ABSTRACT
As many as 50% of patients with schizophrenia do not take oral antipsychotic medications as prescribed, yet long acting injections are rarely utilized. Community agencies that serve this population are often over-burdened and poorly funded. There are negative attitudes on the part of both physicians and consumers about injections. Transportation and logistics are often problematic. We describe the unique opportunity provided by the need for bi-weekly or monthly injections to establish a recovery-oriented group around injection visits. Our approach discusses methods and resources to help overcome some of the common barriers by establishing advocates within the agency, establishing necessary infrastructure, providing education for consumers, providers, and staff, sharing information about successful outcomes with clinic staff and working through billing issues. We also recommend public advocacy on the part of the clinic and consumers to work with state funding sources to change regulations that may limit appropriate clinical care.
Subject(s)
Antipsychotic Agents/administration & dosage , Community Mental Health Services , Delayed-Action Preparations , Patient Acceptance of Health Care , Humans , Injections, Intravenous , Medication Adherence , Program Development , Schizophrenia/drug therapyABSTRACT
The process of recovery in schizophrenia involves resolving persistent symptoms, addressing cognitive impairments, and improving functional outcomes. Our research group has demonstrated the efficacy of cognitive adaptation training (CAT)--a home-based psychosocial treatment utilizing environmental supports such as medication containers, signs, checklists, and the organization of belongings to bypass deficits in cognitive functioning and cue and sequence adaptive behavior) for improving adherence to medications and functional outcomes in schizophrenia. Early CAT pilot studies utilizing some therapists with training in cognitive behavior therapy (CBT) techniques for psychosis found significant improvements in positive symptoms. More recent larger scale randomized clinical trials failed to replicate this finding with CAT therapists not trained in CBT techniques. Persistent psychotic symptoms substantially impair patients' ability to adapt to life in the community. Cognitive behavior therapy for psychosis (CBTp) is an evidence-based practice for addressing persistent positive symptoms and the distress associated with them. CBTp decreases symptomatology and minimizes the negative effect of persisting symptoms upon individuals with this disorder. We now describe a home-delivered, multimodal cognitive treatment targeting functional outcomes and persistent positive symptoms for individuals with schizophrenia by utilizing both CAT and CBT techniques. We discuss the advantages and challenges of combining these 2 interventions, present a small retrospective data analysis to support their combination into a multimodal treatment, and describe the design of an ongoing randomized trial to investigate efficacy.
Subject(s)
Attitude , Cognition Disorders/therapy , Cognitive Behavioral Therapy/methods , Culture , Problem Solving , Schizophrenia/therapy , Schizophrenic Psychology , Activities of Daily Living/psychology , Adaptation, Psychological , Adult , Attention , Awareness , Cognition Disorders/diagnosis , Cognition Disorders/psychology , Combined Modality Therapy , Cues , Delusions/diagnosis , Delusions/psychology , Delusions/therapy , Female , Humans , Male , Middle Aged , Prospective Studies , Randomized Controlled Trials as Topic , Schizophrenia/diagnosis , SocializationABSTRACT
Schizophrenia is a complex neurodevelopmental disorder characterized by cognitive deficits. These deficits in cognitive functioning have been shown to relate to a variety of functional and treatment outcomes. Cognitive adaptation training (CAT) is a home-based, manual-driven treatment that utilizes environmental supports and compensatory strategies to bypass cognitive deficits and improve target behaviors and functional outcomes in individuals with schizophrenia. Unlike traditional case management, CAT provides environmental supports and compensatory strategies tailored to meet the behavioral style and neurocognitive deficits of each individual patient. The case of Ms. L. is presented to illustrate CAT treatment.
