Family Management in the Prevention of Morbidity of Schizophrenia

TLDR

Environmental stress contributes to morbidity in schizophrenia despite optimal neuroleptic treatment, and further well‑designed studies are needed to confirm these findings. The study compared a family‑based intervention designed to improve problem‑solving in patients and caregivers with a similarly intensive patient‑oriented approach over two years. Thirty‑six patients from stressful parental homes, stabilized on optimal neuroleptics, were randomized to family or individual therapy within a comprehensive community management program. Family‑managed patients experienced fewer exacerbations, lower psychopathology scores, fewer hospital admissions, and a trend toward reduced deficit symptoms and lower neuroleptic doses, with these benefits persisting through the second year and not attributable to prognostic factors, rater bias, life stressors, or medication effects.

Abstract

Environmental stress may contribute to the clinical morbidity of established cases of schizophrenia treated with optimal neuroleptic drugs. A family-based approach that aimed to enhance the problem-solving capacity of the index patient and his family caregivers was compared with a patient-oriented approach of similar intensity over a two-year period. Thirty-six patients who returned to stressful parental households after florid episodes of schizophrenia (CATEGO and DSM-III) were stabilized with optimal neuroleptics before being randomly assigned to family or individual therapy in a comprehensive community management program. After nine months, family-managed patients had fewer exacerbations of schizophrenia, lower ratings of schizophrenic psychopathology, fewer hospital admissions, and a trend toward lower deficit symptoms and reduced neuroleptic dosage. This reduced clinical morbidity was sustained throughout the second year of less intensive follow-up. The relative efficacy of the family approach in this clinical management study did not appear to be due to prognostic factors, rater bias, stressful life events, or the effectiveness of pharmacotherapy. Definitive tests of these findings with respect to efficacy require further well-designed studies.