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Query: UMLS:C0599766 (functional recovery)
 13,441 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Treatment for bipolar disorder consists of 2 goals: 1) managing urgent situations and 2) transitioning patients into maintenance therapy. Patients with bipolar disorder who present in urgent situations, including symptoms of suicidality, aggression, occupational impairment, legal involvement, and psychosis, require quick and efficient identification and resolution of symptoms. Once patients are stabilized, clinicians must then implement maintenance therapy to manage behavioral symptoms, promote optimal functioning, and ultimately, to reach full, functional recovery.
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PMID:Managing bipolar disorder from urgent situations to maintenance therapy. 1840 94

The Graduated Recovery Intervention Program (GRIP) is a novel cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. In this paper, the treatment development process of GRIP is described and data from an open feasibility trial are presented. Findings suggest clinical and psychosocial benefits associated with GRIP, and the treatment was well-received by clients and therapists. The retention rate of 67%, however, suggests the need for protocol modifications to improve engagement. Initial data on the efficacy of GRIP are encouraging, although the study design precludes more robust conclusions at this time.
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PMID:The graduated recovery intervention program for first episode psychosis: treatment development and preliminary data. 1851 80

Despite the expansion of available antipsychotic drugs over the past 50 years, functional outcomes for individuals with schizophrenia have not markedly improved. These agents are efficacious for psychosis but do not adequately address other core domains of schizophrenia psychopathology, namely negative symptoms and cognitive impairment, which have a greater impact on functional outcomes, including vocational or academic performance and interpersonal relationships. In addition, treatment-refractory psychosis still precludes functional improvement in many patients. Schizophrenia is a clinical syndrome consisting of these domains, which likely have some disparities in their respective pathophysiologies. This suggests that drug development should look to other molecular targets besides the D2 receptor, which characterizes the mechanism of available medications for schizophrenia. In this report, we review novel pharmacologic approaches that aim to specifically address each individual domain of schizophrenia. The goal of this future pharmacotherapy strategy is to advance outcomes beyond psychosis remission and toward functional recovery.
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PMID:Better pharmacotherapy for schizophrenia: what does the future hold? 1862 75

"All-causes discontinuation" refers to discontinuation of treatment for any reason, and adherence to medication is an important component of this measure. Two recent landmark studies suggest that adherence is a major issue in patients with first-episode psychosis (FEP) right from the onset of treatment. In this review, the incidence, reasons for, and clinical outcomes of medication discontinuation in FEP are considered. More than 40% of patients with FEP discontinue medication during the first 9 months of treatment, at which point the chances of relapse increase dramatically. Findings concerning predictors of medication discontinuation in this patient population that have been replicated in more than one study include severity of psychopathology, lack of insight into illness, negative attitudes towards medications, comorbid substance use, and medication side effects. Interventions that have the potential to decrease discontinuation rates in patients with psychotic disorders include orally disintegrating tablets, long-acting injectable drugs, cognitive-behavioral therapy, compliance therapy, family support/intervention, and peer support, although these strategies have largely been unexplored in FEP. In addition to the question of medication discontinuation in the acute treatment of FEP, another important issue is how long patients with FEP should be treated with antipsychotics once they have achieved remission; unfortunately, little evidence is available to guide the decision as to whether medication should be discontinued or maintenance treatment provided in this situation. Studies are therefore needed to identify predictors of patients with remitted FEP who are less likely to relapse when medication is discontinued. Taken together, the findings presented in this article underscore the importance of addressing issues related to medication discontinuation as a means of preventing long-term morbidity and enhancing remission and functional recovery in FEP.
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PMID:A review of second-generation antipsychotic discontinuation in first-episode psychosis. 1883 60

