Clinical and psychopharmacologic factors influencing family burden in refractory schizophrenia

Background: This study compares the effect of clozapine and haloperidol and identifies other factors related to family burden as experienced by relati ves of patients with refractory schizophrenia (DSM-III-R). Method: Of 423 patients participating in a multisite randomized clinical tr ial, 221 identified a family member who was actively involved in their care and who agreed to complete a standardized measure of family burden at 6 we eks and 3, 6, 9, and 12 months after randomization, simultaneous with compr ehensive patient assessments. Results: Patient factors most consistently correlated with greater family b urden were symptom severity, days living in the community (i.e., not in the hospital), and frequency of family contact. Among family members, clozapin e was associated with significantly (p = .048) greater reduction in feeling s of dissatisfaction related to providing support to the patient, but not i n objective measures of support, amount of worry the patient engendered, or days of missed employment or household activity. Although clozapine reduce s symptoms, thus lowering family burden, it also increases days living in t he community, which tends to increase family burden, perhaps canceling out the benefit to families of reduced symptoms. Conclusion: Clozapine has a small but significant effect on the experience of families of patients. This is the first study to demonstrate that effect ive pharmacotherapy may be of some benefit to families as well as to patien ts.