Psychosocial treatment in schizophrenia

Psychosocial treatment may not " work " if the term work is narrowly applied to remission of acute episodes, control of symptoms, and prevention of relapses. However, these are not the only criteria by which an intervention for this complex disease should be judged. Schizophrenia is characteristically a multiply handicapping, chronic disorder involving marked impairments in social role functioning (eg, as a spouse or a worker), excess rates of medical illness, and poor quality of life. Medication is generally a necessary component of treatment, but is rarely sufficient given the diffuse nature of residual neurocognitive impairment and the history of social and functional failures that mark adolescent and adult development. Psy-chosocial interventions can play a critical role in a comprehensive intervention program, and are probably necessary components if treatment is viewed in the context of the patient's overall level of functioning , quality of life, and compliance with prescribed treatments. Optimism about the use of psychosocial treatment for schizophrenia has waxed and waned over the years, but there is now a growing consensus that psychosocial interventions play an essential role in the rehabilitation and management of people with schizophrenia. • Problem-specific psychosocial treatment • Family psychoeducation • Day hospital/vocational rehabilitation and educational opportunities • Access to crisis counseling • Easily available inpatient psychiatric care • Supervised residential living arrangements • Case management to obtain entitlements and coordinate the various facets of treatment Issues to be considered in the design and implementation of psychological treatment programs for schizophrenia • Progress in treatment should be expected to be slow and marked by periodic disruptions and periods of regression. Consequently, it is important that treatment be long term, extending over months and years. Treatment should also be guided by concrete, short-term goals that are likely to be achieved (eg, to attend day hospital at least twice a week for 1 month). • While there are a number of illness characteristics that are common to most patients, there are extensive individual differences, as well as differences within the same patient over time. Thus, treatment must be tailored to the needs of each patient and adjusted as the patient changes. • Regardless of the severity of illness, the patient must be included as a partner in treatment planning and goal setting in order to secure effective cooperation. Treatment should be conducted in collaboration with the patient, not done to the patient. Effective treatment targets specific …