According to a report recently published in the American Journal of Psychiatry, schizophrenia patients who received smaller doses of antipsychotic medication, as well as more talk therapy and family support experienced greater recovery rates over the first two years of treatment, compared to patients who received the standard drug-focused care.
To date, over two million people in the U.S. have been diagnosed with schizophrenia. Treatment mainly involves strong doses of antipsychotic drugs that reduce the occurrences of hallucinations and delusions. But these drugs come with side effects such as weight gain and tremors.
Experts believe the findings could pave the way to setting new standards of care in an area of medicine that many consider inadequate. Specifically in the first episode of psychosisâthe first break with reality in which patients become suspicious and deeply afraid.
To determine if smaller doses, one-on-one talk therapy and family support could produce positive results, doctors packaged the medications and treatments and kept the doses as low as possible to minimize side effects. The studyâs lead researcher, Dr. John Kane, assigned 34 community care clinics in 21 states to provide either the standard treatment or the combined package.
The team issued training sessions for staff members at select clinics to deliver the package, which included three elements to complement the medication:
- The first element was assistance with work or school, including help with deciding which classes or opportunities are appropriate.
- The second focused on educating family members to increase their understanding of schizophrenia.
- The last element was one-on-one talk therapy where the diagnosed individual learns how to build social relationships, reduce substance use and manage their symptoms, including mood problems, hallucinations and delusions.
The team then recruited 404 patients with first-episode psychosis, the majority young adults who were diagnosed in their late teenage years or early twenties. Nearly half received the combined package and half received standard treatment. Clinicians monitored both groups using standardized checklists that rate quality of life and symptom severity.
The findings? Kane and his colleagues discovered that the group that started on the combined package treatment scored, on average, more poorly on both measures at the start of the trial. Both groups showed steady improvements over a two-year period but by the end of the trial, those who received the combined package treatment saw more symptom relief and were functioning better. These participants were on drug doses that were 20% to 50% lower, according to Kane.
âOne way to think about it is, if you look at the people who did the bestâthose we caught earliest after their first episodeâtheir improvement by the end was easily noticeable by friends and family,â Kane notes.
Dr. Kenneth Duckworth, medical director for the National Alliance on Mental Illness, suggests the findings are a âgame-changer for the fieldâ in terms of the way it combines multiple, individualized therapies, best suited to the stage of psychosis.
Sources for Todayâs Article:
Carey, B., âNew Approach Advised to Treat Schizophrenia,â New York Times web site, October 20, 2015; http://www.nytimes.com/2015/10/20/health/talk-therapy-found-to-ease-schizophrenia.html?ref=health&_r=0.
Kane, J.M., âComprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program,â The American Journal of Psychiatry; http://dx.doi.org/10.1176/appi.ajp.2015.15050632.