Emerging behavioral and psychotherapeutic interventions for schizophrenia

INTRODUCTION S ince the introduction of typical antipsychotic medications in the 1950s and subsequent development of novel or atypical antipsychotic medications in the 1990s, pharmacological treatment has been central to the management of schizophrenia (1,2). Both typical and novel antipsychotic medications decrease hallucinations and delusions in patients, and reduce relapse rates compared to placebo. A meta-analysis of 65 trials demonstrated that antipsychotic drugs reduced relapse rates at one year (27%) compared to placebo (64%), with evidence also suggesting better quality of life, and fewer aggressive behaviors in treated patients (3). Nevertheless, the long term course of schizophrenia remains disappointing, with only a minority of patients sustaining high levels of psychosocial and occupational function after the first episode of illness. Hegarty conducted a meta-analysis of the pre-and post-chlorpromazine era (1895 to 1992) comparing outcomes at an average of 5.6 years of follow-up (4). Improvement was defined as recovery with minimal to mild clinical symptoms and good psychosocial functioning as indicated by work or independent living. Hegarty found that the proportion of patients diagnosed with narrow criteria (at least six months of illness) who improved increased after the mid-20 th century from 35% to 48%, suggesting that while antipsychotic medication had a modest positive effect on long term outcomes, many patients still failed to show good recovery. A more recent meta-analysis applied a definition of recovery that required both clinical remission and good social functioning that persisted at least two years and included studies from the novel antipsychotic period (5). Using the criteria of sustained clinical and psychosocial recovery, the median proportion of patients who met recovery criteria was only 14%. The recovery rates did not differ by gender, duration of follow-up, time of data collection or strictness of diagnostic criteria. Because the onset of schizophrenia is typically early in adulthood, the disability and diminished quality of life in the disorder takes an enormous toll on affected individuals and caregivers. Moreover, schizophrenia is associated with a 2 to 3-fold increase in mortality rates compared to the general population (6) with life expectancy reduced up to two decades (7-9). Common causes of death include cardiovascular mortality, Emerging behavioral and psychotherapeutic interventions for schizophrenia cancer mortality, chronic obstructive pulmonary disease, influenza and pneumonia, substance-induced death, accidental death and suicide (10,11). Factors that likely contribute to increased mortality in schizophrenia include tobacco smoking, alcohol dependence or addiction, obesity, lack of adequate medical care, lack of …