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    ABSTRACT: Whether psychosocial treatment adds substantially to the prophylactic efficacy of maintenance antipsychotic monotherapy requires a more accurate estimate of relapse risks than those contained in recent reviews. A reappraisal of the literature suggests a 1-year, post-hospital, relapse rate of 40% on medication, and a substantially higher rate among patients who live in stressful environments, rather than earlier estimates of 16%. Relapse rates of 65% at 1 year and over 80% by 2 years among drug discontinued or placebo substituted outpatients are also more accurate than the 53% relapse rate previously estimated. When psychosocial treatment is added to maintenance chemotherapy, there is compelling evidence that relapse rates are reduced by as much as 50% compared with relapse associated with medication and standard care. However, psychosocial treatment without medication is as ineffective as placebo. The additive effects appear greater for recent, theoretically based psychosocial approaches than earlier atheoretical, altruistic forms of caring. However, effects vary according to the patient's clinical state, the nature and timing of the intervention, and the presence of environmental stressors. Regarding adjustment, very little definitive information regarding psychosocial treatment effects has existed until recently. A novel, disorder-relevant approach has now been shown to have broad and significant effects on social adjustment compared with medication and support. However, the magnitude of effects is not fully realized until a third year of treatment: a distinct challenge in the era of managed care. Atypical antipsychotics and more definitive psychosocial strategies that target social cognitive deficits hold promise for enhanced outcomes in the next generation of studies.
    Journal of Psychiatric Research 05/1998; 32(3-4):243-50. DOI:10.1016/S0022-3956(97)00013-7 · 4.09 Impact Factor
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    ABSTRACT: The aim of this paper is to review the current status of knowledge of cognitive deficits and remediation in patients with schizophrenia. Relevant reports were identified by a literature survey. In addition, some outstanding researchers in these areas were asked to add to the identified list relevant literature that was not included. Our review focuses on the cognitive deficits observed in the areas of attention, memory and executive functions. We attempt to classify dysfunctions as vulnerability- or symptom-linked factors, and we discuss the methodological question of a general performance deficit vs. a differential deficit. Furthermore, we briefly delineate how antipsychotics affect cognitive functions. Finally, controlled studies of cognitive training are discussed in more detail. The most outstanding cognitive dysfunctions in patients with schizophrenia can be related to the areas of attention, memory and executive functions. Interest in cognitive remediation has to some extent been rekindled in the 1990s. However, few studies on the effects of cognitive training programs have been conducted.
    Acta Psychiatrica Scandinavica 09/1999; 100(2):85-95. DOI:10.1111/j.1600-0447.1999.tb10829.x · 5.55 Impact Factor
  • American Journal of Psychiatry 12/2001; 158(11):1771-3. DOI:10.1176/appi.ajp.158.11.1771 · 13.56 Impact Factor


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