Evidence-Based Integrated Intervention in Patients with Schizophrenia: A Pilot Study of Feasibility and Effectiveness in a Real-World Rehabilitation Setting.

Gabriele Nibbio,Antonio Vita,Alessandra Mosca,Paolo Cacciani,Paola Corsini,Giacomo Deste,Anna Ceraso,Stefano Barlati

doi:10.3390/ijerph17103352

Abstract

Impairment in real-world functioning remains one of the most problematic challenges that people with schizophrenia have to face. Various psychosocial interventions have proven to be effective in promoting recovery and improving functioning in schizophrenia; however, their implementation and their effectiveness in routine rehabilitation practice are still objects of study. The present pilot study aimed to assess the feasibility and effectiveness on clinical and real-world outcomes of an integrated treatment protocol composed of stable pharmacological treatment, computer-assisted cognitive remediation and social skills training provided in a rehabilitation center. Predictors of functional improvement were also assessed. Seventy-two patients diagnosed with schizophrenia participated in the study. A significant (p < 0.001) improvement in positive, negative and total symptoms, as well as in global clinical severity and real-world functioning outcomes was observed, with a large effect size in positive and total symptoms, global clinical severity and real-world functioning, and a moderate effect size on negative symptoms. Improvement in total symptoms (p < 0.001) and in global clinical severity (p = 0.007) emerged as individual predictors of functional improvement. These findings, although preliminary, suggest that an integrated, evidence-based treatment program is feasible and effective in a real-world rehabilitation context, and that similar interventions should be further implemented in everyday clinical practice.

Highlights

A total of 79 subjects were admitted to the rehabilitation center during the enrolment period and provided consent to participate in the study
A significant improvement (p < 0.001) was observed in real-world functioning, as measured by the Global Assessment of Functioning (GAF) score, with a large effect size (d = 1.273, 95% CI: 0.915–1.631)
The results of the present study show that an integrated treatment protocol, including stable pharmacological treatment, computer-assisted cognitive remediation (CACR) and skills training (SST), for patients with schizophrenia is feasible in a real-world clinical rehabilitation setting, and has a positive impact on functional and clinical outcomes

Summary

Introduction

Schizophrenia represents one of the most debilitating mental health disorders, and is often associated with significant deficits in neuro-cognitive [1,2] and socio-cognitive performance [3], as well as with marked impairments in functional capacity [4] and social skills [5]. These deficits are likely to have an impact on various everyday functional skills, such as initiating and maintaining social relationships, entering and maintaining paid jobs, living independently in the community as well as managing selfcare, healthcare and basic financial resources, resulting in a significant impairment in real-world functional outcomes [6,7]. Public Health 2020, 17, 3352; doi:10.3390/ijerph17103352 www.mdpi.com/journal/ijerph

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