Academic journal article Hong Kong Journal of Psychiatry

A Pilot Study on Psychological Interventions with Chinese Young Adults with Schizophrenia

Academic journal article Hong Kong Journal of Psychiatry

A Pilot Study on Psychological Interventions with Chinese Young Adults with Schizophrenia

Article excerpt

Abstract

Objectives: To investigate the functional and clinical status of a group of Chinese schizophrenic patients after treatment with individually tailored psychological treatment over a 9month period.

Patients and Methods: Thirty six 15- to 32-year-old Chinese schizophrenic patients were recruited into the study from 2001 to 2002. The patients were randomly assigned into treatment and waitlist groups. At baseline their pre-treatment clinical status, social functioning, and other clinically relevant parameters were assessed. The psychological treatments were conducted by 2 experienced clinical psychologists and assessed by face-to-face interviews.

Results: After the treatment period, outcome measures supported the use of adjuvant psychotherapy in the routine treatment programme for subjects with schizophrenia; both positive and negative symptoms improved compared to baseline status (p < 0.001).

Conclusions: The findings support the use of psychotherapeutic interventions to promote better adaptation to the psychotic disorder.

Key words: Behavior therapy; Cognitive therapy; Psychotherapy; Schizophrenia; Schizophrenic psychology

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Introduction

Schizophrenia is one of the most widely studied mental disorders. Psychiatrists have been struggling to find the best treatment model to optimise recovery and minimise chance of relapse. Conventional antipsychotic medications are successful in controlling positive symptoms, but have undesirable side-effects. (1) In addition, the 2-year relapse rate is still around 30 to 50%. (2,3) The introduction of second-generation anti-psychotics has renewed hope for patients with schizophrenia. Randomised controlled trials have shown that such medication is better at controlling positive symptoms, extrapyramidal side-effects, and possibly negative symptoms too. (4) However, the newer drugs increase the risk of metabolic syndrome and the associated weight gain jeopardises treatment adherence. (5) Although medications attenuate the severity of the most florid symptoms in schizophrenia, negative symptoms (interfering with normal functioning) still persist. This has posed great difficulties for patients to return to society. Because of these constraints, emphasis on psychosocial treatment models, as part of the multi-facet rehabilitation programme in the treatment of schizophrenic patients, should not be neglected.

Efficacy of psychological treatments has been evaluated in many studies. Family therapy, based on the notion that clinical outcomes of schizophrenia are affected if the family exhibits highly expressed emotions, is reported to reduce relapses. (6) Studies also suggest that social skills training confers significant benefits by reducing hospitalisation and family burdens. (7,8) Similarly, a work-related skills training programme in Hong Kong demonstrated success in securing jobs.7 Cognitive behavioural treatment showed promise in that dysfunctional information processing of schizophrenic patients could be successfully tackled. (9) Despite many such studies, there has been no systematic study to evaluate the efficacy of psychotherapy used in combination with medication, in the treatment of schizophrenia in Hong Kong.

We set out to study an individually tailored psychological treatment programme (various psychotherapeutic modalities to optimise the psychosocial outcomes of young schizophrenic patients). Our aim was to evaluate the evolution of clinical parameters in schizophrenic patients receiving psychological treatment.

Methods

Subjects

Subjects were young adults with diagnosis of schizophrenia, according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria, and actively being followed up in local psychiatric settings at the time of the study. Public and private psychiatric clinics were notified and encouraged to refer their patients for the psychological treatment programme. …

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