Researchers from The University of Manchester have shown cognitive therapy can be used as a safe and acceptable alternative treatment to for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs.
Antipsychotic drugs are usually the first line of treatment for schizophrenia; however, many patients refuse or discontinue their pharmacological treatment.
Research published in The Lancet shows cognitive therapy significantly reduced psychiatric symptoms in patients not taking antipsychotic drugs.
The study, funded by the National Institute for Health Research, aimed to establish whether cognitive therapy was effective in reducing psychiatric symptoms in people with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs.
Researchers randomly selected 74 patients aged 16-65 years with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs for psychosis at two UK centres between February 2010 and May 2013. The patients were randomly assigned to receive two types of treatment. 37 received cognitive therapy plus treatment as usual and 37 received treatment as usual.
The researchers then looked at each patient's total score on the positive and negative syndrome scale (PANSS). This was assessed at the start of the treatment and at months 3, 6, 9, 12, 15, and 18.
There were eight serious adverse events: two in patients in the cognitive therapy group (one attempted overdose and one patient presenting risk to others, both after therapy), and six in those in the treatment as usual group (two deaths, both of which were deemed unrelated to trial participation or mental health; three compulsory admissions to hospital for treatment under the mental health act; and one attempted overdose).
Overall the researchers found cognitive therapy significantly reduced psychiatric symptoms and seems to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs.
Professor Anthony Morrison, from the School of Psychological Sciences based at The University of Manchester, said: "Our evidence suggests cognitive treatments do benefit patients with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs but a larger, definitive trial is now needed."
Writing in a linked Comment in The Lancet, Oliver Howes from the Clinical Sciences Centres and Institute of Psychiatry, London, said: "Morrison and colleagues' findings provide proof of concept that cognitive therapy is an alternative to antipsychotic treatment. Clearly this outcome will need further testing, but, if further work supports the relative effectiveness of cognitive therapy, a comparison between such therapy and antipsychotic treatment will be needed to inform patient choice. If positive, findings from such a comparison would be a step change in the treatment of schizophrenia, providing patients with a viable alternative to antipsychotic treatment for the first time, something that is sorely needed."
Professor Morrison and colleagues are about to commence such a study in Manchester to compare cognitive therapy alone with antipsychotic medication alone and with a combined treatment in people with schizophrenia spectrum disorders.
- Anthony P Morrison, Douglas Turkington, Melissa Pyle, Helen Spencer, Alison Brabban, Graham Dunn, Tom Christodoulides, Rob Dudley, Nicola Chapman, Pauline Callcott, Tim Grace, Victoria Lumley, Laura Drage, Sarah Tully, Kerry Irving, Anna Cummings, Rory Byrne, Linda M Davies, Paul Hutton. Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. The Lancet, 2014; DOI: 10.1016/S0140-6736(13)62246-1
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