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Biomedical subjects

R P Liberman

Publications and source records attributed to R P Liberman.

At least 19 recordsLinked to original sources
PubMed1995

Basic elements in biobehavioral treatment and rehabilitation of schizophrenia.

The psychopathology and associated disabilities experienced by persons with schizophrenia have only partially responded to conventional pharmacological and psychosocial treatment approaches. Biobehavioral therapy employs behavioral and symptomatic assessment, social learning principles, and skills training, to amplify the effects of pharmacotherapy. Comprehensive, continuous, and integrated biobehavioral therapy--aiming at early detection and treatment of schizophrenic symptoms, family and social skills training, and teaching coping and illness self-management skills--has been documented to improve the course and outcome of schizophrenia as measured by symptom recurrence, social functioning, and quality of life. Biobehavioral therapies must be delivered in the context of a collaborative relationship among patients, families and clinicians that together can optimize outcomes. Services need to be provided by assertive, outreach, community-based teams that tailor the type, frequency and scope of services to the phase of the individual's illness.

Adult↗
PubMed1994

Fluphenazine vs placebo supplementation for prodromal signs of relapse in schizophrenia.

BACKGROUND: We studied the effectiveness of treating patients with low doses of fluphenazine decanoate and supplementing them with oral fluphenazine when there was evidence of prodromal symptoms of psychotic exacerbations. METHODS: Eighty schizophrenic patients who were receiving 5 to 10 mg of fluphenazine decanoate every 2 weeks were monitored for prodromal symptoms using an idiosyncratic prodromal rating scale. When patients met our criteria for a prodromal episode, they were randomly assigned to a double-blind comparison of oral fluphenazine hydrochloride (5 mg twice daily) or a placebo for the current and future prodromal episodes. We compared rates of psychotic exacerbations in the two treatment groups. RESULTS: Thirty-six patients (45%) met the criteria for a prodrome at some point during the trial and were randomized to drug or placebo. Using survival analysis during the entire 2 years, we did not find a significant difference between fluphenazine and placebo in the likelihood that a prodrome would continue to an exacerbation. Survival analysis beginning at the start of the second year of treatment did indicate a significant reduction in exacerbation risk for patients receiving drug supplementation (P = .032). Similarly, there was no difference between the two groups in the proportion of time at risk spent in exacerbation during the first year, but patients receiving active drug supplementation spent less time in an exacerbated state in the second year (P = .05). CONCLUSIONS: Our treatment strategy appeared to be effective for some patients, particularly those who were able to remain in the study beyond the first year. Although the occurrence of a prodrome was a fairly good marker that a patient was at high risk of ultimate exacerbation with our low-dose maintenance protocol, prodromes were not highly sensitive indicators of imminent exacerbation.

Acute Disease↗
PubMed1994

Psychosocial treatments for schizophrenia.

Based upon educational and social learning principles, social skills training and family management modalities have been validated as effective in improving coping skills and symptomatic course and outcome of schizophrenia. Combined with judicious doses of antipsychotic medication, these modalities have been designed from the conceptualization of schizophrenia as a stress-related, biomedical disorder, with those afflicted having enduring vulnerability to the emergence or exacerbation of psychotic symptoms with associated social disability. Behaviorally oriented modalities require integration with a comprehensive psychiatric service delivery system to confer protection against relapse.

Antipsychotic Agents↗
PubMed1994

Psychosocial treatment for obsessive-compulsive disorder.

State-of-the-art psychosocial treatment for obsessive-compulsive disorder is based on behavior therapy strategies and techniques with adjunctive pharmacological treatment. The critical therapeutic element is the prolonged confrontation of the individual with the stimuli that provokes obsessive thoughts or compulsive actions, without the individual then engaging in cognitive or ritualistic avoidance behaviors. For the clinician, a decision model for treating this disorder is drawn from recent behavioral and pharmacological research, as well as from the individual's self-help capacities. Judicious use of currently available treatments can reduce suffering and restore lost psychosocial functioning in obsessive-compulsive patients and their families.

Adult↗
PubMed1994

Optimal drug and behavior therapy for treatment-refractory schizophrenic patients.

