A form of psychotherapy known as cognitive
behavioural therapy may be an effective option for schizophrenia
patients who are unable or unwilling to take antipsychotic drugs, a new study
How therapy works
Reporting in The Lancet, British researchers say that the treatment
can help ease patients' psychotic
symptoms and boost their personal and social functioning.
They note that many people with schizophrenia cannot take standard
"As many as half of all people with schizophrenia choose not to take
drugs because of side effects that can include serious weight gain, development
of metabolic disorders and an increased risk of sudden cardiac death, because the
treatment is not felt to be effective, or because they do not perceive that
they need treatment," study author Anthony Morrison, from the University
of Manchester, said in a journal news release.
Changing detrimental thought patterns
"Currently, no evidence-based safe and effective treatment alternative
exists," he added.
To see if cognitive behavioural therapy might work in these cases,
Morrison's team tracked the outcomes of 74 schizophrenia patients aged 16-65
who had stopped taking antipsychotic drugs for at least six months.
As part of the treatment, a therapist worked with some of the patients to
help them change detrimental thought patterns and behaviours.
future of schizophrenia
The patients in the cognitive behavioural therapy group showed greater
improvements after 18 months than those who didn't receive the therapy, the
Prior research has shown that schizophrenia patients benefit from cognitive
therapy in combination with antipsychotic drugs, but the effectiveness of
cognitive therapy in patients who were not taking medication hadn't been
The findings show "that cognitive therapy is an acceptable intervention
for a population who are usually considered to be very challenging to engage in
mental health services," Morrison said.
Two experts in the United States said these early results are promising, but
more study may be needed.
"Non-compliance or medication refusal is a substantial therapeutic
issue" when treating patients with schizophrenia, said Dr Russell Joffe,
chairman of psychiatry and behavioural science at Staten Island University Hospital,
in New York City.
He noted that's there's been good data to support the use of cognitive behavioural
therapy in mood or anxiety disorders, "but there is limited data in
psychotic disorders" such as schizophrenia. Still, the study was small and
focused on short-term treatment, whereas "schizophrenia is a chronic and
persistent mental illness," Joffe said.
may have faulty brain 'switch
"Demonstrating the effectiveness of new treatments for major
psychiatric illness is always a good thing, given the enormous burden of
suffering," he said. "This data, however, is very preliminary and
further research needs to be done before confronting the substantial logistic
challenges in implementing such treatment on a broad clinical basis."
Mainstay of treatment
Dr Mary Badaracco is a professor at the NYU School of Medicine and the
director of psychiatry at Bellevue Hospital Centre in New York City. She said
the study "adds to the growing body of evidence supporting the usefulness
of cognitive behavioural therapy approaches in patients with schizophrenia, an
illness that can cause lifelong suffering and heartbreaking disability."
She stressed, however, that "the results of this study should not be
used to encourage patients not to take medications, which remain the mainstay
Morrison's team agreed with Badaracco that schizophrenia patients on
antipsychotics should not suddenly stop taking the drugs. They should first
discuss the matter with their doctor.
"The study does, however, underline the usefulness of cognitive behavioural
therapy – an intervention that is free of the sometimes intolerable effects of
some medications," Badaracco said. The new finding may also provide
"another source of hope for the 1% of the world's population that suffers
from this illness."
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