Talk therapy, lower-dose meds deemed more effective for schizophrenia

A government-backed study shows that treating schizophrenia with talk therapy and lower doses of medication is more successful than the traditional treatment using high doses of anti-psychotic drugs, according to a study report published Tuesday.

The study results, published in The Journal of American Psychiatry, offer new hope to schizophrenics and their families and could upend standards of treatment for the disorder, which affects an estimated 3 million people in the United States.

The two-year National Institute of Mental Health (NIMH) study involved a treatment called Navigate, part of an early-intervention model that treats people with schizophrenia as soon as they experience their first psychotic hallucinations or other symptoms. The treatment included weekly meetings with mental health clinicians who managed patients’ medication and offered support for getting them back on track at work or school.

Among more than 400 people in the study who were divided between the Navigate program and a traditional treatment program, those who were enrolled in Navigate had significantly better outcomes in their quality of life, interpersonal relationships their participation in work or school.

"Our study shows that this kind of treatment can be implemented in clinics around the country. It improves outcomes and the effects are greater for those with a shorter duration of untreated psychosis," Dr. John M. Kane, a psychiatry professor at the Hofstra North Shore–LIJ School of Medicine and lead author of the study, said in a statement.

The standard treatment for schizophrenia — a mental illness marked by hallucinations, paranoia and other forms of psychosis — tends to involve anti-psychotic drugs that dampen the symptoms but can have side effects such as extreme weight gain, violent tremors and drowsiness. The illness typically manifests in a person’s early 20s, and previous research has shown that schizophrenic patients who start treatment as close to their first episode as possible tend to do better in the long run.

Countries such as Denmark and the United Kingdom that have nationalized health care systems have been able to create successful programs for schizophrenia that emphasize therapy, low doses of medication and family education and support.

The NIMH study was the first in the U.S. to look at a similar approach. The 223 patients assigned to the Navigate program stayed in treatment longer than the control group — an average of 23 months, compared with 17 months for the patients who underwent standard treatment.

Navigate patients scored higher on tests every six months that measured their sense of purpose and motivation as well as their engagement in activities and their social interactions. Similar results were seen during monthly check-ins that monitored the need for outpatient services and emergency medical treatment. The patients in the Navigate group improved more over two years and were taking lower doses of anti-psychotic drugs, according to the study.

Since 2014, 32 states have added early-intervention programs to their existing programs to treat first-episode psychosis, using federal funds to subsidize services that insurance companies typically do not cover, such as care coordination and supported employment and education (PDF).

"Dr. Kane's work is having an immediate impact on clinical practice in the U.S. and is setting a new standard of care,” said Robert Heinssen, the director of the division of services and intervention research at NIMH. “We're seeing more states adopt coordinated specialty care programs for first-episode psychosis, offering hope to thousands of clients and family members who deserve the best care that science can deliver.”