Guideline No 30: Psychosocial Interventions in the Management of Schizophrenia

Psychosocial Interventions in the Management of Schizophrenia
Section 1: Introduction

Schizophrenia affects one person in a hundred at some stage in life. The onset is usually in the twenties or thirties and the subsequent course is variable. Unless the initial illness is brief, incomplete recovery and further relapses are the most likely outcome.

Both the positive symptoms (thought disorder, hallucinations, delusions) and the negative symptoms (social withdrawal, self neglect, lack of motivation) may contribute to a deterioration in interpersonal relationships.

Following an admission to hospital, patients with schizophrenia who are discharged to an environment where there are high levels of criticism, hostility and over-involvement are three or four times more likely to relapse than those moving to an environment where these features are not present.² Family Interventions have been formulated to reduce these features, to lessen the burden on carers and reduce the frequency of relapse. This approach, however, has not been made generally available.³

Cognitive Behaviour Therapy has been shown to benefit some patients with schizophrenia.^{4,
5, 6, 7}

As with other psychosocial interventions, there are difficulties in subjecting this individually-tailored approach to systematic study. The most recently published study shows clear and lasting benefit for a substantial number of patients with treatment-resistant sysmptoms. ^{6,
7, 8} However, it is unclear how to target those most likely to benefit.

Note that, in most research studies, psychosocial interventions have been supervised by experienced clinical psychologists and some studies have found the techniques to be less widely accepted and effective in ordinary practice (see section 5.2). Although it is anticipated that appropriate health or social work professionals will be able to carry out this work in everyday practice, training will be required (see section 4.1).

For simplicity, the guideline refers throughout to 'patients' with schizophrenia. The guideline development group recognise that some readers may prefer to substitute alternative terminology such as 'client' or 'service user', according to individual preference.