4284.1: Tuesday, November 14, 2000 - Table 1

Abstract #16220

Psychiatric rehabilitation plus medication reduces relapse best if sustained

Martin Gittelman, PhD and Zebulon Taintor, MD. Psychiatry, NYU School of Medicine, 160 West 94th Street, New York, NY 10025, 212 663-0131, qittem01@med.nyu.edu

Psychosocial Rehabilitation aims to reduce relapse, disability, handicap, complications, and poor quality of life. Methods used include organization of services, education, social and vocational skills, stress reduction, organization of families, and support of other treatments (esp. medication), all in full partnership with patients and families. A review of previously published studies of the interaction of psychosocial interventions and rehabilitation programs shows that psychosocial interventions increase medication efficacy (including what studies have been published on the new antipsychotics) by about 40% in terms of preventing relapse as defined by rehospitalization or emergency room visits Program retention is the best predictor of decreased relapse, superior to program type.. Continuity of care and maintaining contact with patients is more important than program type. This is particularly true in the French system, which has spends less per capita than the US and has fewer different types of rehabilitation programs. Psychiatric rehabilitation is in danger of being seen as a bunch of off-the-shelf skills that could be provided briefly according to a set of reductionist guidelines. Change occurs in the context of the doctor-patient relationship and the relationship of the patient to the treatment team. Chronic mental illness requires years of continuous treatment for progress from primitive defenses to coping skills, otherwise "progress" is illusory. For-profit managed care, with its emphasis on minimal services and short term outcomes, can be predicted to bring about more relapses in the long run unless it is sustained. Programs in China involving 450,000 patients reduce relapse while costing little.

Learning Objectives: At the conclusion of the session, participants will be able to: 1. define the contents of psychiatric rehabilitation, 2. discuss the relative contribution of program type vs. program retention to relapse, 3. describe rehabilitation as a dynamic process

Keywords: Coordination, Treatment Outcomes

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA