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William R. McFarlane, MD; Ellen Lukens, PhD; Bruce Link, PhD; Robert Dushay, PhD; Susan A. Deakins, MD; Margaret Newmark, CSW; Edward J. Dunne, PhD; Bonnie Horen, MA; Joanne Toran, MPA

Arch Gen Psychiatry. 1995;52(8):679-687.

Abstract
Objective
To compare outcomes in psychoeducational multiple-family group treatment vs psychoeducational single-family treatment.

Method
A total of 172 acutely psychotic patients, aged 18 to 45 years, with DSM-III-R schizophrenic disorders were randomly assigned to single- or multiple-family psychoeducational treatment at six public hospitals in the state of New York. Psychotic relapse, symptom status, medication compliance, rehospitalization, and employment were assessed independently during 2 years of supervised treatment.

Results
The multiple-family groups yielded significantly lower 2-year cumulative relapse rates than did the single-family modality (16% vs 27%) and achieved markedly lower rates in patients whose conditions had not remitted at index hospital discharge (13% vs 33%). The relapse hazard ratio between treatments was 1:3. The relapse rate for both modalities was less than half the expected rate (65% to 80% for 2 years) for patients receiving individual treatment and medication. Rehospitalization rates and psychotic symptoms decreased significantly, and medication compliance was high, to an equal degree in both modalities. Psychoeducational multiple-family groups were more effective than single-family treatment in extending remission, especially in patients at higher risk for relapse, with a cost-benefit ratio of up to 1:34.

Conclusion
Psychoeducational multiple-family groups were more effective than single-family treatment in extending remission, especially in patients at higher risk for relapse, with a cost-benefit ratio of up to 1:34.

Author Affiliations
From the Biosocial Treatment Research Division of the Department of Epidemiology of Mental Disorders, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York. Dr McFarlane is now affiliated with Maine Medical Center, Portland.

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