Schizophrenia is a disease characterized by hallucinations, social withdrawal, and poor cognitive function. Today, there are over two million people who have schizophrenia in the US. Current first line treatments for schizophrenia have severe side effects and are usually lifelong. MRI studies have proven that brain activity is decreased in patients who are taking antipsychotic medications, such as Haloperidol. Antipsychotics, while somewhat effective at treating hallucinations and delusions, are less effective at treating the mood-related symptoms of schizophrenia, which include social withdrawal, lack of motivation, and emotional reactivity. Because these symptoms often persist despite resolution of hallucinations, it is often extremely difficult for patients to live on their own or maintain stable employment. Additionally, those suffering from hallucinations or paranoia may turn to substance abuse as a coping mechanism. Therefore, individuals with severe schizophrenia can become a significant emotional and financial burden on their caretakers and often become destitute or homeless.
However, a recent study funded by Congress suggests that there may be safer alternatives to this treatment regimen. The NAVIGATE trial explores the effect of a multidisciplinary approach to management of psychosis. In addition to antipsychotic medications, patients in the trial received a number of additional therapy modalities, including individual psychotherapy, family support, and job training assistance. Outcomes measured include quality of life, cost-effectiveness, and rates of hospitalization. Initial findings of the NAVIGATE trial suggest that increased length of time in this treatment approach resulted in significant improvement in quality of life and greater community involvement when compared to subjects who continued to receive the current standard of care.
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Researchers speculate that inadequate emotional regulation plays an important role in the development of psychosis. Therefore, treatments that target an individual’s response to stress may result in significant improvement in the severity of each episode of psychosis. In this approach, one-on-one “talk therapy”, providers work closely with the individual to teach tools which will enable the patient to build stable social relationships, reduce substance abuse, and manage hallucinations or delusions.
This holistic approach is already being implemented in countries such as Scandinavia and Australia with moderate success. Based on the results in these countries combined with the results of the NAVIGATE trial, it is hoped that Medicare and Medicaid will revise their treatment guidelines to support this novel approach. While there is much more work to be done to realize the full potential of psychotherapy for this condition, patients and their families can have hope that soon, we may not have to rely solely on a lifetime of medication to manage schizophrenia.
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