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Managing Low-Functioning Schizophrenics

Research suggests that one-third to one-half of patients with schizophrenia continue to experience residual symptoms or have intolerable adverse effects relating to their treatment. The effect of medications on functional outcomes has been modest, even when drug regimens are optimized. Compounding the problem are the disorganized and negative symptoms associated with schizophrenia, which are less responsive to medications than hallucinations and delusions. Today, more patients with schizophrenia are being treated in the community, but many continue to function at a low level. As such, additional interventions like cognitive therapy have been explored for schizophrenia, but these approaches have had varied success. Most cognitive therapy treatments assessed in studies have addressed delusions and hallucinations and have not focused on patients with neurocognitive impairment and poor functioning. A Novel Approach in Managing Schizophrenia In the October 3, 2011 Archives of General Psychiatry, my colleagues and I had a study published in which we assessed a novel version of cognitive therapy aimed at increasing functional outcomes and promoting recovery in low-functioning patients with schizophrenia. In addition to residual positive and negative symptoms, these individuals had trouble with information processing for memory, attention, and executive functioning. By design, our intervention shifted the emphasis from taking a symptom-oriented approach to using a person-oriented therapeutic strategy based on interests, assets, and strengths. We wanted to improve the level of functioning by enhancing productivity, independence, and the quantity and quality of social interactions. The intervention treated functional outcomes as a primary target of therapy. More patients with schizophrenia are being treated in the community, but many continue to function at a low level. Participants in the...
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