Community Mental Health Journal

, Volume 47, Issue 6, pp 660–667 | Cite as

Recovery from Schizophrenia: A Four-year Study of an Inner City Cohort

  • Marina EconomouEmail author
  • Alexandra Palli
  • Lily Peppou
  • Michael Madianos
Original Paper


Converging evidence support the establishment of integrative approaches combining pharmacotherapy and psychosocial interventions for the treatment of patients with schizophrenia. Nonetheless, most studies have been limited with regard to treatment duration and their external validty has been questioned. The present study aimed at evaluating the effectiveness of the routine use of a continued integrative treatment approach in promoting clinical and social recovery from schizophrenia over 4 years. At a community mental health centre in Athens, 60 consecutive cases with a DSM-IV diagnosis of schizophrenic spectrum disorders were included into the study. Indepedent raters assessed the patients’ level of functioning, cognitive impairment, disability, distress and caregivers’ stress at baseline and annually for 4 years. The results of the study showed a stable linear pattern of improvement in all outcome measures with moderate to small effect sizes; while competitive employment and independent living emerged as the areas which benefited the least from the treatment program. Overall, the study supports the application of evidence-based integrative strategies to routine services, as long as they are provided in a timely and continued manner.


Schizophrenia Recovery Effectiveness Evidence-based treatment Integrative approach 


