More than 2 million people in the United States have a diagnosis of schizophrenia, and the treatment for most revolves mainly around 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.
The new report, published today in the American Journal of Psychiatry and funded by the National Institute of Mental Health, comes as Congress debates mental health reform and interest in the effectiveness of treatments grows amid a debate over the possible role of mental illness in mass shootings.
The new 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 Heinssen, the director of services and intervention research at NIMH, 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, 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 after that first episode people started the combined treatment, the better they did, the study also 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 more holistic approach that the study tested is based in part on programs in Australia, Scandinavia and elsewhere that have improved patients' lives in those countries for decades. This study is the first test of the approach in this country — in the "real world" as researchers described it, meaning delivered through the existing infrastructure, by community mental health centers.