Psychosocial treatment, antipsychotic postponement, and low-dose medication strategies in first-episode psychosis: A review of the literature – Bola, Lehtinen, Cullberg and Ciompi

Reconsidering medication-free research in early-episode schizophrenia prompts a review of acute psychosocial treatments using medication postponement protocols. We describe and compare the different psychosocial treatment approaches. Studies were included in the review if initial psychosocial treatment combined with a time-limited postponement of antipsychotics was compared to initial antipsychotic treatment using a quasi-experimental or better research design and reportcd outcomes of at least one year. Five studies were included (N=261). each reporting modestly better long-term outcomes than initial medication treatment. resulting in a composite sma l l – medium effect-size advantage ( r .= 0.17). In addition, 27-43% of experimental patients were not receiving anti psychotics at the two- or three-year follow-up. These projects demonstrate the feasibility of a carefully supervised approach to medication-free research and also suggest a strategy for integrating biological, psychological and social treatment components in early-episode psychoses. Initial psychosocial treatment combined with a time-limited postponement of antipsychotic medications for eligible, non-dangerous. early-episode patient- may facilitate a reduction in long-term medication dependence and the discrimination of similar but pathophysiologically different diagnostic entities. Rigorous evaluation in a randomized controlled trial designed to identify medication and psychosocial treatment-responsive subgroups of patients may contribute to diagnostic specificity and improved patient outcomes. Psychosis Vol. I, No. I, February 2009, 4 18 Read More Here: Continue Reading…

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“The Open Dialogue Approach to Psychosis: Its Poetics and Micropolitics” – Seikkula & Olson

In Finland, a network-based, language approach to psychiatric care has emerged, called “Open Dialogue.” It draws on Bakhtin’s dialogical principles (Bakhtin, 1984) and is rooted in a Batesonian tradition. Two levels of analysis, the poetics and the micropolitics, are presented. The poetics include three principles: “tolerance of uncertainty,” “dialogism,” and “polyphony in social networks.” A treatment meeting shows how these poetics operate to generate a therapeutic dialogue. The micropolitics are the larger institutional practices that support this way of working and are part of Finnish Need-Adapted Treatment. Recent research suggests that Open Dialogue has improved outcomes for young people in a variety of acute, severe psychiatric crises, such as psychosis, as compared to treatment-as-usual settings. In a nonrandomized, 2-year follow up of first-episode schizophrenia, hospitalization decreased to approximately 19 days; neuroleptic medication was needed in 35% of cases; 82% had no, or only mild, psychotic symptoms remaining; and only 23% were on disability allowance. Read more here: The Open Dialogue Approach to Psychosis: Its Poetics and Continue Reading…

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‘Family and Network Therapy Training for a System of Care: ‘A Pedagogy of Hope’” – Olson

In the past decade, the field of family therapy has witnessed the emergence of a new template for practice based on reflection and narrative, instead of strategy and intervention. There also are broader social and cultural frameworks, especially regarding gender and issues of social justice. The style of practice has evolved from a hierarchical one to therapeutic conversation based on collaboration. The intellectual movements of postmodernism and feminism challenged traditional cybernetic and systems models and provided the seeds for new forms of therapy. This evolving tradition as a whole can be traced back to the communication research of Gregory Bateson and his colleagues in Palo Alto. One of the distinguishing features of postmodern therapy is the stance of treating the patient and family as members of a partnership within a network that includes the professionals and anyone else connected to the situation (Seikkula et al., 1995). Read more: Family and Network Therapy Training for a System of Care: “A Pedagogy of Continue Reading…

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“Inner and Outer Voices in the Present Moment of Family and Network Therapy” – Seikkula

Compared to narrative and solution-focused therapies, in dialogical approaches the therapists’ position becomes different. Therapists are no longer interventionists with some preplanned map for the stories that clients are telling. Instead, their main focuses on how to respond to clients’ utterances as answers are the generators for mobilizing one’s own psychological resources, since ‘for the word (and consequently for a human being) there is nothing more terrible than a lack of response’ (Bakhtin, 1984, p.127). Respecting the dialogical principle that every utterance calls for a response, team members strive to answer what is said. Answering does not mean giving an explanation or interpretation, but, rather, demonstrating in a therapist’s response that one has noticed what has been said and, when possible, opening up a new point of view on what has been said. This is not a forced interruption of every utterance to give a response, but an adaptation of one’s answering words to the emerging natural rhythm of the conversation. Team members respond as fully embodied persons, with genuine interest in what each person in the room has to say, avoiding any suggestion that someone may have said something wrong. As the process enables network members to find their voices, they also become respondents to themselves. For a speaker, hearing her own words after receiving the comments that answer them enables her to understand more of what she has said. Read more here: Inner and Outer Voices in the Present Moment of Family and Network Continue Reading…

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