Rehabilitation Interventions to Promote Recovery from Schizophrenia: A Systematic Review

Abstract

Only one out of seven patients recovers after a first episode of psychosis despite psychiatric care. Rehabilitation interventions have been developed to improve functional outcomes and to promote recovery. We conducted a systematic review of the effectiveness of the main psychiatric rehabilitation interventions following a search of the electronic databases Pubmed, ScienceDirect, and Google Scholar using combinations of terms relating to cognitive remediation, psychoeducation, cognitive-behavioral therapies, and schizophrenia. Eighty articles relevant to the topic of interest were found. According to results, cognitive remediation has been found to be effective in reducing the impact of cognitive impairment, social skills in the learning a variety of skills and to a lesser extent in reducing negative symptoms, psychoeducation in improving compliance and reducing relapses, and cognitive therapy in reducing the intensity of or distress related to positive symptoms. All psychosocial rehabilitation interventions should be considered as evidence-based practices for schizophrenia and need to become a major part of the standard treatment of the disease.

Textbook descriptions of people with psychosis – some ethical aspects

“…[5][6][7] In recent years, much has been written about recovery from psychosis. [8][9][10][11][12][13][14][15][16][17][18] There has been a growing awareness towards the central role and influence human relationships have in the recovery process. [12][13][14][15][16][17][18] Several studies have focused on the importance of user involvement 13,14,[18][19][20] and staff attitudes, 16,[21][22][23][24][25][26][27] but, interestingly, very little attention has been paid to how leading textbooks in the mental health field describe and present people having psychosis and how psychosis as such is communicated to students and the professionals.…”

The effect of assertiveness training in schizophrenic patients on functional remission and assertiveness level

“…The Turkish validity and reliability study of the 30-item scale was performed by Voltan. 33 The 3, 6,7,8,10,18,20,21,22,25,27,28, and 29th items (13 items) are positive expressions; and the 1,2,4,5,9,11,12,13,14,15,16,17,19,23,24,26, and 30th items (17 items) are negative expressions. Expressions are scored from a range of 1 to 6 and the positive expressions are reversed.…”

“…3,4 While drug therapy in schizophrenia targets positive and negative symptoms, disorganized behaviors, mood, and cognitive symptoms; psychosocial interventions including programs such as individual interviews, family education, social skills training, holistic approach group therapies, supportive therapy, and cognitive-behavioral therapies are provided for self-care deficiencies, poor quality of life, interpersonal relationship problems, noncompliance with treatment, dysfunctions, addiction, and signs of disability in social and professional skills. [5][6][7][8][9] It has been reported that psychosocial skills training, which is frequently applied in the rehabilitation of schizophrenia patients, increases quality of life, social functioning levels, self-esteem, communication skills, compliance to treatment levels, and insights of the patients; reduces disability, relapse, and repeated hospitalization; and has positive effects on positive and negative symptoms. [10][11][12][13][14][15] It is also reported that social skills training programs increase interpersonal relationships and assertiveness skills in schizophrenia.…”

“…While the definition of "clinical healing" traditionally known as the concept of healing, refers only to the alleviation and absence of symptoms, the second criterion of "social functioning" is defined as accessing a meaningful and valuable life. 7,9 Evaluated independently of the symptoms and in addition to gaining insight into health and treatment (HT), the concept of "functional recovery" includes the ideal functioning in areas such as patients' fulfilling their DLS, achieving administrative and financial mastery, performing chores, providing the social environment necessary for interpersonal relationships, and life and occupational functionality. 24 Schizophrenia causes significant deterioration of social function such as failure to maintain personal care and independent living skills, quitting hobbies, lack of enjoying leisure time, not fulfilling the socially defined roles such as spouse, family member, friend, employee or student, decrease in academic achievement, dropping out, difficulties in maintaining relationships with family and friends or not functioning at work, a significant reduction in employment levels, and difficulties in acquiring and maintaining secure housing.…”

“…24,26 Impaired functioning in patients with schizophrenia causes poor prognosis, recurrent hospitalization, and reduced quality of life, and therefore, the patient is expected to reach social competence and fulfill social functions with the treatment of these symptoms. 6,7,13,14,23 The assertiveness training implemented in line with these goals appears to be effective in schizophrenia patients and has been shown to increase patients' assertiveness skills, communication skills, and self-esteem, and reduce social anxiety and psychiatric symptoms. 22,23,27 Psychiatric nurses who play an active role in rehabilitation services, perform psychosocial interventions and have direct contact with the patient, should plan specific training programs to diagnose and meet the basic training needs of patients.…”