The importance of psychosocial interventions and patient involvement in the treatment of schizophrenia.

The multifactorial nature of schizophrenia and the wide-ranging impact of the illness on the patient, their family, carers and healthcare providers mean that clinicians must be prepared to take a holistic approach to treatment. It is widely recognized that a patient's beliefs about their treatment and their experiences of schizophrenia can be very important in determining both attitude towards treatment compliance and behaviour in response to symptoms of the illness and environmental stress. Antipsychotic therapy remains the cornerstone of treatment for schizophrenia. However, there is now growing evidence to support the benefits of non-pharmacological interventions, when used in combination with antipsychotic treatment, in relieving symptoms, improving occupational and social functioning and reducing the risk of relapse. In particular, these interventions appear to provide benefits in coping skills and social and vocational functioning, as reflected in a greater ability to function independently and an improvement in quality of life. Systematic assessment of non-pharmacological therapies in schizophrenia is still a relatively new science, but there is good evidence that psychosocial therapies, such as family intervention therapy, cognitive-behaviour therapy and compliance therapy can markedly change a patient's behaviour and improve adherence to treatment and hence interaction with families, carers and healthcare providers. Psychosocial interventions can be implemented from the first episode of psychosis onwards and can contribute to an improved overall outcome in schizophrenia, to patients being more satisfied with their treatment, and to a better quality of life for the patient and their family. Initial comprehensive assessment will involve regular contact with the patient and opens channels for an ongoing dialogue. It is important that these discussions with the patients and their families and carers not only cover the need for social, emotional and behavioural support but include regular discussion of the acceptability and side-effects of antipsychotic treatment so that problems can be identified and addressed promptly. While the importance of non-pharmacological interventions in improving the quality of patient care is becoming widely accepted, access to psychological, psycho-educational and family support is by no means universal in current clinical practice. It is important that these services, provided by appropriately trained personnel, are made available to all patients for whom they may be appropriate.