Saturday, October 31, 2020

Psychosocial Therapy for Schizophrenia

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INTRODUCTION

Schizophrenia is a psychiatric disorder involving chronic or recurrent psychosis. It is commonly associated with impairments in social and occupational functioning. [1]. It is among the most disabling and economically catastrophic medical disorders, ranked by the World Health Organization as one of the top ten illnesses contributing to the global burden of disease [2].

Antipsychotic medications are first-line treatment for schizophrenia. They have been shown in clinical trials to be effective in reducing symptoms and behaviors associated with the disorder. However, most patients with schizophrenia experience disabling impairment even after benefiting from antipsychotics, including positive and negative symptoms, cognitive deficits, poor social functioning, and episodes of acute symptomatic relapse. Empirically validated psychosocial interventions, added to antipsychotic medication, target one or more of these deficit areas.

This topic addresses psychosocial interventions for schizophrenia. Psychosocial interventions for severe mental illness (not limited to schizophrenia), including assertive community treatment and supported employment, are discussed separately. The epidemiology, pathogenesis, clinical presentation, clinical manifestations, course, diagnosis and pharmacotherapy for schizophrenia are also discussed separately. Common comorbid presentations of schizophrenia are also discussed separately.

Psychosocial Treatments for Schizophrenia

Antipsychotic drugs have proven to be crucial in relieving the psychotic symptoms of schizophrenia — hallucinations, delusions, and incoherence — but are not consistent in relieving the behavioral symptoms of the disorder.

Even when patients with schizophrenia are relatively free of psychotic symptoms, many still have extraordinary difficulty with communication, motivation, self-care, and establishing and maintaining relationships with others. Moreover, because patients with schizophrenia frequently become ill during the critical career-forming years of life (ages 18 to 35), they are less likely to complete the training required for skilled work. As a result, many with schizophrenia not only suffer thinking and emotional difficulties, but lack social and work skills and experience as well.

It is with these psychological, social and occupational problems that psychosocial treatments may help most. While psychosocial approaches have limited value for acutely psychotic patients (those who are out of touch with reality or have prominent hallucinations or delusions), they may be useful for patients with less severe symptoms or for patients whose psychotic symptoms are under control. Numerous forms of psychosocial therapy are available for people with schizophrenia, and most focus on improving the patient’s social functioning — whether in the hospital or community, at home or on the job. Some of these approaches are described here. Unfortunately, the availability of different forms of treatment varies greatly from place to place.

Rehabilitation

Broadly defined, rehabilitation includes a wide array of nonmedical interventions for those with schizophrenia. Rehabilitation programs emphasize social and vocational training to help patients and former patients overcome difficulties in these areas. Programs may include vocational counseling, job training, problem-solving and money management skills, use of public transportation, and social skills training. These approaches are important for the success of the community-centered treatment of schizophrenia, because they provide discharged patients with the skills necessary to lead productive lives outside the sheltered confines of a mental hospital.

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