The challenge of psychiatric rehabilitation in schizophrenia

Abstract

Many persons with schizophrenia continue to struggle with psychiatric symptoms and poor social adjustment, even when prescribed appropriate doses of antipsychotic medications. Psychiatric rehabilitation involves using psychosocial interventions to minimize symptoms and relapse while maximizing social functioning in schizophrenia. In this article, the scope of psychiatric rehabilitation is first defined and then the rationale for psychiatric rehabilitation is presented. The challenges to implementation of psychiatric rehabilitation strategies are next articulated. Finally, brief reviews of the four most empirically validated psychiatric rehabilitation techniques are presented.

Rehabilitation Interventions to Promote Recovery from Schizophrenia: A Systematic Review

“…The impact of psychosocial interventions on functional outcomes seems to be improved by combining elements from each therapeutic approach (16, 17, 94, 95). Clinical experience showed the relevance of combining techniques based on patient issues and the stage of the disease.…”

“…Rehabilitation or psychosocial interventions have been developed to complement psychotherapy and psychopharmacological treatments (16, 17). Indeed, drug treatments and supportive therapies do not have a specific effect on cognitive impairment, insight, social skills, and interaction disorders, whereas rehabilitation tools especially target these dimensions (17, 18).…”

Implementing a Continuum of Evidence-Based Psychosocial Interventions for People with Severe Mental Illness: Part 2—Review of Critical Implementation Issues

“…Organizational Structure and Workforce The fragmentation of services, frequent personnel turnover, and shortages of highly trained specialist therapists that characterize many mental health systems hinder the implementation of needed psychosocial services and the development of advanced professional skills. 19,29,42,44,45,47,48 Organizations' ability to train professionals and retain qualified personnel is critical for successful implementation efforts and in the delivery of high-quality services. 28,49 Large organizations with a larger pool of professionals are often able to replace personnel that leave with people with new skills and knowledge of best practices.…”

“…20,21 There is little doubt that inadequate funding and under-staffed or -skilled programs and services are all key impediments to the implementation of psychosocial EBPs. 17,23,29,44,52,57 Lack of funds to pursue professional development and the absence of incentives to promote high-quality services can dampen staff morale and slow the uptake of EBPs. 9,13,15,29,44,45 Timely access to people with expertise and perceived legitimacy with EBPs is another key facilitator of change.…”

“…17,23,29,44,52,57 Lack of funds to pursue professional development and the absence of incentives to promote high-quality services can dampen staff morale and slow the uptake of EBPs. 9,13,15,29,44,45 Timely access to people with expertise and perceived legitimacy with EBPs is another key facilitator of change. In the Optimal Treatment Project, the ongoing support and technical assistance of the project leader was identified as a major determinant of success in the implementation of best practices in the treatment of schizophrenia across numerous countries.…”