Bottom-up rehabilitation in schizophrenia

Abstract

Summary and conclusion: schizophrenia and selfcontrol. The present study demonstrates that in many cases, chronic schizophrenia does not need to implicate long term hospitalization if patients are exposed to their residual abilities and helped to find suitable accommodations and working situations outside the clinic. Thus,the results strongly plead for further development and implementation of community based care for schizophrenic patients. Top down rehabilitation should be based upon the assessment of individual skills deficits and should be individually tailored. Together with this general implication, the present study shows that more emphasis should be put upon the further development of training and prosthetics to optimalize formal cognitive functioning, the further development of cognitive behavioural interventions to reduce cognitive disturbances of content (reality distortion), and the identification of specific problems, in need for training of a more elaborate style of problem-oriented coping. Thus, if patients with schizophrenia want to 'survive' outside the hospital, it seems necessary for them to develop more control with regard to the process of information processing, the content of information processing and specific individual problems. Consequently, the implications of the present study stress that it is not 'vulnerability' alone that is the central impeding factor in the rehabilitation process of patients with schizophrenia. Schizophrenia is also associated with symptoms lower in the diagnostic hierarchy, especially with irrational thinking which is associated with the inability to perform particular skills, depression, grief, hopelessness, anxiety, worrying, muscular tension and irritability (Dryden & Hill, 1992). Therefore, it is suggested here, that not 'vulnerability' but 'cognitive selfcontrol' in general should be the central theoretical and practical concept in rehabilitation. It seems, in other words, that rehabilitation should return to its source; Bleuler (1911) defined it as 'the development of selfcontrol, and the proper utilization of time'.