FIRST INTERNATIONAL CONGRESS OF
NEURO-PSYCHIATRY
ITALY – CUBA 2013
Palace of Conventions in Havana, Cuba, from 18 to 20 November 2013.
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Psychosocial Treatment for Schizophrenia: evidences in Residential Mental Healh Services
A. Vaccaro, F. Bianchetti, A. Catania, E. Domanico, M.E. Trevisan, F. Rancati, C. Zoppellaro,
Comunità La Casa di Nicola, Tavernola B.sca (BG); Comunità Il Tiglio, Acqui (AL); Comunità Teseo, Milano.
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ABSTRACT
A large body of research support the efficacy of Psychosocial Treatments for schizophrenia and schizoaffective disorders, particularly learning-based therapies. There are three approaches to building skills in individuals with schizophrenia and other serious mental disorders: the Token Economy, Social Skills Training and Cognitive Remediation.
The aims of the present study were to consider the efficacy of Psychosocial Treatments and the appropriate timing, frequency and duration of intervention and to assess how cognitive remediation implements Social Skills as a bricks in a wall.
Thirty adult inpatients (from 18 to 55 years of age) with ICD-10-based diagnoses of schizophrenia were randomly assigned to three different groups: active intervention from 24 months (IPT-a group); active intervention from 12 months (IPT-b group); and treatment as usual (control group). Outcome measures were cognition (ENB-2) and social skills assessment (Valutazione Abilità Sociali)
Patients with schizophrenia can clearly improve their social competence with social skills training and cognitive remediation, which may translate into a more adaptive functioning in the community.
Cognitive behavior therapy may benefit the large number of patients who continue to experience disabling psychotic symptoms despite optimal pharmacological treatment.
Summary of the intervention (dott. Ascanio Vaccaro, Health Director Comunità Terapeutica Crest “TESEO”)
Dear colleagues, I’m so proud to stay here for the international psychiatric congress in Cuba.
I’d like to show you an italian experience in the north side of the country that involved three Residential Communities and selected respectively 10, 8 and 6 schizophrenic inpatients for a confrontation among one center where we’re practicing Social Skills Training and Neuro Cognitive Training since two years ago, one more since one year ago and the last one where isn’t practicing similar programs.
First of all I’m showning you the results of the first Center named “La casa di Nicola” positioned close to the Iseo’s lake in Italy. For starter please pay attention on the individual result at time zero (T0) and time one (T1). Time zero is two years before than time one (october 2013). In this residential center the professional operators were formed in about eight mounts before to practice SST and NCT. You could appreciate also slide that demonstrate the difference from T0 and T1 in every groups. Such as I told you, the period considered from time zero and one were two years, so that clarify the big improvment and the gap of the others group. Compared to the group control the difference is obvious. Compared to “Teseo – Milano” the gap is not so big.
Our group implemented a structured and individualized rehabilitation program for psychotic patients: Social Skills Training and Neurocognitive Individualized Training, in which NCT tasks are highly individualized and aspects of patients’ real life are modelled into SST.
The aims of the present study were to consider the efficacy of the integrated approach and the appropriate timing, frequency and duration of interventions and clarify controversial aspects and evaluate the effectiveness of new structured and individualized interventions with respect to usual rehabilitation activities implemented in Italian Residential Mental Health Services.
Emerging evidences demonstrated a relationship between cognitive deficits and social disability in patients with schizophrenia; currently they are considered an important target of both pharmacological and psychological (in particular, Neuro Cognitive Trainings, NCT) treatments of these patients. Deficits of social skills might also contribute to the poor outcome of schizophrenia; the Social Skills Training (SST) is the most largely used intervention designed to improve social competence of patients with schizophrenia. The results of studies investigating the efficacy of NCT and SST are not univocal, probably due to differences in the implementation of the programs and the heterogeneity of participants.
The majority of data on long term interventions on social disabilities are shown in international experiences for systematized models which are mainly cognitive-behavioural informed. Few dates are related to the experiences carried out in Italy after the changes in the psychiatric services.
In the last years, integrated interventions have been developed to improve both the deficits of cognitive functions and social competence. Results of integrated interventions appear promising, but not sufficiently consolidated. Controversial aspects include the choice of outcome indices and methods to individualize treatments, to guarantee generalization and persistence over time of eventual improvements.
Now focus on the results of the group control living in Alessandria (Italy). The enterely period considered in this case, from T0 and T1, was sixt mounts. Such as we was waiting, we found a minimum improvment, probably due to the observator bias and aspecific factors related to relationship.
Finally the group named “Teseo – Milano”, where the introduction of Social Skills Training and Neuro-Cognitive Training were completed exactly one year ago, after a formation’s training of the professional operators for about sixt mounths, shown that, the improvment were very important. The average of the result were intermediate bethween the Residenzial Center “La casa di Nicola” and group control of Alessandria. The last slide shows a mistake. It was inverted the result of the Assertivity group of Teseo Milano and group control, so that the column of the intermediate result concernes Teseo Milano such as is logic to wait.
I don’t know if you have experience with this specific psychiatric rehabilitation. In Italy is not so usual. Frequently you might find the psichosocial rehabilitation based on “relationship”, art therapy, rehabilitation with animals as pet therapy, hippotherapy and so and so. However this psychosocial rehabilitation is based on evidence, verifying and well structured. The targets are the executives function, the central coherence and a theory of mind.
Unfortunately we didn’t use any statistic method for the comparison of the different result. Furthermore the period of the observation were different.
Anyway we observed the maximum improvment during the first sixt mounts until one year. During the second year the improvment is stable, but not so big such as the first one.
Sure we need more controlled studies to investigate better what I’m telling you and I’ll be very proud to lissen other similar experiences and have exchange with who want send me an email.
In conclusion, in my opinion, is more likely rich the goal to reduce the negative symptoms, cognitive and social disability of schizophrenia practicing SST and NCT than practicing the other traditional programs.