New research published in The Lancet suggests that cognitive therapy could be an effective treatment option for patients with schizophrenia who cannot or will not take antipsychotic medication.
The research team, led by Prof. Anthony Morrison of the University of Manchester and Prof. Douglas Turkington of Newcastle University, both in the UK, says that their findings indicate that cognitive therapy could improve personal and social functioning for schizophrenic patients, as well as reduce psychotic symptoms.
According to the National Institute of Mental Health, approximately 1.1% of the US population suffer from schizophrenia.
The most common treatment for the disorder is antipsychotic medication.
However, the investigators note that many people with schizophrenia choose not to take these drugs because of the side effects associated with them. These can include severe weight gain, development of metabolic disorders, and increased risk of death from heart attack.
The researchers say that some people may also avoid taking the drugs because they do not believe they are effective, or they do not understand that they need treatment.
"Currently no evidence-based safe and effective treatment alternative exists," adds Prof. Morrison.
Cognitive therapy versus usual treatment
For their study, the research team analyzed 74 individuals aged between 16 and 65 years who had schizophrenia spectrum disorders.
All participants had decided not to take or had stopped taking antipsychotic medication for a minimum of 6 months.
Subjects were randomly assigned to one of two groups. The first group underwent 26 sessions of cognitive therapy over a period of 9 months plus usual care, while the second group had usual care alone.
During the cognitive therapy sessions, a therapist worked closely with the participants to re-evaluate psychotic experiences and help change negative behaviors and thought patterns.
Participants were assessed for changes in symptoms at 3, 6, 9, 12, 15 and 18 months after the study baseline using the Positive and Negative Syndrome Scale (PANSS). A lower rating on this scale represents better functioning.
Cognitive therapy 'a viable alternative treatment'
At each assessment, the researchers found that participants in the cognitive therapy group had consistently lower PANSS scores, compared with the usual care group.
After the final assessment at 18 months, 41% of 17 participants who underwent cognitive therapy showed a minimum 50% improvement in their total PANSS scores, compared with only 18% of 17 participants who received usual care.
Furthermore, the investigators say that participants were very accepting of cognitive therapy and drop-out and withdrawal rates were low.
Commenting on the findings, Prof. Morrision says:
"We have shown that cognitive therapy is an acceptable intervention for a population who are usually considered to be very challenging to engage in mental health services.
Antipsychotic medication, while beneficial for many people, can have severe side effects. Evidence-based alternatives should be available to those who choose not to take these drugs. For many, cognitive therapy might prove to be the preferred form of treatment."
However, he adds that a larger trial is required to confirm the clinical implications of the team's findings.
Writing in a comment piece linked to the study, Oliver Howes of the Clinical Sciences Centres and Institutes of Psychiatry in the UK says that this study has provided proof of concept that cognitive therapy could be used as an alternative treatment to antipsychotic medication.
However, he notes that further studies are needed that compare the two treatments in order to inform patient choice. The research team say they are in the processing of carrying out such a study.
"If positive, findings from such a comparison would be a step change in the treatment of schizophrenia, providing patients with a viable alternative to antipsychotic treatment for the first time, something that is sorely needed," adds Howes.
Last year, Medical News Today reported on a study suggesting that cognitive therapy is effective for health anxiety, while another study suggests the therapy could help older veterans with depression .
Written by Honor Whiteman