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The Effects of Dose Reduction and Family Treatment

Nina R. Schooler, PhD; Samuel J. Keith, MD; Joanne B. Severe, MS; Susan M. Matthews; Alan S. Bellack, PhD; Ira D. Glick, MD; William A. Hargreaves, PhD; John M. Kane, MD; Philip T. Ninan, MD; Allen Frances, MD; Marc Jacobs, MD; Jeffrey A. Lieberman, MD; Rosalind Mance, MD; George M. Simpson, MD; Margaret G. Woerner, PhD

Arch Gen Psychiatry. 1997;54(5):453-463.

Abstract
Background
Previous studies have examined dose reduction and family treatment in schizophrenia, but none has examined their interaction. This study assessed the impact of dose reduction of antipsychotic medication and family treatment on relapse and rehospitalization during maintenance treatment.

Methods
Subjects were 313 male and female outpatients at 5 centers with a DSM-III-R diagnosis of schizophrenia or schizoaffective disorder. In a 3X2 design, subjects were randomized to 1 of 3 medication strategies using fluphenazine decanoate under double-blind conditions: continuous moderate dose (standard) (12.5-50 mg every 2 weeks); continuous low dose (2.5-10 mg every 2 weeks); or targeted, early intervention (fluphenazine only when symptomatic). Subjects also were randomized to 1 of 2 family treatment strategies (supportive or applied). Supportive family management involved monthly group meetings. The more intensive applied family management involved monthly group meetings and home visits where communication and problem-solving skills were taught. Patients and families were treated and assessed for 2 years.

Results
Both continuous low-dose and targeted treatment increased use of rescue medication and relapse; only targeted treatment increased rehospitalization. This pattern was consistent across both family treatments; there were no differences between family treatments.

Conclusions
These findings reaffirm the value of antipsychotic medication in preventing relapse and rehospitalization. The absence of family treatment differences may be because both conditions engaged families.

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