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Family factors identifying schizophrenic patients at risk of relapse
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FAMILYFAcImSIDEmIF!CINGSCHIzoPHRmIcPATImIS
AT RISK OF RELAPSE
Make B. L&all, Ph.D.*, Stephen R. Marder, M.D., Jim Mintz, Ph.D., Joanne Mckenzie, R.N. WestxosAngelesvAMedicalcenter, Blvd., Ins Angeles, CA 90073
Brenkxd
Division, 11301 Wilshire
family as ~primarylong-termcaretakerof~schizophrenicpatients. This raakesthequalityof~familyenvirorrmentinrreasinglyimportanttothe m cor&ct& in the U.S. and England with uveralltrea~processo oclmmtsthatcertaintypesof ~~f~;cp&$cpcpulationsd immentsareassociatedwithhigherrelapse rates. Ihesestxliesambasedonthe %qmssedRmtion~ constructasderived fmn theCa&emellFamily Interview (CFI). Hokever, form clinical and arKlti.lTe-conslmungan thecl?Iistoo~ ,"""l"p""t mstnmmt . This pilot study tested three brief, mre efficient alternatives for assessingfamilidlemationdLenv~~taspredictorsof relapse-theKreismanPatientF&jectionScale, Hogarty's GlobalJudgment Criticism Scale, ard the Gott&mU~leserHcstility/AnxietysCales ratings patientswho fulfilledlXMof five-mimte speech samples. Subjectswere III criteria for SchizophrenicDisomders ard were followed systematically fortwoyearsonmadicationmaintemmeusing fluphenazinedecanoate. Sgparate~statisticalanalyses wa.reperfomsd using (1) a oosteriori chotanizationof the scales arxd(2) a txiori analysis of scale scores as continuaxsvariables. All threeof the emtionalenvironment basedan~dichotcQcizedscores~significantpredidorsofrelapseat2 yearsusingsurvivalanalysis. The me&man Scale significantlypredicted relapse: P C.01, dichotmized scores: p K.04, continuous scores. The G&ts&a&-Gleser Hostility/AnxietyScales significantlypredicted relapse: p C.01, dichotmized scow: pc.01, Hostility Scale alone on the continuous scale. The Hcgarty Criticism Scale significantlypredicted relapse: pC.03, dichotanizedscores; r~& significantforthecontinuous scale. Four dmqra#ic factors (age, education, ethnicity,duration of illness) related torelap6eatstatisticallysignificantlevels. Whenthesewere included in survival analysisas covariates,the G&k&alk+leser Hostility Scale (p =.004). Sumival analysis rerknedasignificantpredictorofoutcms withcovariates(CoxModels) assessed all factors that related to outcms (family factors, dcee, demographics)and fomdthatonlytheGottschalkGleserHostility Scale (evaluatedas acontinuousvariable) predicted relapse (p C.01). These findings suggest that brief interview procedures are available for assessing familial em ironment and may help identify patients at risk of relapse. A casual explanation should not be concluded fmnmesefimdiqs. Furtherstudiesneedtoevaluate reciprocal interactionsbetween familyfactorsandthecourse of schizophrenicillness.
FAMILYFAcImSIDEmIF!CINGSCHIzoPHRmIcPATImIS
AT RISK OF RELAPSE
Make B. L&all, Ph.D.*, Stephen R. Marder, M.D., Jim Mintz, Ph.D., Joanne Mckenzie, R.N. WestxosAngelesvAMedicalcenter, Blvd., Ins Angeles, CA 90073
Brenkxd
Division, 11301 Wilshire
family as ~primarylong-termcaretakerof~schizophrenicpatients. This raakesthequalityof~familyenvirorrmentinrreasinglyimportanttothe m cor&ct& in the U.S. and England with uveralltrea~processo oclmmtsthatcertaintypesof ~~f~;cp&$cpcpulationsd immentsareassociatedwithhigherrelapse rates. Ihesestxliesambasedonthe %qmssedRmtion~ constructasderived fmn theCa&emellFamily Interview (CFI). Hokever, form clinical and arKlti.lTe-conslmungan thecl?Iistoo~ ,"""l"p""t mstnmmt . This pilot study tested three brief, mre efficient alternatives for assessingfamilidlemationdLenv~~taspredictorsof relapse-theKreismanPatientF&jectionScale, Hogarty's GlobalJudgment Criticism Scale, ard the Gott&mU~leserHcstility/AnxietysCales ratings patientswho fulfilledlXMof five-mimte speech samples. Subjectswere III criteria for SchizophrenicDisomders ard were followed systematically fortwoyearsonmadicationmaintemmeusing fluphenazinedecanoate. Sgparate~statisticalanalyses wa.reperfomsd using (1) a oosteriori chotanizationof the scales arxd(2) a txiori analysis of scale scores as continuaxsvariables. All threeof the emtionalenvironment basedan~dichotcQcizedscores~significantpredidorsofrelapseat2 yearsusingsurvivalanalysis. The me&man Scale significantlypredicted relapse: P C.01, dichotmized scores: p K.04, continuous scores. The G&ts&a&-Gleser Hostility/AnxietyScales significantlypredicted relapse: p C.01, dichotmized scow: pc.01, Hostility Scale alone on the continuous scale. The Hcgarty Criticism Scale significantlypredicted relapse: pC.03, dichotanizedscores; r~& significantforthecontinuous scale. Four dmqra#ic factors (age, education, ethnicity,duration of illness) related torelap6eatstatisticallysignificantlevels. Whenthesewere included in survival analysisas covariates,the G&k&alk+leser Hostility Scale (p =.004). Sumival analysis rerknedasignificantpredictorofoutcms withcovariates(CoxModels) assessed all factors that related to outcms (family factors, dcee, demographics)and fomdthatonlytheGottschalkGleserHostility Scale (evaluatedas acontinuousvariable) predicted relapse (p C.01). These findings suggest that brief interview procedures are available for assessing familial em ironment and may help identify patients at risk of relapse. A casual explanation should not be concluded fmnmesefimdiqs. Furtherstudiesneedtoevaluate reciprocal interactionsbetween familyfactorsandthecourse of schizophrenicillness.