It's Never Too Late

Schizophrenia appears to respond to psychosocial treatments in mid- and late-life, according to Dilip Jeste, M.D.

At APA's 2005 Institute on Psychiatric Services, Jeste presented data from a study that he and his team had published earlier this year showing that community-dwelling patients with schizophrenia or schizoaffective disorder aged 42 to 72 may respond to psychosocial treatment.

In that study, 76 patients with schizophrenia or schizoaffective disorder were randomized to cognitive-behavioral therapy and social-skills training (CBSST) or treatment as usual. Patients were assessed using the Independent Living Skills Survey, Beck's Cognitive Insight Scale, Comprehensive Module Test to assess outcome of CBSST, and psychopathology (PANSS, HAM-D) at baseline, three months, and six months.

The treatment arm consisted of three modules of four weekly sessions each, for a total of 24 group sessions, on “thought challenging,”“ seeking social support,” and “solving problems.” Treatment was manualized with homework assignments after“ classes.” The patients had had schizophrenia or schizoaffective disorder for approximately three decades on average.

Eighty-six percent of the patients completed the treatment. While there was no significant change in psychopathology in these pharmacologically stabilized patients, there was significant improvement at three and six months on frequency of social activities, cognitive insight, and mastery of the skills taught in the three modules.

“Psychosocial treatments work in older persons with schizophrenia,” Jeste concluded. “Successful aging is not an oxymoron, even in people with chronic schizophrenia.”

The study, “A Randomized, Controlled Trial of Cognitive-Behavioral Social Skills Training for Middle-Aged and Older Outpatients With Chronic Schizophrenia,” was published in the March American Journal of Psychiatry and is posted at<http://ajp.psychiatryonline.org/gi/content/full/162/3/520>.