New research indicates that the reinforcement with a new cognitive therapy program can improve outcomes in patients with schizophrenia dysfunction.
A small study, published recently in the online version of Archives of General Psychiatry, showed that patients with severe schizophrenia and major cognitive impairment who participated in a cognitive therapy program for 18 months in addition to normal treatment, which comprised antipsychotic drug, ratings were improving the overall functionality significantly higher than those who received standard treatment.
Patients who received cognitive therapy also had more improvement in schizophrenic symptoms 'positive' hallucinations and delusions, as well as negative symptom apathy.
Lead author Dr. Paul M. Grant, PhD, assistant professor at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, told Medscape Medical News : "We were able to help those who were assigned to group cognitive therapy to improve their functional outcome, which helped to do a little more to get out more, to make friends, that sort of thing. "
He said: "It is a group of patients who really has not received satisfactory treatment.And they responded to it with respect to their negative symptoms and positive symptoms. Decreased the voices and delusions. "
Dr. Grant added that the main key message for clinicians is that these patients have more potential than you seem to have.
Dr. Grant said: "There are psychosocial treatments that work in this group, to which many have given up, including themselves. Not believe they can improve their lives.However, this is proof that something can be done satisfactory. "
"We created a protocol and ultimately what we're trying to do is see how domain can acquire their own lives and how patients can achieve recovery."
Difficult to treat
According to investigators, two to three million American adults currently suffer from schizophrenia. Of these, nearly two thirds have a chronic form of the disorder.
Report: "Patients with chronic schizophrenia have dysfunctional represent high direct and indirect costs for treatment due to loss of employment and productivity and a low quality of life."
Dr. Grant said: "These patients are the most costly psychiatric services. For example, in Philadelphia are up to 5% to 10% of patients with Medicare, but they represent over 25% of costs. "
Unfortunately, researchers say, "antipsychotic medication and psychosocial interventions have shown limited effectiveness in promoting better functional outcomes."
Although previous research has shown that cognitive therapy has been successful to help a "wide range" of psychiatric disorders has not been focused on patients with schizophrenia who have poor performance and cognitive disorders.
The researchers note in their paper: "By adapting cognitive therapy to patients with schizophrenia have poor performance, we changed the emphasis from predominantly oriented approach in symptoms, which is characteristic of the protocols in the UK, a therapeutic approach aimed highlighting the person's interests, strengths and positive factors of the patients. "
"We focus our treatment methods to identify and promote specific goals to improve the quality of life and reintegration into society."
A 'right step'
For this study, 60 outpatients between 18 and 65 years of age with dysfunction who had schizophrenia and neurocognitive disorders (65% black, 31% white) were built between January 2007 and August 2009 at the University of Pennsylvania. The average the duration of schizophrenia was 15.5 years. Neurocognitive impairment was defined as "difficulty in information processing tasks of memory, attention and executive function."
All participants were randomly assigned to receive cognitive therapy protocol adapted by the researcher rather the standard treatment (n = 31, 67.8% male, mean age 34.3 years) or just the normal treatment for 18 months (n = 29, 65.5% male, mean age 42.9 years).
The primary endpoint was improvement of psychosocial functioning, as shown in the global rating scale after 18 months. Secondary endpoints included improvements in the Scale for the Assessment of Positive Symptoms and the four subscales of the Scale for the Assessment of Negative Symptoms.
Positive symptoms of schizophrenia were measured consisted of hallucinations, delusions, and disorganization. The subscales included abolition of negative symptoms-apathy, anhedonia-asocial, alogia and affective indifference.
The results showed that the group receiving cognitive therapy showed more improvement in global functioning at 18 months than the group that received only standard treatment ( p = 0.03).
The scale of negative symptoms was significantly greater for the group with cognitive therapy in the abolition-apathy compared with the group that received only standard therapy ( p = 0.01), as well as significantly greater improvements in symptom scale positive ( p = 0.04).
There were no significant differences between groups for emotional indifference, the alogia or anhedonia-asocial.
The researchers note in their paper: "Age was adjusted in the analysis and no significant group differences in initial antipsychotic drugs (class or level) or medication changes during the course of study."
They note that this is the first time that patients with schizophrenia "selected from the end of the range of dysfunction" has shown clinically relevant improvements after receiving a psychosocial intervention.
Dr. Grant said, "Some of the patients who were referred for this study had not really changed in 15 or even 20 years and psychiatrists said they were not going to change.However, we show that this was wrong. " "This is an appropriate step to actually improve their lives."
Report to be published later this year, a manual that describes in detail the cognitive therapy program. In addition, researchers are currently exploring how to adapt the protocol of cognitive therapy in hospitalized patients with schizophrenia.
Hope of negative symptoms
Dr Douglas Turkington, FRCPsych, Department of Psychiatry at Newcastle University , UK, and Dr. Anthony P. Morrison, PhD, School of Psychological Sciences of the University of Manchester , UK, in an accompanying editorial noted: "So far, treatments have offered little hope for persistent negative symptoms [schizophrenia].
However, the study by Dr. Grant and colleagues suggests that cognitive therapy, "which is based on a cognitive model that involves fear of failure and corresponding behaviors aimed at avoiding it, may improve negative symptoms in a population clinically difficult. "
The editorial authors note that previously most of the attention has focused on the positive symptoms of the disorder in which hallucinations and delusions, yet debilitating negative symptoms, such as reduced motivation and alogia, are some major problems for patients and their families.
Although they note that the study is "very welcome", he concludes that "research is needed based on more models for this group of disabled patients."
The study was funded by a grant for Distinguished Research from the National Alliance for Research on Schizophrenia and Depression and by grants from the Heinz Foundation and the Barbara and Henry Jordan Foundation. Three of the authors, including Dr. Grant, report having received royalties from Guilford Press. The authors of the editorial have disclosed no relevant financial conflicts of interest.
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