Postponing antipsychotic medications and integrating psychological and social treatment to those suffering early episodes of schizophrenia may help reduce long-term dependence on antipsychotic drugs, according to a review of published research.
The review, conducted by USC associate professor John Bola and three European psychiatrists, was published in the first issue of Psychosis: Psychological, Social and Integrative Approaches. The publication is the official scientific journal of the International Society for the Psychological Treatments of Schizophrenia.
Bola’s paper reviews studies of what happens when people diagnosed with first episodes of schizophrenia spectrum illnesses are given psychosocial support instead of anti-psychotic drugs in the first few weeks of treatment.
This treatment method differs from current medical practices in the United States and other developed countries that traditionally hospitalize and immediately treat acute first-episode patients with antipsychotic medications. However, the review has found that specially designed psychosocial treatment with time-limited trial postponement of antipsychotic drugs can result in modestly better long-term outcomes with 25 percent to 40 percent of patients not requiring medications and others at relatively low doses.
“Simultaneously achieving these two outcomes, both modestly better functioning and lower dependence on antipsychotic medications, is important due to the serious side effects and shortened life expectancy associated with long-term antipsychotic medication use,” Bola said. “This is a victory for the consumer (patient).”
Authors analyzed five studies published between 1978 and the present with a majority of first- or second-episode schizophrenia subjects.
Most of the treatments included a small home-like environment and continual close collaboration with family members. Subjects were given clear information on the illness, treatment and its risks. Many of these therapeutic measures were intended to “induce a state of long-lasting emotional relaxation,” according to one study in the report.
Each study had a three-to-six week antipsychotic medication postponement protocol. This means that if patients remained non-dangerous and symptoms improved, they were not treated with such medications during the initial postponement period, Bola said. If they got worse, then antipsychotics were started.
In some of the analyzed studies, agitated patients or those not sleeping well were treated with benzodiazepine medications – minor tranquilizers such as Valium or Ambien – to help calm them down or restore their sleep cycle during the postponement period.
“Psychosocial treatment in first episodes of schizophrenia can help us distinguish which patients need and which patients do not need antipsychotic medications,” Bola said. “This both advances scientific knowledge while simultaneously supporting a patient’s desire to reduce medication side effects.”
In a 2006 review, Bola and other researchers found no evidence that early episodes of schizophrenia without medication resulted in long-term harm for patients, casting doubt on the long-term practice of immediately medicating for one year following diagnosis.