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New schizophrenia therapies show promise, but treatment continues to be inadequate for many patients

The brain disorder schizophrenia affects about 2.5 million Americans and 20 to 30 percent of the homeless. The symptoms of this chronic psychotic condition range from hallucinations, hearing voices, paranoia, and social withdrawal to unusual behavior and disorganized thinking. These symptoms make it difficult if not impossible for patients to carry on at home, school, or work. Until recently, drugs used to treat schizophrenia had such severe side effects that patients were reluctant to keep taking them.

Recent advances in drugs and psychosocial therapies have made it possible, at least in theory, for people with schizophrenia to return to more normal lives. However, treatment of many patients with schizophrenia, particularly those cared for under the auspices of public programs like Medicaid and Medicare, remains inadequate, concludes the Schizophrenia Patient Outcomes Research Team (PORT). The PORT was supported by the Agency for Healthcare Research and Quality (contract 290-92-0054).

The PORT, led by Anthony F. Lehman, M.D., M.S.P.H., of the University of Maryland School of Medicine, issued its treatment recommendations in January 1998. Yet in a recent survey of people being treated for schizophrenia, the researchers found that less than half of the 700 patients surveyed were receiving treatment that met its recommendations. Dr. Lehman and his colleagues cite institutional and system barriers to good care, such as restrictions on prescriptions for newer antipsychotic medications, which are much more expensive than conventional agents, to lack of evening and weekend hours to accommodate family-support programs.

The team found evidence that treatment programs which combine medications with psychosocial services ranging from reality-based and cognitive "problem-solving" therapy to family education and support. The new antipsychotics are as effective as conventional agents (for example, chlorpromazine and haloperidol), reducing relapse rates 40 to 50 percent in usual practice, and they have fewer unpleasant neurologic side effects. Also, patients on medication whose families receive schizophrenia education, support, and communication training have 50 percent lower relapse rates than patients on medication alone.

See "Quality of care in mental health: The case of schizophrenia," by Dr. Lehman, in the September 1999 Health Affairs 18(5), pp. 52-65.

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