Family Psychoeducation, Social Skills Training, and Maintenance Chemotherapy in the Aftercare Treatment of Schizophrenia

TLDR

High relapse rates (~41 %) after discharge prompted the development of family psychoeducation and social skills training as aftercare treatments for schizophrenia. A two‑year randomized trial enrolled 103 high‑EE schizophrenia patients, assigning them to medication alone, medication plus family psychoeducation, medication plus social skills training, or the combined intervention. The combined family and social skills intervention eliminated relapse (0 %) versus 41 % in controls, while each alone reduced relapse to ~20 %; relapse was absent in households that lowered expressed emotion, and only the combined treatment maintained remission in persistently high‑EE households, though later data suggest relapse may be delayed rather than prevented.

Abstract

Relapse rates averaging 41% in the first year after discharge among schizophrenic patients receiving maintenance neuroleptic treatment led to the development of two disorder-relevant treatments: a patient-centered behavioral treatment and a psychoeducational family treatment. Following hospital admission, 103 patients residing in high expressed emotion (EE) households who met Research Diagnostic Criteria for schizophrenia or schizoaffective disorder were randomly assigned to a two-year aftercare study of family treatment and medication, social skills training and medication, their combination, or a drug-treated condition. First-year relapse rates among those exposed to treatment demonstrate a main effect for family treatment (19%), a main effect for social skills training (20%), and an additive effect for the combined conditions (0%) relative to controls (41%). Effects are explained, in part, by the absence of relapse in any household that changed from high to low EE. Only the combination of treatment sustains a remission in households that remain high in EE. Continuing study, however, suggests a delay of relapse rather than prevention.