During the past decade there has been a major advance in clinical management of schizophrenic disorders (Falloon & Shanahan, 1990; Lam, 1991; Schooler & Hogarty, 1987). This has resulted from application of strategies based upon a vulnerability-stress model of mental disorders. This considers mental disorders to result from interactions between specific biological vulnerability and non-specific environmental stresses (Falloon & Fadden, 1993).
Therapeutic interventions derived from this model combine biomedical strategies, predominantly optimal pharmacotherapy, with psychosocial strategies that aim to enhance the capacity of the index patient and his/her social network to cope with the impact of environmental stresses on the course of the disorder. Ten controlled studies have been published since 1980 that meet minimal standards of research design, with follow-up for at least 1 year (Bellack, Turner, Hersen, & Luber, 1985; Falloon, 1985; Gunderson et al., 1984; Hogarty et al., 1986; Leff, Kuipers, Berkowitz, Eberlein-Fries, & Sturgeon, 1982; Leff et al., 1989; Malm, 1982; McFarlane, 1990; Tarrier et al., 1988; Wallace & Liberman, 1985). Nine also provided 2-year results. Overall, these studies show that the addition of psychosocial strategies to optimal case management and long-term drug prophylaxis halves the rate of major clinical exacerbations in people suffering from schizophrenia. This benefit is most notable during the first year after a major schizophrenic episode, particularly when the psychosocial interventions encompass patients' immediate social support systems, usually the family or marital household (Falloon, 1985; Hogarty et al., 1986; Leff et al., 1982; Leff et al., 1989; McFarlane, 1990; Tarrier et al., 1988).