Talk Therapy Found to Ease Schizophrenia

Schizophrenia therapy without medication! As suspected, it appears the mental health branch has been simply treating this disorder by pumping out meds to their patients without trying to counsel their patients. The answer is not always drugs!

More than two million people in the United States have a diagnosis of schizophrenia, and the treatment for most of them mainly involves strong doses of antipsychotic drugs that blunt hallucinations and delusions but can come with unbearable side effects, like severe weight gain or debilitating tremors.

Now, results of a landmark government-funded study call that approach into question. The findings, from by far the most rigorous trial to date conducted in the United States, concluded that schizophrenia patients who received smaller doses of antipsychotic medication and a bigger emphasis on one-on-one talk therapy and family support made greater strides in recovery over the first two years of treatment than patients who got the usual drug-focused care.

Its findings have already trickled out to government agencies: On Friday, the Centers for Medicare & Medicaid Services published in its influential guidelines a strong endorsement of the combined-therapy approach. Mental health reform bills now being circulated in Congress “mention the study by name,” said Dr. Robert K. Heinssen, the director of services and intervention research at the centers, who oversaw the research.

In 2014, Congress awarded $25 million in block grants to the states to be set aside for early-intervention mental health programs. So far, 32 states have begun using those grants to fund combined-treatment services, Dr. Heinssen said.

Experts said the findings could help set a new standard of care in an area of medicine that many consider woefully inadequate: the management of so-called first episode psychosis, that first break with reality in which patients (usually people in their late teens or early 20s) become afraid and deeply suspicious. The sooner people started the combined treatment after that first episode, the better they did, the study found. The average time between the first episode and receiving medical care — for those who do get it — is currently about a year and half.

The drugs used to treat schizophrenia, called antipsychotics, work extremely well for some people, eliminating psychosis with few side effects; but most who take them find that their bad effects, whether weight gain, extreme drowsiness, or emotional numbing, are hard to live with. Nearly three quarters of people prescribed medications for the disorder stop taking them within a year and a half, studies find.

“As for medications, I have had every side effect out there, from chills and shakes to lockjaw and lactation,” said a participant in the trial, Maggie, 20, who asked that her last name be omitted. She did well in the trial and is now attending nursing school.

Doctors praised the study results.

“I’m very favorably impressed they were able to pull this study off so successfully, and it clearly shows the importance of early intervention,” said Dr. William T. Carpenter, a professor of psychiatry at the University of Maryland, who was not involved in the study.

Dr. Mary E. Olson, an assistant professor of psychiatry at the University of Massachusetts Medical School, who has worked to promote approaches to psychosis that are less reliant on drugs, said the combined treatment had a lot in common with Open Dialogue, a Finnish program developed in the 1980s. “These are zeitgeist ideas, and I think it’s thrilling that this trial got such good results,” Dr. Olson said.

In the new study, doctors used the medications as part of a package of treatments and worked to keep the doses as low as possible — in some cases 50 percent lower — minimizing their bad effects. The sprawling research team, led by Dr. John M. Kane, chairman of the psychiatry department at Hofstra North Shore-LIJ School of Medicine, randomly assigned 34 community care clinics in 21 states to provide either treatment as usual, or the combined package.

The team trained staff members at the selected clinics to deliver that package, and it included three elements in addition to the medication. First, help with work or school such as assistance in deciding which classes or opportunities are most appropriate, given a person’s symptoms. Second, education for family members to increase their understanding of the disorder. And finally, one-on-one talk therapy in which the person with the diagnosis learns tools to build social relationships, reduce substance use and help manage the symptoms, which include mood problems as well as hallucinations and delusions.

For example, some patients can learn to defuse the voices in their head — depending on the severity of the episode — by ignoring them or talking back. The team recruited 404 people with first-episode psychosis, mostly diagnosed in their late teens or 20s. About half got the combined approach and half received treatment as usual. Clinicians monitored both groups using standardized checklists that rate symptom severity and quality of life, like whether a person is working, and how well he or she is getting along with family members.

The group that started on the combined treatment scored, on average, more poorly on both measures at the beginning of the trial. Over two years, both groups showed steady improvement. But by the end, those who had been in the combined program had more symptom relief, and were functioning better as well. They had also been on drug doses that were 20 percent to 50 percent lower, Dr. Kane said.

“One way to think about it is, if you look at the people who did the best — those we caught earliest after their first episode — their improvement by the end was easily noticeable by friends and family,” Dr. Kane said. The gains for those in typical treatment were apparent to doctors, but much less obvious.

Dr. Kenneth Duckworth, medical director for the National Alliance on Mental Illness, an advocacy group, called the findings “a game-changer for the field” in the way it combines multiple, individualized therapies, suited to the stage of the psychosis.

The study, begun in 2009, almost collapsed under the weight of its ambition. The original proposal called for two parallel trials, each including hundreds of first-episode patients. But recruiting was so slow for one of the trials that it was abandoned, said Dr. Heinssen.

“It’s been a long haul,” Dr. Heinssen added, “but it’s worth noting that it usually takes about 17 years for a new discovery to make it into clinical practice; or that’s the number people throw around. But this process only took seven years.”

LINK

Counseling techniques help and it took them 17 years to find this out? Scary.....

Is it now possible to assume that there are other ways to better treat patients with mental issues then to simply pump them up on drugs?

This isn't new. It just took a long time for them to go through the legality and ethics issues surrounding it, I think. As the article said, the outcome depends on the severity of the symptoms. Psychology is still learning, and while over-medication is an issue with people who are psychotic, it is a sight better than torturing them to get them to stop like they used to in the past.

