Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study.
BACKGROUND
Antipsychotic drugs are limited in their ability to improve the overall outcome of schizophrenia. Adding psychosocial treatment may produce greater improvement in functional outcome than does medication treatment alone.


OBJECTIVE
To evaluate the effectiveness of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia.


METHODS
Randomized controlled trial.


METHODS
Ten clinical sites in China.


METHODS
Clinical sample of 1268 patients with early-stage schizophrenia treated from January 1, 2005, through October 31, 2007. Intervention Patients were randomly assigned to receive antipsychotic medication treatment only or antipsychotic medication plus 12 months of psychosocial intervention consisting of psychoeducation, family intervention, skills training, and cognitive behavior therapy administered during 48 group sessions.


METHODS
The rate of treatment discontinuation or change due to any cause, relapse or remission, and assessments of insight, treatment adherence, quality of life, and social functioning.


RESULTS
The rates of treatment discontinuation or change due to any cause were 32.8% in the combined treatment group and 46.8% in the medication-alone group. Comparisons with medication treatment alone showed lower risk of any-cause discontinuation with combined treatment (hazard ratio, 0.62; 95% confidence interval, 0.52-0.74; P < .001) and lower risk of relapse with combined treatment (0.57; 0.44-0.74; P < .001). The combined treatment group exhibited greater improvement in insight (P < .001), social functioning (P = .002), activities of daily living (P < .001), and 4 domains of quality of life as measured by the Medical Outcomes Study 36-Item Short Form Health Survey (all P < or = .02). Furthermore, a significantly higher proportion of patients receiving combined treatment obtained employment or accessed education (P = .001).


CONCLUSIONS
Compared with those receiving medication only, patients with early-stage schizophrenia receiving medication and psychosocial intervention have a lower rate of treatment discontinuation or change, a lower risk of relapse, and improved insight, quality of life, and social functioning.


BACKGROUND
clinicaltrials.gov Identifier: NCT00654576.
Guo
Xiaofeng
X
Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Zhai
Jinguo
J
Liu
Zhening
Z
Fang
Maosheng
M
Wang
Bo
B
Wang
Chuanyue
C
Hu
Bin
B
Sun
Xueli
X
Lv
Luxian
L
Lu
Zheng
Z
Ma
Cui
C
He
Xiaolin
X
Guo
Tiansheng
T
Xie
Shiping
S
Wu
Renrong
R
Xue
Zhimin
Z
Chen
Jindong
J
Twamley
Elizabeth W
EW
Jin
Hua
H
Zhao
Jingping
J
D000203:Activities of Daily Living; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D001364:Awareness; D002681:China; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010353:Patient Education as Topic; D011788:Quality of Life; D012008:Recurrence; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*; D012917:Social Adjustment; D016896:Treatment Outcome
D014150:Antipsychotic Agents
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