Differentiating the effects of pharmacological and psychosocial interventions in an intensive rehabilitation programme

It is of clinical importance to identify the contribution of the individual components in a composite intervention, but this is difficult in practice. The aim of this study was to differentiate the effects of pharmacological and psychosocial interventions in improving the symptoms of patients with schizophrenia undergoing an intensive rehabilitation programme. The Krawiecka Goldberg Vaughn scale was used to record the symptoms of 19 long-stay inpatients in the rehabilitation programme. Ratings were made every 2 weeks for periods of between 1 year and 20 months. Analysis of the time course of symptoms showed that substitution of a single novel antipsychotic for conventional antipsychotic regimes was followed by a significant reduction in delusions but no improvement in hallucinations or negative symptoms. However, hallucinations and negative symptoms reduced significantly over the whole period of the observations, indicating an effect of the composite psychosocial interventions in the programme. For patients with persistent psychotic symptoms, changing from conventional to novel antipsychotic medication is likely to reduce delusions, whereas hallucinations and negative symptoms may be more responsive to a combination of psychosocial interventions.