Early recognition, internsive intervention and other protective and risk factors for psychotic relapse in patients with first psychotic episodes in schizophrenia

Abstract

Prevention of relapse is the main purpose of Intervention in schizophrenia. Early studies found that antipsychotic medication protected patients against relapse. Subsequent research showed that family intervention therapy in combination with pharmacotherapy was superior to pharmacotherapy alone and to individual therapy in combination with pharmacotherapy. More recent research has focused on expressed-emotien (EE) status and has tried to determine what type of family intervention best suits patients from particular family types. The Amsterdam relapse prevention study investigated the effectiveness of a family behavioral management approach combined with standard individual therapy in comparison with standard individual therapy alone in young, recent-onset, first- or second-episode schizophrenic patients whose families had been taken through a supportive psychoeducational program while the patient was in hospital. The standard individual therapy was highly effective, and further benefit of family intervention could not be demonstrated. Patients in high-EE families were most at risk of relapse; cannabis abuse was the second most important risk factor. Among low-EE families, the relapse rate in the combination intervention group was higher (13%) than in patients given standard individual therapy alone (0%); this suggests that psychosocial intervention approaches need to be tailored to suit family type. Since intensive intervention has a short duration in relation to the length of the disorder in most patients, strategies must be developed for continuity of care. Involving family members in the continuity of care programs may be a crucial step in the delay or remission of psychotic relapse, combined with maintenance of atypical antipsychotic medication.