Marvin Herz

• University of Rochester

Illness management is a broad set of strategies designed to help individuals with serious mental illness collaborate with professionals, reduce their susceptibility to the illness, and cope effectively with their symptoms. Recovery occurs when people with mental illness discover, or rediscover, their strengths and abilities for pursuing personal go...

This study examined whether a program for relapse prevention (PRP) is more effective than treatment as usual (TAU) in reducing relapse and rehospitalization rates among outpatients with schizophrenia. Eighty-two outpatients with DSM-III-R schizophrenia or schizoaffective disorder were randomly assigned to receive either PRP (experimental group, n =...

Three types of early intervention for schizophrenia are reviewed: 1) intervention during the prodromal phase with the goal of preventing the onset of schizophrenia; 2) intervention during the early phases of a first episode of schizophrenia; and 3) intervention during the prodromal phase of relapse in patients who have had previous psychotic episod...

The long-term effects of a combination of clozapine and psychosocial treatment were evaluated in a sample of treatment-refractory state hospital patients with schizophrenia. A repeated-measure design was used. Thirty-one patients with schizophrenia received both clozapine and an enhanced psychosocial treatment program. Data were collected at baseli...

The value of monitoring for prodromal symptoms in patients with schizophrenia has been questioned by some investigators who point out that their positive predictive value, sensitivity, and specificity can be low in relation to relapse. This article focuses on methodological and conceptual issues which should be considered in evaluating the usefulne...

This is a 2-year, double-blind, placebo-controlled study of 101 patients, evaluating the relative efficacy of intermittent medication (given only when the patient shows early signs of relapse) compared with moderate doses of maintenance medication for stable schizophrenic outpatients. Patients were dropped from the study if they had three prodromal...

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 Medication Clinic of a large, urban Mental Health Center was screened for schizophrenic patients eligible for an intermittent medication approach. A total of 112 patients were evaluated, and 39, or 34.8 percent of the sample, met our basic inclusion criteria. No sex or age differences were found for eligibility. Sufficient eligible patients wer...

Long-term outcome studies have shown that schizophrenia is an illness whose course is usually characterized by exacerbations and remissions. This chapter summarizes pertinent literature regarding treatment of acute episodes; early intervention to prevent the development of full relapse; and pharmacological, behavioral, and psychotherapeutic strateg...

There has been little systematic study of early signs of relapse in schizophrenia. Determination of a prodromal symptom profile could facilitate early intervention before the development of a full-blown episode. A structured questionnaire was used to assess prodromal symptoms in two samples of schizophrenic patients, one of which included family in...

Under new cost-containment regulations such as diagnostically related groups (DRGs) and capitation-based programs such as health maintenance organizations (HMOs), it will be advantageous to employ treatment strategies which reduce the utilization of hospitalization for acute psychiatric episodes. Results of clinical research studies have demonstrat...

Of 15 unmedicated chronic schizophrenic patients with acute exacerbations and 15 healthy controls given the dexamethasone suppression test (DST), 11 patients and two controls were nonsuppressors. The results add to the evidence that the DST has limited value in psychiatric diagnosis.

Although clinicians know that the acute symptoms of schizophrenia exacerbate and remit during the course of the illness, few studies detail the process leading to psychotic episodes. As an introduction to the problem of recognizing relapse in schizophrenic outpatients, the author discusses interviews that were conducted with one group of family mem...

Because of neuroleptics' potential long-term side effects, the authors conducted a pilot study of an alternative to maintenance medication for stable schizophrenic outpatients. The doses of 19 patients were gradually reduced to zero over 8 weeks, and medication was then given only when a patient experienced early signs of relapse. The patients atte...

Although schizophrenia is a chronic illness with exacerbations and remissions, there has been surprisingly little systematic study of early signs of relapse. The authors gave 145 chronic schizophrenic patients and 80 family members a structured interview regarding early signs of relapse and other information related to the relapse period. Most pati...

This article presents the long-term follow-up effects of brief vs standard hospitalization on families. One hundred seventy-five newly admitted inpatients who lived with their families were randomly assigned to standard inpatient care, brief hospitalization followed by the availability of transitional day care, and brief hospitalization. All patien...

An effort was made to determine patient characteristics that have differential prognostic significance, depending on treatment assignment to one of three treatment approaches: standard inpatient care (n = 63), brief hospitalization followed by day care (n = 61), and brief hospitalization without day care (n = 51). All were followed by outpatient ca...

In recent years there has been a significant decrease in the length of hospital stays for psychiatric patients. The author examines whether the shorter stays are justified by results of controlled studies and, if so, what is the most appropriate hospital milieu for short-term units. He summarizes several studies supporting his opinion that short-te...

The authors compared the use of inpatient and day care services, number of readmissions, use of special services, use of drugs, costs to family and community, and differential dollar costs of three treatment approaches--brief hospitalization followed by day care, brief hospitalization followed by outpatient care, and standard hospitalization. They...

The author present two-year follow-up data of a controlled study of 175 newly admitted inpatients who lived with families, comparing the relative efficacy of brief hospitalization (with and without transitional day care) and standard hospitalization (with all patients offered outpatient aftercare). The long-term results confirm the preliminary find...

A total of 175 newly admitted inpatients who lived with families were randomly assigned to three treatment groups: standard inpatient care (discharge at the therapist's discretion), brief hospitalization (one week or less) with transitional day care available, and brief hospitalization without day care. Outpatient aftercare was offered to all patie...

A total of 175 newly admitted inpatients who lived with their families were randomly assigned to three treatment groups: standard inpatient care and brief hospitalization with and without transitional day care. Case reports of 6 of the 9 patients considered "study failures" illustrate that effective postdischarge adaptation is limited by the patien...

A total of 175 newly admitted inpatients who lived with families were randomly assigned to three treatment groups: standard inpatient care (discharge at the therapist's discretion), brief hospitalization (one week or less) with transitional day care available, and brief hospitalization without day care. Outpatient aftercare was offered to all patie...

The authors designed a study to test the relative efficacy of minimal individual contact versus group therapy, given an equal amount of therapist time allocated to each treatment. One hundred forty four aftercare patients were randomly assigned to either group or individual therapy conducted by 12 incoming first year residents. Results at the end o...

The authors report the results of their controlled study to compare the efficacy of day versus inpatient hospitalization for those patients for whom both treatments are equally feasible clinically. Newly admitted inpatients from the catchment area were randomly assigned to either day or inpatient care. Outcome evaluations, including measures of psy...

focus on 3 approaches [to psychosocial treatments for schizophrenia]: psychotherapy (both individual and group), social skills training, and vocational rehabilitation individual psychotherapy [intensive insight-oriented psychotherapy, supportive psychotherapy] / group psychotherapy (PsycINFO Database Record (c) 2012 APA, all rights reserved)

An analysis was made to determine the degree to which the pattern among psychiatric symptoms is determined by known differences in raters of these symptoms. Ratings were made by 2 psychiatrists whose background and interests were different. "Clusters revealed by the 2 analyses were mutually consistent and similar to the clusters which have been fou...