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Picking Up the Pieces

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Drug treatment may not be necessary for some people suffering from a first episode of schizophrenia, according to a USC study published in the May issue of Schizophrenia Bulletin.

Although 25 percent to 40 percent of patients who experience a first-time psychotic episode might be able to recover without medication, all patients currently are treated with drugs.

“The problem is that mental-health providers do not know how to identify patients who might do better without medication,” said John Bola, a professor of social work at USC and author of “Predicting Drug-Free Treatment Response in Acute Psychosis.”

Bola found three characteristics that, taken together, identify these individuals with an accuracy of nearly 80 percent. His findings resulted from an analysis of a 13-year study that compared drug treatment in a hospital to psychosocial treatment in a halfway house.

Patients in the halfway house received minimal or no medication in the first 45 days of treatment.

Patients who did well without drugs generally had good social skills – they had friends, were involved in sports and dated – before their first episode. They also had fewer symptoms of schizophrenia, such as speech disturbances, paranoid ideas and hallucinations and were older when they had their first psychotic episode, generally in their mid-20s.

The disorder is generally characterized by incoherent thinking, hallucinations and delusions.

“It appears possible – over a period of time and with replication – to identify clients who do not need medication but can, in a supportive environment, be helped through a psychotic episode,” said Bola.

The next step for Bola is to test this model further before launching a clinical trial.

“There is hope that, with a protected environment and social supports, we may be able to treat some individuals without needing antipsychotic medications, sparing them the risk of side effects,” Bola said.

Since the late 1990s, research has found that patients taking anti-psychotic medication, including Zyprexa, are prone to diabetes and related illnesses.

In July, researchers from Duke University and the Food and Drug Administration identified 289 reports of patients taking Zyprexa who had developed diabetes or hyperglycemia. They detailed 23 deaths from the mid-1990s through February 2002, in the journal Pharmacotherapy.

In addition, patients may experience side effects, such as twitching, low energy and weight gain. It’s not uncommon for sufferers to stop using the drugs because of these and other discomforts.

Studies in Switzerland, Sweden and Finland show success in treating many first psychotic-episode patients without drugs, said Bola, who hopes that he may one day be able to replicate these successful treatments in Los Angeles.

“Giving people the chance to put their lives back together without depending on medications,” he said, “is putting faith in their ability to help heal themselves.”

Contact Gilien Silsby at (213) 740-4751.

Picking Up the Pieces

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