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A Revolution in Schizophrenia Care

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There’s a new way to treat schizophrenia, and it’s catching on across the country—indeed, around the world.

The old approach: Give people with schizophrenia high doses of antipsychotic drugs to quell their symptoms. But those drugs have serious side effects, and there is widespread concern that many patients are getting doses much higher than necessary.

 The new approach: Focus on the patient’s whole life with a combination of talk therapy, family education and vocational and educational support in a new comprehensive team-based approach—with the goal of helping the patient become a productive member of the community…often with fewer medications.

Getting the right kind of help quickly is key. Schizophrenia often comes up suddenly, typically between the ages of 16 and 30—the new approach works best with people whose condition has been recently diagnosed.

If you know someone who has just started to suffer from this chronic mental illness, here’s the best way to get help—when it can do the most good.

THE NEW MODEL

Schizophrenia patients who participate in this team approach see greater improvements in their symptoms than patients who receive the usual drug-centered care. Doctors use the lowest dose of antipsychotic medication possible and include the patient in the decision making, tapering medicine as symptoms diminish.

While the approach is a good one for anyone with schizophrenia, the best results happen when the program starts within 18 months after a first episode of psychosis. Indeed, the key study that supports it is called RAISE, which stands for Recovery After an Initial Schizophrenia Episode.

“The longer you go with difficulty functioning, the more difficult it is to get back to where you were before,” says John Kane, MD, chair and professor of psychiatry, Hofstra North Shore-Long Island Jewish School of Medicine, a lead RAISE researcher. “But if you can get back to feeling well and doing well quickly, you have a better chance of sustaining that.”

The individual elements that make RAISE work aren’t unique in schizophrenia care—what’s new is bringing them all together in a team approach. One key component is a type of talk therapy called resilience therapy, which helps the patient pursue meaningful goals, understand how psychotic episodes affect his/her life and develop coping strategies. Patients learn to deal with symptoms such as anxiety, hallucinations and sleep problems by using relaxation techniques, cognitive restructuring, distraction, exercise and mindfulness. Family therapy is another key element—it helps caregivers better understand the illness—as is occupational therapy, which provides support with school or jobs.

Now it’s really taking off in communities around the nation. The program was originally implemented in 34 clinics in 21 states, but a new $25 million federal grant now provides money for training for states that want to set up new RAISE-like programs, and 32 states are now participating.

A new study, published in Schizophrenia Bulletin, finds that it’s cost-effective, too. While it costs an average of $3,600 a year more than conventional care, the benefits alone are worth the extra expense. But if RAISE helps a patient use less medication, which can cost as much as $12,000 a year for one drug, the program may even save money.

GETTING HELP

If you or a family member is suffering a first psychotic episode, the most important thing is to get treatment as soon as possible. Contact your state or local community mental health center, and ask if there is a program with some or all of the elements of RAISE available. You can also check to see if your state has a RAISE program and contact it directly to see if you can participate.

Learn as much as you can about the illness…work closely with the clinical team…and make sure the clinicians are communicating with each other. The right kind of help, at the right time, can make all the difference in the world.

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Source: John M. Kane, MD, adjunct clinical professor, department of psychiatry and behavioral sciences, The Saul R. Korey Department of Neurology, chair, department of psychiatry and behavioral sciences, Hofstra North Shore University Hospital- Long Island Jewish School of Medicine, Bronx, New York. He currently directs the NIMH-funded Advanced Center for Interventions and Services Research in Schizophrenia at Zucker Hillside Hospital, Glen Oaks, New York.

Study titled “Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program” by researchers at Hofstra North Shore University Hospital-Long Island Jewish School of Medicine, Bronx, New York, et al., published in Schizophrenia Bulletin.

Study titled “Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program” by researchers at Hofstra North Shore University Hospital-Long Island Jewish School of Medicine, Bronx, New York, et al., published in The American Journal of Psychiatry. Date: February 16, 2016 Publication: Bottom Line Health
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