Relapse and Rehospitalization During Maintenance Treatment of Schizophrenia: The Effects of Dose Reduction and Family Treatment

doi:10.1001/archpsyc.1997.01830170079011

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Vol. 54 No. 5, May 1997

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Relapse and Rehospitalization During Maintenance Treatment of Schizophrenia

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 treatmentin schizophrenia, but none has examined their interaction. Thisstudy assessed the impact of dose reduction of antipsychoticmedication and family treatment on relapse and rehospitalizationduring maintenance treatment.

Methods
Subjects were 313 male and female outpatients at 5 centers witha DSM-III-R diagnosis of schizophrenia or schizoaffective disorder.In a 3X2 design, subjects were randomized to 1 of 3 medicationstrategies 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). Subjectsalso were randomized to 1 of 2 family treatment strategies (supportiveor applied). Supportive family management involved monthly groupmeetings. The more intensive applied family management involvedmonthly group meetings and home visits where communication andproblem-solving skills were taught. Patients and families weretreated and assessed for 2 years.

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

Conclusions
These findings reaffirm the value of antipsychotic medicationin preventing relapse and rehospitalization. The absence offamily treatment differences may be because both conditionsengaged families.

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