by B. Bower
H opes for improving the treatment of schizophrenia, a debilitating mental disorder, rest mainly on continuing innovations in antipsychotic medications. Now, a new study suggests that over the long haul, individual psychotherapy tailored to strengthen interpersonal skills and control social stress markedly helps many people suffering from the disorder.
This new form of schizophrenia treatment, dubbed "personal therapy," resulted in lower relapse rates and progressively better social functioning over 3 years, at least for people able to live with family members and meet basic survival needs, contend social worker Gerard E. Hogarty of the University of Pittsburgh School of Medicine and his colleagues.
"If a new medication had treatment effects of the same magnitude as those reported by Hogarty's group [for personal therapy], it would be seen as a major advance and adopted as the main drug treatment for schizophrenia," remarks William T. Carpenter Jr., a psychiatrist and schizophrenia investigator at the Maryland Psychiatric Research Center in Baltimore. "Unfortunately, the influence of this new finding will be severely muted because it involves a psychosocial approach."
Personal therapy operates on the theory that stress-related emotions worsen symptoms of schizophrenia, such as delusions, hallucinations, social withdrawal, and apathy (SN: 10/25/97, p. 261).
In this approach, a therapist first helps a person to notice his or her physical and emotional reactions to stress and teaches various strategies for coping with and relaxing in the social arena. After a year or more of weekly sessions, the therapist encourages the person to more actively engage others at work and in the community and presents more advanced social skills, such as identifying and dealing with criticism from others.
Hogarty's group recruited 151 people hospitalized for their first episode of schizophrenia. Upon leaving the hospital, each volunteer was maintained on some form of antipsychotic medication and assigned at random to 3 years of personal therapy, family therapy (which teaches all family members how to live with a mentally ill relative), or supportive meetings with a nurse who monitored drug effects and offered general encouragement.
Among the 97 participants who lived with their families, those who received personal therapy experienced far fewer recurrences of severe schizophrenia symptoms and took their medication with greater regularity than those in the other two groups, the scientists report in the November American Journal of Psychiatry.
Personal therapy recipients living with their families also displayed improved social adjustment over the entire 3-year period, whereas family and supportive approaches yielded more modest social improvements that occurred only in the first year of treatment.
However, among the 54 individuals who lived alone or with nonfamily members, schizophrenia symptoms reappeared and worsened most often for those receiving personal therapy. People living independently of their families tended to start out with particularly severe symptoms and found it difficult to secure housing, food, and clothing on their own. As a result, the demands of personal therapy may have overwhelmed them, the researchers suggest.
It remains unclear whether the new data on personal therapy will affect how clinicians treat schizophrenia, especially in light of current financial constraints. Moreover, future studies are needed to evaluate the method's effectiveness in combination with new antipsychotic drugs, assert psychiatrists Wayne S. Fenton of Chestnut Lodge Hospital in Rockville, Md., and Thomas H. McGlashan of Yale University in an accompanying comment.
Fenton, W.S., and T.H. McGlashan. 1997. We can talk: Individual psychotherapy for schizophrenia. American Journal of Psychiatry 154(November):1493.
Hogarty, G.E., et al. 1997. Three-year trials of personal therapy among schizophrenic patients living with or independently of family, I: Description of study and effects on relapse rates. American Journal of Psychiatry 154(November):1504.
Hogarty, G.E., et al. 1997. Three-year trials of personal therapy among schizophrenic patients living with or independently of family, II: Effects on adjustment of patients. American Journal of Psychiatry 154(November):1514.
Bower, B. 1997. Kids with schizophrenia yield brain clues. Science News 152(Oct. 25):261.
William T. Carpenter Jr.
Maryland Psychiatric Research Center
P.O. Box 21247
Baltimore, MD 21228
Gerard E. Hogarty
Western Psychiatric Institute and Clinic
3811 O'Hara Street
Pittsburgh, PA 15213
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