An integrated community-based approach
Continuous maintenance atypical antipsychotic therapy improves functional recovery
Integrating continuous maintenance atypical antipsychotic therapy with psychosocial rehabilitation in a community mental health setting improves outcomes,1 said Professor Tae-Yeon Hwang, Ministry of Health and Welfare, Republic of Korea.
Continuous maintenance atypical antipsychotic therapy may:
- reduce psychotic symptoms
- improve neurocognitive performance and ability to manage the environment
- improve learning capacity1
Furthermore, patients on continuous maintenance atypical antipsychotic therapy are more receptive to rehabilitation,1 he said.
Factors to address to ensure medication adherence
Medication adherence is a key factor influencing outcomes but ensuring adherence can be challenging
Medication adherence is a key factor influencing outcomes but ensuring adherence can be challenging. Nonadherence rarely results from a single cause,2 said Professor Tae-Yeon Hwang. Some of the many causes are:
- Patient-related factors; such as cognitive impairment and comorbidity
- Treatment-related factors; such as side effects, costs of treatment, polypharmacy
- Environment-related factors; such as social and financial support, location of treatment provision, attitude towards treatment
- Physician-related factors; such as provision of information and the doctor-patient relationship2
Medication adherence is higher when caregivers not only understand its importance in achieving a good outcome but are also provided with appropriate support through family interventions and therapy,3 said Professor Johannes Wancata, Medical University of Vienna, Austria.
Medication adherence is higher when caregivers understand its importance in achieving a good outcome
Family intervention and therapy to support the caregivers
Substantial support is provided by family caregivers, explained Professor Wancata. The support might include preparing food, assistance and encouragement within the household, protection from self-injury and attending psychiatric services with the patient.
As a result, family caregivers carry a substantial burden, added Professor Wancata. Additional burdens include loss of social contacts and isolation, feelings of guilt that they might be responsible for the illness, financial consequences and stigmatizing experiences.
Family interventions decrease the risk of psychotic relapse and readmission to hospital
German guidelines on the management of schizophrenia highlight caregivers as essential for treatment and rehabilitation, he added. The guidelines therefore recommend supporting family caregivers with family interventions including information, psychoeducation, practical, social and emotional support and problem-solving techniques.4
Providing such family intervention and therapy not only improves medication adherence but also decreases the risk of psychotic relapse and readmission to hospital.3,5