Recovery From Schizophrenia: Etiological Models and Evidence-Based Treatments by Glenn D. Shean

Author:Glenn D. Shean
Language: eng
Format: mobi
Tags: Hindawi Publishing Corporation
ISBN: 9789774541070
Publisher: Hindawi Publishing Corporation
Published: 2010-06-14T21:00:00+00:00

12PORTRecommended

Psychosocial Therapies

The majority of individuals diagnosed with schizophrenia experience sev-

eral relapses in which acute symptoms reemerge after a period of remis-

sion. Each relapse is associated with decreases in cognitive functioning

and quality of life, loss of self esteem, increased social stigma, and signifi-

cant social disruption. Relapse prevention therefore must be an important

part of treatment services designed to help people reestablish and main-

tain previous levels of functioning. Antipsychotic medications are effective

in treating acute psychotic symptoms and in reducing the likelihood of

relapse. These medications do not however, help patients gain self aware-

ness or insight into their problems, acquire adaptive coping and social

skills, expand their repertory of stress coping strategies or help them deal

with real life situations. Programs that combine antipsychotic medications

with an array of psychosocial therapies tailored to the specific needs and

interests of the individual have been demonstrated to be more effective than

medication alone (Lehman et al. [321]). The PORT committee identified six psychosocial evidence-based practices (EBPs) to be utilized during any

phase of the disorder, but noted that it would be unusual for all six prac-

tices to be administered at the same time since individuals have different

clinical and psychosocial needs at different points, and some psychosocial

interventions share treatment components.

Recommendation 15: Family Intervention (FI). Persons with schizophrenia

and their families who have ongoing contact with each other should be

offered a family intervention, the key elements of which include a dura-

tion of at least 9 months, illness education, crisis intervention, emotional

support, and training in how to cope with illness symptoms and related

problems.

144

Recovery from Schizophrenia

Rationale. Randomized clinical trials have consistently demonstrated

that family interventions, in combination with adequate pharmacother-

apy, significantly reduce 1-year relapse rates. Other beneficial outcomes of

family interventions include reduced rates of hospital admission, reduced

family burden, and improved patient-family relationships. Effective family

intervention programs integrate treatment with medication within a mul-

tidisciplinary team approach to the patient and family.

By the late 1970s high relapse rates among discharged schizophrenic

patients were apparent even when patients were medication compliant.

At about the same time research indicated that highly stimulating forms

of psychosocial interventions and family interactions involving high levels

of expressed emotion (EE) could evoke psychotic symptoms in vulnerable

patients (Leff and Vaughan [317]). The key components of EE have been identified as high levels of critical comments, hostility, over involvement

and low levels of warmth directed by family members and other caregivers

toward the patient. Each of the negative components of EE was found

to be correlated with higher rates of relapse of schizophrenic symptoms.

Patients discharged to high EE families have a nine-month relapse rate of

about 50% compared to 15% for low EE families (Vaughan et al. [359]).

Family members that fail to understand the disorder, often become frus-

trated, angry and accusatory with the former patient, and react in ways that

increase the likelihood of relapse. Family psychoeducational interventions

(FI) are designed to counteract the problems associated with high levels

of family EE. Research has demonstrated that the course of schizophrenia

for individuals, who are in close contact with family members, depends to a

significant extent on how family members interact and deal with the patient

during and after an initial episode of psychosis. Because

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.