Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study

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 vs combined with psychosocial intervention on outcomes of early-stage schizophrenia.

Design: Randomized controlled trial.

Setting: Ten clinical sites in China.

Participants: Clinical sample of 1268 patients with early-stage schizophrenia treated from January 1, 2005, through October 31, 2007. Intervention Patients were randomly assigned to receive antipsychotic medication treatment only or antipsychotic medication plus 12 months of psychosocial intervention consisting of psychoeducation, family intervention, skills training, and cognitive behavior therapy administered during 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 of any-cause discontinuation with combined treatment (hazard ratio, 0.62; 95% confidence interval, 0.52-0.74; P < .001) and lower risk of relapse with combined treatment (0.57; 0.44-0.74; P < .001). The combined treatment group exhibited greater improvement in insight (P < .001), social functioning (P = .002), activities of daily living (P < .001), and 4 domains of quality of life as measured by the Medical Outcomes Study 36-Item Short Form Health Survey (all P < or = .02). Furthermore, a significantly higher proportion of patients receiving combined treatment obtained employment or accessed education (P = .001).

Conclusion: Compared with those receiving medication only, patients with early-stage schizophrenia receiving medication and psychosocial intervention have a lower rate of treatment discontinuation or change, a lower risk of relapse, and improved insight, quality of life, and social functioning.

Trial registration: clinicaltrials.gov Identifier: NCT00654576.

Figure 1

Study flowchart. The figure showed the numbers of patients screened for potential inclusion, the reasons for exclusions from randomization, and primary outcome in one-year followed-up. 29 patients refused psychosocial intervention were excluded from the final analysis because their follow-up was not carried out.

Figure 2

(A)Time to treatment discontinuation because of any cause. Kaplan-Meier survival analysis showed a significant difference between medication treatment group and combined medication and psychosocial intervention group (Log-rank test: χ²=28.846, df=1, p<0.001). (B)Time to treatment discontinuation because of relapse. Kaplan-Meier survival analysis showed a significant difference between medication treatment group and combined medication and psychosocial intervention group (Log-rank test: χ²=18.115, df=1, p<0.001).