The real-life effectiveness of psychosocial therapies on social autonomy in schizophrenia patients: Results from a nationwide cohort study in France

Strategies for Psychiatric Rehabilitation and their Cognitive Outcomes in Schizophrenia: Review of Last Five-year Studies

BACKGROUND

Cognitive deficits are core features of Schizophrenia, showing poor response to antipsychotic treatment, therefore non-pharmacological rehabilitative approaches to such a symptom domain need to be identified. However, since not all patients with Schizophrenia exhibit the same cognitive impairment profile, individualized rehabilitative approaches should be set up.

OBJECTIVES

We explored the last five-year literature addressing the issue of cognitive dysfunction response to rehabilitative methodologies in Schizophrenia to identify possible predictors of response and individualized strategies to treat such a dysfunction.

CONCLUSION

A total of 76 studies were reviewed. Possible predictors of cognitive rehabilitation outcome were identified among patient-specific and approach-specific variables and a general overview of rehabilitative strategies used in the last five years has been depicted. Studies suggest the existence of multifaced and multi-domain variables that could significantly predict pro-cognitive effects of cognitive rehabilitation, which could also be useful for identifying individual-specific rehabilitation trajectories over time.An individualized rehabilitative approach to cognitive impairment in Schizophrenia is possible if taking into account both patient and approach specific predictors of outcomes.

The Effect of Mindfulness-Based Psychosocial Skills Training on Functioning and Insight Level in Patients with Schizophrenia

This study aims to determine the effect of mindfulness-based psychosocial skills training (MBPST) on the functional recovery and insight level in patients with schizophrenia. In this study, 40 patients with schizophrenia registered in the Aksaray Community Mental Health Centre were divided into two groups: the intervention group (n = 20) and the non-intervention group (n = 20). The Functional Recovery Scale in Schizophrenia (FRSS) and the Beck Cognitive Insight Scale (BCIS) were measured at preintervention and postintervention. The posttest mean scores of FRSS and BCIS of the intervention group were statistically higher than the non-intervention group (p < 0.05). The MBPST program improved functional recovery and cognitive insight in schizophrenia. In line with these results, it has been recommended that MBPST program should be provided along with medical treatment in Community Mental Health Centres.

The use of random-effects models to identify health care center-related characteristics modifying the effect of antipsychotic drugs

Purpose

A case study was conducted, exploring methods to identify drugs effects modifiers, at a health care center level.

Patients and methods

Data were drawn from the Schizophrenia Outpatient Health Outcome cohort, including hierarchical information on 6641 patients, recruited from 899 health care centers from across ten European countries. Center-level characteristics included the following: psychiatrist’s gender, age, length of practice experience, practice setting and type, countries’ Healthcare System Efficiency score, and psychiatrist density in the country. Mixed multivariable linear regression models were used: 1) to estimate antipsychotic drugs’ effectiveness (defined as the association between patients’ outcome at 3 months – dependent variable, continuous – and antipsychotic drug initiation at baseline – drug A vs other antipsychotic drug); 2) to estimate the similarity between clustered data (using the intra-cluster correlation coefficient); and 3) to explore antipsychotic drug effects modification by center-related characteristics (using the addition of an interaction term).

Results

About 23% of the variance found for patients’ outcome was explained by unmeasured confounding at a center level. Psychiatrists’ practice experience was found to be associated with patient outcomes (p=0.04) and modified the relative effect of “drug A” (p<0.001), independent of center- or patient-related characteristics.

Conclusion

Mixed models may be useful to explore how center-related characteristics modify drugs’ effect estimates, but require numerous assumptions.