Individualized and Team-Driven Care Can Improve Symptoms of Schizophrenia

A 2015 study in the American Journal of Psychiatry provided exciting evidence of a novel treatment’s effectiveness in treating schizophrenia. The new treatment changes the way medical providers respond to first time psychotic episodes and emphasizes early treatment, as well as collaboration among the healthcare team and the patient. This team-based approach demonstrates the benefits of providing care that is individualized and communicated with the patient.
Schizophrenia affects more than 2 million people in the United States and accounts for almost 30 percent of all spending on mental health according to the National Institutes of Health. Currently, the most common treatment for schizophrenia involves high doses of antipsychotic drugs, but for many people these treatments fail to effectively manage the symptoms and instead leave them to deal with debilitating side effects such as violent tremors and excessive weight gain. That’s why effective alternative treatments are greatly needed.
Dr. Kim Mueser, who is a clinical psychologist and executive director of the Center for Psychiatric Rehabilitation, developed the psychosocial portion of the new treatment called NAVIGATE. This regiment has three main goals: providing tools for building social relationships and dealing with a first psychotic episode, working with a counselor to integrate back into society as soon as possible, and educating family members about schizophrenia. Most importantly, the NAVIGATE program must begin within six months of the first psychotic episode. This is in stark contrast to our current timeline for the treatment of schizophrenia where the average time between the first psychotic episode and treatment is about a year and half.
Along with providing tips for managing positive symptoms of schizophrenia, the program also stresses the importance of helping people to not define themselves based on their illness. Researcher Jennifer Gottlieb says that after one psychotic episode, people can feel instantly pathologized and their identity becomes that of a patient. The program helps these “patients” to harness positive characteristics that they’ve always had in order to recover from the episodes and move forward as a person.
At the conclusion of the two-year study, the results were very positive. Compared to the experimental group that received a medication driven treatment, the NAVIGATE group displayed more improvement in quality of life and lessening of symptoms. It appears that keeping doses of medication as low as possible and supplementing with well planned and individualized interventions like NAVIGATE really can make a difference in the lives of schizophrenic patients. Dr. Kenneth Duckworth of the National Allienace on Mental Illness has called it a “game changer for the field.”
In my opinion, this new approach is successful largely because it emphasizes communication between healthcare providers. According to Mueser, the care team met regularly to plan and coordinate on the best plan of action. In the end, the decisions were based on the patient’s personal goals, which were then communicated with the patient’s family and the NAVIGATE team to help make it happen.
This collaborative approach to providing care is the best option going forward and should be a point of emphasis for new doctors entering the field. It can be easy for a doctor to feel like they’re alone in the responsibility to make a final decision, but this new early intervention program provides room for other care providers like counselors and psychologists to weigh in on the best direction of action.
In the end, I think this leads to a better decision for the patient’s health and better care from the team as a whole. It also reflects the Association of American Medical College’s emphasis on training a new kind of doctor: one that possesses more than just scientific knowledge, including the skills to treat the entire individual and promote understanding in how people think, interact, and make decisions. As a healthcare system, we are finally beginning to realize how important mental health is in relation to the rest of the physical body and effective treatments like NAVIGATE are a testament to that.