Richard W. Brown
Practical Considerations in the Psychosocial Maintenance Treatment of Schizophrenic and Bipolar Outpatients
Although schizophrenia is a thought disorder and bipolar disorder is a mood disorder, many clinicians consider their treatment in parallel because of each of these disorders’ pervasive, debilitating chronic effects, which can be compared. The review of the literature in this paper examines psychosocial interventions in the maintenance treatment for these severe mental illnesses. While the literature points to cognitive-behavioral psychotherapy in coordination with pharmacotherapy as potentially the most efficacious treatment, the realistic, practical clinical picture is much more complex and not always as clear-cut. Since the majority of schizophrenic and bipolar patients are not willing or very capable of undergoing long-term psychotherapy, the more practical psychosocial intervention option is case management and medication management. A consideration of noncompliance, medical problems, co-occurring disorders, substance abuse, suicidal tendencies, and other practical concerns in the treatment of these populations is needed in order to gain insight into the best maintenance intervention possible for these severely mentally ill outpatients.