TOPICS > Health

In treating schizophrenia, a balancing act between drug and talk therapy

October 20, 2015 at 6:35 PM EST
More than 2 million Americans have schizophrenia, a chronic brain disorder that can causes hallucinations, delusions, memory problems and depression. A new landmark study finds that high levels of potent antipsychotic drugs is not as effective a treatment as lower doses combined with therapy and support. Gwen Ifill talks to Dr. Robert Heinssen of the National Institute of Mental Health.
LISTENSEE PODCASTS

GWEN IFILL: But, first, we will turn to a pair of health stories getting a lot of attention today. In a moment, we explore why one of the most important voices in cancer research, the American Cancer Society, is changing its guidelines for mammograms.

But, first, we turn to a landmark study that could change the way schizophrenia is treated. More than two million Americans have this chronic and sometimes severe brain disorder. Symptoms can include hallucinations, delusions and hearing voices, and problems with memory, fatigue and depression.

For years, this has been treated with high level — high levels of potent antipsychotic drugs. But a new study finds lower doses, combined with therapy and support, can be more effective.

Dr. Robert Heinssen is with the National Institute of Mental Health, which funded the six-year study.

Welcome.

DR. ROBERT HEINSSEN, National Institute of Mental Health: Good evening.

GWEN IFILL:
First, define for people what schizophrenia actually is. People know what they know from TV and movies.

DR. ROBERT HEINSSEN: So, schizophrenia is a condition that affects the way the person interacts with the world. They can experience an altered sense of perception. Their thinking can be impaired. It also affects the kind of emotional experiences they have.

So, people may withdraw from those around them. They may lose opportunities to pursue their education or to get a job. So, it’s — it affects the quality of their thinking, the quality of their emotional life, and their relationships in general.

GWEN IFILL: And how has it been treated typically?

DR. ROBERT HEINSSEN: Well, in the United States, we have tended to have a treatment system that focuses on the latter stages of the disorder. So, sometimes, people are ill for several years before they come to the attention of the health care system. And once they do come into the health care system, the focus is on managing the psychotic symptoms that are distressing to the individual, their family, and are often the calls of drawing negative attention to the person.

GWEN IFILL: So, a big part of this finding is that early treatment is necessary, I assume, since you’re saying that so much of this is diagnosed late, but also talk therapy instead of drug therapy. Explain the difference.

DR. ROBERT HEINSSEN: So, what we know about the needs of people with schizophrenia are that there are multiple areas of impairment, their psychotic symptoms, their social functioning.

There’s cognition in terms of thinking and memory and so forth. And there’s also functional capability, school and work. Medications do a very, very good job with psychotic symptoms. They can give people relief from the psychotic symptoms, but they don’t necessarily touch the other areas of impairment.

For that, we need therapies that can engage the person’s interests, their motivation, their curiosity, give them a pathway to recovery, and then support them in that process, where they can learn and be reinforced, acquire more adaptive stances.

GWEN IFILL: It sounds like the support is more than just treatment. It’s also family support and support in the workplace as well.

DR. ROBERT HEINSSEN: So, the experience of psychosis is very traumatic for the family. Very often, the people closest to the individual with schizophrenia are at a loss. What is going on? How can we help?

So this treatment takes that into account, emphasizes education for family members, support for family members, and really engaging them as active partners in helping the person recover.

GWEN IFILL: Two of the things that leap to mind as you think about schizophrenia, or any disease like this, is the side effects of drug therapy and whether that also caused you to search for an alternative, and also the cost of drug therapy, or of talk therapy, which is more expensive.

DR. ROBERT HEINSSEN: So, in terms of the side effects, you know, we know that people in the early stages of psychosis are very responsive to antipsychotic medications.

They actually get a much more robust response than people who have been ill for years. But they’re also more vulnerable to side effects. So it’s a very — it’s a balancing act to find a therapeutic window where you’re getting good benefit, but minimizing the side effects, because some of the side effects include things like weight gain that actually then put the person at risk for medical conditions like diabetes, heart disease, and so forth.

So, in this treatment, there’s very, very careful attention to the dose of the medications, how the person is experiencing that dose in terms of relief, what kinds of side effects they may be developing, and then a careful integration of medical and psychiatric care to make sure that we’re not compounding the problems of psychosis with medical problems that have their own burden.

GWEN IFILL: And as far as expense?

DR. ROBERT HEINSSEN: Well, you know, there will be a cost-effectiveness analysis that will follow the study that was reported today.

But our initial sense of this is, is that, yes, there are more up-front costs in terms of outpatient treatment, the individual therapy, the family treatment, the supported employment and education, which is key to getting the person back on the path to meaningful work.

But we really think that these up-front costs will be offset, both by reduced reliance on emergency and crisis care, in-patient hospitalizations and emergency room visits, but also, because people have a much greater opportunity to become employed, become citizens who are fully engaged in the work force, making contributions, that those factors will be included in the cost-effectiveness and probably will show us that, in the long run, this is well worth the investment, the investment in these young people’s future.

GWEN IFILL: So there’s a payback in other ways, is what you’re saying?

DR. ROBERT HEINSSEN: Well, I think there’s a payback to our society, that we get fully functioning citizens who are — yes.

(LAUGHTER)

GWEN IFILL: Who are fully functioning.

DR. ROBERT HEINSSEN: Who are fully functioning and fully contributing, which is what they want, as a society, what we should want.

GWEN IFILL: Right.

Dr. Robert Heinssen of the National Institute of Mental Health, thank you very much.

DR. ROBERT HEINSSEN: Thank you.

SHARE VIA TEXT