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Maintenance treatment of schizophrenia: A review of dose reduction and family treatment strategies

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Abstract

Maintenance treatment in schizophrenia requires the integration of both medication and psychosocial treatment interventions for maximum effect. We review the recent evidence for strategies drawn from both domains. For the use of anti-psychotic medication we focus on studies of dose reduction using two strategies that differ in assumptions regarding the action of medication. They are: continuous low-dose and targeted, early intervention or intermittent treatment. For psychosocial interventions we focus on studies of family treatment. Regarding dose reduction, we conclude that both strategies are feasible but the targeted strategy incurs higher relapse and rehospitalization rates. Regarding family treatment, we conclude that family treatment provides benefits beyond other psychosocial interventions or usual care, but that there is no evidence for differences in efficacy among family treatments.

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References

  1. Kane J, Schooler NR, Marder SR, Simpson GM, Casey DE: Methods for clinical evaluation of pharmacologic treatments of schizophrenia. In:Clinical Evaluation of Psychotropic Drugs (Prien RF, Robinson DS, Eds.) New York: Raven Press, 1994, pp. 345–372.

    Google Scholar 

  2. Davis JM: Overview: Maintenance therapy in psychiatry. I. Schizophrenia.Am J Psychiatry, 132:1237–1245, 1975.

    PubMed  Google Scholar 

  3. Schooler NR: Maintenance medication for schizophrenia: strategies for dose reduction.Schizophr Bull, 17:311–324, 1991.

    PubMed  Google Scholar 

  4. Kane JM, Marder SR: Psychopharmacologic treatment of schizophrenia.Schizophr Bull, 19:287–302, 1993.

    PubMed  Google Scholar 

  5. Goldstein MJ, Rodnick EH, Evans JR, May PRA, Steinberg MR: Drug and family therapy in the aftercare of acute schizophrenics.Arch Gen Psychiatry, 35:11679–1177, 1978.

    Google Scholar 

  6. Kane JM, Rifkin A, Woerner M, Reardon G, Sarantakos S, Schiebel D, Ramos-Lorenzi J: Low-dose neuroleptic treatment of outpatient schizophrenics.Arch Gen Psychiatry, 40:893–896, 1983.

    PubMed  Google Scholar 

  7. Kane JM, Rifkin A, Woerner M, Reardon G, Kreisman D, Blumenthal R, Borenstein M: High dose vs. low dose strategies in the treatment of schizophrenia.Psychopharm Bull, 21:533–537, 1985.

    Google Scholar 

  8. Kane JM, Woerner M, Sarantakos S: Depot neuroleptics: A comparative review of standard, intermediate, and low dose regimens.J Clin Psychiatry, 47(Suppl.):30–33, 1986.

    PubMed  Google Scholar 

  9. Marder SR, Van Putten T, Mintz J, McKenzie J, Lebell M, Faltico G, May PRA: Costs and benefits of two doses of fluphenazine.Arch Gen Psychiatry, 41:1025–1029 1984.

    PubMed  Google Scholar 

  10. Marder SR, Van Putten T, Mintz J, Lebell M, McKenzie J, May PRA: Low and conventional dose maintenance therapy with fluphenazine decanoate: Two year outcome.Arch Gen Psychiatry, 44:518–521 1987.

    PubMed  Google Scholar 

  11. Johnson DAW, Ludlow JM, Street K, Taylor RDW: Double-blind comparison of half-dose and standard flupenthixol decanoate in the maintenance treatment of stabilized out-patients with schizophrenia.Br J Psych, 151:634–638, 1987.

    Google Scholar 

  12. Hogarty GE, McEvoy JP, Munetz M, DiBarry AL, Bartone P, Cather R, Cooley SJ, Ulrich RJ, Carter M, Madonia JM, Environmental/Personal Indicators in the Course of Schizophrenia Research Group: Dose of fluphenazine, familial expressed emotion, and outcome in schizophrenia.Arch Gen Psych, 45:797–80, 1988.

    Google Scholar 

  13. Kane JM, Davis JM, Schooler NR, Marder SR, Brauzer B, Casey DE: A one-year comparison of four dosages of haloperidol decanoate.Schizoph Res, 9:239–240, 1993.

