Landmark study could change how schizophrenia is treated

Each year, approximately 100,000 adolescents and young adults in the United States experience their first episode of psychosis, a frightening symptom of schizophrenia and other mental health disorders characterized by impaired thoughts and emotions that lead to a disconnection from reality.

Treatment typically involves antipsychotic medications to suppress symptoms and avoid a relapse, but due to gaps in mental health care many patients face severe delays in getting the help they need.

Now a new government-funded landmark study, published online today by The American Journal of Psychiatry, highlights the need for people to receive care soon after psychotic symptoms begin and suggests a more team-based, coordinated approach can result in better health outcomes.

"The goal is to move away from this chronic illness model that focuses on keeping symptoms at bay and more towards one of early intervention and the possibility of recovery," Amy Goldstein, Associate Director of Prevention at the National Institute of Mental Health (NIMH), told CBS News.

A team of researchers led by Dr. John M. Kane, professor and chairman of the department of psychiatry at The Hofstra North Shore-LIJ School of Medicine and The Zucker Hillside Hospital, trained clinical staff at real-world clinics around the country to use a coordinated specialty care treatment program that involved recovery-oriented psychotherapy, low doses of antipsychotic medications, family education and support, case management, and work or education support.

Kane's research is one of two studies that make up the Recovery After an Initial Schizophrenia Episode (RAISE) project funded by the NIMH.

"The goal is to link someone experiencing first episode psychosis with a coordinated specialty care team as soon as possible after psychotic symptoms begin," Kane said in a statement. "Our study shows that this kind of treatment can be implemented in clinics around the country. It improves outcomes and the effects are greater for those with a shorter duration of untreated psychosis."

The study involved just over 400 people aged 15 to 40 who had experienced only one episode of psychosis. Of that group, 223 patients were seen at a clinic using the coordinated specialty care program and 181 were treated at clinics using "typical care," determined by the attending clinician's choice and the availability of treatment options.

The results showed that those treated with the team-based approach remained in treatment for longer and experienced greater improvement in their symptoms, interpersonal relationships, quality of life, and involvement in work and school compared with patients at the typical-care sites.

Additionally, the researchers found that the time between the first episode of psychosis and the beginning of treatment was very important in determining how well the patient responded to care.

Half of the patients in the study were treated within 74 weeks of their first psychotic symptoms, while half had longer periods of untreated psychosis. Those who received treatment in under 74 weeks using the team-based, coordinated approach responded far better to interventions than those who remained untreated longer and those receiving standard community care.

"One of the key takeaways from the study is that it's important to deliver the right evidence-based treatment and to do it at the right time, which is really as early as possible after the onset of psychotic symptoms," Goldstein said.

Experts say the study has big implications for how schizophrenia is treated in the United States.

"Dr. Kane's work is having an immediate impact on clinical practice in the U.S. and is setting a new standard of care," Robert Heinssen, director of the Division of Services and Intervention Research at NIMH, said in a statement. "We're seeing more states adopt coordinated specialty care programs for first episode psychosis, offering hope to thousands of clients and family members who deserve the best care that science can deliver."

But Dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation, a nonprofit organization focusing on mental health research, points out that although the study shows appropriate care and support can lead to positive health outcomes, much more still needs to be done.

"Unfortunately, too many people do not receive this level of care," he said. "While this study is a step forward, we need to put funding into additional research to develop even more effective methods of treatment and prevention."