patient care perspectives

Functional Level in Schizophrenia Post Stabilization With Antipsychotic Medication

by Leslie Citrome, MD, MPH

Overview

Once positive symptoms are controlled, the overall goal in the maintenance phase of treatment is for the patient to develop and sustain a fulfilling life, the specifics of which vary from patient to patient. Psychosocial treatment, cognitive therapy, and vocational rehabilitation are some approaches to facilitate this goal.

Expert Commentary

Leslie Citrome, MD, MPH

Clinical Professor
Department of Psychiatry and Behavioral Sciences
New York Medical College
Valhalla, NY

“According to the recovery model of schizophrenia, recovery does not mean an elimination of the illness. Rather, it means learning to live with the illness in a way that allows the patient to have a fulfilling life.” 

Leslie Citrome, MD, MPH

Schizophrenia is a progressive illness. Specifically, after each relapse, it becomes increasingly difficult—and is often impossible—for a patient to return to their previous level of functioning. According to the recovery model of schizophrenia, recovery does not mean an elimination of the illness. Rather, it means learning to live with the illness in a way that allows the patient to have a fulfilling life.

For many patients, a fulfilling life involves living independently and having some type of employment and strong social relationships. While some patients can live independently, others cannot. Many individuals continue to live with their parents, which becomes problematic when time marches on and parents become elderly. In many instances, independent living skills may need to be taught. For those who have been living in institutions, efforts have also been made to teach independent living skills. For example, some treatment facilities have an “apartment program” in which patients learn independent living skills in a mock-up of an apartment, complete with cooking facilities. As these patients have never had to use such skills before, learning them can be difficult, but some individuals can eventually live relatively independently with enough time and effort. In other instances, many people with schizophrenia can benefit from semi-structured or structured communal living arrangements.

Preserving functional status remains a significant unmet need in the treatment of schizophrenia. Of note, cognitive functioning in patients with chronic mental illness is typically lower than that of the general population, and this may be particularly true in schizophrenia.

Current pharmacotherapies do little to preserve or restore cognitive functioning, resulting in only minor cognitive improvement. Fortunately, psychosocial therapy, cognitive remediation, and vocational therapy can help patients achieve some degree of functional independence. Although living independently and finding suitable employment are goals for patients with schizophrenia, treatment goals differ for each person, highlighting the importance of individualizing treatment plans according to the patient’s individual circumstances, preferences, and values.

References

Bozzatello P, Bellino S, De Marzi G, et al. Effectiveness of psychosocial treatments on symptoms and functional domains in schizophrenia spectrum disorders: a prospective study in a real-world setting. Disabil Rehabil. 2019;41(23):2799-2806. doi:10.1080/09638288.2018.1480666

Jahn FS, Skovbye M, Obenhausen K, Jespersen AE, Miskowiak KW. Cognitive training with fully immersive virtual reality in patients with neurological and psychiatric disorders: a systematic review of randomized controlled trials. Psychiatry Res. 2021;300:113928. doi:10.1016/j.psychres.2021.113928

Lahera G, Gálvez JL, Sánchez P, et al. Functional recovery in patients with schizophrenia: recommendations from a panel of experts. BMC Psychiatry. 2018;18(1):176. doi:10.1186/s12888-018-1755-2

Tsang MMY, Man DWK. A virtual reality-based vocational training system (VRVTS) for people with schizophrenia in vocational rehabilitation. Schizophr Res. 2013;144(1-3):51-62. doi:10.1016/j.schres.2012.12.024

Vita A, Barlati S, Ceraso A, et al. Effectiveness, core elements, and moderators of response of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized clinical trials. JAMA Psychiatry. 2021 Apr 20;e210620. doi:10.1001/jamapsychiatry.2021.0620

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