Clinical and Psychopharmacologic Factors Influencing Family Burden in Refractory Schizophrenia
J Clin Psychiatry 2000;61(9):671-676
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: This study compares the effect of
clozapine and haloperidol and identifies other factors related to
family burden as experienced by relatives of patients with
refractory schizophrenia (DSM-III-R).
Method: Of 423 patients participating in a
multisite randomized clinical trial, 221 identified a family
member who was actively involved in their care and who agreed to
complete a standardized measure of family burden at 6 weeks and
3, 6, 9, and 12 months after randomization, simultaneous with
comprehensive patient assessments.
Results: Patient factors most consistently
correlated with greater family burden were symptom severity, days
living in the community (i.e., not in the hospital), and
frequency of family contact. Among family members, clozapine was
associated with significantly (p = .048) greater reduction in
feelings of dissatisfaction related to providing support to the
patient, but not in objective measures of support, amount of
worry the patient engendered, or days of missed employment or
household activity. Although clozapine reduces symptoms, thus
lowering family burden, it also increases days living in the
community, which tends to increase family burden, perhaps
canceling out the benefit to families of reduced symptoms.
Conclusion: Clozapine has a small but
significant effect on the experience of families of patients.
This is the first study to demonstrate that effective
pharmacotherapy may be of some benefit to families as well as to