Relapse and rehospitalization during maintenance treatment of schizophrenia. The effects of dose reduction and family treatment.
Relapse and rehospitalization during maintenance treatment of schizophrenia. The effects of dose reduction and family treatment.
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DOI：
10.1001/archpsyc.1997.01830170079011
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发表时间：
1997-05
影响因子：
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通讯作者：
N. Schooler;S. Keith;J. Severe;S. Matthews;A. Bellack;I. Glick;W. Hargreaves;John M. Kane;P. Ninan;Allen J. Frances;M. Jacobs;J. Lieberman;R. Mance;G. Simpson;M. Woerner
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文献类型：
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作者：
N. Schooler;S. Keith;J. Severe;S. Matthews;A. Bellack;I. Glick;W. Hargreaves;John M. Kane;P. Ninan;Allen J. Frances;M. Jacobs;J. Lieberman;R. Mance;G. Simpson;M. Woerner
背景 先前的研究已经检验了精神分裂症的剂量减少和家庭治疗，但没有一个研究检验了它们之间的相互作用。本研究评估了抗精神病药物剂量减少和家庭治疗对维持治疗期间复发和再住院的影响。方法 受试者为 5 个中心的 313 名男性和女性门诊患者，经 DSM-III-R 诊断为精神分裂症或分裂情感障碍。在 3 x 2 设计中，受试者在双盲条件下被随机分配至使用氟奋乃静癸酸酯的 3 种药物策略中的一种：连续中等剂量（标准）（每 2 周 12.5-50 mg）；持续低剂量（每2周2.5-10毫克）；或有针对性的早期干预（仅在有症状时使用氟奋乃静）。受试者还被随机分配到两种家庭治疗策略中的一种（支持性或应用性）。支持性家庭管理包括每月举行小组会议。更密集的家庭管理包括每月举行小组会议和家访，教授沟通和解决问题的技能。患者及其家属接受了为期 2 年的治疗和评估。结果 持续低剂量和靶向治疗均增加了救援药物的使用和复发；只有针对性治疗才能增加再住院率。这种模式在两个家庭治疗中都是一致的。家庭治疗之间没有差异。结论 这些发现再次证实了抗精神病药物在预防复发和再住院方面的价值。家庭待遇不存在差异可能是因为这两种情况都涉及家庭。
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.