Effect of Antipsychotic Medication Alone vs Combined With Psychosocial Intervention on Outcomes of Early-Stage Schizophrenia

Abstract

Context 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 versus combined with psychosocial intervention on outcomes of early stage schizophrenia. Design, Setting, and Participants Randomized controlled trial of a clinical sample of 1268 patients with early stage schizophrenia, conducted at 10 clinical sites in China from 2005–2007. Intervention Patients were randomly assigned to antipsychotic medication treatment only or antipsychotic medication plus 12 months of psychosocial intervention, consisting of psycho-education, family intervention, skills training and cognitive-behavioral therapy, administered over 48 group sessions. Main Outcome Measures 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 for any cause discontinuation with combined treatment (hazard ratios [HR], 0.62; 95% confidence interval [CI], 0.52–0.74; p<0.001); and lower risk for relapse with combined treatment (HR, 0.57; 95%CI, 0.44–0.74; p<0.001). The combined treatment group exhibited greater improvement in insight (p<0.001), social functioning (p=0.002), activities of daily living (p<0.001), and in 4 domains of quality of life as measured by Medical Outcome Study Short-Form 36-item questionnaire (all p-values<0.02). Furthermore, a significantly higher proportion of patients receiving combined treatment obtained employment or accessed education (p=0.001). Conclusions Compared to those receiving medications only, early stage schizophrenia patients receiving medications and psychosocial intervention had a lower rate of treatment discontinuation or change, lower risk of relapse, and improved insight, quality of life and social functioning.

The effectiveness of manual-guided, problem-solving-based self-learning programme for family caregivers of people with recent-onset psychosis: A randomised controlled trial with 6-month follow-up

“…In line with the symptom reduction, the patients' risk and 27 frequency of re-hospitalisations in the SPBB participants were also significantly reduced (i.e., 64% and 59% reduction, respectively, at 6 months post-intervention). The findings can also be explained by the benefit of the SPBB in increasing caregivers' knowledge about the illness and problem-solving skills, which could lead to their better coping with the newly adopted caring role and making better use of community mental health care services as preferred (Craig et al, 2004, Guo et al, 2010. Consequently, these caregivers could better facilitate their patients to manage the mental illness and its symptoms.…”

The effectiveness of mutual support group intervention for Chinese families of people with schizophrenia: A randomised controlled trial with 24-month follow-up

“…Family psycho-education is well accepted and widely used in the US (Dyck et al, 2002, McFarlane et al, 1995, other Western countries (Sellwood et al, 2001), and mainland China (Guo et al, 2010, Li and Arthur, 2005, Xiong et al, 1994; however, four systematic reviews on clinical trials of family intervention for people with schizophrenia (Asen, 2002, Bustillo et al, 2001, Pharoah et al, 2010 have concluded that this approach to family intervention can only produce a modest effect on family functioning and well-being, particularly in the longer term (e.g., >1 year). The findings of this study also revealed that psycho-education groups may not have a substantial effect on the health outcomes of both patients and their family members at 24 months after the intervention.…”

“…First, the sample was recruited from two of 20 outpatient clinics in Hong Kong and the participants had suffered from schizophrenia for less than five years. Therefore, families might be more optimistic and motivated about the potential for change and the promotion of health (Chien et al, 2008, Guo et al, 2010.…”

An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments

“…An example of this is a study by Lalova et al [121] which found that three forms of cognitive remediation aimed at improving neurocognition, autobiographical memory, and metacognition led to improved awareness of symptoms, as well as overall insight. A second example of a multicomponent treatment was designed by Guo et al [122] and includes cognitive behavior therapy, family therapy, psychoeducation, and skills training [122]. In a clinical trial testing the effects of this intervention, it was shown that this combination of practices resulted in improvements in insight and treatment attitudes above and beyond a treatment as usual group.…”