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Times explores impact of integrated care model for schizophrenia treatment

Talk Therapy Found to Ease Schizophrenia

Our Review Summary

Psychiatrist and woman patient

Update: The Times has issued a correction to this story. The correction states that the story erroneously claimed that the experimental approach in the study used lower drug dosages. “Though it studied a program intended to reduce medication dosages, the researchers do not yet know for sure if dosages were lowered or by how much,” the correction notes.”Therefore, the study did not conclude ‘that schizophrenia patients who received smaller doses of antipsychotic medication and a bigger emphasis on one-on-one talk therapy and family support made greater strides in recovery.’ (The study did conclude that the alternative treatment program as a whole led to better outcomes.)”

We changed the headline of our review from “Times captures impact of new, less drug-intensive schizophrenia treatment” to “Times explores impact of integrated care model for schizophrenia treatment.” The correction does not affect our ratings for the story, but the references we made in the review to the lowered drug dosages are no longer appropriate and have been stricken. In addition, the tone of the review would have been more circumspect had we known that the intended reduction in drug dosages had not been confirmed by the researchers.

In a large randomized controlled trial in 34 community clinics across the U.S., researchers compared usual care for first episode psychosis with a program of integrated care that included not only drugs, but also help with school and work, family education about the problems and how best to help, as well as one-on-one talk therapy. The government (National Institute of Mental Health)-funded study found that those receiving the integrated program of care experienced more symptom relief and functioned better than those in the treatment-as-usual group. Their doses of medication were also 20-50% lower. Those receiving treatment earlier on in their psychotic episodes also did better.

The story overall does a solid job of covering the study and its implications. But we wish it had pushed a bit harder to quantify the benefits shown in the 2-year trial with some hard numbers. We applaud the discussion of federal policy and financing, but also wish there had been some discussion of the costs of therapy itself. The inclusion of a variety of perspectives on the research brings depth and nuance to the coverage.

 

Why This Matters

Psychiatric treatment in the U.S. has become very drug focused. Other countries are ahead of us on using more integrated care models like the one described in this story, so it’s great to see its success “proven” with a randomized trial. With solid evidence to back it, this model will hopefully become a more accepted approach to practice in the U.S.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not touch on costs for the more comprehensive treatment — including educating families and providing more counseling for patients. True costs and potential savings would be very hard to quantify, and would accrue over time as people hopefully stay in school and jobs, and have fewer admissions to the hospital etc. Even if the story couldn’t address these issues precisely, some mention of them would have been helpful. We do applaud the story for exploring the political and reimbursement context. This was especially good:

Its [study] findings have already trickled out to government agencies: On Friday, the Centers for Medicare & Medicaid Services published in its influential guidelines a strong endorsement of the combined-therapy approach.Mental health reform bills now being circulated in Congress “mention the study by name,” said Dr. Robert K. Heinssen, the director of services and intervention research at the centers, who oversaw the research.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story says drug doses were 20-50% lower, which is a very big deal considering the side effects of these drugs. But overall it leaves us hungry for numbers. It says patients in the therapy group, who received more one-on-one talk therapy and family counseling “made greater strides in recovery over the first two years of treatment than patients who got the usual drug-focused care.” But nowhere in the story does it tell us how “strides” were measured or give us a percentage by which they exceeded those for the control group.

It would have taken some additional legwork to find these numbers, which were not reported in plain English in the study itself. But the paper did report some numbers that were very easy to understand and were not mentioned in the story:

“Over the 2 years, 34% of the NAVIGATE group and 37% of the community care group (adjusted for length of exposure) had been hospitalized for psychiatric indications (not significant).”

We wished the story had pressed the study authors more about this.

Does the story adequately explain/quantify the harms of the intervention?

Not Applicable

It’s conceivable that changing the standard of care for patients by reducing drug doses may carry some risk. Could some patients’ symptoms be less-well controlled? Then again, drugs are very much overused in this area. And on average the study showed better symptom relief with the lower doses. No harms were documented in the study–no increase in hospitalizations at least.  So while we can’t give credit here, we won’t ding the story either. We’ll rate it Not Applicable.

Does the story seem to grasp the quality of the evidence?

Satisfactory

While we would have liked a few more numbers, the story does explain that the comprehensive study included many clinics nationwide and two years of follow up on 404 patients. Since schizophrenia is a chronic condition, studies going beyond two years would help solidify these results — and the study itself mentioned that the researchers plan to follow patients out to five years. Overall, however, we think the description of the evidence is sufficient to warrant a Satisfactory rating.

Does the story commit disease-mongering?

Satisfactory

There was no disease mongering.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story quotes experts who were not authors on the study.

Does the story compare the new approach with existing alternatives?

Satisfactory

There were good explanations of the two alternatives being compared by the research itself — the drug-focused standard and the more comprehensive integrated care.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story touches on availability when it says, “In 2014, Congress awarded $25 million in block grants to the states to be set aside for early-intervention mental health programs. So far, 32 states have begun using those grants to fund combined-treatment services, Dr. Heinssen said.” That doesn’t provide as much detail as readers might like as to when and where they might find these services, but it gives a general idea of where things stand.

Does the story establish the true novelty of the approach?

Satisfactory

The story makes it clear that this was the most rigorous trial of this particular version of treatment in the United States. It notes that such treatment has been more widely used in Europe.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story shows original reporting and does not rely on a news release.

Total Score: 7 of 9 Satisfactory

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