title: Identifying an optimal treatment for schizophrenia: a 2-year randomized controlled trial comparing integrated care to a high-quality routine treatment.
abstract: OBJECTIVE
  This study used repeated outcome measures over a 2-year period to compare the clinical and social benefits of routine schizophrenia treatment with those of evidence-based pharmacological and psychosocial treatment strategies.
  
  
  METHODS
  One hundred patients who were diagnosed with schizophrenia according to DSM-IV criteria were randomly assigned to 24 months of either optimal case management (OCM) or routine case management (RCM). OCM involved minimally effective doses of antipsychotic medication with compliance training, an identical treatment programme with the addition of manual-based communication and problem solving training to help patients and caregivers manage stress, social skills training, supported employment, cognitive-behavioural strategies for residual psychotic and non-psychotic symptoms, as well as anger management and substance use counselling. RCM involved minimally effective doses of antipsychotic medication with compliance training, the monitoring of side effects, education about schizophrenia and its optimal treatment, detection of early warning signs and supportive psychotherapy to address practical problems. The symptoms, impairment, disability, unmet needs, quality of life of the patients were examined by blinded researchers every 6 months.
  
  
  RESULTS
  Statistically and clinically significant advantages were observed for OCM versus RCM on all measures. Most of these advantages increased throughout the 24-month period.
  
  
  CONCLUSIONS
  This study helps demonstrate the importance of psychosocial interventions in the treatment of schizophrenia. Recent advances in evidence-based psychosocial strategies can be implemented into routine clinical practice with additional clinical and social benefits.
authors: Department of Psychiatry, Marmara University, School of Medicine, İstanbul, Turkey. mzsungur@superonline.com
authors: Mehmet
authors: M
authors: Sungur
authors: Haldun
authors: H
authors: Soygür
authors: Perihan
authors: P
authors: Güner
authors: Besti
authors: B
authors: Üstün
authors: Ilkten
authors: I
authors: Çetin
authors: Ian R
authors: IR
authors: Falloon
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D017028:Caregivers; D019090:Case Management; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data*; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D011340:Problem Solving; D011788:Quality of Life; D012559:Schizophrenia / Q000628:therapy*; D012917:Social Adjustment; D016896:Treatment Outcome; D014421:Turkey
chemical_list: D014150:Antipsychotic Agents