NAMI Guide Educates Patients, Families

The National Alliance on Mental Illness (NAMI) released the Consumer and Family Guide to Schizophrenia Treatment last month in response to the results of a landmark study showing that fewer than half of individuals with schizophrenia receive adequate treatment.

"It's a disgrace that more than half of the two-plus million Americans suffering from schizophrenia today receive substandard care," said NAMI Executive Director Laurie Flynn at a NAMI-sponsored press briefing in Washington, D.C., last month. "The NAMI guide empowers people to push for the treatments and services that have been shown to work."

The results of a national five-year study of schizophrenia show that fewer than half of the patients treated for schizophrenia are receiving proper doses of antipsychotic medications or appropriate psychosocial interventions, according to Anthony Lehman, M.D., principal investigator of the study and director of the Center for Mental Health Services Research, University of Maryland School of Medicine.

"Clinicians understand the need to prescribe antipsychotic medications, but the most effective approach integrates appropriate medication management with psychosocial treatments," said Lehman.

The researchers found that combined medication and psychosocial interventions such as helping the patient's family members to cope with the illness cut the relapse rate for psychosis to 20 percent, compared with 40 percent for anti-psychotic medication alone, according to Lehman.

A team of 15 investigators from the University of Maryland and Johns Hopkins University analyzed published scientific research on schizophrenia and assessed the quality of evidence for schizophrenia treatment. After documenting the most effective treatments, the researchers developed the Schizophrenia Patient Outcomes Research Team (PORT) Treatment Recommendations, which NAMI translated into an easy-to-understand consumer guide.

Lehman commented that the PORT recommendations are scientifically based and consistent with APA's Practice Guideline on the Treatment of Patients with Schizophrenia.

To better understand how to improve care, the researchers compared their treatment recommendations with current clinical practice. They surveyed more than 700 patients with schizophrenia from inpatient and outpatient settings in two states and reviewed their medical records.

Less than 50 percent of patients were receiving treatment consistent with the study recommendations, Lehman observed. An exception was the rate of prescription for antipsychotic medications, which was found to be around 90 percent, though not always at an appropriate dose.

For example, researchers found that only 29 percent of patients with schizophrenia received the appropriate dose of anti-psychotic medications. Another 32 percent of patients were prescribed above the recommended dose range and another 40 percent below the recommended dose range, according to Lehman.

These were among other key findings:

• Only half of the study participants reporting side effects from antipsychotic medications received appropriate treatment to counteract these side effects.


• Less than 50 percent of the patients with depression received antidepressants, despite the fact that 15 percent of people with schizophrenia commit suicide.


• African Americans are almost twice as likely as whites to be overmedicated with antipsychotic medications and not be prescribed medication for serious symptoms of depression.


• Less than 10 percent of families of outpatients with schizophrenia receive education and support.


• Even though 85 percent to 90 percent of individuals with serious mental illness are unemployed, less than one-fourth are involved in any employment assistance program.


• Only between 2 percent and 10 percent of individuals with schizophrenia are participating in assertive community treatment programs even though they are widely known to be highly effective.

Lehman commented, "There is good evidence that the Program for Assertive Community Treatment model is effective in reducing the relapse rate of people with schizophrenia."

This program consists of a mobile team of care providers who provide direct treatment and support to people with schizophrenia where they live.