Using Patient-Centered Assessment in Schizophrenia Care: Defining Recovery and Discussing Concerns and Preferences

Syndromal recovery, satisfactory quality of life, and adequate functionality are relevant goals that define successful treatment of schizophrenia. Recovery requires effective symptom control in multiple clinical domains but also sufficient self-care and social and educational/vocational functionality. The finding that residual negative and cognitive symptoms have been related strongly to inadequate levels of functioning in people with schizophrenia is related to the fact that current pharmacologic agents tend to be most effective for the positive symptoms of the disease. Additional challenges include psychiatric comorbidities and adverse events related to medication that can lead to secondary negative and cognitive symptoms and nonadherence, all of which can worsen outcomes. Treatment modalities that target cognition and functional rehabilitation without introducing tolerability issues are needed. In general, pharmacologic interventions should be combined with evidence-based nonpharmacologic treatments, and patient-reported outcomes as well as measurement-based care should be employed, ideally in a coordinated specialty care framework. To facilitate positive treatment decisions, a combined shared decision and motivational interviewing approach should be implemented.