Date Published: 6 February 2014
Cognitive therapy found to be safe and acceptable to treat schizophrenia
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Cognitive therapy has recently been found to be a safe and acceptable alternative treatment to for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs, according to research from Manchester University (England).
This is useful information because although antipsychotic drugs are usually the first line of treatment for schizophrenia, many patients refuse or discontinue such pharmacological treatment. In view of this reality, the study set out to establish whether or not cognitive therapy was effective in reducing psychiatric symptoms in people with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs.
How the research was structured:
Researchers randomly selected 74 patients aged 16-65 years who had been diagnosed with schizophrenia spectrum disorders and who had chosen not to take antipsychotic drugs for psychosis. The patients involved participated at two UK centres between February 2010 and May 2013. They were randomly assigned to receive two types of treatment. Thirty-seven of the patients received cognitive therapy plus treatment as usual, while the other thirty-seven received only the usual treatment.
The researchers considered each patient's total score on the positive and negative syndrome scale (PANSS). This was assessed at the start of the treatment and at fixed intervals after 3, 6, 9, 12, 15, and 18 months.
Patient outcomes noted during or after the study:
8 of the 74 patients experienced some serious adverse events (2 of those were in the 'cognitive therapy' group, while 6 were in the 'just treatment as usual' group):
Of the 2 who were in the cognitive therapy group, both of the following adverse events occured after therapy:
- one attempted an overdose
- one patient presenting risk to others
Of the 6 who were in the usual treatment only group:
- one attempted an overdose
- two deaths occured - both of which were deemed unrelated to trial participation or mental health
- three patients were taken as compulsory admissions to hospital for treatment under the mental health act
Overall, the researchers found that cognitive therapy significantly reduced psychiatric symptoms and seemed to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs.
Comments from the experts:
Professor Anthony Morrison, of Manchester University's School of Psychological Sciences, said:
" Our evidence suggests cognitive treatments do benefit patients with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs but a larger, definitive trial is now needed."
Writing in a linked Comment in The Lancet, Oliver Howes from the Clinical Sciences Centres and Institute of Psychiatry, London, said:
" 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 his colleagues are about to begin a new study comparing cognitive therapy alone with antipsychotic medication alone and with a combined treatment in people with schizophrenia spectrum disorders.
University, England (UK)