Community Life After Hospital Closure Improves Cognition, Symptoms, & Social Functioning

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Researchers in Japan followed 78 patients with schizophrenia diagnoses following the closure of a psychiatric hospital, and found consistent improvement in measures of cognition, psychiatric symptoms, and social functioning over the course of five years. “Symptoms and global functioning improved almost consistently over the course of the follow-up period . . . These results suggest that care settings affect the course of cognition, and addressing these conditions may lead to a certain degree of cognitive improvement even among schizophrenia patients who have been chronically institutionalized.” Results appear in Schizophrenia Research.

Long-term course of cognitive function in chronically hospitalized patients with schizophrenia transitioning to community-based living. Online April 10, 2014. Schizophrenia Research. doi:10.1016/j.schres.2014.03.015

Abstract:

Schizophrenia is associated with impairments in social interactions, and the conditions under which patients live and undergo treatment appear to have an important role in the course of the disease. However, the influences of care settings on the course of cognition remain controversial. The closure of psychiatric hospitals and the transition to community-based living is a golden opportunity to address this issue. The aims of the present study were to examine (1) the longitudinal course of cognition as well as the psychopathology and social functioning of schizophrenia patients who had been chronically hospitalized and then discharged, and (2) the key cognitive predictors of the functional outcome of such patients. Seventy-eight patients were transferred to the community after the closure of a psychiatric hospital. These patients were followed-up for 5years and underwent annual examinations that included measures of cognition, psychiatric symptoms, and social functioning. Fifty-six patients completed all the assessments. Although consistent improvements were shown in the cognitive domains for attention and memory, the initial improvements in global cognition and processing speed ultimately began to decline. Symptoms and global functioning improved almost consistently over the course of the follow-up period. Stepwise multiple regressions revealed category fluency at baseline predicted social functioning at 5years. However, this correlation was no longer significant when psychopathological variables were included as predictors. These results suggest that care settings affect the course of cognition, and addressing these conditions may lead to a certain degree of cognitive improvement even among schizophrenia patients who have been chronically institutionalized.

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

6 COMMENTS

  1. Of course it does. How could such a perverse environment— one that insists that the people subject to it are constitutionally unable to exercise their own agency and have no rational choice but to submit to the will of mental health professionals who appear not to have a rudimentary understanding of human psychology and who demonstrate that daily— make people better psychologically, mentally, emotionally, and functionally? Those diagnosed with schizophrenia have essentially been ordered not to function and have been given drugs that will assure that they are properly incapacitated.

  2. Well, maybe those “in charge” are starting to realize that disrespecting and turning everyone into schizophrenics, with their antipsychotics, isn’t actually going to be beneficial to humanity? How pathetic, however, that they have to research to conclude environment matters, rather than just innately knowing such a common sense basic reality. Psychiatry’s stupidity is staggering.

  3. Isn’t this exactly what the Quackers in the 1800’s already knew?

    Their moral treatment was composed of giving people good food, dressing them in good clothes, housing them in comfortable and pleasant surroundings, and taking people out into Nature for walks so that they could get fresh air and sunshine. In other words, they housed them properly and treated them like human beings! They had a very high recovery rate if I remember correctly.