Results of a large government-funded study call into question current drug-only approaches to treating people diagnosed with schizophrenia. The study, which the New York Times called “by far the most rigorous trial to date conducted in the United States,” found that patients who received increased drug counseling along with individual talk therapy, family training, and support for employment and education experienced a greater reduction in symptoms, were more likely to resume work and school, and reported a higher quality of life than those receiving current standard treatments.
Current treatments for schizophrenia in the United States, or the control condition in this study, often require lifelong use of antipsychotic drugs. Side effects from these drugs are so severe that almost three out of four patients stop taking their prescriptions, against medical advice, after a year and a half.
The new treatment program called NAVIGATE includes four different interventions for people suffering from their first experience of psychosis. First, antipsychotic drugs are managed differently. According to the ‘Times report, doses were reduced by 20-50%. Second, the families of the suffering individual are given “psychoeducation.” Meanwhile, the patient participates in resilience-focused individual therapy and, finally, an employment and education program.
The NAVIGATE program shares some similarities with the Open Dialogue programs that have been successful in Finland since the 1980s. It involves a whole team of mental health care workers, including psychologists and social workers as well as psychiatrists, and uses a shared-decision making approach, allowing the clients and their family members to have equal input in the recovery process.
The study, called Recovery After an Initial Schizophrenia Episode (RAISE), was led by Dr. John Kane from Hofstra University and will be published in the American Journal of Psychiatry. It included thirty-four clinics spread out over 21 states and began recruiting participants in 2010. Seventeen of the clinics implemented the NAVIGATE program, and seventeen continued to provide standard care. Every participant enrolled in the trial for at least two years. The researchers used various mental health assessment tools regularly throughout the treatment period, but the primary outcome measure was quality of life.
In total, 223 patients were included in the NAVIGATE program, and 181 enrolled in standard care. The researchers found that the participants enrolled in the experimental program were significantly more likely to be working or going to school, experienced greater improvement in depression and psychosis symptoms, and were less likely to be hospitalized for psychiatric reasons.
Another key finding in this study is that patients who were treated sooner after their onset of symptoms derived substantially more benefit from the NAVIGATE treatment. This lead the researchers to suggest that “prolonged duration of untreated psychosis is an issue of national importance.”
Editors Note: While RAISE and Open Dialogue may have similarities, it is an error to say that the former is based on the latter as was previously implied on this post. In addition, the current study does not report on any differences in antipsychotic dosages between the two groups and this article has been updated to reflect this omission.
New York Times: Talk Therapy Found to Ease Schizophrenia
The Washington Post: Study suggests new way to treat people after first schizophrenia episode
NIH Director’s Blog: Study May RAISE Standard for Treating First Psychotic Episode
Kane, J. M., Robinson, D. G., Schooler, N. R., Mueser, K. T., Penn, D. L., Rosenheck, R. A., . . . Heinssen, R. K. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program. American Journal of Psychiatry, 0(0), appi.ajp.2015.15050632. doi:doi:10.1176/appi.ajp.2015.15050632 (Full Text)