A new study suggests cognitive therapy might provide a safe and effective alternative to the antipsychotic drugs that as many as half of people with schizophrenia eschew to avoid side effects that range from discomforting to deadly.
Previous research has shown cognitive therapy effective only in combination with drugs but not alone, says investigator Anthony Morrison, a professor at the University of Manchester in the United Kingdom.
"Antipsychotic drugs are the mainstay of treatment for schizophrenia, but 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,” Morrison said. “Currently, no evidence-based safe and effective treatment alternative exists.”
The investigators assessed the effects of cognitive therapy in 74 people with schizophrenia — ages 16 to 65 — who’d stopped taking medication for at least six months. Developed in the 1960s by American psychologist Aaron T. Beck, cognitive therapy is a form of cognitive behavioral therapy seeking to identify and change dysfunctional thinking.
Thirty-seven study participants were randomly chosen to receive 26 sessions of cognitive therapy over a nine-month period, with the other 37 serving as a control group for comparison. At 18-month intervals afterward, investigators then measured participants on a standard scale of psychological symptoms known as the Positive and Negative Syndrome Scale (PANSS). On average, those who received cognitive therapy scored “significantly lower” on psychological symptoms associated with the disorder.
After 18 months, seven of the 17 participants — or 41 percent — had improved by more than 50 percent on the total psychological score. By comparison, three of the 17 in the control group improved by as much, equating to 18 percent.
Douglas Turkington, a psychiatry professor at Newcastle University, says study participants “tolerated” cognitive therapy well with few drop-outs over the nine-month course. "One of our most interesting findings was that when given the option, most patients were agreeable to trying cognitive therapy.”
However, the doctor warned people with schizophrenia against a sudden change in treatment regimen. “If someone is on antipsychotics they should not just suddenly stop taking them as there is a major risk of relapse,” he said. “Medical advice should always be sought if you are considering stopping your medication."
Acknowledging the study’s small size, Morrison said a larger clinical trial would truly establish whether people with schizophrenia may replace drugs with cognitive therapy. We have showed that cognitive therapy is an acceptable intervention for a population who are usually considered to be very challenging to engage in mental health services,” he said. “For many, cognitive therapy might prove to be the preferred form of treatment.”
Oliver Howes, of the Clinical Sciences Centres and Institute of Psychiatry in London, wrote a commentary accompanying the study, which the investigators published on Wednesday in The Lancet. "Clearly this [study] outcome will need further testing, but, if further work supports the relative effectiveness of cognitive therapy, a comparison between such therapy and antipsychotic treatment will be needed to inform patient choice,” he wrote. “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."
Schizophrenia is a chronic and disabling brain disorder affecting one percent of the general population, but as many as 10 percent of those with a first-degree relative with the disorder, according to the National Institutes of Health. Auditory hallucinations and paranoia may affect people with schizophrenia, who often suffer symptoms through a lifetime. Although many live high-quality lives, few have jobs with many on disability benefits and dependent on others.
Source: Morrison A. Cognitive Therapy Might Be Beneficial For People With Schizophrenia Not Taking Antipsychotic Drugs. The Lancet. 2014.