Evidence-Based Reviews

Recovery from schizophrenia: Fact or fiction?

Current Psychiatry. 2004 July;3(7):19-30

References

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Social/vocational network. Family, friends, neighbors, and social workers play an important role in the patient’s development during recovery. They provide positive stimulation (such as physical activities and social or vocational engagements) and support.

To equip the patient’s network for this responsible task, provide them with training (such as in acceptance, empathy, feedback, and communication), education, and guidance. Support groups can enhance the social networks of patients whose own networks are too small to prevent social isolation or overburdening of members.

Vocational training and mediation also may be stabilizing. Religious activities are central to self-understanding and recovery for many psychiatric patients and may improve outcomes.²⁰

Patient skills. To achieve stabilization and continue their recovery, patients must develop social interaction skills and coping strategies. Conversation training, for example, seems to help improve social interaction. Patients in remission must learn to:

find or create low-stress, positively stimulating environments in which their recovery can flourish
tolerate discomfort and stress
overcome internalized stigma about recovery.

Patients also need to learn when and how to withdraw from hectic, stressful environments and from people who are overly emotional, patronizing, or hold unrealistic expectations about them.

Pharmacotherapy. Sound pharmacotherapy underlies rehabilitation and psychosocial treatment of patients in remission from schizophrenia.²¹ Healthy neurobiological functioning and equilibrium may help normalize social-emotional behavior and create opportunities to improve all life dimensions via psychotherapy, psychosocial guidance, education, and training.

Dosages often can be reduced during recovery, titrating gradually downward to reduce the risk of relapse. Suggested antipsychotic dosages during recovery are listed in Table 3. Be patient and consistent when adjusting dosages, guided by information in package inserts, from clinical trials, and in recent articles on specific medications. When introducing a medication, start with the lowest dosage and increase in small steps until symptoms are reduced and side effects are minimal.

Discontinuing antipsychotics. Is it therapeutically reasonable to discontinue antipsychotics after recovery? Probably not.

Relapse rates in unmedicated patients with schizophrenia appear extremely high—perhaps 8 or 9 out of 10 cases—even during remission. By comparison, relapse rates appear very low—perhaps 3 or 4 out of 10 cases—for remitted patients who remain on antipsychotics. Atypical antipsychotics or low doses of conventional agents are generally well-tolerated and safe in the long term.²²

Patient monitoring. Patients in remission from schizophrenia benefit from:

24-hour phone lines to call for guidance, treatment, and quick interventions
central, alert treatment coordination among psychiatrists, psychologists, social workers, therapists, vocational experts, and activity counselors.

Psychiatrists in solo or small-group settings may need to seek out these resources in their communities. The goal of this team approach—in cooperation with the patient’s social network—is to help the patient develop employment and social activities appropriate to his or her needs and capabilities.

Related resources

Ascher-Svanuw H, Kraus A. Psychoeducational groups for patients with schizophrenia: a guide for practitioners. Gaithersburg, MD: Aspen Publishers, 1991.
Suzuki T, Uchida H, Tanaka KF, et al. Revising polypharmacy to a single antipsychotic regimen for patients with chronic schizophrenia. Int J Neuropsychopharmacol 2004;7(2):133-42.
American Psychiatric Association. Schizophrenia (patient/family information). www.psych.org/public_info/schizo.cfm
Schizophrenia.com. Nonprofit Web community providing information, support, and education. www.schizophrenia.com

Drug brand names

Aripiprazole • Abilify
Carbamazepine • Tegretol
Clozapine • Clozaril
Haloperidol • Haldol
Lamotrigine • Lamictal
Olanzapine • Zyprexa
Quetiapine • Seroquel
Risperidone • Risperdal
Ziprasidone • Geodon

Disclosure

The author reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.