Functional Adaptation Skills Training (FAST): A randomized trial of a psychosocial intervention for middle-aged and older patients with chronic psychotic disorders
Department of Psychiatry (0680), University of California, San Diego, La Jolla, CA 92093-0680, USA. Schizophrenia Research
(Impact Factor: 3.92).
10/2006; 86(1-3):291-9. DOI: 10.1016/j.schres.2006.05.017
Behavioral interventions designed to improve functioning of older patients with schizophrenia and other chronic psychotic disorders have the potential to significantly increase patients' independence and quality of life. This study evaluated a psychosocial intervention designed to improve everyday living skills of middle-aged and older outpatients with chronic psychotic disorders.
A total of 240 patients with a DSM-IV-based chart diagnosis of schizophrenia or schizoaffective disorder participated in a 24-week, randomized controlled trial comparing a behavioral group intervention called "Functional Adaptations and Skills Training" (FAST; n=124) to a time-equivalent attention-control (AC; n=116) group focused on improving functional skills.
Compared to participants randomized to AC, those in the FAST intervention demonstrated significant improvement in everyday living skills (p=.046) and social skills (p=.003), but not medication management skills (p=.268).
Results suggest that middle-aged and older patients with psychotic disorders may benefit from participation in interventions designed specifically to improve functional skills.
Available from: Adolfo J. Cangas
- "Algunas de las sesiones abordan temáticas tan importantes como planificar el día a día, resolver problemas con la medicación, vías de reconexión con la comunidad y sus recursos, identificar signos de alarma de recaídas, planificar un plan de emergencia y afrontar el estrés de la vida en comunidad. El módulo de control/manejo del abuso de sustancias va dirigido especialmente a diagnósticos de patología dual y en general a cualquier consumidor de sustancias (Ho, Tsuang y Liberman, 1999; Patterson et al., 2006; Roberts, Shaner y Eckman, 1999). Este módulo suele combinarse con el de ocio y tiempo libre, con el de habilidades básicas de comunicación, el de relaciones interpersonales e íntimas y con el de habilidades para la búsqueda y mantenimiento de trabajo. "
Available from: Saeed Farooq
- "This motivational intervention is aimed at increasing the probability of taking medications consistently by highlighting the advantages of adherence and developing strategies to counteract drawbacks using tools such as “decisional balance” activity in which the perceived benefits and drawbacks of taking medications are elicited.17 To address the primary drawback of side effects, an adverse event tracking form may be used to assist in recognition of side effects, along with a personalized treatment plan to counteract these.18 "
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ABSTRACT: Nonadherence to treatment is a major challenge in all fields of medicine, and it has been claimed that increasing the effectiveness of adherence interventions may have far greater impact on the health of the population than any improvement in specific medical treatments. However, despite widespread use of terms such as adherence and compliance, there is little agreement on definitions or measurements. Nonadherence can be intermittent or continuous, voluntary or involuntary, and may be specific to single or multiple interventions, which makes reliable measurement problematic. Both direct and indirect methods of assessment have their limitations. The current literature focuses mainly on psychotic disorders. A large number of trials of various psychological, social, and pharmacologic interventions has been reported. The results are mixed, but interventions specifically designed to improve adherence with a more intensive and focused approach and interventions combining elements from different approaches such as cognitive-behavioral therapy, family-based, and community-based approaches have shown better outcomes. Pharmacologic interventions include careful drug selection, switching when a treatment is not working, dose adjustment, simplifying the treatment regimen, and the use of long-acting injections. The results for the most studied pharmacologic intervention, ie, long-acting injections, are far from clear, and there are discrepancies between randomized controlled trials, nationwide cohort studies, and mirror-image studies. Nonadherence with treatment is often paid far less attention in routine clinical practice and psychiatric training. Strategies to measure and improve adherence in clinical practice are based more on personal experience than on research evidence. This overview focuses on strategies used for improving treatment adherence in psychiatric disorders in the light of current evidence, with emphasis on public health aspects of treatment adherence and the management of nonadherence in routine clinical practice.
Available from: Michael Schoenbaum
- "Although a number of studies have shown that targeted interventions may improve certain functional skills (Patterson et al., 2006), it has yet to be shown that these changes lead to sustained improvements in residential status. Thus, it seems likely that these impairments are substantial, are present at or before the time of the first episode, and are not responsive to current treatments. "
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ABSTRACT: The Social Security Administration (SSA) is considering whether schizophrenia may warrant inclusion in their new "Compassionate Allowances" process, which aims to identify diseases and other medical conditions that invariably quality for Social Security disability benefits and require no more than minimal objective medical information. This paper summarizes evidence on the empirical association between schizophrenia and vocational disability. A companion paper examines the reliability and validity of schizophrenia diagnosis which is critically relevant for granting a long-term disability on the basis of current diagnosis.
This is a selective literature review and synthesis, based on a work plan developed in a meeting of experts convened by the National Institute of Mental Health and the SSA. This review of the prevalence of disability is focused on the criteria for receipt of disability compensation for psychotic disorders currently employed by the SSA.
Disability in multiple functional domains is detected in nearly every person with schizophrenia. Clinical remission is much more common than functional recovery, but most patients experience occasional relapses even with treatment adherence, and remissions do not predict functional recovery. Under SSA's current disability determination process, approximately 80% of SSDI/SSI applications in SSA's diagnostic category of "Schizophrenia/Paranoid Functional Disorders" are allowed, compared to around half of SSDI/SSI applications overall. Moreover, the allowance rate is even higher among applicants with schizophrenia. Many unsuccessful applicants are not denied, but rather simply are unable to manage the process of appeal after initial denials.
Research evidence suggests that disability applicants with a valid diagnosis of schizophrenia have significant impairment across multiple dimensions of functioning, and will typically remain impaired for the duration of normal working ages or until new interventions are developed.
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