Thirteen treatment-refractory schizophrenic patients (10 men and three women) who were receiving more than 50 mg/day of haloperidol and who had been hospitalized for more than 1 year successfully tolerated a mean dose reduction of 63% with consequent improvement in psychopathology and side effects. The addition of intensive behavior therapy to the optimal dose of haloperidol yielded further improvements in functional behavior, such as self-care and social interaction.

Adult↗
PubMed1994

Behavioural family management in schizophrenia. Outcome of a clinic-based intervention.

To test further the highly successful outcomes of a controlled study of in-home behavioural family management (BFM) for schizophrenic patients, a clinic-based version of this intervention was compared with customary care alone for 41 schizophrenic patients in a Veterans Administration (VA) mental health clinic. Monthly Brief Psychiatric Rating Scale (BPRS) ratings, conducted by clinic psychiatrists who were 'blind' to the patients' assignment, revealed that 3 (14%) patients who received behavioural family management as well as customary care, as compared with 11 (55%) patients who received customary care alone, had symptomatic exacerbations during the first year of treatment.

Adolescent↗
PubMed1992

Optimal drug and behavior therapy for treatment-refractory institutionalized schizophrenics.

Institutionalized persons with a deteriorating form of schizophrenia that was refractory to neuroleptic medication were titrated downward in their haloperidol dose. Based on ratings of their clinical status, an optimal dose was reached that was an average 66 percent reduction from their initial levels. Patients then participated in a personalized, intensive behavior therapy program to remediate their extreme, persisting deficits and disturbances in behavior.

Adult↗
PubMed1992

Whither cognitive-behavioral therapy for schizophrenia?

Clinical studies of cognitive therapy and rehabilitation for persons with schizophrenia have generated promising findings of improvements in patients' cognitive and clinical status. However, the results do not appear to be specific to a particular form of intervention, and long-term evaluations of cognitive therapy, as an element in a comprehensive system of care, need to be conducted for clinical validation. Rehabilitation efforts should be congruent with laboratory findings of specific cognitive deficits, including those that are "vulnerability indicators" and endure beyond symptomatic episodes. With the demonstration that chronic schizophrenic patients can learn a variety of cognitive and behavioral skills through Integrated Psychological Therapy and other psychosocial treatments, the future appears bright for a profusion of new modalities aimed at cognitive-behavioral rehabilitation, especially those that emerge from what is known about information-processing deficits in schizophrenia.

Brain Injuries↗
PubMed1992

Technique for training schizophrenic patients in illness self-management: a controlled trial.

OBJECTIVE: To determine whether schizophrenic outpatients receiving low-dose neuroleptic therapy could learn and retain complex information and skills related to self-management of their illness, a novel technique of teaching, using cognitive and behavioral methods, was designed to compensate for the patients' learning disabilities. METHOD: The subjects were 41 patients with DSM-III-R schizophrenia who were receiving constant maintenance neuroleptic drug therapy. They were randomly assigned to structured, modularized skills training or to supportive group psychotherapy. RESULTS: The patients who received skills training made significant gains in each of the areas taught, while those participating in group therapy did not. The skills learned during training were retained without significant erosion over a 1-year follow-up period. CONCLUSIONS: The effectiveness of modularized teaching of illness self-management skills to schizophrenic patients appears to be largely independent of baseline psychology and symptom improvement. Such an approach is useful for overcoming or compensating for the enduring cognitive and information processing deficits commonly found in schizophrenia.

Activities of Daily Living↗
PubMed1992

Effectiveness and replicability of modules for teaching social and instrumental skills to the severely mentally ill.

OBJECTIVE: This study evaluated the effectiveness and replicability of psychoeducational modules designed to improve the social and instrumental competencies of severely mentally ill patients. METHOD: Staff in seven facilities used the modules to teach 108 severely mentally ill patients. Staff received 2 days of formal training followed by periodic consultation. Each module's effectiveness was measured by a test of the patients' knowledge and performance of the skills taught in that module. Staff's adherence to the instructional techniques specified in the modules was measured by directly observing them and assessing the fidelity of their behaviors to those specified in the modules. RESULTS: The patients' skills significantly improved and were maintained during a 1-year follow-up, and staff accurately followed the modules with minimal consultation. CONCLUSIONS: These training modules are effective and replicable techniques for teaching social and instrumental skills to severely mentally ill patients. The modules can be easily disseminated to a variety of facilities and used as components in a comprehensive rehabilitation program.

Activities of Daily Living↗