The Treatment Strategies in Schizophrenia (TSS) study is a five year collaborative study sponsored by NIMH involving five sites. 540 patients with schizophrenia will be recruited, with informed consent, to enter the study during an episode of illness requiring hospitalisation. Following a period of stabilisation, patients will be randomly assigned to double-blind treatment with standard dose, low dose or placebo dose of fluphenazine decanoate every two weeks for two years. Symptom exacerbation and relapses will be treated with open fluphenazine hydrochloride and hospitalisation if needed. The patient and their families will also be randomly assigned to applied or supportive family management conditions. The major aim is to study these different treatment strategies and to look at the interaction of the pharmacological and family management conditions. The Computer Tomographic Study of Schizophrenia study plans to CT scan TSS patients as they enter the double-blind phase, using late generation CT scanners. Matched medical control scans will be obtained from the Radiology files to compare the proportion of schizophrenic subjects and medical controls having evidence of lateral ventricular enlargement, sulcal and cerebellar atrophy, and enlargement of the third ventricle. The hypothesis being tested is that schizophrenic patients with lateral ventricular enlargement will show differential treatment response to the different treatment conditions compared to the schizophrenic patients without lateral ventricular enlargement. Schizophrenic patients with lateral ventricular enlargement are expected to have a poorer premorbid level of functioning, symptomatology marked by negative symptoms, poorer psychosocial functioning and a higher incidence of neuroleptic side-effects.
