Science + Technology

UCLA Study Names 10 Keys to Recovery from Schizophrenia

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UCLA NeuropsychiatricInstitute researchers have identified 10 key factors to recovery fromschizophrenia. The findings open opportunities to develop new treatment andrehabilitation programs and to reshape the negative expectations of manydoctors, patients and their families.

Based on analyses ofthe professional literature and the cases of 23 schizophrenia patients whosuccessfully returned to work or school with their symptoms under control, thefindings appear in the November 2002 edition of the International Review ofPsychiatry.

Factors detailed in thestudy that influenced recovery included 1) family relationships, 2) substanceabuse, 3) duration of untreated psychosis, 4) initial response to medication,5) adherence to treatment, 6) supportive therapeutic relationships, 7)cognitive abilities, 8) social skills, 9) personal history and 10) access tocare.

"Our findings join agrowing body of research that flies in the face of the long-held notion thatindividuals diagnosed with schizophrenia are doomed to a life of disabilitywith little expectation for productive involvement in society, a fatalisticview that in itself is damaging to prospects for recovery," said lead authorDr. Robert P. Liberman, a research scientist at the UCLA NeuropsychiatricInstitute and professor of psychiatry at the David Geffen School of Medicine atUCLA.

"By understanding thedynamics of recovery, we can design more effective courses of treatment andcombat the pessimism held by many doctors, patients and families struggling tocope with this debilitating disease," said Liberman, director of the UCLAPsychiatric Rehabilitation Program and Center for Research on Treatment andRehabilitation of Psychosis. "Increasing the rate of recovery fromschizophrenia will help destigmatize this disease, reduce the emotional burdenon families, and lighten the financial weight on communities, states and thenation."

Liberman and hiscollaborator, Dr. Alex Kopelowicz, medical director of the San Fernando MentalHealth Center and associate professor of psychiatry at UCLA, edited theNovember 2002 edition of the International Review of Psychiatry. Their articlesare joined by those from an international array of investigators on the processof recovery, prospects for improving schizophrenia treatment and suggestionsfor future research.

The findings:

Factors identified askeys to recovery from schizophrenia included:

1.      Familyrelationships: Family stress isa powerful predictor of relapse, while family education and emotional supportdecrease the rate of relapse. Among study participants, 70 percent reportedgood or very good family relationships.

2.      Substanceabuse: National Institute ofMental Health research estimates the prevalence of lifetime substance abuseamong schizophrenia patients at 47 percent, well above the overall rate. Thoughthree-quarters of the study participants reported substance abuse prior totreatment, just 17.4 percent reported abuse after the onset of schizophrenia.None reported illicit drug use in the past year, and just two reportedoccasional alcohol consumption.

3.      Durationof untreated psychosis: Longerduration of symptoms prior to treatment correlates directly with greater timeto remission and a lesser degree of remission. Among study participants, only13 percent reported a delay of more than a year between the onset of symptomsand treatment.

4.      Initialresponse to medication:Improvement of symptoms within days of receiving antipsychotic drugssignificantly predicts long-term results of treatment. Among the study group,87 percent reported effective control of symptoms with their firstantipsychotic medication.

5.      Adherenceto treatment: Failureto take antipsychotic medication as prescribed hampers both short-term andlong-term recovery. All study participants reported adherence to psychiatriccare and medication regimens.

6.      Supportivetherapy: Positive relationshipswith psychiatrists, therapists and/or treatment teams engender hope and areessential to improvement. Among study participants, 91 percent reported ongoingpsychotherapy, and 78 percent reported that accessible and supportivepsychiatrists and therapists contributed to their recovery.

7.      Cognitiveabilities: Neurocognitivefactors such as working memory, sustained attention and efficient visualperception are strong predictors of recovery. Among study participants, allshowed normal or near normal functioning on tests of flexibility in solvingproblems, verbal working memory and perceptual skills.

8.     Social skills: Negative symptoms, or poor interpersonal skills relative to socialexpectations, correlate with the degree of disability caused byschizophrenia. No study participantsshowed more than very mild negative symptoms.

9.      Personalhistory: Premorbid factors, orthose in place prior to the onset of the disease, that affect treatment outcomeinclude education and IQ, age of onset, rapidity of onset, work history, andsocial skills. Among study participants, level of education was used as ameasure of premorbid history. A total of 70 percent graduated from college beforebecoming ill, and an additional 13 percent completed two years of college.Three of the remaining four subjects worked full time before their illnessbegan.

10.  Accessto care: Continuous,comprehensive, consumer-oriented and coordinated treatment is crucial torecovery. Among study participants, 91 percent reported receiving antipsychoticmedication and psychotherapy, 47.8 percent social skills training, 56.5 percentfamily participation, 26 percent vocational rehabilitation, and 61 percentbenefits from self-help groups.

The study:

Schizophreniaencompasses a group of psychotic disorders characterized by disturbances inthought, perception, emotion, behavior and communication that last longer thansix months. In addition, the disorders are associated with disability in work,school, social relations and independent living skills.

The cause or causes ofschizophrenia is unknown. Genetic factors may play a role, as identical twinsand other close relatives of a person with schizophrenia are more likely todevelop the disorder. Psychological and social factors, such as drug abuse,stressful life challenges and interpersonal relationships, may also play a rolein development.

In identifying factorsto recovery, Liberman and his team reviewed a growing body of literature thatshow recovery from schizophrenia can occur under two conditions: 1) when thedisorder is treated early with assertive case management and use ofantipsychotic medication; and 2) when more chronic or relapsing forms aretreated for lengthy periods of time with comprehensive, continuous care.

In addition, theresearchers examined the cases of 23 schizophrenia patients who met specificrecovery criteria, including remission of symptoms as well as successfulfunctioning at work and school, independent living and social relationships.

The National Institute ofMental Health and the National Alliance for Research on Depression andSchizophrenia funded the study. UCLA Neuropsychiatric Institute researchersinvolved in the study with Liberman included Kopelowicz, Dr. Joseph Ventura andDr. Daniel Gutkind.

The UCLA Neuropsychiatric Institute isan interdisciplinary research and education institute devoted to theunderstanding of complex human behavior, including the genetic, biological,behavioral and sociocultural underpinnings of normal behavior, and the causesand consequences of neuropsychiatric disorders. In addition to conductingfundamental research, the institute faculty seeks to develop effectivetreatments for neurological and psychiatric disorders, improve access to mentalhealth services, and shape national health policy regarding neuropsychiatricdisorders.

Online resources

       UCLANeuropsychiatric Institute: www.npi.ucla.edu/ UCLA Center for Researchon Treatment & Rehabilitation of Psychosis: www.npi.ucla.edu/irc/

       InternationalReview of Psychiatry, CARFAX Publishing Ltd: www.carfax.co.uk

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