Researchers discover antipsychotic medications modestly help patients with schizophrenia improve social, interpersonal and community living (psychosocial) skills. The social enhancements appear to occur when either older or second generation medications are used.
However, scientists say additional research is needed to help patients with schizophrenia to restore more of their psychosocial functioning.
According to the authors, improvements in psychosocial skills among patients with schizophrenia have been notoriously difficult to achieve, even when the more disruptive symptoms of the disease can be controlled.
“Helping patients with schizophrenia restore their psychosocial functioning remains a challenge,” said National Institute of Mental Health Director, Thomas R. Insel, M.D.
Insel comments that results from the new Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE) study “reinforce the growing understanding that we must do a better job of helping patients get their life skills back on track.”
During the study Insel and collegues evaluated the social and vocational functioning, interpersonal relationships, and psychological well-being of 455 participants—about one-third of all patients in the CATIE study—who completed an initial evaluation before the study began and were available to provide data after 12 months of treatment.
In the first phase of the CATIE study, patients were randomly assigned to take either perphenazine—an older, first-generation antipsychotic medication—or one of several newer, second-generation medications (olanzapine, quetiapine, risperidone, or ziprasidone).
The researchers found that those patients who stuck with their initial treatment showed some improvement in their psychosocial functioning, and there were no differences among the medications in making these gains.
The results are consistent with previously reported CATIE results (http://www.nimh.nih.gov/healthinformation/catie.cfm) in which few differences were seen among perphenazine and the newer, second-generation antipsychotic medications in effectively reducing symptoms.
The patients who made the greatest gains were the ones with the poorest community living skills at the beginning of the study, but they were also more likely to discontinue treatment early in the process. As noted in previous CATIE reports, many patients discontinued their initial treatments because of intolerable side effects or ineffectiveness.
“Over the long run patients are more likely to function better in the community if they are able to stay on their initial treatment, especially those who are the most impaired,” said Dr. Swartz. “More intensive rehabilitative interventions and outreach may help patients stick with their treatment and make greater gains.”
Patients who made few gains in community living skills were those with higher-level psychosocial skills at the beginning of the study. Swartz and colleagues posit that patients encountered a “ceiling effect” at which point additional psychosocial skill improvement was unlikely without additional rehabilitative treatment.
“Overall, the findings reiterate the widely held belief that antipsychotic medications alone are not sufficient in helping patients make meaningful gains in real-world functioning,” said Dr. Swartz. “Dedicated rehabilitative services that help patients learn to function at work and in social settings are sorely needed.”