Prolonged Recovery Copy

Treatment response used to be evaluated using a single dimension – looking primarily at recovery from positive symptoms, such as hallucinations and delusions. However, it is more appropriate to see psychosis defined as an illness that affects a number of dimensions. For example, not only the positive symptoms, but also negative symptoms (loss of energy, decreased motivation); cognitive symptoms (disorganization, difficulties with attention and concentration); affective symptoms (depression), and so on, including functional outcome measures.

With these numerous measures now being considered, the concept of treatment resistance, or prolonged recovery has broadened. Individuals may show improvement in some of these areas but not others. Clearly recovery is multidimensional.

In those who are not responding to treatment, various factors must be considered. Antipsychotic medication remains the cornerstone of treatment in psychosis, and failing to take the medication can be associated with persistent symptoms that can mimic treatment-resistance (when in fact, it is more related to not taking the medication or noncompliance). There is variability in response to antipsychotic medications, with individuals showing response to certain medications and not to others. For this reason, it is important to try different medications and strategies with people who have not responded. Other behaviors, such as substance abuse, can exacerbate or diminish symptom control, and this too can result in an individual appearing to have prolonged recovery.

In order to optimize treatment outcome, it is essential that a systematic approach be taken to treatments. This includes ensuring that different antipsychotics have been tired, and that this has been done in a way that maximizes the chance of success – adequate doses for a sufficient duration of time. More information on medications and prolonged recovery is covered in the module of pharmacotherapy.

In treating prolonged recovery the approach should include more than just medication. To this end, the best response seems to occur in individuals who receive medication and a full range of psychosocial interventions.