There's no doubt the discovery of anti-psychotic drugs was a breakthrough. Previously people with schizophrenia could expect hospital confinement and little in the way of actual treatment. Today's anti-psychotics are safer than the early versions, but they still have serious side-effects and because their prescription for psychosis is so routine, there's a danger that some people, who might otherwise recover with psychological help only, are taking them unnecessarily.
This is a difficult area to study because any research that denies patients the drugs they need will rightly raise alarm bells. John Bola and colleagues scoured the literature looking for studies where drug treatments for schizophrenia were delayed for a set period of time, in conditions where patients received plentiful psychological and social support. They found five such studies involving 261 participants with schizophrenia, many of whom were not given anti-psychotic medication immediately. Their outcomes were compared between one and three years' later with patients who were treated with drugs straight away.
These studies included the Rappaport Agnews State Hospital Project (pdf), the Soteria project and Soteria Bern Project (pdf), the Finnish API Project and the Cullberg Parachute Project. Across all these studies, the psychosocial treatments varied, but in general patients were provided with a community-based therapeutic milieu with ample social support, a relaxing environment, and with family therapy often also included.
Among the patients for whom drug treatment was delayed, about one-third actually ended up recovering without needing to take medication at all, and longer-term, their outcomes tended to be superior to those patients who were treated with drugs immediately.
Bola's team said these findings show that in a residential care context (where medication can be prescribed swiftly if needed) it is possible to research drug-free approaches to schizophrenia in a safe and ethical way. And they added that that the findings point to a sub-type of schizophrenia that is associated with spontaneous recovery, in contrast to the trend for deterioration shown by the majority of patients.
"The above cited studies at least highlight the fact that no disadvantages and several advantages have been noted with no or a low-dose anti-psychotic medication in combination with psychosocial interventions for first episode schizophrenia spectrum patients," the researchers said.
Previously on the Research Digest: "Caring for psychotic patients with maximum kindness and minimum medication".
JR Bola, K. Lehtinen, J Cullberg, L Ciompi (2009). Psychosocial treatment, antipsychotic postponement, and low-dose medication strategies in first-episode psychosis: A review of the literature. Psychosis, 1 (1), 4-18
Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.