Treatment for schizophrenia should focus on improving real-world effectiveness outcomes, including functional capacity and health-related quality of life. This study was designed to provide information on psychosocial intervention on outcome of early stage schizophrenia, in particular on functional outcome in real-world practice. We found that combined treatment improved medication adherence, risk of relapse and hospital admission, insight, quality of life, and social/occupational functioning.
Treatment discontinuation in patients with schizophrenia is strikingly common; the CATIE study reported that 74 percent of patients discontinued their medications in the 18-month study2
and the EUFEST study reported that an average of 42 percent discontinued their medications at 1 year follow-up.45
Discontinuing medication is associated with symptom exacerbation, relapse, increased hospitalization, and poor long-term course of illness.46,47
Our study showed a lower rate of medication discontinuation compared to the above studies. One reason could be that our psychosocial intervention reduced the risk of treatment discontinuation and improved insight and medication compliance; another reason could be that family members are more involved patients’ care in China, similar to other Asian or developing countries. This kind of family involvement and support could further reduce medication discontinuation rates and subsequently improve outcomes. Another potential reason for better outcomes in the combined treatment group was that medication and psychosocial treatments occurred on the same day each month for patients, allowing the psychiatrists and other care providers reinforce the importance of participation in all components of treatment.
Prevention of relapse is the cornerstone to improving all areas of long-term outcome and achieving long-term improvements in quality of life and level of functioning. The risks of relapse and hospital admission were significantly lower in the combined treatment group than in the medication alone group in this study.
Improvements in quality of life represent evidence of a good treatment outcome for patients with schizophrenia. After 12 months of treatment, more improvements of quality of life were seen in patients who received combined treatment. Better quality of life outcomes in the combined treatment group were demonstrated not only in mental health domains, but also in physical health domains, suggesting that combined treatment may afford the best combination of effectiveness and improved quality of life.
Social outcomes reflect how patients live, function in society and perform their various roles (e.g., having a job, going to school, or having friends). Our study showed that a significantly higher proportion of patients receiving combined treatment obtained employment or accessed education. Thus, the findings support the results from previous studies that patients with schizophrenia receiving combined treatment had better outcomes.12, 13, 50–53
In particular, integrating a comprehensive therapy with medication treatment in early stage schizophrenia patients before to the disease becomes chronic and disabling could improve long-term outcomes.
Psycho-education, family intervention, skills training and CBT have proven to be effective in treating people with schizophrenia.5,7–10, 30, 53
To our knowledge, this is one of a very few studies to take this integrated intervention approach and address outcome as a whole, with the goal of improving overall outcome in early stage schizophrenia patients. Our once-monthly comprehensive psychosocial intervention approach is different from the common therapy model used in the US and other western countries. Though this study cannot indicate whether this intensive therapy model can be applied in other countries, it did provide evidence that the model was practical and showed better efficacy compared to medications alone in improving overall outcome for early stage patients with schizophrenia. This result may be particularly informative to Asian, African, or Latin American countries, where schizophrenia patients tend to live with their families and family members are often involved in patient care.
This study has several limitations. First, this was a 12-month trial; a longer-term randomized clinical trial would contribute substantially to understanding the longer-term effects of psychosocial intervention on outcomes. Second, although measures were taken to maintain the blinding, it is not known how effective the blinding was. However, several outcome measures were not vulnerable to bias, such as rehospitalization, lost to follow-up, and treatment non-compliance. Third, although the combined psychosocial intervention showed better overall efficacy than medications alone, we do not know whether the effects of the combined intervention were equally attributable to all of the modules.