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Author: Schizophrenia Bulletin

Family Interventions for Schizophrenia

schizophrenia Bulletin, Vol. 21, No. 4, 1995 National Institute of mental health Abstract This article reviews the existing evidence for the efficacy and effectiveness of psychoeducational family interventions in the treatment of persons with schizophrenia. There is substantial evidence that psychoeducational family interventions reduce the rate of patient relapse. There is suggestive, though not conclusive, evidence that these interventions improve patient functioning and family well-being. Interventions with multifamily groups that include the patient may be of superior benefit for subgroups of patients. More research is necessary to determine the critical ingredients of family interventions, to expand the groups of...

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Cost of Relapse in Schizophrenia

Cost of relapse in schizophrenia Schizophrenia Bulletin, Vol. 21, No. 3, 1995 National Institute of mental health Abstract To estimate the national annual cost of rehospitalization for multiple-episode schizophrenia outpatients, and to determine the relative cost burden from loss of medication efficacy and from medication noncompliance, the yearly number of neuroleptic-responsive multiple-episode schizophrenia inpatients in the United States who are discharged back to outpatient treatment was estimated. The cohort at risk for future relapse and rehospitalization was determined. The research literature on the expected rates of relapse for schizophrenia patients on maintenance antipsychotic medication was reviewed; in particular, monthly...

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Conventional Antipsychotic Medications for Schizophrenia

schizophrenia Bulletin, Vol. 21, No. 4, 1995 National Institute of mental health Abstract This article reviews the existing evidence for the efficacy and effectiveness of conventional anti psychotic medications in the treatment of schizophrenia. Among the issues reviewed are their efficacy for acute symptom episodes and for long-term maintenance therapy, differential efficacy among medications, the gap between research-based efficacy rates and effectiveness rates in practice, dosing strategies, and the treatment of first-episode cases. Evidence for efficacy is overwhelming for reduction of positive symptoms but quite limited for other outcomes. Effectiveness in practice may be substantially less than efficacy in clinical trials, perhaps owing to patient heterogeneity, prescribing practices, and noncompliance. First-episode patients should be treated with antipsychotic medication, but perhaps at lower dosages, with consideration of a gradual decrease or discontinuation at 6 months to 1 year. Schizophrenia Bulletin, 21(4): 567-577, 1995. Conventional antipsychotic medications refer to those widely used and available in the United States before 1990, including the phenothiazines, butyrophenones, thioxanthenes, dibenzoxazepines, and dihydroindolones. Their common mode of action is to block dopamine D2 receptors throughout the brain, and their therapeutic activity is presumably related to such blockade in the mesolimbic system. Their widespread use, as well as the anticipated future availability of nonconventional antipsychotic agents, underlines the importance of examining research that supports use of conventional agents. This article reviews evidence for the efficacy and effectiveness...

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Vocational Rehabilitation in Schizophrenia

schizophrenia Bulletin, Vol 21, No. 4, 1995 National Institute of mental health Abstract Schizophrenia exacts a heavy toll on a person’s capacity to work, and a variety of vocational rehabilitation interventions have been developed over the past few decades to enhance the vocational capacities of persons with this disorder. The research literature on outcomes of vocational rehabilitation during the era of deinstitutionalization for persons with schizophrenia is reviewed. Most vocational rehabilitation programs have a positive influence on work-related activities, but most have failed to show substantial and enduring impacts on independent, competitive employment. Recent advances in supported employment suggest...

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Psychological Interventions for Schizophrenia

schizophrenia Bulletin, Vol. 21, No. 4, 1995 National Institute of mental health Abstract This review examines the impact of dynamic and supportive psychotherapies (both individual and group) and psychosocial skills training on clinical and social outcomes for individuals with schizophrenia. The relatively few controlled trials of individual or group psychotherapies for persons with schizophrenia exhibit serious methodological problems that limit their generalizability. Reality-oriented approaches appear to be superior to dynamic, insight-oriented psychotherapies, but further research is needed to identify and evaluate disorder-specific models that target specific deficits and disabilities in schizophrenia. Research on psychosocial skills training models shows that...

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