The role of the family and improvement in treatment maintenance, adherence, and outcome for schizophrenia.

INTRODUCTION

In the context of a large, random assignment, controlled study evaluating the relative effectiveness and safety of antipsychotic medication (CATIE), we examined the relationship between treatment outcome and 2 family variables: their presence and their ability to support treatment adherence.

METHODS

Post hoc, we assessed the 50 study patients (40 of whom had families) and their families by dividing them into 2 groups. The first had a family/significant other, available and mostly supportive, to work collaboratively on adherence with the treatment team (n = 27). The second group either did not have the family/significant other or, if they did, lacked support for long-term maintenance (n = 23). Next, we examined outcome on 2 measures: study completion (vs discontinuation) and global outcome.

RESULTS

Of 27 patients with available/supportive families, 23 remained in treatment for the full study course. In contrast, 13 of 23 patients, who were discontinued or dropped out, either did not have families or, if they had them, were unable to support adherence (P < 0.01). As to global outcome, 24 of the 27 patients who had supportive families improved, compared with only 9 of the 23 of the other group (P < 0.001).

DISCUSSION

In summary, in the context of a large medication efficacy-effectiveness trial, we present data suggesting that having a "family" available and supportive (regardless of the interpersonal issues between patient and family) improves outcome mediated by improving long-term adherence.