Does participation in psychosocial treatment augment the benefit of clozapine? Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia.
BACKGROUND
This study examines the role of participation in psychosocial treatment as a mediator of the clinical effectiveness of clozapine.


METHODS
Subjects participated in a 12-month double-blind random-assignment trial comparing clozapine and haloperidol in patients hospitalized 30 to 364 days for refractory schizophrenia at 15 Department of Veterans Affairs medical centers. A broker-advocate case management intervention was used to facilitate participation in psychosocial treatments and to document such participation.


RESULTS
Between those who continued receiving clozapine (n=122) or a conventional antipsychotic drug (n=169) for 12 months, those receiving clozapine were more likely to participate in psychosocial rehabilitation treatment. Although they were no more likely to receive clinical recommendations for such treatments, they were more likely to both verbally accept recommendations and to act on them. Structural equation modeling shows that participation in psychosocial treatment did not play a mediating role in clozapine's effect on outcomes at 6 months, but was associated with both reduced symptoms and improved quality of life at 12 months.


CONCLUSIONS
Clozapine facilitates participation in psychosocial treatment, and such enhanced participation is associated with improved quality-of-life and symptom outcomes. Psychosocial rehabilitation should be offered concomitantly with clozapine.
Rosenheck
R
R
Veterans Affairs Connecticut Healthcare System, West Haven 06516-2770, USA. Robert.Rosenheck@Yale.edu
Tekell
J
J
Peters
J
J
Cramer
J
J
Fontana
A
A
Xu
W
W
Thomas
J
J
Henderson
W
W
Charney
D
D
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D019090:Case Management; D003024:Clozapine / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D010358:Patient Participation; D011613:Psychotherapy; D011788:Quality of Life; D012050:Rehabilitation, Vocational; D012559:Schizophrenia / Q000188:drug therapy* / Q000534:rehabilitation / Q000628:therapy; D012944:Social Support
D014150:Antipsychotic Agents; D003024:Clozapine; D006220:Haloperidol