Cognitive therapy for a major depressive episode in residual schizophrenia.

The present paper describes cognitive approaches to the treatment of a major depressive episode in a patient with residual schizophrenia. The goal of therapy was to increase and stabilize the patient's physical activity through decreasing dysfunctional cognition pertinent to inertia. A therapeutic strategy of 'scheduling activities' was first selected, but to no effect. The vicious circle of alternating excessive activity and total inertia remained unchanged. Based on a revised cognitive case conceptualization, a second strategy, 'scheduling inertia', was then introduced, in which the patient was asked to stay in bed or take a rest for planned periods of time every day. This intervention helped the patient to counteract her perfectionist beliefs. The results suggest that 'scheduling inertia' may be a useful strategy for improving inactivity in a major depressive episode during the residual phase of schizophrenia.