Therapy without drugs may suffice to ward off psychosis

NEW YORK (Reuters Health) - Young adults at very high risk of psychotic illness should receive talk therapy rather than antipsychotic drugs as an initial treatment, a new study suggests.

The results might ease fears about overtreating people who have warning signs of psychosis but not a full-blown disease, but the study findings were not conclusive because the number of participants was too small.

"This shows it's quite safe and reasonably effective to offer supportive psychosocial care to these patients," Dr. Patrick McGorry, an author of the study, told Reuters Health. There is "no evidence to suggest that antipsychotic medications are needed in first-line" treatment, he said.

The clinical trial included 115 clients of a Melbourne, Australia, clinic for young people deemed to be at "ultra-high risk" for a psychotic disorder such as schizophrenia.

The study was open to individuals between the ages of 14 and 30 who met at least one of three criteria: having low-level psychotic symptoms, having had previous brief episodes of psychotic symptoms that went away on their own or having a close relative with a psychotic disorder along with low mental functioning during the past year.

The study compared three regimens: talk therapy focused on reducing depression symptoms and stress while building coping skills plus a low dose of the antipsychotic risperidone, or talk therapy plus a placebo pill or therapy emphasizing social and emotional support plus a placebo.

The goal was to see how many participants in each group progressed to full-blown psychosis.

After a year, there was no notable difference between the groups, however about 37 percent of the participants dropped out during the study. McGorry said if the trial had included more people, significant differences between the groups might have emerged.

The study appears online in the Journal of Clinical Psychiatry.

Researchers have been working to identify people at risk of developing psychotic disorders. "The importance of detecting early signs and symptoms of a serious mental illness is not controversial," said Dr. Matcheri Keshavan, a professor of psychiatry at Harvard Medical School. "But the best way of treating or preventing it remains controversial."

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Therapy without drugs may suffice to ward off psychosis