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New Treatment For Mentally Ill Cuts Back on Medication : Schizophrenia: Camarillo State Hospital trials show lowering medication can help most schizophrenics. Ironically, the hospital pioneered the use of anti-schizophrenic medication.

December 28, 1989|WILLIAM OVEREND | TIMES STAFF WRITER

The 11 schizophrenic patients in the special research unit at Camarillo State Hospital were having a party.

They chatted among themselves and with the hospital staff over lunch. When the meal was finished, one played the piano while the others sang some songs.

Nine months earlier, the scene would have been inconceivable.

These patients, all suffering from severe schizophrenia, had been among the most heavily medicated in Camarillo's mentally ill population.

But the medicine wasn't helping them. They were unresponsive to even the highest doses of such powerful drugs as Thorazine and Haldol.

Instead, they had simply suffered the side effects--tremors, muscle rigidity and a slow shuffling walk similar to the symptoms of Parkinson's disease.

The idea of Dr. Robert P. Liberman and his colleagues at Camarillo's research center was to gradually reduce the medication of these 11 patients and see how they would respond over a period of months.

In most of the patients, the results were remarkable. Eight of the 11 had become much more alert and responsive to their surroundings, one step closer to their ultimate return to the outside world.

The project was just one of the dozen or so research programs under way at any given time among the mentally ill and developmentally disabled at Camarillo.

Since the 1950s, Camarillo and California's other state mental hospitals have periodically found themselves in the center of controversy, first for the mass warehousing of thousands of patients, later as they emptied their populations into surrounding communities.

There have been scandals from time to time, cases of patient abuse and neglect common to mental hospitals everywhere. Through it all, with little public fanfare, Camarillo's research program has become one of the most important in the world.

During the 1950s, researchers at Camarillo performed the critical tests that led to widespread acceptance of the generation of drugs now used in treating schizophrenia.

In more recent years, in partnership with the UCLA Neurological Institute, Camarillo researchers have continued the research into schizophrenia while branching out into other fields.

The research, occupying about a dozen psychiatrists and psychologists at any time, ranges from the treatment of autistic children to controversial studies of the factors contributing to increased left-handedness among the mentally ill and retarded.

This particular group of schizophrenic patients was participating in a double-blind test aimed, ironically, at finding ways to reduce the medical profession's current reliance on some of the anti-schizophrenic drugs first tested at Camarillo 40 years ago.

Neither the hospital staff nor the patients themselves knew when the medication levels were being lowered.

As the dosages were dropped, however, most of the patients showed a marked increase in mental alertness. Only in three cases were there negative reactions requiring continuation of the previous levels of medication.

"There's an emerging awareness in the mental health field that a goodly number of patients suffering schizophrenia do not respond well to the medications now in use, maybe 20% or so," Liberman explained.

"There is no reason to give medication with serious side effects to people if there are no benefits," he continued. "This is part of an effort to return these people to a point where they can eventually be released and function on their own."

The lowered dosages of Thorazine and other drugs are only the first step in a two-phase project, Liberman added.

The second phase is a concentrated three-month training program, using videotapes and role modeling techniques developed at Camarillo over the last four years, designed to teach patients how to properly medicate themselves and communicate their medical problems to health professionals.

"The core problem for these people is that they feel they have no control over their disease," Liberman said. "We want patients to get the know-how and the skills to take their medication and a greater sense that they are in control of their illness."

Part of the training teaches schizophrenics to watch out for tremors, muscle spasms and other side effects of their medications that require the intervention of a doctor. They are also taught to look for feelings of irritation and suspicion that are the warning signs of a full-blown schizophrenic episode.

"The most important thing we are trying to do here is get a better handle on what part of the illness responds best to medication and what is best handled by social therapy," Liberman said.

"Most of these patients will be going back to their homes or to board-and-care facilities," he added. "The disabilities they have--such as lack of initiative and social withdrawal--are most likely to respond to behavior therapy rather than drugs.

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