Rationale for Emphasis on Management over Treatment of Schizophrenia in Clinical Practice

Abstract

There is a need for clinicians to emphasize "management" over "treatment" in their pharmacologic approach to schizophrenia. Using the term "treatment" may set up unrealistic expectations for a fuller recovery to a premorbid level of functioning, with potential use of overmedication and polypharmacy as well as possible unwanted adverse effects. The "management" concept allows clinicians to work with the best current medication practice, taking into account the wide variability in the course of illness and response to treatment. Prescribing clinicians should work collaboratively with other caregivers to enhance adaptive behavior and functional outcome through psychosocial rehabilitative interventions, within the context of recovery.

Type 1 and Type 2 psychosis‐related disorders for optimal treatment and management

“…One should also be mindful that repeated focusing on atypical thoughts and feelings associated with psychosis symptoms for clinical assessment or for promoting insight and understanding may unwittingly reinforce the long‐standing habit of obsessive preoccupations with atypical thoughts and behaviors for people with Type 2 Psychosis. As such, it may be more proper to emphasize a management approach over treatment in working with this population (Ahmed et al, 2007, 2016).…”

“…As such, it may be more proper to emphasize a management approach over treatment in working with this population (Ahmed et al, 2007(Ahmed et al, , 2016.…”

“…Psychosis and psychosis‐related disorders (including schizophrenia) have been one of the most challenging psychiatric disorders to treat. Despite successful recovery and relapse rates, a substantial number continue to struggle with ongoing “psychotic symptoms” and residual functional impairments needing ongoing treatment and support services (Ahmed et al, 2007; Jaaskelainen et al, 2013; Javitt & Coyle, 2004; Owen et al, 2016). Psychosis may reflect an underlying deficit in “information processing” that may contribute to “atypical” thoughts, feelings, and behaviors with impaired level of functioning and at‐risk behaviors raising need for clinical services (Ahmed & Boisvert, 2013; Ahmed et al, 2014; Bodatsch et al, 2013; Turetsky et al, 2009).…”

Nonmedical Interventions for Schizophrenia

“…A moderate percent of clients who take psychiatric medications regularly have a stable life, enough so that the concept of recovery has been redefined professionally to refer to patients on medication who are asymptomatic for a long period of time (Collier, 2010;Jääskeläinen, et al, 2012;Jenkins & Carpenter-Song, 2005;McEvoy, 2008;Torgalsbøen & Rund, 2010;Treuer, et al, 2010;Warner, 2009). By extension, drug-regimen compliance by patients has become a major focus of some professionals (Ahmed, et al, 2007;Velligan, et al, 2010). Several authors have also looked at treatment outcomes broadly (Carone, et al, 1991;Patel, et al, 2006).…”