The task of judging an individual's functional recovery is not an easy one for healthcare professionals. Indeed, increasing one's accuracy in predicting one's ability to self-maintain would be of great value for determining if functional recovery has or is occurring. The purpose of this review is to examine existing measures for assessing remission/normalization of functional status among people with psychosis. Our review evaluates 8 measures of functional ability encompassing self-report, clinical, and performance-based measures. We elected to utilize a grading system to aid readers in understanding the merit of a scale for use in assessing functional recovery. In this approach, a letter grade (A, B, or C) was assigned to each of 4 domains we deemed important to professionals in electing to use specific assessments: (1) Ease of Administration, (2) Reliability, (3) Validity/Relationship to Real-World Outcomes, and (4) Sensitivity to Change/Use in Clinical Trials. Results indicated that no "gold standard" measure has been developed to date, but performance-based measures appear to have the most evidence for predicting concurrent self-maintenance abilities (eg, residing independently or maintaining work). More research on existing measures is needed, and greater funding for developing new measures of functional recovery is strongly recommended.
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PMID:A review of instruments for measuring functional recovery in those diagnosed with psychosis. 1902 22

Compliance and relapse are major issues in the treatment of psychotic disorders. About 50% of subjects with schizophrenia do not comply with treatment and relapse rates of 65% are reported after one year and 80% after two years. Drug treatments are effective against psychotic symptoms, but cannot promote functional recovery or prevent relapses when prescribed alone. The factors influencing compliance include side effects and the patients' awareness of their illness. Psychosocial interventions, cognitive remediation and psychotherapy have been proposed as adjuvant treatments to increase compliance and to decrease the rate of relapse. Most of these interventions have been shown to increase compliance and to decrease the rate of relapse, but the most robust results have been achieved with cognitive behavioral therapy.
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PMID:Patients' health literacy in psychotic disorders. 1930 May 80

The Graduated Recovery Intervention Program (GRIP) is a new individual cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. The purposes of this study were to evaluate the feasibility and tolerability of the GRIP intervention, and to compare the effectiveness of GRIP versus treatment as usual (TAU) for improving specific clinical and psychosocial outcomes. Forty-six individuals with first episode psychosis were randomized to GRIP+TAU or TAU alone. Primary outcomes focused on social and role functioning, and quality of life. Secondary outcomes included psychotic symptoms, depression, substance use, social support, attitudes toward medications, well-being, and hospitalizations. The results indicate that GRIP was well-tolerated, as evidenced by good attendance and low drop-out rates, and well-received (based on positive feedback from participants). Although the majority of mixed model analyses were not statistically significant, examination of within-group changes and effect sizes suggests an advantage for GRIP over TAU in improving functional outcomes. These advantages and the fact that the GRIP intervention demonstrated feasibility and tolerability suggest that this intervention is worthy of further investigation.
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PMID:A pilot investigation of the Graduated Recovery Intervention Program (GRIP) for first episode psychosis. 2081 84

This prospective analysis aimed to study the influence of psychopathological dimensions on the global functioning of persons suffering from psychotic disorders, taking into account the role of a broad range of potential confounders. A large international cohort (n=1888) with ICD-10 non-affective psychosis was evaluated both at baseline during a hospital admission and three months after discharge. Trained interviewers administered a global functioning scale (GAF) and a psychopathological scale (BPRS) at baseline and follow-up). Baseline BPRS psychopathological dimensions were extracted using Principal Component Analysis. Results of multiple linear regression analyses demonstrated that affective symptoms (depressive or manic) prospectively predict a better global functioning, whilst agitation/cognitive symptoms determined poorer global functioning. Other predictors showing an independent effect on better global functioning were medication compliance, country of residence, female gender, married or coupled status, younger age and having a diagnosis of schizoaffective disorder rather than schizophrenia or other ICD-10 psychosis. A predicting model for global functioning in patients with psychosis is provided, showing that assessment of affective and agitation/cognitive symptoms should be emphasised during admission as they can be more informative than positive/negative symptoms in prospectively planning follow-up care that is geared towards a better functional recovery.
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PMID:Acute psychopathology as a predictor of global functioning in patients with ICD-10 non-affective psychosis: a prospective study in 11 European countries. 2162 22

