What's New in Schizophrenia Treatment?
Mark Hickman,
Ph.D. and Linda Groce, BSN, RNC
In
1998, Schizophrenia Bulletin published a critical study of schizophrenia
treatment. The report indicated that over half of the two million Americans
with schizophrenia fail to receive adequate care. In addition:
1.
Schizophrenics received inappropriate dosages of antipsychotic medications
in about two-thirds of the cases studied.
2. Despite the fact that 15% of schizophrenics commit suicide, fewer than
half of depressed schizophrenics received antidepressant medications.
3. While 75 to 80 percent of schizophrenics studied had significant side
effects, only half of these received medications to address the side effects.
4. Blacks with schizophrenia were overmedicated twice as often as were
whites.
5. Less than 10 percent of families of persons with schizophrenia received
education and supportive services, despite the fact that research has
shown that education improves clinical outcomes.
6. Vocational rehabilitation was available to only 22.6 percent of adults
with schizophrenia.
7. Fewer than 10 percent of persons with schizophrenia were involved in
assertive community treatment programs, despite the fact that such programs
are effective in preventing relapse and hospital recidivism.
Everyone from
behavioral scientists to cognitive scientists, from psychosocial theorists
to rehabilitation specialists, and from the National Alliance of the Mentally
Ill to medical journals, is writing about schizophrenia. New treatments
all focus on empowering the client as an active part of the treatment
team. Specifically, groups like the National Alliance for the Mentally
Ill (NAMI), in cooperation with a growing number of social scientists,
assert that:
1. Our carefully
designed treatment goals are of little value unless the client wants to
achieve those goals.
2. All people
are more invested in plans that they, themselves, helped to build.
3. Clients who
go for prolonged periods of time without feeling better will lose hope,
and treatment
compliance declines.
This
focus on treatment goals as plans that are embraced by the client, with
the therapist having responsibility for increasing motivation, is not
unlike the innovative approaches of William R. Miller (1992) to the treatment
of addictions. Miller proposed that our rigidity in defining goals for
clients (e.g. insisting on a goal of full sobriety) may block our opportunity
to help many people-like those with less severe alcohol problems who might
be able to achieve controlled drinking, as well as those who need a goal
of sobriety, but won't be able to accept that until they have experienced
failure in a controlled drinking plan.