dr Falloon is presently with Buckingham (England) Hospital.

Footnotes
Accepted for publication April 13, 1984.

Reprint requests to Buckingham Hospital, Buckingham MK18 1NU, England (Dr Falloon).

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