While new medications have greatly relieved the symptoms of schizophrenia and other severe mental disorders, additional treatments that simply teach patients, particularly older patients, how to function in the real world have the potential to significantly improve independence and quality of life, according to a new study published today in the American Journal of Geriatric Psychiatry.

Researchers led by Thomas L. Patterson, Ph.D., of the University of California, San Diego have been seeking more effective methods for treating older patients with severe mental illness, chiefly schizophrenics but those with other serious, chronic mental disorders as well. They say new antipsychotic drugs have been highly effective at alleviating the symptoms of schizophrenia but that such improvements “do not automatically translate into an improved ability to function in the real world.”

“Medications alone are not the answer,” Patterson said. “Patients still need to learn how to function in society, particularly older patients who are frequently lacking such skills.”

Patterson and his colleagues decided they would test “behavioral interventions” that might be particularly effective for older patients, as most research into this type of treatment has focused on younger patient groups. The emphasis on older patients also stems from the fact that the number of older people suffering from schizophrenia is on the rise, placing ever-increasing burdens on healthcare resources. Costs associated with treatment and lost productivity have made schizophrenia one of the nation’s most “expensive” mental disorders.

The investigators designed a 24-session program—each session lasts about two hours—called “functional adaptive skills training,” or FAST, that seeks to improve a patient’s ability to handle such routine tasks as taking medicine, obtaining transportation and managing finances. They tested FAST’s effectiveness by selecting a group of 32 middle-aged patients with long-term histories of schizophrenia or “psychotic mood disorders” and randomly assigning half of them to the program and half to “treatment as usual.”

Researchers found that the group of test patients who participated in the FAST program experienced much greater improvements in handling everyday tasks than did those who did not. The study notes that “these improvements were evident immediately after completion of the intervention program and persisted at 3-month follow-up.”

The researchers cautioned that it’s difficult to determine how the program’s benefits would play out given the variables involved in each patient’s encounters with the “real world, with all its complexities.” For example, newly acquired abilities to master transportation logistics could vary depending on the existence of mass transit systems. Nonetheless, they note, “rehabilitation success even in small increments is significant in terms of reduced suffering.”

Patterson and his colleagues believe their “findings point to a need to continue to develop and test behavioral interventions designed for older, seriously mentally ill patients in order to improve their real-world functioning.”

“Interventions that improve medication adherence, everyday living skills and general psychosocial functioning may reduce the need for long-term care while minimizing the burden on institutional healthcare systems,” the authors state.

The American Journal of Geriatric Psychiatry is the official journal of the American Association for Geriatric Psychiatry and can be found online at http://ajgp.psychiatryonline.org.