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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

Gerard E. Hogarty, MSW; Carol M. Anderson, PhD; Douglas J. Reiss, PhD; Sander J. Kornblith, PhD; Deborah P. Greenwald, PhD; Carol D. Javna, PhD; Michael J. Madonia
Arch Gen Psychiatry. 1986;43(7):633-642. doi:10.1001/archpsyc.1986.01800070019003.
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• Relapse rates averaging 41% in the first year after discharge among schizophrenic patients receiving maintenance neuroleptic treatment led to the development of two disorderrelevant treatments: a patient-centered behavioral treatment and a psychoeducational family treatment. Following hospital admission, 103 patients residing in high expressed emotion (EE) households who met Research Diagnostic Criteria for schizophrenia or schizoaffective disorder were randomly assigned to a two-year aftercare study of (1) family treatment and medication, (2) social skills training and medication, (3) their combination, or (4) a drug-treated condition. First-year relapse rates among those exposed to treatment demonstrate a main effect for family treatment (19%), a main effect for social skills training (20%), and an additive effect for the combined conditions (0%) relative to controls (41%). Effects are explained, in part, by the absence of relapse in any household that changed from high to low EE. Only the combination of treatment sustains a remission in households that remain high in EE. Continuing study, however, suggests a delay of relapse rather than prevention.


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