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Psychosis: Psychosocial treatment

Types of psychosocial treatment

Psychotherapy and psychosocial interventions are an important component of treatment for patients with schizophrenia and schizoaffective disorder. They are typically administered through local specialty psychiatric services and community treatment teams. These approaches include:

  • Cognitive-behavioural therapy (CBT)Particularly useful for treatment-resistant patients with persistent positive or negative symptoms.
  • Family interventions: Include family psychoeducation, multiple-family groups (particularly early in the course of the illness), and evaluating and addressing caregiver burden.
  • Employment and academic interventions: Include supported employment and academic accommodations through student services at secondary and post-secondary institutions
  • Social skills and life skills training: Teach independent living skills to help people with schizophrenia function in their communities
  • Case management: Includes community case workers and community treatment teams for housing and employment assistance, disability support programs.

Psychoeducation

Psychoeducation helps people with schizophrenia to understand and cope with their illness. It is linked to reduced relapse and readmission rates, improved medication adherence and better quality of life. It should be an ongoing process with patients and their families.

Psychoeducation often focuses on issues around treatment non-adherence that can result from:

  • lack of insight into the illness
  • concurrent alcohol or other drug use
  • problems with the therapeutic alliance
  • medication side-effects
  • complicated dosage schedules
  • problems accessing treatment
  • financial obstacles to obtaining medication

Psychoeducation can deliver the following simple messages to improve medication adherence:

  • Antipsychotics can take a couple of weeks to start working.
  • Take the medications every day.
  • Side-effects are usually mild and improve over time.
  • Continue your medications, even after you feel better, or your symptoms may return.
  • Do not stop antipsychotic medication before checking with your doctor.
  • Alcohol and recreational drugs can affect how well the medication works.

Take a self-management approach with patients:

  • Always include patient education (e.g., patient information handouts)
  • Involve patients, and their families when appropriate, in the management of their own illness by actively collaborating with them in the diagnosis and treatment planning.

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Frequently asked questions

Clinical guidelines

Treatment of schizophrenia (CPA, 2005)