Treatment of schizophrenia: An update II. Psychologic and psychosocial treatment

Abstract

In a preceding paper the vulnerability-stress model of schizophrenia was presented, and it was stated that practically all patients with schizophrenia should receive a neuroleptic maintenance therapy at lowest efficient dosage. In the present paper psychologic and psychosocial treatment modalities are discussed. Good empirical data on the effects of the treatment are focused on. Therapeutic alliance is the basis of all therapy, be it biologic or psychosocial. Continuity of care is essential. All patients should be offered some kind of supportive psychotherapy. Psychoeducational family intervention should always be considered when patients live in close contact with their relatives and should be introduced as soon as possible. Social skills training should be tried when deficits in specific skills are clearly and chronically disabling. Insight-oriented psychotherapy should in general not be offered to patients with schizophrenia because of the high cost/benefit ratio and the risk of deterioration and because there are still no empirically founded criteria for deciding which schizophrenic patients could benefit from this treatment. Both articles are summarized in the conclusion, and priorities are suggested.