UCLA-led study explores how people with schizophrenia stay productive while managing symptoms

People who have schizophrenia may be worried that the disorder will prevent them from living independently, pursuing higher education or holding down a demanding job. In reality, many people do manage their illness and live full and highly productive lives.

A new study by researchers at the David Geffen School of Medicine at UCLA and colleagues at the University of Southern California describes some of the strategies people with schizophrenia have used to overcome the disorder and function successfully in their careers. The research was published November 15 in the journal Psychiatric Services.

The researchers conducted up to three interviews each with 10 men and 10 women with schizophrenia from the Los Angeles area. All of them continued to have some psychotic symptoms even as they were employed in professional, technical or managerial occupations.

“To the best of our knowledge, no previous studies have addressed how individuals with schizophrenia who also met some definition of recovery manage the symptoms of their disease,” said Amy Cohen, an associate research psychologist in the department of psychiatry and biobehavioral sciences at the Geffen School and the study’s first author.

The researchers found that the people they interviewed had adopted numerous coping strategies to prevent and deal with symptoms, including avoiding stressful situations, staying away from alcohol and drugs and taking their prescribed medications. The interviewees also said they try to interact with people who are supportive and non-judgmental and that they use various cognitive strategies to help them reason through problematic thoughts and whether or not those thoughts are based in reality.

The subjects also mentioned religion and spirituality, and exercise and diet, as ways they prevent or deal with psychiatric instability, Cohen said. Some individuals reported that calm, soothing places help them cope, while others said they preferred to seek out more activity.

And some said jobs and educational activities could be distracting, but others said that school or career help by providing a sense of belonging.

“One big surprise — and disappointment — was the disparity between the education of these individuals and the salaries they were earning,” Cohen said. “Most of the patients studied had college or advanced degrees but still made less than $50,000 annually despite working in a large, urban city.”

Even with the various coping strategies they employ, about half of those surveyed reported having difficulty managing their daily lives, not having felt close to another person within the prior week and experiencing recent hallucinations or delusions — which are characteristic of the disorder.

Social stigma continues to be a serious problem for those affected by schizophrenia and other mental illnesses.

“There is a widespread misunderstanding that individuals with schizophrenia are violent and dangerous, often homeless, and beyond help,’’ Cohen said.

Prior studies have shown that half to two-thirds of people with schizophrenia will significantly improve or fully recover, enabling them to live fulfilling and productive lives. Cohen said she hopes the findings provide encouragement for people battling the stigma of mental illness and that the study helps inform treatment for schizophrenia.

“The bulk of treatments for schizophrenia were developed from observations of individuals who are quite ill or hospitalized, rather than patients who have achieved a level of recovery,” Cohen said. “And the prevailing medical model continues to presuppose the expertise of the clinician over the individual with the disorder. This study allows for new insights by leveraging first-hand experiences of those with schizophrenia.”

The research was supported by a grant from the Greenwall Foundation to Elyn Saks of the University of Southern California, and by a Larson Research Award to co-author John Brekke, also of USC. Cohen receives research support from Ameritox, a drug testing and pain medication monitoring firm.

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