Should psychosocial treatment for schizophrenia focus on the proximal or distal consequences of the disorder?

摘要

Schizophrenia is characterized by a range of symptoms, most notably psychotic and negative symptoms, with mood and substance abuse problems also common. Although the disorder is diagnosed mainly in terms of symptoms, impairments in psychosocial functioning are another defining feature, including the ability to work or go to school, social relationships and the capacity for independent living. While a decline in cognitive functioning is not incorporated into most diagnostic criteria for schizophrenia, it is a common correlate widely believed to occur in most people with the disorder. The broad and pervasive impact of schizophrenia, combined with the relatively early age at which the disorder usually develops, in early adulthood, is a major reason for it being ranked as one of the 10 most burdensome diseases in the world, despite its prevalence of only about 1% in the general population (Murray & Lopez, 1996).