Psychotherapeutic interventions in schizophrenic disorders
KALLERGIS G., MADIANOS M.

Introduction

Farmacotherapy can improve the symptoms of schizophrenia but has limited effect on the social impairments that characterizes this disorder and limits functioning and quality of life.

The psychosocial treatments benefit the symptoms as well as social and vocational functioning.

At the recent progress decades was realized in both psychopharmacological and psychosocial treatments of schizophrenia and contributed to the therapeutical well of coping with schizophrenia.

Schizophrenia on one hand, is believed to be a biologically based disease, therefore the emphasis on the use of medications. On the other hand the needs of individuals with schizophrenia are varied and extended in social level.

The antipsychotic drugs are an important protective factor against the relapse. However the percentage of relapses for individual compliant with medication are 40% for the first post discharge and 15% in successive years.

Furthermore drugs do not appear to provide the necessary skills that contribute to successful transition to the community.

The 25% of psychotic patients fail to remain in therapeutic program.

It seems also, that relapses are connected with stress, speak in favour of psychological care in schizophrenia.

Although pharmacotherapy remains the important factor in the treatment, it appears that additional benefits are associated with a combination of somatic and psychosocial approaches.

The psychosocial approaches strengthen the vulnerable individual and social support systems in order to protect from environmental stress.

The aim of the study is the overview of published reviews that treat the psychosocial interventions in schizophrenic disorders. We selected overviews that treat psychosocial interventions and specifically, group, family and individual therapy.

Conclusions

Efficacy studies of group, family, and individual therapy interventions with schizophrenic patients over the past 20 years indicate the following:

Traditional social skills training (‘SS‘) improves communication skills, but the behaviors doesn't generalized to improved social competence.

Broad based training like the UCLA Social Independent Living Skills modules enhance knowledge of specific skill areas, such knowledge may generalize to improved social competence.

Less structured, discussion-focused therapies have yielded mixed results. Some demonstrate positive treatment effect for symptoms and social functioning, whereas others report no benefits.

Family therapy can improve symptoms, relapse, and social and vocational functioning in schizophrenic patients.

Individual medication education sessions enhance medication knowledge and treatment compliance.

Nonpsychoanalytic individual therapy was more associated with symptom and less with social competence.

Family therapy provided better outcome than individual therapy. Studies comparing family with group therapy or individual and group therapy have not been reported.

There is suggestive evidence that when family therapy and TSST was administered simultaneously there was a better outcome than with either treatment or medication alone.

Furthermore we must report the increasing references, in last years, that push forward the application of cognitive therapy in the schizophrenic disorders and the suggestion we must applicate the cognitive therapy techniques, as a adjuvant therapy together with a whosoever therapeutic intervention.

Multicentre study about the psycho education with the participation of Greece (University of Athens), report "the psycho education intervention is associated with a statistically significant improvement in patients' symptoms and social functioning as well as in family burden and coping strategies" and suggest that "it is possible to introduce psycho educational interventions in routine settings". Others authors support similar positions.

An other model is suggesting by community health mental Center of University of Athens called "Community Psychotherapy of psychosis". Its aim is:

  1. to remove positive and negative symptoms.
  2. reduce stress
  3. the positive strengthening of individual in the community environment.

Finally in another multicentre study with the participation of university of Athens it is attempted to find the optimal treatment, the optimal combination of therapeutic interventions.

The authors suggests that "every person with a schizophrenic disorder should be provided with a combination of":

  1. optimal dose, antipsychotics,
  2. strategies to educate himself and his carers to cope more efficiently with environmental stresses,
  3. cognitive-behavioural strategies to enhance work social goals and reducing residual symptoms, and
  4. assertive home-based management to help prevent and resolve major social needs and crises, including recurrent episodes of symptoms.

At the first 2 year (of five) in 603 cases results that "one half of recent cases had achieved full recovery from clinical and social morbidity". However there are several authors suggesting the combination of therapeutic interventions in Schizophrenia.

Key words: Psychotherapies (individual, group, family, combination), schizophrenic disorders.