It has long been believed that only the minority of people could recover from schizophrenia. However, a Norwegian research team have found that more than half of the study participants in their recent treatment study are doing well. Treated over a four year period, 55 per cent of the young people were partially or fully recovered. Furthermore, 10 per cent of those who are fully recovered no longer needed medication.
"Having such a high proportion be well-functioning shows that schizophrenic patients have a greater potential to get well than previous research has shown," says Professor Anne-Kari Torgalsbøen at the University of Oslo’s Department of Psychology.
"The results of this study give hope not only to patients and their relatives, but also provide inspiration for everyone who treats young people with psychotic disorders," she says.
Study participants were recruited within five months of being hospitalized or starting outpatient treatment for first-episode mental disorders. "Schizophrenia means that the patient has had serious delusions or hallucinations, and a big drop in their ability to function," says Torgalsbøen. "These symptoms create a lot of anxiety and create a huge emotional strain,"
Not only are the symptoms of psychosis difficult to manage, the stigma of mental health makes it especially hard for people to share their experiences. As one paitent said
"How well you do as a person has a lot to do with how you’re treated as a person."
The treatment programme is based on the Norwegian Directorate of Health’s national professional guidelines. It includes psycho-education and symptom management strategies. It also included discussions, and some received cognitive therapy. "They get training in thinking critically about how realistic their thoughts are," says Torgalsbøen.
The majority of participants have received regular, systematic treatment over several years. Most have taken antipsychotic medication during the follow-up period.
They also received help with finding a vocation, at first through supported work and then regular employment. One participant who was asked what she had found effective about the treatment, responded: "I got help building myself up again.”
Torgalsbøen's research has also focused on traits associated with full or partial recovery.
"The participants who recover show greater resilience than those who are still struggling with their challenging symptoms and ability to function,” says Torgalsbøen.
Resilience is the psychological ability to adapt positively to adversity. People with good resilience can handle crises and stresses in a positive way. This was measured in a questionnaire, and involved them agree or disagreeing with statements such as:
• "I'm not easily discouraged by defeat." • "I'm working to reach my goals, regardless of the obstacles I meet on the road."
Torgalsbøen suggested that the study shows that individuals who manage to put the disease behind them and look ahead have more success in regaining their health. This study may point to a new approach in the treatment of schizophrenia, says Professor Kenneth Hugdahl at the University of Bergen. "Torgalsbøen has turned the problem on its head and asked questions that haven’t been asked before, like what helps someone get healthy," says Hugdal, who is a professor of biological psychology. "We can imagine that future treatment would try to strengthen the resilience of people with low levels of resilience," he says. "And in any event, showing that schizophrenia is not a hopeless disease is a very important message.”
One critical factor in the study was the early intervention. “It’s important to emphasize that these patients received early treatment. For example, we know that cognitive therapy works better when the patient gets help early so that the irrational thoughts don’t get a foothold," says Torgalsbøen. This means that it is not simply a question of replicating this treatment programme with older patients.
Another important factor is the low dropout rate within the study. Treatment completion rates are always a strong indicator or treatment outcome. Torgalsbøen attributes the close follow-up of participants as being important in the high retention rate. "We’ve been conducting follow-ups once a year for ten years and have a low dropout rate of only 21 per cent," she says. “Other studies have lost contact with these people, which has probably led to the number of completely healthy participants being underreported in the past.”
Poor retention rates therefore may have masked promising outcomes in previous studies. When sustaining people in the treatment processes itself is critical to their overall outcome. "This and other new international studies show that schizophrenic patients have far greater potential for improvement than expected," says Torgalsbøen.
To read a review of the research study, click here.