Professional Documents
Culture Documents
History, Evidence,
Treatment Principles
and Future Directions
Paraprofessional Staff
Phenomenological Approach
Hospital ER
Soteria
164 Days2
READMISSION
Readmission to 24-hour Care -.162 .08
Number of Readmissions -.983 .02
Days in Readmission -23.63 n.s.
1. Difference in the probability of membership in the 2 best
categories.
2. Difference in the probability of readmission.
3. Difference in the expected value.
Multivariate Two-Year Outcomes:
Soteria vs. Hospital Control (N=129)
(continued)
OVERALL
Composite Outcome (SD) 0.47 .03
1. Soteria (Mosher)
2. Soteria Bern (Ciompi)
3. Finnish Need Adapted
(Lehtinen et al.)
4. Swedish Parachute (Cullberg)
Outcomes vs. Usual Treatment
Percent Percent
Study Design Duration Medication- Medication Effect
free -free Size “r”
(completers) (intent-to-
treat)
Soteria Quasi 2-years 43% (29/68) 35% 0.19
(29/82)
Soteria- Case- 2-years 43% (6/14) 43% (6/14) 0.09
Bern control
Conclusions:
• Medications improve course of first-
episodes
• Unethical to not medicate
• Biological toxicity?
• Medicate in prodrome to “prevent”
psychosis
Bola, J. R. (2006). At issue: Medication-
free research in early episode
schizophrenia: Evidence of long-term
harm? Schizophrenia Bulletin
Meta-analysis
Effect size (r)
0.10 small
0.30 medium
0.50 large
Study Selection Criteria
2. Quasi-experimental or random
6 Studies: N = 623
Effect Size Mean: r = -0.09
SE = 0.09 Z = -1.00, n.s.
Fixed Effects 95% CI (-.27, .09)
Conclusion
No evidence of long-term benefit from
medicating first-episodes
Possible small advantage for
psychosocial treatment with limited
antipsychotic treatment
Limiting anti-psychotic use in early
episodes, while providing psychosocial
treatment, does not appear harmful to
clients
NY Times
Revisiting
Schizophrenia: Are
Drugs Always
Needed?
Benedict Carey,
Science Section,
March 21, 2006.
Treatment Principles: Soteria and
Soteria-Berne (Mosher & Ciompi)
Critical Ingredients
1. Small, home-like, sleeping no more than 10
persons including two staff (1 man & 1woman)
on duty, 24 to 48 hour shifts to allow prolonged
intensive 1:1 contact as needed
2. Staff convey positive expectations of recovery,
validate the psychotic person’s subjective
experience of psychosis as real – even if not
amenable to consensual validation
3. Staff put themselves in the shoes of the other
by “being with” the clients, use everyday
concepts and language to reframe the
experience of psychosis
Soteria & Soteria-Bern
4. Preservation of personal power to maintain
autonomy and prevent the development of
unnecessary dependency
5. Daily running of house shared to the extent
possible. “Usual” activities, shopping, cooking,
cleaning, gardening, exercise etc. promoted.
6. Minimal role differentiation encourages flexibility
of roles, relationships and responses
7. Minimal hierarchy mutes authority, encourages
reciprocal relationships and allows relatively
structure-less functioning- with meetings
scheduled quickly to solve problems as they
emerge
Soteria & Soteria-Bern
8. Sufficient time spent in program for relationships
to develop that allow precipitating events to be
acknowledged, usually disavowed painful
emotions to be experienced and expressed, and
put into perspective by fitting them into the
continuity of the person’s life
9. Integration into the local community to avoid
prejudice, exclusion and discrimination
10. Post-discharge relationships encouraged (with
staff and peers) to allow easy return (if
necessary) and foster development of peer-based
problem solving community based social
networks
Finnish Need-Adapted
Individual Treatment Principles
Therapy meeting
“Ihmettely” ~curiosity Klaus Lehtinen 5.6.2000
Swedish Parachute Project:
Principles of Need-Adapted Treatment
1. Early intervention (<24 hrs.)
2. Therapeutic orientation (person with chaotic
inner world need to understand self)
3. Family meetings (<24 hrs.)
4. Continuity of Care (> 5 yrs.)
5. Lowest dose neuroleptics (none if possible)
6. Therapeutic in-patient milieu (personal, low
stimulus, non-institutional, 3-6 person)
7. Early Rehabilitation
Treatment Comparison: I
john.bola@gmail.com