A game-changing study of treatment programs for people with early signs of schizophrenia shows that an emphasis on talk therapy and socialization can be more effective than medication alone.
The study was funded by the National Institute of Mental Health (NIMH) to the tune of $25 million and published Tuesday in The American Journal of Psychiatry. It casts doubt on the status quo of drug-focused care for people with severe mental illness -- arguably some of society’s most marginalized.
In America today, more than two million people live with a diagnosis of schizophrenia, according to NIMH. Many are prescribed antipsychotic drugs, which control hallucinations but often result in undesirable, sometimes debilitating, side effects.
For years, psychiatrists have focused on managing symptoms rather than seeking recovery, said Dr. Robert K. Heinssen, director of the Division of Services and Intervention Research at NIMH, who oversaw the research.
"The big difference here is that we're saying, 'Let's focus on the early stages when the person still has the resources for growth and change and development,' " he told NCR. "Let's offer them a combination of treatments that not only addressees the psychiatric symptoms, but also their relationship with their family, so that it's put back on a positive trajectory.
"Let's look at their academic goals if they’re young. Let's look at their work goals if they're older, and let’s give them active, effective treatments that help them achieve those goals."
According to Heinssen, the study suggests it is possible to "maximize recovery, so that people can go on to complete school, get a job, have friendships, establish a family, and so forth -- in other words, to achieve the things that all of us aspire to as fully functioning adults and contributing members of society."
The study lasted five years and was conducted by John Kane, chairman of the psychiatry department at Hofstra North Shore-LIJ School of Medicine. It was conducted in 34 community clinics across 21 states, focusing on newly diagnosed schizophrenics.
Half of the patients received the "usual care," or drug-focused treatment, Heinssen said. The other half received the experimental treatment, which introduced elements of talk therapy and focused on personal ambition related to work or education, while administering lower doses of drugs.
"People in the experimental group did better than people in the control group over a 24-month period," said Heinssen.
Additionally, he said, the study looked at how fast first signs of schizophrenia were treated and found that "for people who received the experimental intervention, and were in the lower range of untreated psychosis, the effect size almost doubled."
Such findings confirm what researchers like Yale University professor of psychiatry Larry Davidson have long professed: that focusing on the person "behind the symptom" and fostering hope is more effective -- and humane -- than merely administering drugs.
The NIMH study "addresses a population that has been marginalized for 200 years," Davidson told NCR, "and [shows] that people [with schizophrenia] are responsive to compassion and care." It suggests that "we should stop trying to medicate our problems away and listen to people instead."
Davidson, who directs Yale University's Program for Recovery and Community Health, said that the NIMH study replicates similar findings made in Australia, Norway and Denmark. "It's a big deal that it's been done now in the U.S. by highly respected, mainstream psychiatrists," he said.
Heinssen said the findings are already affecting significant policy changes.
So far, 32 states using block grant funds to implement early intervention mental health programs have "signed on and said they will be moving in this direction and starting one of these [combined treatment] programs by 2016," he said.
"We're really looking at this as a way of investing in the lives of these young people who have had a very traumatic and life altering event, but one that's not life ending," he said. "There is hope, and that's what we're trying to communicate."
[Vinnie Rotondaro is NCR national correspondent. His email address is vrotondaro@ncronline.org.]
