Combination therapy benefits early-stage schizophrenia patients
MedWire News: Psychosocial therapy combined with antipsychotic treatment improves medication adherence, insight, quality of life, and social functioning, and reduces relapse risk in patients with early-stage schizophrenia compared with antipsychotic treatment alone, research shows.
"Antipsychotic drugs have been shown to be effective against psychotic symptoms, and they are now the mainstay of therapy for patients with schizophrenia," explain Jingping Zhao (Central South University, Hunan, China) and team.
However, they add: "Long-term therapy with antipsychotics is associated with a range of adverse effects, poor adherence, and high rates of medication discontinuation. Most patients, even those with a good response to medication, continue to experience disabling residual symptoms, impaired social and occupational functioning, and a high risk of relapse."
To investigate whether a psychosocial intervention can improve outcomes for such patients, the team studied 1268 patients with early-stage schizophrenia who were aged an average of 26 years.
The participants were randomly assigned to receive antipsychotic treatment alone or antipsychotic treatment plus psychosocial therapy. This consisted of group psychoeducation, family intervention, skills training, and cognitive behavior therapy, each of which was delivered on the same day once a month for 12 months in a total of 48 1-hour sessions.
There were no significant differences between study groups regarding baseline demographic and clinical characteristics.
Overall, 744 patients (60.0%) completed the 1-year follow-up period, including 406 (67.2%) in the combined intervention group and 338 (53.2%) in the medication-alone group.
Analysis revealed that patients in the combined treatment group were 38% less likely to discontinue or change treatment due to any cause, and 43% less likely to relapse over the study period than those in the medication-alone group.
Compared with patients in the medication-alone group, those in the combined treatment group also showed greater improvements in scores on the Insight and Treatment Attitudes Questionnaire, the Global Assessment Scale (social functioning), the Activities of Daily Living Scale, and four domains of quality of life on the Medical Outcomes Study 36-Item Short Form Health Survey over the study period.
The researchers also found that a significantly higher proportion of patients assigned to the combined treatment group obtained employment or accessed education during the 1-year period than those in the medication-alone group, at 30.1% versus 22.2%.
"Our study suggests that combined treatment in patients with early-stage schizophrenia reduces the rate of treatment discontinuation and risk of relapse. It also improves insight, adherence to treatment, quality of life, and social functioning."
They add: "Integrating comprehensive therapy with medication treatment in the early stage of schizophrenia is critically important and should be recommended as the standard of care."
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By Mark Cowen