September 21, 2005
NAMI Praises NIMH Study on Treatment of Schizophrenia;
Medications Must Be Chosen Carefully;
Issues Identified for Continued Research
Arlington, VA - The National Alliance on Mental Illness (NAMI) this week praised the National Institute for Mental Health (NIMH) for the first installment in a series of studies on the treatment of schizophrenia.
The "Clinical Antipsychotic Trials of Intervention Effectiveness" (CATIE) are the largest comparative study of old generation and newer "atypical" medications ever conducted. Findings from the study, published in the New England Journal of Medicine, have implications for both the role of medication in treating schizophrenia and continued access to a range of options.
"The CATIE study is an important first step in giving physicians and consumers basic information to make informed choices in selecting medications to treat schizophrenia," said NAMI medical director Ken Duckworth.
"It underscores the need for greater investment in scientific research - particularly in moving toward more effective, third-generation medications and ultimately a cure for schizophrenia."
The study found that old and new medications are comparably effective, but both are also associated with a high rate (74%) of discontinuation by consumers due to side effects or incomplete control of symptoms. Although older medications performed as well as newer medications, the study noted that based on previous research, newer agents "appear more efficacious than conventional drugs in reducing negative symptoms (e.g., lack of emotion, interest and expression)."
"For many Americans living with schizophrenia, newer generation medications have made the difference in level of recovery," Duckworth said. "For each person, the choice of medication must be made carefully. Different medications have different side-effects. They are not interchangeable."
Clinical factors affecting the choice of medication, include family history, height, weight, ethnicity, and co-occurring conditions.
Future installments of the CATIE study also will address predictors of response, cost-effectiveness, outcomes and quality of life.
"Discontinuation in taking medication is only one measurement of effectiveness," Duckworth said.
NAMI noted that the study especially suggests the need for greater research on non-adherence in taking medication, including:
- Those factors that influenced 26% of consumers to continue taking medication in contrast to the large majority that discontinued treatment.
The degree to which anosognosia (lack of insight)— in which as many as 60% of persons with schizophrenia sometimes believe they are not sick—may have contributed to the high rate of discontinuation.
Other factors, such as improvements in symptoms, or ones unrelated to the effects of medication.
"More research is needed, but clearly over time, CATIE's findings will have a significant impact on decisions being made by states and other mental healthcare payers," said NAMI executive director Michael. J. Fitzpatrick. "Treating individuals requires a range of individualized medication options, but the bottom-line is that they must be evidence-based."
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NAMI has made available several tools that can assist advocates in addressing concerns related to CATIE. View the tools which include talking points and 10 questions and answers on CATIE.
In 2004, NAMI released its own 40-page report, "Roadmap to Recovery and Cure" (pdf, opens in a new browser window) calling for smarter, stronger federal government research on serious mental illnesses, including a $1 billiion increase for the NIMH over five years.