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What does person-centered care look like for patients with schizophrenia?

Person-centered treatment and care should be a vital component of psychiatry, aiming to promote the health and well-being of the patient with focus on the individual’s experience of illness1. But what does this really mean in practice? An EPA2020 symposium provided hospital and community perspectives on the paradigm shift towards a person-centered and recovery-oriented approach.

What is person-centered care?

Care should be personalized, coordinated, enabling and treats the person with dignity, compassion and respect

Related concepts to person-centered medicine include:

  • Personalized medicine – customize healthcare to individual differences
  • Precision medicine – identify patients at risk of developing a disease
  • Predictive medicine – predict treatment responses and outcomes

These all are components of ‘person-centered’ care, but the term should not be limited to classifying individuals by response to particular treatments. Shifting the focus to the patient, as a person, allows experience of mental illness to be viewed through a person’s eyes rather than a patient’s. This multi-perspective approach involves biological, psychological and social/environmental components2. Care should be personalized, coordinated, enabling, and treats the person with dignity, compassion and respect3.

Hospital perspective

Wolfgang Gaebel (Heinrich-Heine University, Dusseldorf, Germany) presented the hospital perspective, where care for schizophrenia is guided by clinical practice guidelines, which already include person-centered approaches, such as shared decision making4. This could be strengthened with outcome measures related to empowerment, insight or recovery. In the long-term this requires healthcare system reorganization towards system-based approaches, with interdisciplinary collaboration including wider disciplines.

Emphasis on recovery

A patient-centered model recommends paradigm shift from symptom control and achieving and maintaining remission to the emphasis on recovery

The European Brain Council project "The Value of Treatment" provided recommendations for a patient-centered model for brain disorders5. This requires a paradigm shift from symptom control, and achieving and maintaining remission, to an emphasis on recovery.

Core elements of recovery-orientation include empowerment, resilience, dignity, self-determination, choice, and community inclusion. It is key that people in recovery lead the way.

Community perspective

Michaela Amering (Medical University of Vienna, Austria) argued that a person-centered approach needs community-based alternatives to conventional services including acute crisis interventions, independent living, and vocational rehabilitation. Interventions that support people in their adult roles while continuing to live with their mental illness have the most robust effect size6.

Integrated treatment

Improving the ability to perform tasks relevant to everyday life is critical for any therapeutic intervention in schizophrenia

Person-centered care involves integrated treatment with antipsychotics plus psychosocial interventions said Armida Mucci (University of Campania, Naples, Italy). Four-year follow-up of the Italian Network for Research In Psychoses Baseline Study showed only 34% of patients were offered integrated treatment7.  Analysis of the network structure between baseline and follow-up demonstrated the high centrality of functional capacity and everyday life skills, suggesting that improving the ability to perform tasks relevant to everyday life is critical for any therapeutic intervention in schizophrenia.

Psychosocial therapies are effective on symptomatology, cognition and functioning8. This is consistent with patient-identified goals that are targeted towards improved functioning.

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. https://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/college-reports/2018-college-reports/cr215
  2. Engel GL. Am J Psychiatry 1980;137:535-44
  3. https://www.health.org.uk/sites/default/files/IdeasIntoActionPersonCentr...
  4. https://www.dgppn.de/_Resources/Persistent/43ca38d4b003b8150b856df48211df68e412d9c9/038-009k_S3_Schizophrenie_2019-03.pdf
  5. Mohr P, et al. Eur Psychiatry 2018;53:107-15
  6. Davidson L. Schizophr Bull 2010;36:107-8.
  7. Galderisi S, et al. World Psychiatry 2020;19:81-91
  8. Fond G, et al. Prog Neuropsychopharmacol Biol Psychiatry 2020;101:109927
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