    Article  Google Scholar 

  14. Herz MI, Szymanski HV, Simon JC: Intermittent medication for stable schizophrenic outpatients: an alternative to maintenance medication.Am J Psychiatry, 139:918–922 1982.

    PubMed  Google Scholar 

  15. Herz MI, Glazer WM, Mostert MA, Sheard MH, Szymanski HV, Hafez H, Mirza M, Vaha J: Intermittent vs. maintenance medication in schizophrenia.Arch Gen Psych, 48:333–339, 1991.

    Google Scholar 

  16. Carpenter WT, Jr., Hanlon TE, Heinrichs DW, Kirkpatrick B, Levine J, Buchanan RW: Continuous vs. targeted medication in schizophrenic outpatients: Outcome results.Am J Psychiatry, 147:1138–1148, 1990.

    PubMed  Google Scholar 

  17. Jolley AG, Hirsch SR, McRink A, Manchanda R: Trial of brief intermittent prophylaxis for selected schizophrenic outpatients: Clinical outcome at one year.Br Med J, 298:985–990, 1989.

    Google Scholar 

  18. Jolley AG, Hirsch SR, Morrison E, McRink A: Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenic outpatients—Clinical and social outcome at two years.Br Med J, 301:837–842, 1990.

    Google Scholar 

  19. Pietzcker A, Gaebel W, Kopcke W: A German multi-center study on the neuroleptic long-term therapy of schizophrenic patients' preliminary report.Pharmacopsychiatry, 19:161–166, 1986.

    Google Scholar 

  20. Pietzcker A, Gaebel W, Kopcke W, et al: Intermittent versus maintenance neuroleptic long-term treatment in schizophrenia—2 year results of a German multicenter study.J Psychiat Res, 27:321–339, 1993.

    Article  Google Scholar 

  21. Keith SJ, Schooler NR: Psychosocial and psychotherapeutic strategies for long-term treatment of schizophrenia. In:International Review of Psychiatry (Costa e Silva JA, Nadelson CC, eds.). American Psychiatric Press, Inc., Washington, DC, 1993, pp. 229–262.

    Google Scholar 

  22. Bellack AS, Mueser KT: Psychosocial treatment for schizophrenia.Schizophr Res, 19:317–336, 1993.

    Google Scholar 

  23. Johnson, D.: The Family's Experience of Living with Mental Illness. In: (Lefley H, Johnson D eds),Families as Allies in Treatment of the Mentally Ill; New Directions for Mental Health Professionals. American Psychiatric Press, Inc., Washington, DC 1990, pp. 31–63.

    Google Scholar 

  24. Lefley HP, Johnson DL (eds):Families as Allies in Treatment of the Mentally Ill: New Directions for Mental Health Professionals. Washington, DC: American Psychiatric Press, Inc., 1990.

    Google Scholar 

  25. Brown GW, Birley JLT, Wing JK: Influence of family life on the course of schizophrenic disorders: A replication.Br J Psychiatry, 112:241–258, 1972.

    Google Scholar 

  26. Vaughn CE, Leff JP: The influences of family and social factors on the course of psychiatric illness.Br J Psychiatry, 129:125–137, 1976.

    PubMed  Google Scholar 

  27. Haas GL, Glick IR, Clarkin JF, Spence JH, Lewis AB, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V. Inpatient family intervention: A randomized clinical trial. II. Results at hospital discharge.Arch Gen Psychiatry, 45:217–224, 1988.

    PubMed  Google Scholar 

  28. Glick I, Spencer J, Clarkin J, Haas Gl, Lewis AB, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V: A randomized clinical trial of inpatient family intervention: IV. Follow-up results for subjects with schizophrenia.Schizophr Res, 3:187–200, 1990.

    Article  PubMed  Google Scholar 

  29. Leff J, Kuipers L, Berkowitz R, Eberlein-Vries R, Sturgeon D: A controlled trial of social intervention in the families of schizophrenic patients.Br J Psychiatry, 141:121–134, 1982.

    PubMed  Google Scholar 

  30. Leff J, Kuipers L, Berkowitz R, Sturgeon D: A controlled trial of social intervention in the families of schizophrenic patients: Two year follow-up.Br J Psychiatry, 146:594–600, 1985.

