Clinical and Psychopharmacologic Factors Influencing Family Burden in Refractory Schizophrenia

Background: This study compares the effect ofclozapine and haloperidol and identifies other factors related tofamily burden as experienced by relatives of patients withrefractory schizophrenia (DSM-III-R).

Method: Of 423 patients participating in amultisite randomized clinical trial, 221 identified a familymember who was actively involved in their care and who agreed tocomplete a standardized measure of family burden at 6 weeks and3, 6, 9, and 12 months after randomization, simultaneous withcomprehensive patient assessments.

Results: Patient factors most consistentlycorrelated with greater family burden were symptom severity, daysliving in the community (i.e., not in the hospital), andfrequency of family contact. Among family members, clozapine wasassociated with significantly (p = .048) greater reduction infeelings of dissatisfaction related to providing support to thepatient, but not in objective measures of support, amount ofworry the patient engendered, or days of missed employment orhousehold activity. Although clozapine reduces symptoms, thuslowering family burden, it also increases days living in thecommunity, which tends to increase family burden, perhapscanceling out the benefit to families of reduced symptoms.

Conclusion: Clozapine has a small butsignificant effect on the experience of families of patients.This is the first study to demonstrate that effectivepharmacotherapy may be of some benefit to families as well as topatients.