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Personal Therapy Helps Schizophrenia Patients Avoid Relapse
By Carl Sherman
A psychosocial intervention designed to help patients with schizophrenia
recognize and respond appropriately to arousing stimuli improves function and
reduces relapse. Personal therapy, as it is called, aims to create a therapeutic umbrella to protect the patients from affective dysregulation, Gerard Hogarty said at the annual meeting of the New Clinical Drug Evaluation Unit sponsored by the
National Institute of Mental Health, Bethesda, Md.
Rather than simply protecting patients against noxious stimuli in the
environment, through family therapy, for example, it focuses on internal
sources of arousal and affective dysregulation, and it aims to teach
autoprotective coping strategies and others, such as avoidance, relaxation,
and conflict resolution, said Mr. Hogarty, of Western Psychiatric Institute
and Clinic, Pittsburgh.
The identification of internal cues that portend relapse is an important
part of the therapy, he said. Mr. Hogarty described what he called the first 3-year studies of a specific, definitive psychosocial therapy for schizophrenia. The dropout rate was notably low (17%), he said. The trials involved two populations of schizophrenic and schizoaffective patients who had been admitted to Western Psychiatric Clinic; 97 lived with their families, and 54 did not. The 97 patients living with their family were somewhat younger (mean age 29 vs. 33 years), had not been sick as long, and had had fewer hospitalizations.
Of the 97 patients living with family, two randomized groups received family
as well as personal therapy. Among treated patients living with family, relapses were significantly fewer than among controls. The difference came more marked with time, with no relapses at all in the treated group after the first year. By the end of the study, 86% of patients treated with therapy alone had remained well, compared with 62% in the control group, Mr. Hogarty said. In patients not living with family, however, personal therapy appeared to precipitate relapse. Eleven patients relapsed during the trial, compared with four controls. These patients had been discharged to very unstable residences and faced significantly more conflict than the family patients.