The Schizophrenia Patient Outcomes Research Team (PORT) Treatment Recommendations and the results of a corresponding study of actual patient care, both published in Schizophrenia Bulletin (Vol. 24, No. 1, 1998), underscore the need for greater efforts to ensure that treatment research findings are translated into clinical practice.
Schizophrenia Treatment Recommendations
Based on an exhaustive review of current scientific evidence documenting the most effective treatments, a team of more than 15 scientists from three major research centers developed the first science-based guidelines for schizophrenia treatment: The Schizophrenia Patient Outcomes Research Team (PORT) Treatment Recommendations.
Funded by the National Institute of Mental Health and the Agency for Health Care Policy and research, the five-year study identified medical treatments and non-medical services that have been proven to reduce schizophrenia symptoms and improve recovery.
The researchers organized a total of 30 treatment recommendations into seven categories of intervention: (1) antipsychotic medications; (2) additional medications for depression, anxiety or hostility; (3) electroconvulsive therapy; (4) psychological treatments; (5) family interventions; (6) vocational rehabilitation; and (7) assertive community treatment.
Schizophrenia Patient Study
Combining the expertise of the Center for Research on Services for Serious Mental Illness (at Johns Hopkins University and the University of Maryland), the University of Maryland Center for Mental Health Services Research, and the Maryland Psychiatric Research Center (at the University of Maryland), the research team went on to study the actual treatment received by hundreds of individuals with schizophrenia to determine how well their care conformed to the corresponding treatment recommendations.
The researchers found alarming rates of inappropriate dosages of antipsychotic medications; untreated depression; untreated side effects; second-class treatment of African Americans; inadequate family supports; and minimal vocational rehabilitation and community-based treatment programs.
Overview of key findings
Inappropriate dosages of antipsychotic medications: While most patients with schizophrenia do receive antipsychotic medication, only 29.1 percent receive the appropriate dosage over the long-term. About one-third (31.9) percent of patients are prescribed above the recommended dosage range and another third (39.1 percent) below range.
Depression not treated: Fewer than half of the patients who also have depression receive antidepressant medication, despite the fact that 15 percent of people with schizophrenia commit suicide.
Untreated side effects: Although the majority of study participants (74.2 percent of inpatients and 79.1 percent of outpatients) reported side effects from their antipsychotic medications, only about half of these (53.9 percent inpatients and 46.1 percent outpatients) receive appropriate treatment to counteract these side effects.
Second-class treatment of African Americans: African Americans are almost twice as likely to be overmedicated with antipsychotic medications (27.4 percent of minority patients versus 15.9 percent of their Caucasian counterparts), which also corresponds to a higher reported rate of side effects. In addition, African Americans are twice as likely to be denied medication for serious symptoms of depression (29.6 percent versus 47.3 percent of their Caucasian counterparts).
Inadequate family supports: Fewer than 10 percent of families of outpatients with schizophrenia receive education and support, even though the vast majority of families are in regular contact with their relative with schizophrenia and family education has been shown to improve clinical outcomes.
Vocational rehabilitation lacking: Even though 85 to 90 percent of individuals with serious mental illness are unemployed, less than one-fourth (22.6 percent) of those with schizophrenia are involved in any type of employment assistance program.
Minimal community-based treatment: 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 in treating the most severe cases of schizophrenia and in preventing relapse and hospitalization.
The Program for Assertive Community Treatment (PACT) model consists of a team of care providers who provide direct treatment and support to people with schizophrenia where they live, not in a clinical setting. PACT team members make sure medications are being taken, watch out for early signs of worsening symptoms, and help clients with daily tasks, such as grocery shopping, managing money, and scheduling doctor appointments.
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