Several Factors May Improve Chances Of Recovery From Schizophrenia

Most people think of schizophrenia as a chronic illness with little hope of recovery. But some patients defy the odds and function well despite their illness.

Take the case of “John,” a 29-year-old resident of Los Angeles. He developed schizophrenia during college, yet still managed to graduate. Today, he works full time as a paralegal, enjoys his work, and has a number of friends. “Overall, things are going very well,” he says.

Yet what makes it possible for patients like John to recover? Robert Liberman, M.D., a professor of psychiatry at the University of California at Los Angeles and director of the UCLA Psychiatric Rehabilitation Program, along with UCLA colleagues have conducted preliminary research to find out. As they reported in the November International Review of Psychiatry, the answer appears to be a number of factors—from access to comprehensive, continuous care to having a supportive family.

Liberman and his coworkers launched their search for answers as to why some patients manage to recover symptom-wise and socially from schizophrenia by searching the recent psychiatric literature on the subject. They came up with 10 tentative explanations: a good premorbid history; a short duration of untreated psychosis; access to comprehensive, continuous care; a supportive therapist; a good initial response to antipsychotic drugs; adherence to treatment; absence of substance abuse; absence of negative symptoms; good neurocognitive functioning; and a supportive family.

For a pilot study Liberman and his coworkers recruited 23 persons who had had schizophrenia or schizoaffective disorder between 12 and 23 years and who had recovered from their illness according to criteria the researchers had established. For instance, the individuals had to score “moderate” or below on each of the positive and negative symptom items of the Brief Psychiatric Ratings Scale for two consecutive years. They had to be employed at least half time for two consecutive years. They had to live on their own and handle their own money, shopping, food preparation, laundry, and personal hygiene. They had to interact with a friend or acquaintance outside the family at least once a week.

Liberman and his team then attempted to see, with interviews and tests, whether the putative schizophrenia recovery factors they had identified also explained why these 23 subjects had recovered. The answer was yes in every case, they found.

Regarding premorbid functioning, nearly all subjects were at near-normal levels prior to the onset of schizophrenia. Sixteen (70 percent) had graduated from college, three (13 percent) had completed two years of college, and three were working full time. Only three (13 percent) of the subjects had experienced a delay of more than a year between the onset of psychotic symptoms and treatment with antipsychotic medications.

Regarding access to comprehensive, continuous care, 21 (91 percent) were receiving psychopharmacological and psychotherapeutic treatment at the time of study. What’s more, 18 (78 percent) reported that accessible, supportive psychiatrists and therapists had contributed to their recovery. One subject, for instance, said, “I’ve received continuous treatment for schizophrenia for over 24 years and have been able to find psychiatrists who will listen to me and help me find medications that are not toxic.”

Twenty (87 percent) of the subjects experienced control of their symptoms with their first antipsychotic medication.

All 23 subjects adhered to their antipsychotic drug regimens. Further, 13 (57 percent) believed that the use of antipsychotic medications represented their most effective strategy for coping with their illness.

Only four (17 percent) of the subjects had used illicit drugs or had abused alcohol after the onset of their schizophrenia.

Regarding negative symptoms, no subjects showed more than very mild ones.

All study participants showed normal or near-normal functioning on tests of executive functioning, visual-perceptual skills, verbal fluency, and other neurocognitive functions.

Finally, 16 subjects (70 percent) had good or very good relationships with their families. Further, of the eight subjects who were married or had been married, six (75 percent) said that their spouse had played a key role in their recovery.

The researchers are next going to study some of these factors further, Liberman told Psychiatric News, not just to document further their role in recovery, but also to identify those that might be malleable. In fact, they have already attempted to tease out neurocognitive factors responsible for recovery from those that underlie schizophrenia vulnerability and will be submitting their findings to a scientific journal, Liberman said.

After they have identified some of the schizophrenia recovery factors that are pliable, Liberman explained, they hope to target them with intervention programs designed to enhance them and thus promote recovery.