Monday, May 24, 2004

Schizophrenia: talking may help when drugs don't

New research has strengthened the case for using 'talk therapy' in the treatment of schizophrenia, especially for those who don't respond well to drugs.

A large-scale analysis of the scientific literature has found strong evidence for the use of cognitive behavioural therapy (also known as talk therapy or CBT) in people who have not responded well to medication.

Led by Professor Philippa Garety, a clinical psychologist at the Institute of Psychiatry at King's College London, the research was presented to the annual meeting of the American Association for the Advancement of Science being held in Denver, USA.

"The magnitude of the effect of this therapy is similar to the effects of the newest anti-psychotic medication - average reduction symptoms of 20 to 40% - and without the side-effects that medications typically cause," said the British researcher.

About one in every 100 Australians experience schizophrenia at some point in their life, suffering delusions and hallucinations such as hearing voices and believing other people want to harm them. In extreme cases it can lead to suicide.

Although medication is always recommended as the first line of treatment, 50% of people continue to have worrying symptoms even after taking medication, Garety, [said.]

In addition, many people refuse to take medications or only take them intermittently, especially once they are out of hospital, she said.

One reason is the side-effects of medication, which can range from feeling jittery to weight gain. Another is that up to 20% of people with schizophrenia do not accept that they have a mental illness in the first place.

Garety said in CBT, the therapist does not tell the sufferer they are wrong, but rather assumes they have been trying to make sense of events around them, and then gently tries to suggest other interpretations.

"You would say: 'I can see the basis on which you concluded that, but let's see what else the evidence might lead to' - trying to open up some flexibility and questioning," she said.

Barriers to clinical use

Although 'talk therapy' has been around since the late 1970s, its use in schizophrenia has been relatively recent and there are a number of barriers to it being used more widely in clinical settings, say health workers.

According to schizophrenia researcher Dr Philip Ward of the University of New South Wales in Sydney, clinical psychologists are generally trained in CBT, but there are few of them in the public health system in Australia.

While the Australian government was giving family physicians incentives to train in CBT, there was "a question mark" over this approach, he, [said.] One option might be to just make psychologist consultations rebateable by Medicare, the country's national health system.

According to Dr Frances Dark, a consultant psychiatrist in public practice in the northeastern Australian state of Queensland who is trialing CBT, group-based therapy may be an option if resources are limited. However, longer consultations were a likely consequence if the medical profession were to adopt the technique. [So what?]

"Our health care system has been devised around a system that relied on medication," she, [said], "Now we have got evidence-based psychotherapies for mental illness, we need to reorganise our services in order to deliver them."

By Anna Salleh posted 24 May 04


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