The New Emphasis on Community Functioning in Schizophrenia

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TCPR: Dr. Ongur, I know you’ve been interested in creative ways of helping patients with psychosis function well in the community. Are we not doing very well as a field in improving the functioning of our schizophrenic patients?

Dr. Ongur: We actually do very well when using antipsychotics to treat positive symptoms, whether those are symptoms of schizophrenia or manic episodes. We can take patients who are psychotic, put them on an antipsychotic, and over the ensuing weeks most of the positive symptoms will come under control. If they are hearing voices, we can quiet the voices, and we can improve their delusional thinking so that they can do reality testing. And for patients who are manic, we can treat grandiosity and excessive activity.

TCPR: And isn’t that enough to improve patients’ functioning in the community?

Dr. Ongur: There are a couple of lines of research showing that treating the positive symptoms is not sufficient. The first line of research has focused on the relationship between positive symptoms and functioning in the community, broadly defined as living on your own, holding down a job, and having meaningful relationships. As it turns out, the positive and manic symptoms are not directly related to these abilities. In other words, some patients are free of these positive symptoms and yet not able to live independently, and then other patients have significant positive symptoms and can function very well. What does seem to predict functioning, however, is cognitive functioning and negative symptoms.

Read the full interview here:

http://pro.psychcentral.com/the-new-emphasis-on-community-functioning-in-schizophrenia/0017255.html

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That was interesting - until they got to the scary part of reducing meds & putting up with some short-term psychosis.

We’ve been there, done that, and it didn’t work for my son. I agree that it’s worth a try because it works for some & some people do have a single psychotic episode then they recover completely.

I was hoping for some practical advice or treatment options to help with community functioning.

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Sorry - I hadn’t read all the way down through the article before I posted it.

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No problem - if you didn’t, the title was a little misleading.

I was all excited about what it might say since I’m jumping through all the disability hoops because he’s been promised help with that exact thing if he can get Medicare.

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I’m almost in total agreement. My daughter has a lot negative symptoms and her cognitive ability have also dramatically declined since high school.

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I just saw this when it came up as they randomly do on this site.

This is what my son’s psychiatrist believes would work for my son if we could ever get him to take meds. My son’s cognition is fully intact - the psychosis and the extreme paranoia are the problem. If we could have gotten him medicated in those early years he might have never gotten to the point he did.

His paranoia makes him dangerous as he has purchased guns to protect himself in the past.

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