Mental Health Promotion - Schizophrenia

MENTAL HEALTH PROMOTION

Psychiatric rehabilitation has the goal of recovery for cli-ents with major mental illness that goes beyond symptom control and medication management . Working with clients to manage their own lives, make effective treatment decisions, and have an improved qual-ity of life—from the client’s point of view—are central components of such programs. Mental health promotion involves strengthening the client’s ability to bounce back from adversity and to manage the inevitable obstacles encountered in life. Strategies include fostering self-efficacy and empowering the client to have control over his or her life; improving the client’s resiliency, or ability to bounce back emotionally from stressful events; and improving the client’s ability to cope with the problems, stress, and strains of everyday living.

Early intervention in schizophrenia is an emerging goal of research investigating the earliest signs of the illness that occur predominately in adolescence and young adult-hood (Borgmann-Winter, Calkins, Kniele, & Gur, 2006). Accurate identification of individuals at greatest risk is the key to early intervention. Initiatives of early detection, intervention, and prevention of psychosis have been established to work with primary care providers to recog-nize prodromal signs that are predictive of later psychotic episodes, such as sleep difficulties, change in appetite, loss of energy and interest, odd speech, hearing voices, pecu-liar behavior, inappropriate expression of feelings, paucity of speech, ideas of reference, and feelings of unreality. After these high-risk individuals are identified, individual-ized intervention is implemented that may include educa-tion, stress management, or neuroleptic medication or a combination of these. Treatment also includes family involvement, individual and vocational counseling, and coping strategies to enhance self-mastery. Interventions are intensive, using home visits and daily sessions if needed.

Studies in Switzerland (Simon et al., 2006) focused on identifying at-risk individuals demonstrating a core deficit of prodromal symptoms, including cognitive impairment, affective symptoms, social isolation, and a decline in social functioning. In Germany, comprehen-sive cognitive–behavioral therapy has been developed for patients in the early initial prodromal phase, whereas those in the late initial prodromal phase receive low-dose antipsychotic medication along with cognitive– behavioral therapy (Bechdolf, Ruhrmann, & Wagner, 2006b; Hafner & Maurer, 2006). These early interven-tions implemented in Germany, Australia, and the United Kingdom have resulted in improvement of prodromal symptoms, prevention of social stagnation or decline, and prevention or delay of progression to psychosis (Bechdolf, Phillips, & Francey, 2006a).