EARLY RECOGNITION, INTENSIVE INTERVENTION AND OTHER PROTECTIVE AND RISK-FACTORS FOR PSYCHOTIC RELAPSE IN PATIENTS WITH FIRST PSYCHOTIC EPISODES IN SCHIZOPHRENIA

Prevention of relapse is the main purpose of intervention in schizophr enia. Early studies found that antipsychotic medication protected pati ents against relapse. Subsequent research showed that family intervent ion therapy in combination with pharmacotherapy was superior to pharma cotherapy alone and to individual therapy in combination with pharmaco therapy. More recent research has focused on expressed-emotion (EE) st atus and has tried to determine what type of family intervention best suits patients from particular family types. The Amsterdam relapse pre vention study investigated the effectiveness of a family behavioral ma nagement approach combined with standard individual therapy in compari son with standard individual therapy alone in young, recent-onset, fir st-or second-episode schizophrenic patients whose families had been ta ken through a supportive psychoeducational program while the patient w as 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 ab use 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 duratio n in relation to the length of the disorder in most patients, strategi es 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 atypic al antipsychotic medication. (C) 1998 Rapid Science Ltd.