title: Relapse and rehospitalization during maintenance treatment of schizophrenia. The effects of dose reduction and family treatment.
abstract: BACKGROUND
  Previous studies have examined dose reduction and family treatment in schizophrenia, but none has examined their interaction. This study assessed the impact of dose reduction of antipsychotic medication and family treatment on relapse and rehospitalization during maintenance treatment.
  
  
  METHODS
  Subjects were 313 male and female outpatients at 5 centers with a DSM-III-R diagnosis of schizophrenia or schizoaffective disorder. In a 3 x 2 design, subjects were randomized to 1 of 3 medication strategies using fluphenazine decanoate under double-blind conditions: continuous moderate dose (standard) (12.5-50 mg every 2 weeks); continuous low dose (2.5-10 mg every 2 weeks); or targeted, early intervention (fluphenazine only when symptomatic). Subjects also were randomized to 1 of 2 family treatment strategies (supportive or applied). Supportive family management involved monthly group meetings. The more intensive applied family management involved monthly group meetings and home visits where communication and problem-solving skills were taught. Patients and families were treated and assessed for 2 years.
  
  
  RESULTS
  Both continuous low-dose and targeted treatment increased use of rescue medication and relapse; only targeted treatment increased rehospitalization. This pattern was consistent across both family treatments; there were no differences between family treatments.
  
  
  CONCLUSIONS
  These findings reaffirm the value of antipsychotic medication in preventing relapse and rehospitalization. The absence of family treatment differences may be because both conditions engaged families.
authors.affiliation: Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
authors.forename: N R
authors.initials: NR
authors.lastname: Schooler
authors.forename: S J
authors.initials: SJ
authors.lastname: Keith
authors.forename: J B
authors.initials: JB
authors.lastname: Severe
authors.forename: S M
authors.initials: SM
authors.lastname: Matthews
authors.forename: A S
authors.initials: AS
authors.lastname: Bellack
authors.forename: I D
authors.initials: ID
authors.lastname: Glick
authors.forename: W A
authors.initials: WA
authors.lastname: Hargreaves
authors.forename: J M
authors.initials: JM
authors.lastname: Kane
authors.forename: P T
authors.initials: PT
authors.lastname: Ninan
authors.forename: A
authors.initials: A
authors.lastname: Frances
authors.forename: M
authors.initials: M
authors.lastname: Jacobs
authors.forename: J A
authors.initials: JA
authors.lastname: Lieberman
authors.forename: R
authors.initials: R
authors.lastname: Mance
authors.forename: G M
authors.initials: GM
authors.lastname: Simpson
authors.forename: M G
authors.initials: MG
authors.lastname: Woerner
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D003131:Combined Modality Therapy; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005196:Family Therapy; D005260:Female; D005476:Fluphenazine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012008:Recurrence; D012559:Schizophrenia / Q000188:drug therapy / Q000517:prevention & control* / Q000628:therapy; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
chemical_list: D003692:Delayed-Action Preparations; C011825:fluphenazine depot; D005476:Fluphenazine