Effect of Antipsychotic Medication Alone vs Combined With Psychosocial Intervention on Outcomes of Early-Stage Schizophrenia: A Randomized, 1-Year Study
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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.
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Four trials of multicomponent structured psychotherapies versus treatment as usual, with both groups receiving antipsychotic medication, showed large improvements in social functioning (SMD=0.93, 95% CI 0.23-1.63, P≤0.0001, I2=89%, n=893).
“There was good evidence from four trials of large improvements in social functioning due to multicomponent structured psychotherapies against TAU with both groups receiving antipsychotic medication36-39 (SMD = 0.93, 95% CI 0.23–1.63, P≤0.0001, I2 = 89%, n = 893).”
From Effect of psychosocial interventions on social functioning in depression and schizophrenia: meta-analysis (2013) · cites this paper as [37]
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References 53 · Cited by 142
- Authors
- Guo, X., Zhai, J., Liu, Z., Fang, M., Wang, B., Wang, C., Hu, B., Sun, X., Lv, L., Lu, Z., Ma, C., He, X., Guo, T., Xie, S., Wu, R., Xue, Z., Chen, J., Twamley, E. W., Jin, H., & Zhao, J.
- Affiliations
- Central South University (CN)
- ORCID
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2010-09-01
- Volume
- 67
- Issue
- 9
- Pages
- 895
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC3632506
- OpenAlex
- W1967324959
- Cited by
- 142
- References
- 53
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 10 · 2023: 6 · 2022: 12 · 2021: 6 · 2020: 4 · 2019: 13 · 2018: 12 · 2017: 9 · 2016: 11 · 2015: 10 · 2014: 7 · 2013: 17 · 2012: 7
- FWCI
- 6.78
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH080150)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Keywords
- early schizophrenia, antipsychotic drugs, psychosocial interventions, combined psychotherapy and pharmacotherapy, treatment discontinuation, relapse, insight, social functioning, quality of life, family intervention, psychoeducation, cognitive behavioral therapy, skills training
- MeSH terms
- Activities of Daily Living, Adult, Attitude to Health, Awareness, China, Combined Modality Therapy, Female, Health Status, Humans, Longitudinal Studies, Male, Patient Education as Topic, Quality of Life, Recurrence, Schizophrenia, Social Adjustment, Antipsychotic Agents, Cognitive Behavioral Therapy, Treatment Outcome
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