Team-based treatment for psychotic episodes when they first occur dramatically improves this troublesome condition.
Imagine hearing voices that nobody else hears or erroneously thinking someone is reading your thoughts and planning to harm you. These delusions and hallucinations are examples of the sometimes disabling symptoms associated with schizophrenia. Sufferers of this chronic brain disorder can become frightened, agitated, or withdrawn during psychotic episodes. Some say nonsensical things when they try to convey what they are experiencing. Obviously, holding down a job or developing relationships can be difficult if these symptoms aren’t controlled.
About one percent of Americans suffer from schizophrenia, and the condition usually is apparent between the ages of 16 and 30, according to the National Institute of Mental Health (NIMH). Although medical treatment can help control symptoms, high doses of anti-psychotic drugs can cause a multitude of side effects — so many schizophrenics toss their medications aside.
But research led by John M. Kane, MD, chairman of the department of psychiatry at the Hofstra Northwell School of Medicine, has found another way to help people with schizophrenia function better, often with less medication. The key to dramatic improvement is intensive and early treatment.
"The goal is to link someone experiencing first episode psychosis with a coordinated specialty care team as soon as possible after psychotic symptoms begin," said Kane, MD, who headed the study for the Recovery After an Initial Schizophrenia Episode (RAISE) Early Treatment Program, funded by the NIMH.
"Our study shows that this kind of treatment can be implemented in clinics around the country. It improves outcomes, and the effects are greater for those with a shorter duration of untreated psychosis."
For their study, Kane and colleagues trained healthcare providers at clinics around the U.S. to use NAVIGATE, the RAISE program’s multidisciplinary, team-based treatment for first episodes of schizophrenia symptoms. The NAVIGATE approach includes psychotherapy aimed at recovery, low doses of antipsychotic medications, support with work or education (based on the individual's needs and preferences), case management, and family education and support. Specific decisions about treatment plans are made with input between the team of specialists and each patient. When possible, family members are also involved.
To find out how well the NAVIGATE program works, 404 people with an average age of 23 who were experiencing a first episode of psychosis participated in the research — 223 were treated at clinics using the NAVIGATE approach, while 181 were seen at clinics where the patients received “typical care,” primarily involving medication.
Those treated with the NAVIGATE program remained in treatment longer than patients who received typical care. The researchers found the NAVIGATE patients had a significant improvement in their schizophrenia symptoms, interpersonal relationships, and quality of life. Their ability to remain involved in work and school was better, too.
To get the best results, however, Kane and his research team discovered it was important to begin treatment as soon as possible after the beginning of psychotic symptoms. About half of the patients in the study had experienced untreated psychosis for less than 74 weeks before receiving treatment, while the other study participants had longer periods of untreated schizophrenia symptoms. The NAVIGATE patients who were treated early on in their illness experienced far greater improvement in overall symptoms and quality of life compared with those whose symptoms had gone on for a longer period of time and who were receiving standard care.
"Clearly, the take-home message here is that outcomes for young people with early psychosis are better when clinicians do the right things at the right time," said Robert Heinssen, PhD, director of the NIMH’s division of services and intervention research. "Dr. Kane's work is having an immediate impact on clinical practice in the U.S. and is setting a new standard of care. We're seeing more states adopt coordinated specialty care programs for first episode psychosis, offering hope to thousands of clients and family members who deserve the best care that science can deliver."
April 01, 2020
Christopher Nystuen, MD, MBA