Psych · General adult psychiatry — psychosocial rehabilitation in psychosis
Psychosocial rehabilitation in psychosis
Also known as Psychiatric rehabilitation schizophrenia · Psychosocial interventions psychosis · Supported employment IPS psychosis · Family psychoeducation schizophrenia · Cognitive remediation schizophrenia · Social skills training schizophrenia · Illness management and recovery · Recovery-oriented care psychosis
Exam-exhaustive fellowship topic on psychosocial rehabilitation for schizophrenia-spectrum and other psychotic disorders — recovery constructs, PORT-aligned packages (family psychoeducation, IPS, cognitive remediation, skills training, IMR, ACT/ICM), FEP vocational pathways, fidelity, and RANZCP/NICE/APA frames. FRANZCP-primary, globally tagged.
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Red flags
- Using recovery language to justify under-treatment, premature discharge, or denial of evidence-based antipsychotic and psychosocial care
- Discharging high-need or homeless people with psychosis without intensity, housing and fixed-responsibility plan
- Cream-skimming only 'job-ready' clients or prolonged train-and-place when IPS is indicated
- Labelling a service ACT without low caseload, shared team responsibility and in-vivo outreach
- Ignoring secondary drivers of pseudo-disability (EPS, depression, oversedation, residual positives) while declaring rehab failure
- Acute suicide, violence or severe self-neglect managed as 'community rehab' instead of emergency risk care
Meet the patient
A 27-year-old man, three years after his first episode. His voices are quiet on aripiprazole. He has not had an admission in two years. His last discharge summary says "stable" and lists no goals.[1][14]
He gets up at 1pm. He has not worked or studied since the admission. He sees his mother, his brother and his case manager — nobody else. His mother has stopped asking about the future because the answer upsets them both.[2][12]
The clinic asks whether the dose needs adjusting. The examiner asks the question that runs this whole topic: "His symptoms are controlled. Why is his life not?"[1][5][12]
References16ShowHide
- [1]Dixon LB, Dickerson F, Bellack AS, et al. The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements Schizophr Bull, 2010.PMID 19955389
- [2]Bond GR, Drake RE, Becker DR An update on randomized controlled trials of evidence-based supported employment Psychiatr Rehabil J, 2008.PMID 18407876
- [3]Burns T, Catty J, Becker T, et al. The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial Lancet, 2007.PMID 17905167
- [4]Modini M, Tan L, Brinchmann B, et al. Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence Br J Psychiatry, 2016.PMID 27103678
- [5]Wykes T, Huddy V, Cellard C, et al. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes Am J Psychiatry, 2011.PMID 21406461
- [6]Vita A, Barlati S, Ceraso A, et al. Effectiveness, Core Elements, and Moderators of Response of Cognitive Remediation for Schizophrenia: A Systematic Review and Meta-analysis of Randomized Clinical Trials JAMA Psychiatry, 2021.PMID 33877289
- [7]McFarlane WR, Dixon L, Lukens E, et al. Family psychoeducation and schizophrenia: a review of the literature J Marital Fam Ther, 2003.PMID 12728780
- [8]Pharoah F, Mari J, Rathbone J, et al. Family intervention for schizophrenia Cochrane Database Syst Rev, 2010.PMID 21154340
- [9]Mueser KT, Corrigan PW, Hilton DW, et al. Illness management and recovery: a review of the research Psychiatr Serv, 2002.PMID 12364675
- [10]Kane JM, Robinson DG, Schooler NR, et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program Am J Psychiatry, 2016.PMID 26481174
- [11]Killackey E, Allott K, Jackson HJ, et al. Individual placement and support for vocational recovery in first-episode psychosis: randomised controlled trial Br J Psychiatry, 2019.PMID 30251616
- [12]Leamy M, Bird V, Le Boutillier C, et al. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis Br J Psychiatry, 2011.PMID 22130746
- [13]Slade M, Amering M, Farkas M, et al. Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems World Psychiatry, 2014.PMID 24497237
- [14]Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders Aust N Z J Psychiatry, 2016.PMID 27106681
- [15]Dieterich M, Irving CB, Bergman H, et al. Intensive case management for severe mental illness Cochrane Database Syst Rev, 2017.PMID 28067944
- [16]Deegan PE, Drake RE Shared decision making and medication management in the recovery process Psychiatr Serv, 2006.PMID 17085613