Neuroplasticity and outcome in schizophrenia: the role of psychological interventions

Perhaps the best way to consider schizophrenia is as a progressive neurodevelopmental disorder, in which events at various stages in life, from the antenatal period to adolescence, have their effects on the brain. There is already substantial evidence for the notion that the abnormal brain connectivity in schizophrenia may be related to synaptic plasticity. Various forms of psychological intervention, including cognitive-behaviour therapy (CBT), can positively alter not just the symptoms of schizophrenia, but its long-term course. Though medications form an integral part of most treatment guidelines, there is a growing realisation that psychological therapies do “work”, at least for certain specific symptoms. Firm recommendations are also made regarding five kinds of specific psychological intervention for schizophrenia per se: supported employment, skills training, CBT, token economy-based interventions and family-based interventions. In future guidelines, cognitive remediation may join these five approaches. Since schizophrenia is a disorder that affects several aspects of functioning, it is logical to expect that targeting more than one domain could lead to a better outcome. While it is too early to speak of “preventing schizophrenia” through psychological interventions that target neuroplasticity, it is too early to write off this possibility either. Perhaps we need to stop thinking of “schizophrenia” as a monolithic entity. Instead, we should study it in terms of its constituent syndromes and dimensions.