Cognitive therapy might be beneficial for people with schizophrenia not taking antipsychotic drugs

February 5, 2014

For people with schizophrenia who can't or won't take antipsychotic drug treatment, cognitive therapy could be a viable therapeutic alternative, according to a groundbreaking randomized trial published in The Lancet.

The findings suggest that cognitive therapy could be safe and effective in reducing and improving personal and social functioning compared with as usual.

"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 , because the treatment is not felt to be effective, or because they do not perceive that they need treatment. Currently no evidence-based safe and effective treatment alternative exists"*, explains lead author Professor Anthony Morrison from the University of Manchester in the UK.

Although cognitive therapy has helped people with schizophrenia when given in combination with , until now its feasibility and effectiveness in individuals not taking medication was unknown.

The current study assessed whether cognitive therapy could reduce psychiatric symptoms in 74 individuals aged 16 to 65 years with schizophrenia spectrum disorders who had decided not to take or had stopped taking antipsychotics for at least 6 months.

Cognitive therapy involved a therapist working collaboratively with a patient to reappraise psychotic experiences and modify unhelpful thought patterns and behaviours.

Participants were randomly assigned to cognitive therapy (26 sessions over 9 months) plus treatment as usual (37 participants) or to treatment as usual alone (37). Change in symptoms was rated at regular intervals over 18 months on the Positive and Negative Syndrome Scale (PANSS)**. The lower the rating, the better the function.

Average PANSS scores were consistently lower in the cognitive therapy group than in the usual care group. After 18 months, seven (41%) of 17 participants receiving cognitive therapy had an improvement of more than 50% in the PANSS total score compared with three (18%) of 17 receiving treatment as usual. Cognitive therapy was also well tolerated, with low rates of drop-out and withdrawal.

Douglas Turkington, Professor of Psychiatry at Newcastle University, and joint lead author on the paper, said: "One of our most interesting findings was that when given the option, most patients were agreeable to trying cognitive therapy". Professor Turkington also stressed that "if someone is on antipsychotics they should not just suddenly stop taking them as there is a major risk of relapse. Medical advice should always be sought if you are considering stopping your medication."*

According to Professor Morrison, "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. Antipsychotic medication, while beneficial for many people, can have severe side effects. Evidence-based alternatives should be available to those who choose not to take these drugs. For many, cognitive therapy might prove to be the preferred form of treatment. However, a larger definitive trial is needed to confirm the clinical implications of our pilot study."*

Writing in a linked Comment, Oliver Howes from the Clinical Sciences Centres and Institute of Psychiatry, London, UK says, "Morrison and colleagues' findings provide proof of concept that cognitive therapy is an alternative to antipsychotic treatment. Clearly this 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. 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."

Professor Morrison and colleagues are about to commence such a study in Manchester to compare alone with antipsychotic medication alone and with a combined treatment in people with schizophrenia spectrum disorders.

Explore further: CBT is not an effective treatment for symptoms of schizophrenia

More information: Study: www.thelancet.com/journals/lan … (13)62246-1/abstract

Related Stories

CBT is not an effective treatment for symptoms of schizophrenia

January 3, 2014
Health organisations around the world recommend a form of psychotherapy, known as cognitive-behavioural therapy or CBT, for patients with schizophrenia. Now, however, the most extensive study ever undertaken into its effect ...

Long-term varenicline treatment supports tobacco abstinence in people with mental illness

January 7, 2014
Extended treatment with the smoking cessation drug varenicline (Chantix) significantly improved the ability of individuals with serious mental illness to maintain abstinence from tobacco after a standard 12-week course of ...

Cognitive therapy helps reduce severity of distress among psychotic patients

April 5, 2012
Cognitive therapy reduces the severity of psychotic experiences in adults who are at risk of developing conditions such as schizophrenia, a randomised controlled trial published in the British Medical Journal claims.

Study challenges guidelines on art therapy for people with schizophrenia

February 28, 2012
Referring people with schizophrenia to group art therapy does not improve their mental health or social functioning, finds a study published in the British Medical Journal today.

Patients with schizophrenia benefit from 'adherence therapy'

March 4, 2013
(Medical Xpress)—More than half of all patients suffering from schizophrenia do not take antipsychotic medication as prescribed, although this is essential for their effective treatment, according to research published ...

Severely impaired schizophrenics enter dynamic cycle of recovery after cognitive therapy

October 3, 2011
Cognitive therapy has dynamically improved the most neurologically impaired, poorly functioning schizophrenic patients. For the first time, researchers from the Perelman School of Medicine at the University of Pennsylvania ...

Recommended for you

Probing how Americans think about mental life

October 20, 2017
When Stanford researchers asked people to think about the sensations and emotions of inanimate or non-human entities, they got a glimpse into how those people think about mental life.

Itsy bitsy spider: Fear of spiders and snakes is deeply embedded in us

October 19, 2017
Snakes and spiders evoke fear and disgust in many people, even in developed countries where hardly anybody comes into contact with them. Until now, there has been debate about whether this aversion is innate or learnt. Scientists ...

Dutch courage—Alcohol improves foreign language skills

October 18, 2017
A new study published in the Journal of Psychopharmacology, conducted by researchers from the University of Liverpool, Maastricht University and King's College London, shows that bilingual speakers' ability to speak a second ...

Inflamed support cells appear to contribute to some kinds of autism

October 18, 2017
Modeling the interplay between neurons and astrocytes derived from children with Autism Spectrum Disorder (ASD), researchers at University of California San Diego School of Medicine, with colleagues in Brazil, say innate ...

Study suggests psychedelic drugs could reduce criminal behavior

October 18, 2017
Classic psychedelics such as psilocybin (often called magic mushrooms), LSD and mescaline (found in peyote) are associated with a decreased likelihood of antisocial criminal behavior, according to new research from investigators ...

Taking probiotics may reduce postnatal depression

October 18, 2017
Researchers from the University of Auckland and Otago have found evidence that a probiotic given in pregnancy can help prevent or treat symptoms of postnatal depression and anxiety.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.