title: Clinical and psychopharmacologic factors influencing family burden in refractory schizophrenia. The Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia.
abstract: BACKGROUND
  This study compares the effect of clozapine and haloperidol and identifies other factors related to family burden as experienced by relatives of patients with refractory schizophrenia (DSM-III-R).
  
  
  METHODS
  Of 423 patients participating in a multisite randomized clinical trial, 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 weeks and 3, 6, 9, and 12 months after randomization, simultaneous with comprehensive patient assessments.
  
  
  RESULTS
  Patient factors most consistently correlated with greater family burden were symptom severity, days living in the community (i.e., not in the hospital), and frequency of family contact. Among family members, clozapine was associated with significantly (p = .048) greater reduction in feelings of dissatisfaction related to providing support to the patient, but not in objective measures of support, amount of worry the patient engendered, or days of missed employment or household activity. Although clozapine reduces symptoms, thus lowering family burden, it also increases days living in the community, which tends to increase family burden, perhaps canceling out the benefit to families of reduced symptoms.
  
  
  CONCLUSIONS
  Clozapine has a small but significant effect on the experience of families of patients. This is the first study to demonstrate that effective pharmacotherapy may be of some benefit to families as well as to patients.
authors.affiliation: VA Connecticut Health Care System, West Haven, Conn 06516-2770, USA. robert.rosenheck@yale.edu
authors.forename: R
authors.initials: R
authors.lastname: Rosenheck
authors.forename: J
authors.initials: J
authors.lastname: Cramer
authors.forename: G
authors.initials: G
authors.lastname: Jurgis
authors.forename: D
authors.initials: D
authors.lastname: Perlick
authors.forename: W
authors.initials: W
authors.lastname: Xu
authors.forename: J
authors.initials: J
authors.lastname: Thomas
authors.forename: W
authors.initials: W
authors.lastname: Henderson
authors.forename: D
authors.initials: D
authors.lastname: Charney
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D005192:Family Health; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use*; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D011788:Quality of Life; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D012944:Social Support
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine; D006220:Haloperidol