Besides intervention in prepsychotic period, early intervention in psychosis includes interventions done after the onset of the first-episode psychosis, namely psychopharmacological and psychosocial phase-specific intervention. The main aim is to reduce the duration of untreated psychosis (DUP) and to ensure that besides remission of the symptoms there is also a psychosocial recovery. Many centers set up an assertive and integrated early intervention program, involving an active search of patients with a treatment that includes antipsychotic medication, cognitive behavioral therapy, psychoeducation, family and vocational interventions. The authors of this review explain the concepts and main studies that support this kind of treatment in early psychosis. The results of published data show that is possible to reduce the DUP and improve the clinical and functional outcomes with this intervention. Critical period hypothesis proposes that deterioration occurs aggressively in the first 2 to 5 years of early psychosis, so it is crucial to intervene in this period to ensure a functional recovery. Cost-benefit ratio seems to be favorable to early intervention model, with reduction of in-stay period, which is an important component of the direct costs of psychotic illness. Early intervention service model organization is also reviewed by the authors of this research. The results of many studies show favorable outcomes for the integrative early intervention and so many countries included it in their political mental health directives and attributed funds for early intervention in psychosis.
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PMID:[Early intervention in psychosis: first-episode psychosis and critical period]. 2167 49

The first episode of schizophrenia is a field of great interest from both clinical and research perspectives. Most clinical and psychosocial deterioration in schizophrenia occurs within the first 5 years of the onset of the illness, suggesting that this is a critical period for treatment initiation. Therefore, early detection and subsequent effective therapeutic intervention are vital for the patient, as they significantly determine the course and the long term outcome of the disease. Pharmacotherapy is the cornerstone of the whole therapeutic approach. Patients with first-episode psychosis are comparatively more treatment responsive than patients with multiple episodes. They need lower doses of antipsychotic medication but at the same time are quite sensitive to side effects mainly to extrapyramidal symptoms and signs. All current guidelines consider second generation antipsychotics as first choice drug for first episode schizophrenics. Data from few double blind randomized clinical trials indicate that the newer agents show equal or even better efficacy than the neuroleptics and to a certain extend fewer side effects, mainly extrapyramidal symptoms. Despite initial symptom reduction, achievement of full remission -particularly if it is defined according to strict criteria- and even more, achievement of full recovery remains unsatisfactory. Predictors of poor short term and long term outcome include male gender, low educational level, "soft" neurological signs, severe positive symptoms at baseline, cognitive deficits at intake, poor premorbid functioning especially during adolescence, prefrontal neuronal dysfunction, extrapyramidal symptoms and tardive dyskinesia early in treatment, long duration of untreated psychosis or untreated illness. Although published guidelines do not make definitive recommendations about the duration of maintenance treatment after the first episode, recent data suggest that 1 or 2 years might not be adequate. Medication adherence is problematic in first episode schizophrenics even within the first six months. Poor adherence is predicted by male gender, younger age, poor insight after discharge, severe positive symptoms at baseline, alcohol and drug abuse, inadequate family involvement, lower occupational status, not positive relationship with the psychiatrist, bad admission experience and medication side effects. Adjunctive psychosocial interventions may be beneficial across a variety of domains and can assist with symptomatic and functional recovery. Cognitive-behavior therapy has shown modest efficacy in reducing symptoms and assisting patients in adjusting to their illness but has shown minimal efficacy in reducing relapse. Some reports support the benefits of family interventions, while there is a paucity of data evaluating group inter ventions. Comprehensive (i.e. multi element) treatment approaches show promise in reducing symptoms and hospital readmissions as well as improving functional outcomes. More randomized controlled trials are needed to evaluate the ef fectiveness of psychosocial interventions, in general, in first-episode psychosis patients.
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PMID:[First-episode schizophrenia: Pharmacotherapy and psychosocial interventions]. 2246 28


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