Schizophrenia: improving recovery
9 October 2000
A national study has documented the devastating disability experienced by people with schizophrenia.
As part of the Australian National Survey of Mental Health and Well Being, a study was undertaken with the aim of documenting the current conditions experienced by people with a psychotic illness. The study comprehensively assessed a representative sample of patients who were currently receiving treatment from mainstream mental health services. About half the patients had schizophrenia.
The study found that:
- the majority of patients persistently suffered active delusions and hallucinations;
- 85 per cent were dependent on welfare benefits;
- less than 10 per cent had regular, full-time employment; and
- only 2 per cent had good social functioning.
Are patients receiving the appropriate treatment?
The Australian Survey also revealed the very low participation rates in rehabilitation services, with less than 7 per cent of patients receiving ongoing rehabilitation.
Published data (Copolov et al, 1998) from the Clozaril Patient Monitoring System (CPMS) suggests that less than 10 per cent of patients who do not respond to standard treatment are receiving clozapine, the only known effective medication for such patients. Even the small percentage of patients who do finally receive clozapine have had to suffer treatment failure for about 10 years, before starting clozapine.
Can recovery occur more often?
A recently convened working group made up of medical specialists, pharmacists, nurses and general practitioners is in the process of identifying methods that have the best potential for improving the chances of full recovery in schizophrenia. The group obtained an education grant from Novartis Australia (marketer of clozapine) which also sponsored a national consensus meeting held recently to consider this issue.
The following strategies were considered worthy of broader implementation:
- specialist assessment services using psychometric approaches;
- standardised medication practice to minimise side effects;
- early detection and management of treatment failure;
- private psychiatrist integration into clozapine prescribing and monitoring programmes;
- shared care programmes to support general practitioners prescribing clozapine;
- private psychologist integration into provision of psychological services;
- programmes for accelerated re-entry to supported competitive employment; and
- affirmative action for work place reform to increase employment opportunities.
Towards better treatment and more frequent recovery
The working group concluded that recovery rates for patients with schizophrenia could be improved by more than 100 per cent using the above listed strategies.
For example, one-third of patients who are treatment failures respond well to clozapine. Vocational recovery rates with accelerated re-entry to supported competitive employment are double those associated with standard rehabilitation approaches. Use of specialist psychological and family intervention services in combination with medication can double recovery rates from psychotic symptoms, and reduce relapse rates four-fold.
NISAD looks forward to continuing to disseminate the latest information on effective new treatments while supporting cutting edge research that will provide the basis for the next generation of improvements in the management and prevention of schizophrenia.
Last Reviewed: 19 February 2001
