The New York Times just released an article that discusses treatment methods for schizophrenia. Results from a rigorous study conclude that smaller doses of antipsychotic mediation combined with a larger focus on 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” —has a greater impact on “recovery over the first two years of treatment” compared to drug-focused care.
Dr. Anthony O. Ahmed, a recent recipient of the Register's Judy E. Hall Early Career Psychologist Award and a current Assistant Professor of Psychology in Psychiatry at Weill Cornell Medical College who specializes in the development of cognitive interventions for patients with schizophrenia and other psychoses, provided the following expert analysis of this concept:
Early intervention can dramatically improve the prospects of someone with schizophrenia. Psychotic episodes can be neurotoxic to the brain, so the longer an individual goes without treatment, the poorer their prognosis. Early introduction of antipsychotics and psychotherapies that increase patient's ability to monitor and cope with psychotic experiences, mood symptoms, social relationships, and substance use problems early can improve symptoms and psychosocial functioning outcomes in the long run.
Adjunctive psychotherapy can decrease the amount of antipsychotics needed to maintain remission and good psychosocial functioning by 20-50%. Moreover, this approach works better than antipsychotic management alone in the long run. This finding is unsurprising--antipsychotic medication management imposes a burden on patients (e.g., side effects) that may limit their ability to maintain adherence. Adjunctive psychotherapy allows providers to decrease the amount of needed antipsychotics, which leads to a lower burden of side effects, and perhaps better medication adherence. Moreover, involvement in medication management by psychotherapists can improve patient adherence.
Psychotherapy allows patients to increase their sense of self-efficacy regarding monitoring and managing of psychotic and mood symptoms. Clinical trials do indeed support the efficacy of therapies that include self-management modules that allow the patient to practice controlling symptoms (eg.,CBT, Illness Management and Recovery, Wellness Recovery Action Planning). Antipsychotic treatment has often been criticized for fostering dependence and disability on providers. If psychopharmacology and psychotherapy can be reframed towards enhancing the patient's self-management and recovery, we may witness a paradigm shift in the psychiatric care for people with schizophrenia.