Effectiveness of a Combined Therapy of Long-Acting Injectable Risperidone and Psychosocial Intervention for Relapse Prevention in Patients with Schizophrenia

Objective：Schizophrenia is a chronic disorder usually characterized by relapses alternating with periods of full or partial remission. To reduce relapse and rehospitalization rates, new long-acting injectable antipsychotics are needed. In addition, the most effective treatment is expected to include psychosocial intervention such as relapse prevention programs for patients with schizophrenia. Therefore, we examined whether combined therapy involving psychosocial intervention for relapse prevention (PIRP) and longacting injectable risperidone could reduce relapse and rehospitalization rates among outpatients with schizophrenia. Methods：We conducted a prospective study of 65 subjects with schizophrenia who participated in the PIRP program for 1 year. The PIRP program consisted of insight-gaining (psychoeducation on medication and symptoms), relapse prevention, screening for early signs for relapse, and crisis intervention. Outcome measures were efficacy as determined by the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions (CGI), and Global Assessment of Functioning (GAF); relapse rate; and associative variables of relapse and medication compliance. Results：Repeated-measure analysis of variance (ANOVA) showed that the combined therapy significantly improved the scores for the BPRS (p<0.01), CGI (p<0.01), and GAF (p<0.01) by 6 and 12 months of the study, compared with baseline scores. Overall, the 2-year relapse rate of the combined-therapy subjects was 37.1%. Logistic regression analysis showed that medication compliance was a predictor of 2-year relapse (p=0.03). Multiple regression analysis also revealed that medication compliance was related to early treatment discontinuation (p=0.00) and 2-year relapse (p=0.00). Conclusion：These findings indicate that combined therapy can be effective in maintaining medication compliance and reducing BPRS scores, suggesting a role for combined therapy in maintaining medication compliance and reducing schizophrenia symptoms. Studies with larger sample sizes are needed to examine whether these results apply to the overall schizophrenic population.