Science and recovery in schizophrenia.
Mental health advocates and policy makers are increasingly attuned to the importance of the recovery concept, and psychiatrists and neuroscientists increasingly emphasize the medical model and neurobiological mechanisms in relation to schizophrenia. Studies have shown that people with schizophrenia are tremendously heterogeneous in each domain of recovery, and the various domains of recovery are themselves relatively independent from one another. Studies have also shown that current interventions are effective for specific dimensions of the illness and functions, are usually ameliorative rather than curative, and are effective only for a proportion of patients. Hence, the authors suggest defining recovery in terms of improvements in specific domains rather than globally -- for example, "recovery of cognitive functioning" or "recovery of vocational functioning" -- to signify improvements in specific areas. This definition realistically emphasizes states of relative and partial recovery that patients can achieve in response to treatment. The emphasis on a range of improvements in specific areas should allow clinicians to communicate more clearly regarding the current findings and goals of treatment. The article also examines current research on various aspects of recovery, including the effects of treatment on pathophysiology, symptoms, cognitive impairments, quality of life, and self-agency. An operational definition of recovery allows for bridging hope and recovery with important advances in the science of the brain. Future clinical and neuroscience research and service development should emphasize measures of recovery as outcomes for people with schizophrenia.
Lieberman
Jeffrey A
JA
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA. jlieberman@columbia.edu
Drake
Robert E
RE
Sederer
Lloyd I
LI
Belger
Aysenil
A
Keefe
Richard
R
Perkins
Diana
D
Stroup
Scott
S
D000288:Administrative Personnel; D001921:Brain / Q000503:physiopathology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000628:therapy; D003142:Communication; D003289:Convalescence; D006801:Humans; D010344:Patient Advocacy; D010353:Patient Education as Topic; D011369:Professional-Patient Relations; D011570:Psychiatry / Q000379:methods; D011788:Quality of Life / Q000523:psychology; D012559:Schizophrenia / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D012586:Science; D016896:Treatment Outcome