  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Press.Google Scholar
  2. Bond, G. R., Drake, R. E., Mueser, K. T., & Becker, D. R. (1997). An update on supported employment for people with severe mental illness. Psychiatric Services, 48, 335–346.PubMedGoogle Scholar
  3. Bowie, C. R., & Harvey, P. D. (2005). Cognition in schizophrenia: Impairments, determinants and functional importance. Psychiatric Clinics of North America, 28, 613–633.PubMedCrossRefGoogle Scholar
  4. Bustillo, J. R., Lauriello, J., Horan, W. P., & Keith, S. J. (2001). The psychosocial treatment of schizophrenia: An update. American Journal of Psychiatry, 158, 163–175.PubMedCrossRefGoogle Scholar
  5. Chambless, D. L., Baker, M., Baucom, D. H., Beutler, L. E., Calhoun, K. S., et al. (1998). Update on empirically validated therapies, II. Clinical Psychologist, 51, 3–16.Google Scholar
  6. Cohen, J. (1977). Statistical power analysis for the behavioral sciences. New York: Academic Press.Google Scholar
  7. Economou, M., Gramandani, C., Richardson, C., & Stefanis, C. (2005a). Public attitudes towards people with schizophrenia in Greece. World Psychiatry, 4(Suppl. 1), 40–44.Google Scholar
  8. Economou, M., Palli, A., & Falloon, I. R. H. (2005b). Violence, misconduct and schizophrenia: Outcome after four years of optimal treatment. Clinical Practice and Epidemiology in Mental Health, 1, 3–8.PubMedCrossRefGoogle Scholar
  9. Economou, M., Richardson, C., Gramandani, C., Stalikas, A., & Stefanis, C. (2009). Knowledge about schizophrenia and attitudes towards people with schizophrenia in Greece. International Journal of Social Psychiatry, 55, 361–371.PubMedCrossRefGoogle Scholar
  10. Falloon, I. R. H. (1985). Family management of schizophrenia: A controlled study of clinical, family and economic benefits.. Baltimore: John Hopkins University Press.Google Scholar
  11. Falloon, I. R. H., Boyd, J. L., McGill, C. W., Williamson, M., & Razani, J. (1985). Family management in the prevention of morbidity of schizophrenia: I Clinical outcome of a two-year longitudinal study. Archives of General Psychiatry, 42, 887–896.PubMedGoogle Scholar
  12. Falloon, I. R. H., Coverdale, J. H., & Brooker, C. (1996). Psychosocial interventions in schizophrenia: A review. International Journal of Mental Health, 25, 3–21.Google Scholar
  13. Falloon, I. R. H., & Fadden, G. (1993). Integrated mental health care. Cambridge: Cambridge University Press.Google Scholar
  14. Falloon, I. R. H., Montero, I., Sungur, M., Mastroeni, A., Malm, U., et al. (2004). Implementation of evidence-based treatment for schizophrenic disorders: two-year outcome of an international field trial of optimal treatment. World Psychiatry, 3(2), 104–109.PubMedGoogle Scholar
  15. Falloon, I. R. H., & Optimal Treatment Project Collaborators. (1999). Optimal treatment for psychosis in an international multisite demonstration project. Psychiatric Services, 50, 615–618.PubMedGoogle Scholar
  16. Fowler, D., Garety, P., & Kuipers, L. (1995). Cognitive behaviour therapy for psychosis: Theory and practice. Chichester: Wiley and Sons.Google Scholar
  17. Garety, P. A., Fowler, D., & Kuipers, E. (2000). Cognitive-behavioral therapy for medication-resistant symptoms. Schizophrenia Bulletin, 26, 73–86.PubMedGoogle Scholar
  18. Gilmer, T. P., Dolder, C. R., Lacro, J. P., Folsom, D. P., Lindamer, L., Garcia, P., et al. (2004). Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. American Journal of Psychiatry, 161, 692–699.PubMedCrossRefGoogle Scholar
  19. Guy, W. (1976). E.C.D.E.U. Assessment manual for psychopharmacology. Washington: US Department of Health, Education and Welfare.Google Scholar
  20. Hayman-White, K., & Happell, B. (2007). Critique of falloon and the optimal treatment Project. International Journal of Mental Health Nursing, 16(1), 44–49.PubMedCrossRefGoogle Scholar
  21. Herz, M. K., Liberman, R. P., Lieberman, J. A., Marder, S. R., & McGlashan, (1997). American psychiatric association practice guidelines for the treatment of patients with schizophrenia. American Journal of Psychiatry, 154(Suppl. 4), 1–63.Google Scholar
  22. Hogarty, G. E., Kornblith, S. J., Greenwald, D., DiBarry, A. L., Cooley, S., et al. (1997). Three year trials of personal therapy among schizophrenic patients living with or independent of family: I, Description of study and effects on relapse rates. American Journal of Psychiatry, 154, 1504–1513.PubMedGoogle Scholar
  23. Kane, J. M., & Marder, S. R. (1993). Psychopharmacologic treatment of schizophrenia. Schizophrenia Bulletin, 19, 287–302.PubMedGoogle Scholar
  24. Keefe, R. S., Harvey, P. D., Lenzenweger, M. F., Davidson, M., Apter, S. H., et al. (1999). Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetaipaine, risperidone, and sertindole compared to conventional antipsychotics and placebo: A meta-analysis of randomized controlled trials. Schizophrenia Research, 35, 51–68.CrossRefGoogle Scholar
  25. Kopelowicz, A., Liberman, R. P., & Wallace, C. J. (2003). Psychiatric rehabilitation for schizophrenia. International Journal of Psychology and Psychological Therapy, 3(2), 283–298.Google Scholar
