The purpose of this demonstration project is to determine whether an Early Intervention Strategy is effective in reducing relapse and rehospitalization rates in schizophrenic patients who have recently been discharged from the hospital and are at high risk for relapse. Patients will be randomly assigned to an experimental and control group: The Early Intervention Strategy experimental group will receive 1) Education of patients and family members about prodromal symptoms of relapse and 2) Immediate intervention with increased medication and supportive crisis therapy when prodromal symptoms appear until the episode resolves. There is close collaboration between patients, family members, and treatment personnel. The control group will receive Treatment as Usual (individual medication management and support bi-weekly) as outpatients. The relative efficacy of these two treatment programs will be compared over an 18-month period with respect to relapse and rehospitalization rates, major dimensions of psychopathology, social and vocational role functioning, family burden, patient and family satisfaction, patient quality of life, drug side effects and cost effectiveness. It is hypothesized that 1) The rates of relapse and rehospitalization will be statistically significantly higher for patients in the Treatment as Usual Group as compared to patients in the Early Intervention Strategy Group after 18 months. 2) Patients in the Early Intervention Strategy Group will have significantly decreased symptomatology, better social and vocational role functioning, decreased drug side effects, better quality of life, and more satisfaction with treatment, and families will show decreased family burden and more satisfaction with treatment than those in the Treatment as Usual Group. 3) It will be significantly less costly to treat patients in the Early Intervention Strategy Group than the Treatment as Usual Group, the main reason being much reduced hospitalization in the EIS group. Significance: If relapse and rehospitalization rates in schizophrenic patients can be reduced, it will be a great public health benefit and patients will have a sense of control over the course of their illness.
