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Cognitive therapy may be a viable alternative to antipsychotics in schizophrenia

Cognitive therapy is safe and effective in reducing psychiatric symptoms and improving personal and social functioning in people with schizophrenia who are not taking antipsychotic drugs, the results of a randomised controlled trial published online in The Lancet (6 February 2014) suggest.

According to the researchers, the findings indicate that cognitive therapy could be a viable alternative treatment for schizophrenia patients who choose not to take antipsychotics, estimated to account for up to half of people with the condition.

“We are not advocating that people who derive benefit from antipsychotic drugs should consider discontinuation; rather, we are advocating for evidence-based alternatives for those who choose not to on the basis of reasons that might include side effects or perceived inefficacy,” they say.

The trial included 74 individuals with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs. They were randomly assigned to receive cognitive therapy plus usual care, or usual care alone. Cognitive therapy consisted of 26 structured sessions given over nine months, plus up to four booster sessions in the subsequent nine months. Usual care varied but included regular care co-ordination and psychosocial interventions.

The primary endpoint was the total score on the positive and negative syndrome scale (PANSS) measured at three, six, nine, 12, 15, and 18 months. A lower rating indicates better functioning.

At each time point, PANSS scores were lower among patients receiving cognitive therapy plus usual care than in those receiving usual care alone, with an estimated between-group effect size of –6.52 (95 per cent confidence interval ?10.79 to ?2.25; P=0.003).

Furthermore, cognitive therapy was well tolerated, had a low drop-out rate, was associated with significant improvements in personal and social functioning, and improved some dimensions of delusional belief and voice hearing.

The authors say their study “showed that cognitive therapy is an acceptable intervention for a population who are usually considered to be very challenging to engage in mental health services” and call for the findings to be confirmed in a larger trial.

The results are described as “groundbreaking” in an accompanying comment by Oliver Howes, Institute of Psychiatry, London, who says that the study “provides proof of concept that cognitive therapy is an alternative to antipsychotic treatment”.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11133986

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