CLINICAL HANDBOOK OF SCHIZOPHRENIA

212 IV. PSYCHOSOCIAL TREATMENTschizophrenia, who went from a mean oral medication adherence rate of 52.11% (SD =34.46) to a mean of 94.57% (SD = 7.33) over a 2-month period (p < .002).Smart HomesSmart homes have been suggested as supportive environments that may facilitate communityadaptation for patients with schizophrenia. Smart homes have embedded technologydesigned to provide support, to prevent dangers, and to cue specific behaviors. This technology,used to compensate for cognitive deficits, is similar to the environmental supportsprovided in CAT. Smart homes have the capacity for remote data collection, interactionwith the resident, and intervention. For example, a smart home may be able to transmitdata about water faucets or ovens left on, to communicate with the resident about takingmedication or other behaviors, or to shut off equipment automatically from a remote location.Whether such engineered living environments are economically feasible and canbe developed and used in a way to promote the dignity and privacy of individuals withschizophrenia are open questions.SUMMARYEnvironmental supports have been found to improve functional outcomes for patientswith schizophrenia. Given the advances in the development of new technologies, it islikely that the use of electronic environmental supports will continue to increase in thetreatment of multiple medical conditions.KEY POINTS• Cognitive deficits, negative symptoms, and disorganized behavior lead to impairments infunctional outcomes of individuals with schizophrenia.• Environmental supports, such as signs, calendars, checklists, and medication containerswith alarms, can bypass these problems, and cue and sequence adaptive behavior.• Supports can be customized for level of impairment in executive functions and whether theperson’s behavior is characterized more by apathy (difficulty initiating every step of amultistep task) or disinhibition (being highly distracted by inappropriate cues in the environment).• Individuals with apathy need supports to prompt and cue each step of a sequenced task.• Individuals with disinhibition respond well to the reorganization of belongings and the removalof distracting stimuli.• Environmental supports have been found to effectively improve adaptive functioning anddecrease rates of relapse and symptom exacerbation in individuals with schizophrenia.• As technology continues to advance, a wider range of supports may become available toaddress specific problems and difficulties.REFERENCES AND RECOMMENDED READINGSBendle, S., Velligan, D. I., Mueller, J. L., Davis, B. V., Ritch, J. L., & Miller, A. L. (2005). The MedeMonitorfor improving adherence to oral medication in schizophrenia. Schizophrenia Bulletin,31, 519.Epstein, L. H., & Cluss, P. A. (1982). A behavioral medicine perspective on adherence to long-termmedical regimens. Journal of Consulting and Clinical Psychology, 50, 950–971.