Text adapted from "The patient with Psychosis" in Psychiatry in primary care by George Foussias and Z. Jeff Daskalakis (CAMH, 2019).
Psychotherapy and psychosocial interventions are an important component of treatment for patients with schizophrenia or schizoaffective disorder. They are typically administered through local specialty psychiatric services and community treatment teams. These approaches include:
- cognitive-behavioural therapy (CBT), particularly for treatment-resistant patients with persistent positive and/or negative symptoms
- family interventions, including family psychoeducation, multiple-family groups (particularly early in the course of the illness) and evaluating and addressing caregiver burden
- employment and academic interventions, including supported employment and academic accommodations through student services at secondary and post-secondary institutions
- social skills and life skills training
- case management (e.g., community case worker or treatment team for housing and employment assistance, Ontario Disability Support Program).
Psychoeducation helps patients and their families to understand the illness. It should be an ongoing process.
Psychoeducation often focuses on treatment non-adherence that can result from:
- lack of insight into the illness
- concurrent alcohol or other drug use
- problems with the therapeutic alliance
- medication side-effects
- complicated dosage schedules
- problems accessing treatment
- financial obstacles to obtaining medication.
Use simple messages to improve medication adherence; for example:
- “Antipsychotics can take a couple of weeks to start working.”
- “Take the medications every day.”
- “Side-effects are usually mild and improve over time.”
- “Continue your medications, even after you feel better, or else the symptoms may return.”
- “Do not stop antipsychotic medication before checking with your doctor.”
- “Alcohol and recreational drugs can affect how well the medication works.”
Take a self-management approach. This means supporting patient education (e.g., giving patients information handouts or directing them to other resources). Involve patients, and their families when appropriate, in managing their illness by actively involving them in diagnosis and treatment planning.