What non-pharmacological interventions are effective in managing schizoaffective disorder in a primary care context?

Within a primary care setting, the management of schizoaffective disorder primarily involves monitoring and facilitating access to specialist non-pharmacological interventions, which are typically delivered by secondary care mental health services ¹,²,⁴. Primary care professionals should re-refer individuals to secondary care if there is a poor or partial response to treatment, declining functioning, or suspected comorbid substance misuse ¹,²,⁴.

Effective non-pharmacological interventions for psychosis and schizophrenia, which are relevant to schizoaffective disorder, include:

• Family intervention: This has been shown to reduce the risk of relapse, decrease hospital admissions during treatment, and lessen the severity of symptoms for up to 24 months after the intervention ¹,². It should ideally consist of 10 planned sessions over 3 months to 1 year ¹,².
• Arts therapies: These are effective for reducing negative symptoms, with effects sustained for up to 6 months post-treatment ¹,². They should be provided by Health and Care Professions Council (HCPC) registered arts therapists with relevant experience ³.
• Digital Health Technology: Three technologies are available as options in the NHS to help manage symptoms or prevent relapse ¹,²:
  • AVATAR Therapy: Used for managing auditory verbal hallucinations ¹,².
  • SlowMo: A blended digital therapy for managing distressing thoughts or paranoia ¹,².
  • CareLoop: Aims to prevent relapse by monitoring symptoms, thoughts, and feelings via an app ¹,².
  These technologies require delivery or support by a trained mental health professional and appropriate regulatory approval ¹,².
• Cognitive Behavioural Therapy (CBT): Offered for symptom reduction, particularly for persisting positive and negative symptoms, and to promote recovery ³,⁴,⁵. CBT should be delivered by healthcare professionals with appropriate competence and regular supervision ⁴.
• Rehabilitation programmes: Recommended for individuals with complex psychosis who have treatment-resistant symptoms and impairments affecting their social and everyday functioning ¹,²,⁵. These programmes can be delivered in various settings, including community settings ¹,².

Primary care also plays a role in ensuring that the person's family or carers are offered an assessment of their own needs, a focused education and support programme, and are aware of their right to a formal carer's assessment ¹,².