Older Patients with
Schizophrenia
Improve Their Functioning with Treatment Programs
That Emphasize Everyday Skills
New study tests intervention that teaches patients how
to approach routine tasks
(Dec. 4, 2003) - While new medications have greatly relieved the
symptoms of
schizophrenia and other severe mental disorders, additional treatments that
simply teach patients, particularly older patients, how to function in the real
world have the potential to significantly improve independence and quality of
life, according to a study in the American Journal of Geriatric
Psychiatry.
Researchers led by Thomas L. Patterson, Ph.D., of the University of
California, San Diego have been seeking more effective methods for treating
older patients with severe mental illness, chiefly schizophrenics but those
with other serious, chronic mental disorders as well. They say
new antipsychotic drugs
have been highly effective at alleviating the symptoms of schizophrenia but
that such improvements “do not automatically translate into an improved
ability to function in the real world.”
“Medications alone are not the answer,” Patterson said.
“Patients still need to learn how to function in society, particularly
older patients who are frequently lacking such skills.”
Patterson and his colleagues decided they would test “behavioral
interventions” that might be particularly effective for older patients, as
most research into this type of treatment has focused on younger patient
groups. The emphasis on older patients also stems from the fact that the number
of older people suffering from schizophrenia is on the rise, placing
ever-increasing burdens on healthcare resources. Costs associated with
treatment and lost productivity have made schizophrenia one of the
nation’s most “expensive” mental disorders.
The investigators designed a 24-session program—each session lasts
about two hours—called “functional adaptive skills training,” or
FAST, that seeks to improve a patient’s ability to handle such routine
tasks as taking medicine, obtaining transportation and managing finances. They
tested FAST’s effectiveness by selecting a group of 32 middle-aged
patients with long-term histories of schizophrenia or “psychotic mood
disorders” and randomly assigning half of them to the program and half to
“treatment as usual.”
Researchers found that the group of test patients who participated in the
FAST program experienced much greater improvements in handling everyday tasks
than did those who did not. The study notes that “these improvements were
evident immediately after completion of the intervention program and persisted
at 3-month follow-up.”
The researchers cautioned that it’s difficult to determine how the
program’s benefits would play out given the variables involved in each
patient’s encounters with the “real world, with all its
complexities.” For example, newly acquired abilities to master
transportation logistics could vary depending on the existence of mass transit
systems. Nonetheless, they note, “rehabilitation success even in small
increments is significant in terms of reduced suffering.”
Patterson and his colleagues believe their “findings point to a need to
continue to develop and test behavioral interventions designed for older,
seriously mentally ill patients in order to improve their real-world
functioning.”
“Interventions that improve medication adherence, everyday living
skills and general psychosocial functioning may reduce the need for long-term
care while minimizing the burden on institutional healthcare systems,” the
authors state.
Source: American Journal of Geriatric Psychiatry
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