 |
|
Does Participation in Psychosocial Treatment Augment the Benefit of Clozapine?
Robert Rosenheck, MD;
Janet Tekell, MD;
Jeffrey Peters, MD;
Joyce Cramer;
Alan Fontana, PhD;
Weichun Xu, PhD;
Jonathan Thomas, MS;
William Henderson, PhD;
Dennis Charney, MD;
for the Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia
Arch Gen Psychiatry. 1998;55:618-625.
Background This study examines the role of participation in psychosocial treatment as a mediator of the clinical effectiveness of clozapine.
Methods Subjects participated in a 12-month double-blind random-assignment trial comparing clozapine and haloperidol in patients hospitalized 30 to 364 days for refractory schizophrenia at 15 Department of Veterans Affairs medical centers. A broker-advocate case management intervention was used to facilitate participation in psychosocial treatments and to document such participation.
Results Between those who continued receiving clozapine (n=122) or a conventional antipsychotic drug (n=169) for 12 months, those receiving clozapine were more likely to participate in psychosocial rehabilitation treatment. Although they were no more likely to receive clinical recommendations for such treatments, they were more likely to both verbally accept recommendations and to act on them. Structural equation modeling shows that participation in psychosocial treatment did not play a mediating role in clozapine's effect on outcomes at 6 months, but was associated with both reduced symptoms and improved quality of life at 12 months.
Conclusions Clozapine facilitates participation in psychosocial treatment, and such enhanced participation is associated with improved quality-of-life and symptom outcomes. Psychosocial rehabilitation should be offered concomitantly with clozapine.
From the Veterans Affairs Connecticut Healthcare System, West Haven, and Yale School of Medicine, Department of Psychiatry, New Haven, Conn (Drs Rosenheck, Fontana, and Charney and Ms Cramer); Dallas Veterans Affairs Medical Center, University of Texas Southwestern Medical School (Dr Tekell); Pittsburgh Veterans Affairs Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Peters); and the Center for Cooperative Studies in Health Services, Hines Veterans Affairs Medical Center, Hines, Ill (Drs Xu and Henderson and Mr Thomas).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Psychosocial Treatments to Promote Functional Recovery in Schizophrenia
Kern et al.
Schizophr Bull 2009;35:347-361.
ABSTRACT
| FULL TEXT
Subjective Experience of Recovery from Schizophrenia-Related Disorders and Atypical Antipsychotics
Jenkins et al.
Int J Soc Psychiatry 2005;51:211-227.
ABSTRACT
Integrating non-drug treatments in early schizophrenia
LEWIS et al.
Br. J. Psychiatry 2005;187:s65-s71.
ABSTRACT
| FULL TEXT
Effectiveness and Cost of Olanzapine and Haloperidol in the Treatment of Schizophrenia: A Randomized Controlled Trial
Rosenheck et al.
JAMA 2003;290:2693-2702.
ABSTRACT
| FULL TEXT
Maintenance Treatment of Schizophrenia With Risperidone or Haloperidol: 2-Year Outcomes
Marder et al.
Am. J. Psychiatry 2003;160:1405-1412.
ABSTRACT
| FULL TEXT
Clozapine and Haloperidol in Moderately Refractory Schizophrenia: A 6-Month Randomized and Double-blind Comparison
Kane et al.
Arch Gen Psychiatry 2001;58:965-972.
ABSTRACT
| FULL TEXT
Review Article Case Management: an Update
Holloway and Carson
Int J Soc Psychiatry 2001;47:21-31.
ABSTRACT
Determinants of quality of life at first presentation with schizophrenia
BROWNE et al.
Br. J. Psychiatry 2000;176:173-176.
ABSTRACT
| FULL TEXT
Rehabilitation Programmes and Quality of Life in Severe Mental Illness
Browne
Int J Soc Psychiatry 1999;45:302-309.
ABSTRACT
Cost-effectiveness of Clozapine in Patients With High and Low Levels of Hospital Use
Rosenheck et al.
Arch Gen Psychiatry 1999;56:565-572.
ABSTRACT
| FULL TEXT
Intensive Community-Focused Treatment of Veterans With Dual Diagnoses
Rosenheck et al.
Am. J. Psychiatry 1998;155:1429-1433.
FULL TEXT
Don't Forget Psychosocial Support for Schizophrenia
JWatch Psychiatry 1998;1998:9-9.
FULL TEXT
|
