Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature

Abstract

The integration of pharmacotherapy with psychosocial interventions has an important role to play in the improvement of functional outcome of subjects with schizophrenia (SCZ), in all stages of the disorder. It is essential for the adequate management of unmet therapeutic needs, such as negative symptoms and cognitive dysfunctions which account for most of the functional impairment of subjects with SCZ and do not respond to available antipsychotics. Enhancing the knowledge on factors involved in the effectiveness of integrated treatment plans is an important step forward for SCZ care. This review aims to identify factors that might influence the impact of integrated treatments on functional outcome. Most studies on the impact of psychosocial treatments on functional outcome of subjects with SCZ did not control for the effect of prescribed antipsychotics or concomitant medications. However, several factors relevant to ongoing pharmacological treatment might influence the outcome of integrated therapy, with an impact on the adherence to treatment (e.g., therapeutic alliance and polypharmacotherapy) or on illness-related factors addressed by the psychosocial interventions (e.g., cognitive dysfunctions or motivational deficits). Indirect evidence suggests that treatment integration should consider the possible detrimental effects of different antipsychotics or concomitant medications on cognitive functions, as well as on secondary negative symptoms. Cognitive dysfunctions can interfere with participation to an integrated treatment plan and can be worsened by extrapyramidal or metabolic side effects of antipsychotics, or concomitant treatment with anticholinergics or benzodiazepines. Secondary negative symptoms, due to positive symptoms, sedation, extrapyramidal side effects or untreated depression, might cause early drop-out and poor adherence to treatment. Researchers and clinicians should examine all the above-mentioned factors and implement appropriate and personalized integrated treatments to improve the outcome of SCZ.

Negative symptoms and social cognition as mediators of the relationship between neurocognition and functional outcome in schizophrenia

“…Our results have clinical implications as the presence of negative symptoms, especially motivational negative symptoms might limit the transfer to the interpersonal functioning of cognitive remediation ( 16 ). The prevention and treatment of negative symptoms is thus mandatory and any effort should be made to control for the severity of factors that could induce negative symptoms, such as positive symptoms, extrapyramidal side effects or depression, which are the main sources of secondary negative symptoms ( 28 ).…”

“…The pathways to functional outcome are very complex especially when considering the large heterogeneity of negative symptoms, cognitive impairment and also functioning itself, which includes deficits in multiple domains ( 16 , 26 , 27 , 90 ). Our results indicate the prominent impact of neurocognition on everyday life and work skills both directly and indirectly (trough social cognition) ( 6 , 9 ) and the prominent role of the motivational deficit domain of negative symptoms on the interpersonal functioning domain ( 6 , 9 , 73 ).…”

Behavioral effects induced by the cannabidiol analogs HU-502 and HU-556

“…Psychiatry disorders, such as anxiety, depression, and schizophrenia, represent a considerable medical challenge (Whiteford et al ., 2013), as their current pharmacological treatment shows limited efficacy and often produces significant side effects (Levinstein and Samuels, 2014; Murrough et al ., 2015; Giordano et al ., 2022; Howes et al ., 2022). Therefore, different molecules are being continuously studied as potential treatment alternatives.…”

Sleep spindles as neurophysiological biomarkers of schizophrenia

“…[Correction added on 24 April 2024, after first online publication: The Special Issue title has been corrected for this article. ] the disorder (Giordano et al, 2022). Furthermore, continued research efforts are essential to unravel the underlying mechanisms, identify reliable biomarkers and develop more effective interventions to improve the lives of patients with SCZ (Lee et al, 2023;Luptak et al, 2021).…”

“…SCZ has a multifactorial aetiology, involving an interplay of genetic, neurodevelopmental and environmental factors (McCutcheon et al, 2020). The multidimensional nature of SCZ necessitates a comprehensive and integrated approach that combines pharmacological interventions, psychosocial support and psychotherapy to address the diverse symptomatology and functional impairments associated with the disorder (Giordano et al, 2022). Furthermore, continued research efforts are essential to unravel the underlying mechanisms, identify reliable biomarkers and develop more effective interventions to improve the lives of patients with SCZ (Lee et al, 2023; Luptak et al, 2021).…”