Comprehensive family therapy: an effective approach for cognitive rehabilitation in schizophrenia

Abstract

BackgroundAntipsychotic medication has limited abilities to improve the cognitive impairments that accompany schizophrenia. Adding psychosocial treatment may result in marked improvements in cognitive function, as compared to antipsychotic treatment alone. We hypothesized that a combination of individual and family interventions may be a useful cognitive rehabilitation paradigm for schizophrenia.Materials and methodsAn 18-month follow-up clinical trial of 256 stabilized patients with schizophrenia at six communities in Shanghai, People’s Republic of China were randomly assigned to into either a comprehensive family therapy (CFT) group or a usual daily care (UDC) group. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Positive and Negative Syndrome Scale (PANSS) were the primary outcome instruments for this study.ResultsThere was no significant difference between the CFT and UDC for all demographic characteristics at the baseline assessment. During the 18-month follow-up observation, changes in RBANS total score indicated that patients undergoing CFT showed greater improvement from baseline to the follow-up assessments in cognitive function than those in the UDC group (F=9.77, P=0.002). Post hoc analysis showed that the CFT group presented with significant differences in the RBANS total score, immediate memory, visuospatial skill, language, attention, and delayed memory sections compared with the UDC after 18 months of follow-up (all P<0.01).ConclusionOur findings suggest that CFT can be easily adapted and may prove to be an effective approach for improving cognitive function in patients with schizophrenia. Our program provides a potential paradigm for cognitive rehabilitation for schizophrenia patients in the community.

Community-based psychosocial interventions for people with schizophrenia in low and middle-income countries: systematic review and meta-analysis

“…Across all included studies there were a total of 1580 participants with a median sample size of 101, ranging from 45 to 326. Five studies, reported in six papers, were conducted in China [ 35 – 40 ], two studies were conducted in India [ 41 , 42 ] and Iran [ 43 , 44 ], one study, reported in two papers, was conducted in South Africa [ 45 , 46 ], and one study was conducted in Turkey [ 47 ]. All studies were conducted in upper-middle income countries apart from the two studies based in India, which is classified by the World Bank as lower-middle income.…”

“…Five studies took place in urban areas [ 37 , 43 – 47 ], two were exclusively in rural areas [ 35 , 36 , 38 ] and one was set across urban and rural sites [ 41 ]. The study location was not indicated in three studies [ 39 , 40 , 42 ].…”

“… Counsellors None Outpatient care - including medication; no active follow up for non- attenders Symptoms: Positive association Functioning: Positive association Readmission: Positive association Nb All analyses included only those not readmitted. Group B: Comprehensive family/rehabilitation intervention Cai 2015 [ 40 ] China a Individual multisite 18 months Schizophrenia n = 256 [ I = 133, C = 123] 10 weeks. Comprehensive family therapy: (i) Social skills training (medication and symptom management, community re-entry support, recreation for leisure and social independent living skills) 90–120 min/session, 2 sessions/ week for 10 weeks (ii) Family psychoeducation.…”

“…Group B consisted of more comprehensive multi-faceted interventions including components such as family intervention, support developing social and independent living skills, medication adherence support, crisis intervention and dealing with stigma. This group included the Indian COPSI community-based care trial, Chatterjee 2014 [ 41 ], and two Chinese RCTs, Cai 2015 and Ran 2015 [ 35 , 36 , 40 ]. Group C comprised studies focusing on engagement with care following discharge from inpatient facilities, alongside other elements such as social skills training.…”

The <em>NCAN</em> gene: schizophrenia susceptibility and cognitive dysfunction

“…All patients met the diagnoses of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM -IV) and had no other observable physical disease or other psychiatric disorder aside from schizophrenia. Among them, 254 schizophrenic patients were used to test cognitive function, whose inclusion criteria were based on our previous publications:10,11 1) duration of illness <5 years; 2) has a minimum education of primary middle school; 3) receives atypical antipsychotic monotherapy; 4) has maintained a stable condition for >6 months before entry into the study; and 5) has a positive and negative syndrome scale total score <60.…”