Psychosocial treatments for schizophrenia.
ABSTRACT As indicated in recent treatment guidelines, psychosocial treatments play a critical role in the rehabilitation of schizophrenia patients. During the past few years, novel psychosocial treatments have emerged expanding the scope of successful outcomes and designed to address the specific deficits inherent in schizophrenia. This paper provides a brief description and evaluate the efficacy of five new emerging psychosocial treatments for schizophrenia. There is strong evidence for the efficacy of supported employment programs and family therapy, especially those involving multiple family interactions. Although schizophrenia patients appear to derive benefit from cognitive behavioral therapy, no evidence supports it superiority over that of other individual psychotherapies. The trials of cognitive remediation to date have been largely unsuccessful, although new innovative approaches continue to be tested. Finally, substance use treatment specifically designed to address the deficits in schizophrenia patients have been formulated, which are supported by optimistic pilot data and awaiting the completion of on-going clinical trials.
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ABSTRACT: This study provided generalizable national data on the treatment of adult patients with schizophrenia in the United States and assessed conformance with the practice guideline treatment recommendations of the Schizophrenia Patient Outcomes Research Team and the American Psychiatric Association. National data from the American Psychiatric Institute for Research and Education's 1999 Practice Research Network study of psychiatric patients and treatments were used to examine treatment patterns for 151 adult patients with schizophrenia. Analyses were performed and adjusted for the weights and sample design to generate nationally representative estimates. Findings indicated that patients with schizophrenia who were treated by psychiatrists had complex clinical problems and were markedly disabled. Forty-one percent of patients had a comorbid axis I disorder, and 75 percent were currently unemployed. Thirty-five percent were currently experiencing medication side effects, and 37 percent were currently experiencing problems with treatment adherence. Although most patients received guideline-consistent psychopharmacologic treatment, treatment was characterized by significant polypharmacy. Rates of conformance with the guideline recommendations were significantly lower for psychosocial recommendations than for psychopharmacologic recommendations. Although 69 percent of patients received at least some psychosocial treatment, none of the unemployed patients received vocational rehabilitation services in the past 30 days. These data suggest unmet need for psychosocial treatment services among individuals with schizophrenia. These findings raise questions about whether currently available antipsychotic medications are being used optimally or whether they offer limited effectiveness for patients with complex clinical problems who are treated in routine psychiatric practice.Psychiatric Services 04/2005; 56(3):283-91. · 1.99 Impact Factor
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ABSTRACT: AIM: Internet use has grown exponentially in the past decade, but there has been little systematic research to inform our understanding of how this phenomenon may relate to mental illness. Although several characteristics of individuals experiencing psychotic-like experiences (PLEs) may render this group particularly susceptible to problematic Internet use, to date there have been no studies examining Internet use in this group. Because the experience of PLEs is considered a risk "behaviour" for formal psychosis, it is crucial to understand how patterns of Internet use may be tied to the progression of illness. METHODS: A total of 170 young adults were followed for 2 months, and grouped into those showing a steady/improved course of PLEs (PLE-Improved/Constant) and those showing an exacerbation in PLEs (PLE-Increase). Internet addiction and a factor 'Reality Substitute' were examined within and between the two groups. RESULTS: Findings indicated that although both groups reported a similar level of Internet addiction and Reality Substitute at baseline, the PLE-Improved/Constant group showed longitudinal declines in both domains of problematic Internet usage whereas the PLE-Increase group's reported level remained constant. Further, there were moderate correlations between PLEs and domains of problematic Internet use, and the magnitude of association with Reality Substitute for the PLE-Increase group grew significantly over time. CONCLUSION: Taken together, results implicate a close link between continued problematic Internet use and the phenomena of PLEs.Early Intervention in Psychiatry 08/2012; · 1.65 Impact Factor
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ABSTRACT: It is becoming clear to clinicians that functional prognosis is the issue that should be guiding their choice of therapeutic strategy offered to people with schizophrenic disorders. An individual's degree of social autonomy is one of the principal factors determining functional prognosis, and it has become essential to identify the variables that influence it. The ESPASS survey was set up to follow a cohort of 6000 schizophrenic patients in a naturalistic setting, and was conducted over six months by 1170 psychiatrists. Patients were required to meet DSM-IV TR criteria for schizophrenia, with the exception of those suffering from an acute psychotic episode, and to either need a change in their antipsychotic treatment or its initiation. Data collected included patients' sociodemographical characteristics, types of treatment (pharmacological and non-pharmacological), illness characteristics (as determined by the DSM-IV TR criteria), degree of social autonomy (EAS), effectiveness (IAQ scale), overall severity of the illness (CGI - S scale) and patient satisfaction with medical treatment (PASAP self-questionnaire). Concerning the non-pharmacological aspects of treatment that offer patients programmes to increase their autonomy, the survey made it possible to collect data describing real practices and to measure the actual availability of rehabilitation services. It has been verified that the sample of psychiatrists included in this survey, as well as the schizophrenic patients under evaluation, were representative of the French psychiatrist and patient populations. Most importantly, the survey made it possible to objectively evaluate the healthcare services available in France. It seems that the vast majority of public-service psychiatrists have access to hospital and ambulatory facilities for treatment (medical-psychological centers, day-care hospitals and rest centers), as well as access to facilities providing simulated real-life activities. Psychiatrists who are private practitioners have less access to such arrangements for their patients. The vast majority of psychiatrists in both categories are unable to offer their patients active rehabilitation techniques: training in social skills (25%), cognitive remediation (16%), cognitive-behavioral therapies (20%), even though psychoeducation is quite widespread (44%). However, the survey demonstrated that the actual use of these methods was much lower still (2%, 1% and 2%, respectively), although the use of alternative facilities to hospitalization was quite high (day-care hospitals 9%, rest-centers 8%). In total, at the end of the study, the proportion of patients benefiting from some kind of programme to increase their level of autonomy was 41%. These results have demonstrated a link between the evolution of patients' clinical symptoms and their social autonomy. Within the findings, the items that varied most were patient's level of personal care and relations with others, whereas the ability to manage resources seems difficult to influence. Moreover, the results have shown that better development of social autonomy is significantly correlated with the prescription of second-generation antipsychotics. Regarding non-pharmacological treatment, better development of social autonomy is significantly correlated with setting up programmes to achieve this objective, including the use of active rehabilitation techniques. Overall, the survey confirmed the results of earlier work to validate the scale of social autonomy (EAS), and confirmed the robustness of its objective measurements.L Encéphale 10/2010; 36(5):397-407. · 0.60 Impact Factor