3-YEAR TRIALS OF PERSONAL THERAPY AMONG SCHIZOPHRENIC-PATIENTS LIVINGWITH OR INDEPENDENT OF FAMILY .2. EFFECTS ON ADJUSTMENT OF PATIENTS

Objective: Previous analyses of the personal and social adjustment of outpatients with schizophrenia have either relied on the assessment of unrepresentative patients who survived without relapse or used analys es that included relapse assessments, a potential confound when differ ent rates of relapse existed among treatment conditions. The authors' goal was to conduct a study of the effects of personal therapy on outc ome that was designed to take into consideration the effects of relaps e. Methods: They evaluated the effectiveness of personal therapy over 3 years after hospital discharge among 151 patients with schizophrenia of schizoaffective disorder. The patients were randomly assigned to r eceive personal therapy or contrasting therapies in one of two concurr ent trials. One trial included patients who were living with family (N =97); the other included patients who were living independent of famil y (N=54). Patients were assessed at 6-month intervals over 3 years of treatment on measures of personal and social adjustment; patients who relapsed and restabilized and those who did not relapse were included. Results: Personal therapy had positive effects on broad components of social adjustment (role performance) but had few differential effects on symptoms, and patients receiving personal therapy remained more an xious than patients who received family or supportive therapy. For pat ients who were living with family, personal therapy led to better outc omes in overall performance than did the other treatments. Although fa mily therapy had only one positive effect on patients' social adjustme nt, the personal adjustment (residual symptoms) of patients who receiv ed family therapy appeared to improve more than that of patients recei ving personal or supportive therapy. For patients not living with fami ly, personal therapy was more successful than supportive therapy in im proving work performance and relationships out of the home. Longitudin al effects of personal therapy on symptoms were similar to those of fa mily and supportive therapies, particularly in the first 2 years, but personal therapy effect sizes increased over time on measures of socia l adjustment. Conclusions: Personal therapy has pervasive effects on t he social adjustment of patients with schizophrenia that are independe nt of relapse prevention. Supportive therapy, with or without family i ntervention, produces adjustment effects that peak at 12 months after discharge and plateau thereafter. However, personal therapy, a definit ive psychosocial intervention, continues to improve the social adjustm ent of patients in the second and third years after discharge. Brief t reatment would appear to be less effective than a long-term, disorder- relevant intervention for schizophrenia.