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Treating schizophrenia without drugs

People with schizophrenia who don’t want to take antipsychotic medicines could be helped by a talking treatment called cognitive therapy, according to new research.
By Grant Stewart

BMJ Group News

What do we know already?

female therapist consulting female patient

Schizophrenia is a serious long-term mental illness. People with this condition may feel fine for long periods, then have episodes during which they have frightening symptoms. These symptoms can include hallucinations (seeing things and hearing voices that aren’t there), delusions (believing things that aren’t true, for example, that someone is trying to hurt you or control you), and feeling depressed and anxious. Schizophrenia is thought to affect about 7 in every 1,000 people.

Drugs called antipsychotics can help control symptoms for many people. But these drugs are not a cure and they don’t work for everyone. In some people they can cause serious side effects including weight gain and, rarely, a fatal heart condition called sudden cardiac death. So it’s not surprising that many people with schizophrenia don’t like taking the medicine.

Research shows that as many as half of people prescribed antipsychotic drugs for schizophrenia don’t take them. And as many as three-quarters of people who do take them stop doing so in the 18 months after starting.

In this new study, researchers in the UK looked at whether people with schizophrenia who had chosen not to take antipsychotic drugs could be treated without them. They divided 74 volunteers aged between 16 and 65, who all had schizophrenia, into two groups. One group had what was called ‘treatment as usual’. This involved support from their doctor and other local services, but no drugs or extra therapy. The second group had treatment as usual plus a talking treatment called cognitive therapy.

This treatment involved 26 sessions with a therapist over about nine months. In the sessions, the therapists used what they called a problem-based approach. This means that they helped people recognise when they were having symptoms of schizophrenia and worked with them to avoid problems caused by their symptoms.

At the end of the study the researchers measured people’s symptoms using a scale called PANSS. This stands for positive and negative syndrome scale. It measures symptoms such as hallucinations and delusions, and scores them out of 100.

What does the new study say?

At the end of the nine-month study period, people in the cognitive-therapy group had lower symptom scores than people in the usual-treatment group. The scores for people who had cognitive therapy were an average of 6.5 points lower out of 100. Symptoms that improved with cognitive therapy included delusional beliefs and social functioning (being comfortable with other people). Some symptoms didn’t improve, though. These included stress and depression.

Schizophrenia is unpredictable and difficult to live with. So it’s not surprising that quite a lot of people found it hard to stick with the study. By the end about one-third of people in both treatment groups had dropped out. Some of them had decided that cognitive therapy wasn’t helping and some had decided that they wanted to try antipsychotic drugs after all.

One other important finding was that, in general, people in both groups didn’t get any worse over the period of the study. It’s usually assumed that people with schizophrenia will get worse over time without drugs.

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