The current wisdom in psychiatric rehabilitation suggests that social and instrumental skills training combined with judicious neuroleptic therapy, prosthetic environments, and assertive case management confers the greatest degree of protection from relapse while promoting an optimal quality of life for patients suffering serious and long-term mental illness.

Our current study compares intermittent medication with maintenance medication in the treatment of stable schizophrenic out-patients. According to the intermittent approach, known active medication is given only when the patient develops prodromal signs of relapse and until the patient restabilises. After restabilisation, medication is discontinued. The impetus for this work came as the result of our interest in finding ways to diminish the incidence of tardive dyskinesia. Many investigators believe that tardive dyskinesia is generally related to the amount of neuroleptic medication a patient has taken during his lifetime. Since it is routine for many aftercare clinics to maintain these patients indefinitely on antipsychotic medication, ways must be found to reduce the amount of medication taken by chronic schizophrenic patients. This paper will present the background ideas and preliminary studies which led to the present study and preliminary results of the present study.

It has repeatedly been demonstrated that both acutely psychotic and remitted schizophrenics, as well as some relatives of schizophrenics, show experimentally assessable cognitive dysfunctions, i.e. attentional or information-processing deficits. It is therefore assumed that these are at least potential vulnerability indicators for schizophrenia (Nuechterlein & Dawson, 1984; Nuechterlein, 1987).

An important basis for this work is the vulnerability model proposed by Zubin & Spring (1977). They integrated findings on schizophrenia in a second-order model showing the relationship between vulnerability to schizophrenia and stress, adaptation to stress, and especially coping breakdown, i.e. the incapacity to adapt in the shorter or longer term. Thus, given a certain degree of vulnerability, stress, and how the affected individual copes with it are the critical factors for the occurrence of a schizophrenic episode. The work presented here describes an empirical investigation of these two components.

In the past, psychiatry has paid little attention to the relatives of the mentally ill, but this attitude has changed gradually since the 1950s, when increasing numbers of patients began to be discharged from psychiatric hospitals through the introduction of neuroleptics and other changes. Especially for schizophrenic patients, with the low age of onset of the disorder, this development has meant that in many cases, the burden of care fell on their families, and as a consequence of this development, relatives have gradually become an important factor in care (Katschnig & Konieczna, 1987a). This field of involvement of relatives continues to expand, but is becoming increasingly confusing and complex. Our task here is an attempt to offer a structure within which to understand the manifold relative-centred activities that exist today.