  26. Kreyenbuhl, J., Buchanan, R. W., Dickerson, F. B., & Dixon, L. B. (2010). The schizophrenia patient outcomes research team (PORT): Updated treatment recommendations 2009. Schizophrenia Bulletin, 36(1), 94–103.PubMedCrossRefGoogle Scholar
  27. Lacro, J. P., Dunn, L. B., Dolder, C. R., Leckband, S. G., & Jeste, D. V. (2002). Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: A comprehensive review of recent literature. Journal of Clinical Psychiatry, 63, 892–909.PubMedCrossRefGoogle Scholar
  28. Lehman, A. F., Steinwachs, D. M., & Survey Co-Investigators of the PORT Project. (1998). Patters of usual care for schizophrenia. Initial results from the schizophrenia patient outcomes research team (PORT) client survey. Schizophrenia Bulletin, 24, 11–20.PubMedGoogle Scholar
  29. Liberman, R. P., & Associates (1986). Modules for training social and independent living skills. Camarillo: Psychiatric Rehabilitation Consultants.Google Scholar
  30. Liberman, R., Kopelowicz, A., Ventura, J., & Gutking, D. (2002). Operational criteria and factors related to recovery from schizophrenia. International Review of Psychiatry, 14, 256–272.CrossRefGoogle Scholar
  31. Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., et al. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353(12), 1209–1223.PubMedCrossRefGoogle Scholar
  32. Linszen, D., Dingemans, P., & Lenior, M. (2001). Early intervention and a five-year follow-up in young adults with a short duration of untreated psychosis: Ethical implications. Schizophrenia Research, 51, 55–61.PubMedCrossRefGoogle Scholar
  33. Madianos, M. G., & Economou, M. (1999). The impact of a Community Mental Health Center on psychiatric hospitalizations in two Athens areas. Community Mental Health Journal, 3(4), 313–323.CrossRefGoogle Scholar
  34. Madianos, M., Economou, M., Papageorgiou, A., & Stefanis, C. (1995). The first Community Mental Health Center in Greece: Fifteen years of integrated mental health care and psychosocial rehabilitation practice. International Journal of Psychosocial Rehabilitation, 1, 110–114.Google Scholar
  35. Miller, A. L., Chiles, J. A., Chiles, J. K., Crismon, M. L., et al. (1999). The texams medication algorithm project (TMAP) schizophrenia algorithms. Journal of Clinical Psychiatry, 60, 649–657.PubMedCrossRefGoogle Scholar
  36. Milner, K. K., & Valenstein, M. (2002). A comparison of guidelines for the treatment of schizophrenia. Psychiatric Services, 53, 888–890.PubMedCrossRefGoogle Scholar
  37. National Institute for Clinical Excellence. (2002). Schizophrenia: Core interventions in the treatment and management in primary and secondary care. London: NICE.Google Scholar
  38. Patterson, T. L., & Leeuwenkamp, O. R. (2008). Adjunctive psychosocial therapies for the treatment of schizophrenia. Schizophrenia Research, 100, 108–119.PubMedCrossRefGoogle Scholar
  39. Pekkala, E., & Merinder, L. (2002) Psychoeducation for schizophrenia. Cochrane Database of Systematic Reviews, CD002831. Google Scholar
  40. Pfammatter, M., Junghan, U. M., & Brenner, H. D. (2006). Efficacy of psychological therapy in schizophrenia: Conclusions from meta-analyses. Schizophrenia Bulletin, 32(Suppl. 1), 64–80.CrossRefGoogle Scholar
  41. Rosser, R. M., & Kind, P. A. (1978). A scale of valuations of states if illness: Is there a social consensus? International Journal of Epidemiology, 7, 347–358.PubMedCrossRefGoogle Scholar
  42. Schooler, N. R. (2003). Relapse and rehospitalization: Comparing oral and depot antipsychotics. Journal of Clinical Psychiatry, 64(Suppl. 16), 14–17.PubMedGoogle Scholar
  43. Stein, L. I., & Test, M. A. (1980). An alternative to mental hospital treatment. Archives of General Psychiatry, 37, 392–399.PubMedGoogle Scholar
  44. Swartz, M. S., Perkins, D. O., Stroup, T. S., Davis, S. M., Capuano, G., et al. (2007). Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: Findings from the NIMH CATIE study. American Journal of Psychiatry, 164(3), 428–436.PubMedCrossRefGoogle Scholar
  45. Valenstein, M., Copeland, L. A., Blow, F. C., McCarthy, J. F., Zeber, J. E., et al. (2002). Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Medical Care, 40, 630–639.PubMedCrossRefGoogle Scholar
  46. Warner, R. (1994). Recovery from schizophrenia: Psychiatry and political economy. New York: Routledge.Google Scholar
  47. World Health Organization. (1991). Evaluation of methods for the treatment of mental disorders. WHO WHO Technical Report Series no. 812.Geneva: WHO.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Marina Economou
    • 1
    • 2
    Email author
  • Alexandra Palli
    • 1
  • Lily Peppou
    • 1
  • Michael Madianos
    • 3
  1. 1.Anti-Stigma ProgrammeUniversity Mental Health Research Institute (UMHRI)AthensGreece
  2. 2.First Department of PsychiatryAthens University Medical School, Eginition HospitalAthensGreece
  3. 3.Department of Mental Health and Behavioral Sciences, School of Health SciencesUniversity of AthensAthensGreece

Personalised recommendations