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.
Factors identified askeys to recovery from schizophrenia included:
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.
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.
InternationalReview of Psychiatry, CARFAX Publishing Ltd: www.carfax.co.uk