A program for relapse prevention in schizophrenia: a controlled study.
BACKGROUND
This study examined whether a program for relapse prevention (PRP) is more effective than treatment as usual (TAU) in reducing relapse and rehospitalization rates among outpatients with schizophrenia.


METHODS
Eighty-two outpatients with DSM-III-R schizophrenia or schizoaffective disorder were randomly assigned to receive either PRP (experimental group, n = 41) or TAU (control group, n = 41) and were followed up for an 18-month prospective controlled study. Patients in both groups were prescribed standard doses of maintenance antipsychotic medication. Treatment with PRP consisted of a combination of psychoeducation, active monitoring for prodromal symptoms with clinical intervention when such symptoms occurred, weekly group therapy for patients, and multifamily groups. The TAU consisted of biweekly individual supportive therapy and medication management.


RESULTS
Outcome rates over 18 months were 17% for relapse (7 patients) and 22% for rehospitalization (9 patients) in the PRP group, compared with 34% for relapse (14 patients) and 39% for rehospitalization (16 patients) in the TAU group (P = .01 and P = .03, respectively). Addition of age, sex, baseline Global Assessment Scale score, Positive and Negative Syndrome Scale scores (3 measures), and substance abuse to the proportional hazards regression models all yielded nonsignificant effects. The PRP teams were much more likely than the TAU psychiatrists to identify prodromal episodes before patients met objective relapse criteria or needed hospitalization.


CONCLUSIONS
The PRP was effective in detecting prodromal symptoms of relapse early in an episode. Crisis intervention including increased antipsychotic medication use during the prodromal phase reduced relapse and rehospitalization rates.
Herz
M I
MI
Department of Psychiatry, University of Rochester Medical Center, NY, USA. marvin_herz@urmc.rochester.edu
Lamberti
J S
JS
Mintz
J
J
Scott
R
R
O'Dell
S P
SP
McCartan
L
L
Nix
G
G
D000328:Adult; D000553:Ambulatory Care; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011613:Psychotherapy; D011615:Psychotherapy, Group; D012559:Schizophrenia / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D012565:Schizophrenic Psychology; D055502:Secondary Prevention; D016019:Survival Analysis; D016896:Treatment Outcome
D014150:Antipsychotic Agents