Training to recognise the early signs of recurrence in schizophrenia.

Training in early warning signs techniques encourages people to learn, detect and recognise the early warning signs of future illness. Studies indicate that noticing even small changes in signs and symptoms of schizophrenia can often predict future illness and relapse two to 10 weeks later.

Read the full summary here: http://summaries.cochrane.org/CD005147/training-to-recognise-the-early-signs-of-recurrence-in-schizophrenia

From a service user perspective (SUPER), training in recognising early warning signs of illness and relapse seems like a good idea.  Training helps people with mental health problems, health professionals, families and carers to anticipate future illness.  This is preventative, helping people to avoid relapse and admission to hospital.  But it is also a collaborative endeavour, leading to personal insight about illness and self- understanding, so giving people with mental health problems more ownership, a greater say and more power to build their own recovery.

At the opposite end of the spectrum, the authors of the review note that it is possible that training in recognising early warning signs might have difficulties and negatives.  For example, there might be increased depression due to an increased self-focus.  Awareness of illness has also been linked to suicidal thoughts.  Another negative effect might be increased medication due to the increased reporting of people’s symptoms, without reducing relapse.

However, on balance, training and keeping a personal logbook, reflective diary or folder would seem to offer people more insight, control and say in their care.

Aripiprazole versus other atypical antipsychotics for schizophrenia.

This review includes 12 research trials with 6389 people. It evaluates whether aripiprazole is better than other drugs.

Read the full summary here: http://summaries.cochrane.org/CD006569/aripiprazole-versus-other-atypical-antipsychotics-for-schizophrenia

From a service user perspective (SUPER), it is perhaps surprising that there is so little information on the different medications that are available to service users (atypical antipsychotics such as aripiprazole, olanzapine, risperidone and ziprasidone).  The wholesale use of these drugs is widespread, but the benefits as well as the negative side- effects for service users are not fully understood or adequately researched.  Although these medications are thought to help service users, people with mental health issues may have little understanding of the medications that they are taking and little say in which ones they would prefer in their treatment. 

The first line of defence should certainly include medication, but service users should also have a greater say in what medications they would prefer.  Research should not just focus on the effectiveness of these medications, but should look at subjective and personal factors, which is just another way of saying that service users should have more say in the tablets or drugs they take in their treatment.  Taking into account the views of service users and carers, patient preference and impact on quality of life are mentioned by this review as needing further research.  This would encourage people to take their medication, so making it better understood, fair and acceptable for people.

It has also been found that antipsychotic drugs work better and are more acceptable to people when combined with psychological therapies: the ‘talking cures’ of psychotherapy; family therapy; counselling; and cognitive behavioural therapy.  Both objective factors (the effectiveness of medication) and subjective feelings (what treatment or therapy service users say they feel they would prefer) need to be taken into consideration, so as to strike a good balance in the treatment, care and possible recovery of people who use mental health services.