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Moreover, there appears to be no added benefit from a strategy of "intensive applied" family management over lower-intensity "supportive" family management for patients with schizophrenia.
Those were the findings of a study on "Relapse and Rehospitalization During Maintenance Treatment of Schizophrenia" in the May Archives of General Psychiatry by Nina Schooler, Ph.D., of the Western Psychiatric Institute at the University of Pittsburgh, and colleagues.
The study included 313 schizophrenia outpatients at five treatment centers. Three medication strategies were compared: a standard protocol of continuous moderate medication, a continuous "low-dose" strategy, and a "targeted" strategy in which patients were not given medication unless they were symptomatic.
The low-dose strategy increased relapse and the targeted strategy increased both relapse and rehospitalization, the investigators report.
The patients were also randomized to one of two forms of psychosocial treatment: supportive family management involving monthly family meetings, and intensive, applied family management involving monthly group meetings along with home visits during which communication and problem-solving skills were taught.
No significant differences were found between the two strategies. The study "lends no support to the provision of an intervention involving home visits or training in communication and problem-solving skills," Schooler and colleagues say.
However, the study results support the role of family involvement along with medication in the optimal treatment of schizophrenia, they say.
Most clear from the study are the benefits of continued standard-dose medication.
"The use of medication only when symptoms emerge carries higher risks for relapse and rehospitalization," the investigators say. "This strategy should be reserved for patients who refuse medication but accept clinical monitoring. Such patients are better served by remaining in treatment rather than being discharged as uncooperative.
"For most patients with schizophrenia, a moderate dose of medication appears to be the best clinical recommendation," they conclude.
(Psychiatric News, June 6, 1997)