RELAPSE AND REHOSPITALIZATION DURING MAINTENANCE TREATMENT OF SCHIZOPHRENIA - THE EFFECTS OF DOSE REDUCTION AND FAMILY TREATMENT

Background: Previous studies have examined dose reduction and family t reatment in schizophrenia, but none has examined their interaction. Th is study assessed the impact of dose reduction of antipsychotic medica tion and family treatment on relapse and rehospitalization during main tenance treatment. Methods: Subjects were 313 male and female outpatie nts at 5 centers with a DSM-III-R diagnosis of schizophrenia or schizo affective disorder. In a 3x2 design, subjects were randomized to 1 of 3 medication strategies using fluphenazine decanoate under double-blin d conditions: continuous moderate dose (standard) (12.5-50 mg every 2 weeks); continuous low dose (2.5-10 mg every 2 weeks); or targeted, ea rly intervention (fluphenazine only when symptomatic). Subjects also w ere randomized to 1 of 2 family treatment strategies (supportive or ap plied). Supportive family management involved monthly group meetings. The more intensive applied family management involved monthly group me etings and home visits where communication and problem-solving skills were taught. Patients and families were treated and assessed for 2 yea rs. Results: Both continuous low-dose and targeted treatment increased use of rescue medication and relapse; only targeted treatment increas ed rehospitalization. This pattern was consistent across both family t reatments; there were no differences between family treatments. Conclu sions: These findings reaffirm the value of antipsychotic medication i n preventing relapse and rehospitalization. The absence of family trea tment differences may be because both conditions engaged families.