    PubMed  Google Scholar 

  31. Randolph ET, Eth S, Glynn S, Paz GB, Leong GB, Shaner AL, Strachan A, Van Vort W, Escobar J, Liberman RP: Behavioural family management in schizophrenia: Outcome from a clinic-based intervention.Br J Psychiatry, in press.

  32. Tarrier N, Barrowclough C, Vaughn C, Bamrah JS, Porceddu K, Watts D, Freeman H: The community management of schizophrenia: A controlled trial of a behavioral intervention with families to reduce relapse.Br J Psychiatry, 153:532–542, 1988.

    PubMed  Google Scholar 

  33. Tarrier N, Barrowclough C, Vaughn C, Bamrah JS, Porceddu K, Watts D, Freeman H: Community management of schizophrenia: A two-year follow-up of a behavioral intervention with families.Br J Psychiatry, 154:625–628, 1989.

    PubMed  Google Scholar 

  34. Falloon IRH, Boyd JL, McGill CW, Razani J, Moss HB, Gilderman AM: Family management in the prevention of exacerbations of schizophrenia.N Eng J Med, 306:1437–1440, 1982.

    Google Scholar 

  35. Falloon IRH, Boyd J, McGill C, Williamson M, Razani J, Moss HG, Gilderman AM, Simpson GM: Family management in the prevention of morbidity of schizophrenia: Clinical outcome of a two-year longitudinal study.Arch Gen Psychiatry, 42:887–896, 1985.

    PubMed  Google Scholar 

  36. Hogarty GE, Anderson CM, Reiss DJ, Kornblith SJ, Greenwald DP, Javna CD, Madonia MJ: Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia: I. One-year effects of a controlled study on relapse and expressed emotion.Arch Gen Psychiatry, 43:633–642, 1986.

    PubMed  Google Scholar 

  37. Hogarty GE, Anderson CM, Reiss DJ, Kornblith SJ, Greenwald DP, Ulrich RJ, Carter M, and the Environmental-Personal Indicators in the Course of Schizophrenia (EPICS) Research Group: Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. II. Two-year effects of a controlled study on relapse and adjustment.Arch Gen Psychiatry, 48:340–347, 1991.

    PubMed  Google Scholar 

  38. Leff JP, Berkowitz R, Shavit N, Strachan A, Glass I, Vaughn C: A trial of family therapy versus a relatives' group for schizophrenia.Br J Psychiatry, 154:58–66, 1989.

    PubMed  Google Scholar 

  39. Leff J, Berkowitz R, Shavit N, Strachan A, Glass I, Vaughn C: A trial of family therapy versus a relatives' group for schizophrenia: Two-year follow-up.Br J Psychiatry, 157:571–577, 1990.

    PubMed  Google Scholar 

  40. McFarlane WR, Lukens E, Link B, Dushay R, Deakins SA, Dunne EJ, Horen B, Newmark M, Toran J: The multiple family group, psychoeducation and maintenance medication in the treatment of schizophrenia.Arch Gen Psychiatry, In Press.

  41. Zastowny TR, Lehman AF, Cole RE, Kane C: Family management of schizophrenia: A comparison of behavioral and supportive family treatment.Psychiatr Q, 63:159–186, 1992.

    Article  PubMed  Google Scholar 

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Author notes

  1. Samuel J. Keith M.D.

    Present address: Department of Psychiatry, University of New Mexico, Albuquerque, NM

Authors and Affiliations

  1. Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, 15213, Pittsburgh, PA

    Nina R. Schooler Ph.D.

  2. National Institute of Mental Health Division of Clinical and Treatment Research, Rockville, MD

    Samuel J. Keith M.D.,  Joanne B. Severe M.S. &  Susan M. Matthews B.A.

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  1. Nina R. Schooler Ph.D.
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  3. Joanne B. Severe M.S.
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Schooler, N.R., Keith, S.J., Severe, J.B. et al. Maintenance treatment of schizophrenia: A review of dose reduction and family treatment strategies. Psych Quart 66, 279–292 (1995). https://doi.org/10.1007/BF02238750

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