The effect of adjunctive psychotherapy on health related outcomes among patients with schizophrenia

Although antipsychotics have been recommended as the first-line treatment for schizophrenia, many patients are not adherent to their treatment regimens, which leads to worse treatment outcomes. As a result, psychotherapy has been suggested as an adjunctive treatment to improve patients' treatment outcomes. However, the effectiveness of psychotherapy on treatment outcomes is unclear. Therefore, the purpose of this study is to assess whether using psychotherapy in addition to pharmacotherapy improves medication persistency, reduces the risk of hospitalization, and lowers treatment costs among Medicaid populations. 2001 to 2003 Medicaid Analytic eXtract (MAX) files were used as a data source to identify patients with schizophrenia who received antipsychotic treatments. The use of psychotherapy was dichotomized as users versus non-users. Medication persistency was measured as the number of days to discontinuation after the initiation of antipsychotic use. Number of hospitalizations and treatment costs were measured as continuous variables. Factors associated with psychotherapy use were evaluated by a logistic model, and medication persistency between psychotherapy users and non-users was compared by Cox proportional-hazard regressions. Hospitalizations and treatment costs were analyzed by a hurdle model and generalized linear models respectively. The prevalence of psychotherapy use was about 16% in this study. Older and Black patients were less likely to receive psychotherapy, while patients with comorbid depression were more likely to receive psychotherapy. We found psychotherapy only improved patients' persistency within the first two months of follow-up. The use of psychotherapy was not found to be associated with hospitalizations, but it was associated with higher treatment costs. In conclusion, our results suggest that the rate of psychotherapy use was low and that most patients only received psychotherapy for a short period of time. These results may explain the short-term effect of psychotherapy on medication persistency as well as the null association between psychotherapy use and hospitalizations. Since the effect of psychotherapy may not appear until a patient receives sufficient psychotherapy treatment, clinicians should better incorporate psychotherapy into treatment courses. In addition, Medicaid policy makers should make sure that patients with schizophrenia have adequate access to psychotherapy in order to achieve the best treatment outcomes