The whole community-based mental healthcare thing is actually very old--but it requires manpower and expertise that these places didn't have--and funding, too. Typically, I'd think these schizophrenic people would probably be in some sort of state or county hospital and not some cushy hospital. So that means that they get less of the help that they need.

So, it really didn't take them 17 years--it is a financial issue and a legality issue.

Either way, I think it's great that they're moving forward. Bout time they help these poor people. Maybe it will even help the homelessness issue, too.

a reply to: rukia

That is my whole point... alternative medicine within the mental health branch of medicine. Today many people believe popping a pill is the answer to most/all types of sickness to which I disagree.

I have read white papers and articles concerning mental health issues and there are many cases where medication does not help at all but makes the matter worse and I believe it is because science refuses to reach out in areas that they can not document and/or analyze. Science believes man is made of a physical body and mind. I believe man is made into a physical body, mind and spirit, each one requiring different treatment. Science rejects the idea of man having a spirit because they can not confirm or verify it. Now with saying that let me say that slowly..... very slowly some scientist are starting to admit that there is more to a human than simply a body and a mind but it is the minority because I believe if accepting the idea that man has a spirit than it makes it possible that a spiritual world could exist, also the possibility of a creator (God) now involving mankind with religion which is taboo within the science world.

a reply to: DeathSlayer

I know--I was agreeing with you. I was just making sure you didn't generalize the industry of psychology. Because the vast majority of private practitioners are legit. But those practitioners typically don't deal with schizophrenics. They deal with other things like anxiety, eating disorders, depression, OCD, and phobias. And while some people might be offered medication, not everyone is--and medication isn't the focus for these things if talk therapy can help and if you aren't cognitively impaired/in need of medication.

I guess part of the problem lies with the people too, though. Why anyone would go to a crappy professional is beyond me. You have to be your own advocate regarding your health--both mentally and physically. (And that's probably why psychotic people have so much of an issue). So yeah, I'm glad they're finally realizing that medication is, at best, a band-aid.

a reply to: DeathSlayer

Counselling therapy does indeed help but it's more than just talking...

It's about enabling the patient to discover and employ coping mechanisms - teaching the patient how to help themselves and understand what is happening in their brain, when it's happening and how to deal with what is happening - only talking with other people can do this.

In many situations the counselor is not of great use - talking to other sufferers who have developed their own coping mechanisms is very beneficial.

Schizophrenics lose a lot more brain matter than the average person. They can lose up to 5% of their gray matter in specific neuro-regions per year.

Solution? Try antioxidants which would subside the rate of neural decay.

Gray matter = thinking matter. Anything which may cause a person to think, a puzzle, having someone draw a picture of something which the psychotherapist may vocalize, use of the imagination period, placing these people in an alpha state would also help. With the advent of modern technology, it's no wonder why so many of our people today're schizophrenic. TV, google, radio, there's little to no thought involved in using such things.

The heaviest amount of neural decay happens in the areas which people use the least.

Anyway, antioxidants. SOMEONE TELL A PSYCHOLOGIST.

I apologise for this immediately but I can't help laughing at the idea of my reality chatting happily and therapeutically to my non-reality side. Sorry again, I do not mean to undermine or demean this medical problem or belittle its effects on people's lives, no disrespect intended.

But does it work on sluggish schizophrenia?

originally posted by: BrianFlanders
But does it work on sluggish schizophrenia?

It's not a cure - it's all about understanding and developing coping mechanisms. So it's not down to what type of mental illness you have, it's down to how the symptoms are anticipated, interpreted, understood and dealt with.

So yes, once the specific symptoms of a patient's 'sluggish schizophrenia' are apparent then the coping mechanisms can be developed.

It's very positive that self developed and counseling derived coping mechanisms are being discussed. It gives light to those who are not aware and rely on medication alone.

originally posted by: and14263

So yes, once the specific symptoms of a patient's 'sluggish schizophrenia' are apparent then the coping mechanisms can be developed.

Ummmm....I think you kinda missed it.

a reply to: BrianFlanders

I googled and jumped on this.

The concept of 'sluggish schizophrenia' is virtually limited to the USSR and some other East European countries, and may contribute to the mis-diagnosis of democrats as psychiatric patients.

Haven't tried to build any specific "coping mechanisms yet.

a reply to: Shiloh7

Maybe that should be a test?
If you can engage in creative neologism with friends and your friends happily share then maybe its therapeutic.
If you are prone to neologism there may be recreational drugs you should avoid though.
Mocha or Espresso?, maybe neither remember what happened to Poe..

originally posted by: Cauliflower
a reply to: BrianFlanders

I googled and jumped on this.

The concept of 'sluggish schizophrenia' is virtually limited to the USSR and some other East European countries, and may contribute to the mis-diagnosis of democrats as psychiatric patients.

Haven't tried to build any specific "coping mechanisms yet.

Hmmm. Well, you might want to do some more research. If you had to Google it, you probably need to let it sink in for a while.

a reply to: BrianFlanders

Sorry, I thought you were contributing to the discussion constructively! How foolish of my tiny mind

a reply to: BrianFlanders

Hmmm. Well, you might want to do some more research. If you had to Google it, you probably need to let it sink in for a while.

Using psychiatric diagnosis to quiet the voice of religious and political dissidents does date way back.


In relatively recent history there are the accounts of Van Gogh going insane on December 23rd 1888 followed 11 days later by Nietzsche in Germany.

Some noted psychiatrists believed Nietzsche became mentally ill as early as 1881 when he began writing Zarathustra.

www.leonardsax.com...

France declared war against Germany on December 23 1939.
I'm not sure when

All of these

[Nietzche]

ideas were championed enthusiastically by Hitler’s followers and exploited by Nazi propagandists.