Background and Aims: Some patients with the diagnosis of a psychotic disorder wish to minimize or avoid medications. They are seeking a recovery model with the aim of maximizing independence and healing.
Methods: We report qualitative and quantitative data on a group of 69 motivated adult patients with psychosis as a proof of concept study — that management with minimal or no medication is possible for some.
Patients engaged in dialogical psychotherapy, medication management, and integrative medicine practices for at least six months. An additional 209 patients presented for treatment but did not continue for six months. An anonymous, matched comparison group of 69 patients was generated from electronic health records. We measured symptoms serially with the MYMOP-2, the Positive and Negative Syndrome Scale, the MADRS, the Clinical Global Inventory, and the BASIS. Narrative interviews generated qualitative data.
Results: Of our 69 patients, 39 managed psychosis without the use of medication. Another 25 managed well on low-dose antipsychotic medications. Four individuals required progressively higher levels of medication and one decompensated. Our patients functioned at significantly higher levels than the comparison populations and at significantly lower levels of medication. The overall cost-benefit was favorable in creating fewer hospitalization, crises, and diminished suicidality.
Conclusions: The results support the idea that motivated patients can engage in an approach that combines integrative medicine, psychotherapy, and conventional medication management in association with involvement of family and friends in a community effort and can recover without or with low doses of conventional medications. Not all patients can participate in such a program.