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Original Article
September 2010

Effect of Antipsychotic Medication Alone vs Combined With Psychosocial Intervention on Outcomes of Early-Stage Schizophrenia: A Randomized, 1-Year Study

Author Affiliations

Author Affiliations: Mental Health Institute, Second Xiangya Hospital (Drs X. Guo, Zhai, Liu, Fang, Wu, Xue, Chen, and Zhao), and State Key Laboratory of Medical Genetics of China (Dr Zhao), Central South University, Changsha, Hunan; Jining Medical College, Jining, Shandong, China (Dr Zhai); Chongqing Mental Health Centre, Chongqing, China (Dr B. Wang); Beijing Anding Hospital Affiliated to Capital Medical University, Beijing, China (Dr C. Wang); Psychiatric Hospital of Jiangxi Province, Nanchang, Jiangxi, China (Dr Hu); Mental Health Center of West China Hospital, Sichuan University, Chengdu, Sichuan (Dr Sun); Mental Hospital of Henan Province, Xinxiang, Henan, China (Dr Lv); Shanghai Mental Health Centre, Shanghai, China (Dr Lu); Guangzhou Brain Hospital, Guangzhou, Guangdong, China (Drs Ma and He); Hunan Brain Hospital, Changsha, Hunan, China (Dr T. Guo); Nanjing Brain Hospital, Nanjing, Jiangsu, China (Dr Xie); and Department of Psychiatry, University of California, San Diego (Drs Twamley and Jin).

Arch Gen Psychiatry. 2010;67(9):895-904. doi:10.1001/archgenpsychiatry.2010.105

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 ≤ .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