"More than two million people in the United States have a diagnosis of schizophrenia httphealth.nytimes.comhealthguidesdiseaseschizophreniadisorganizedtypeoverview.htmlinlinenytclassifier and the treatment for most of them mainly involves strong doses of antipsychotic drugs that blunt hallucinations and delusions but can come with unbearable side effects like severe weight gain or debilitating tremors. Now results of a landmark governmentfunded study httpajp.psychiatryonline.orgdoifull.appi.ajp.. call that approach into question. The findings from by far the most rigorous trial to date conducted in the United States concluded that schizophrenia patients who received a program intended to keep dosages of antipsychotic medication as low as possible and emphasize oneonone talk therapy and family support made greater strides in recovery over the first two years of treatment than patients who got the usual drugfocused care. The report to be published on Tuesday in The American Journal of Psychiatry and funded by the National Institute of Mental Health comes as Congress debates mental health httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsmentalhealthanddisordersindex.htmlinlinenytclassifier reform and as interest in the effectiveness of treatments grows amid a debate over the possible role of mental illness in mass shootings. Its findings have already trickled out to government agencies On Friday the Centers for Medicare httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsmedicareindex.htmlinlinenytclassifier  Medicaid httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicsmedicaidindex.htmlinlinenytclassifier Services published in its influential guidelines a strong endorsement of the combinedtherapy approach. Mental health reform bills now being circulated in Congress mention the study by name said Dr. Robert K. Heinssen the director of services and intervention research at the National Institute of Mental Health who oversaw the research.  In  Congress awarded  million in block grants to the states to be set aside for earlyintervention mental health programs. So far  states have begun using those grants to fund combinedtreatment services Dr. Heinssen said. Experts said the findings could help set a new standard of care in an area of medicine that many consider woefully inadequate the management of socalled first episode psychosis httphealth.nytimes.comhealthguidesdiseasepsychosisoverview.htmlinlinenytclassifier that first break with reality in which patients usually people in their late teens or early s become afraid and deeply suspicious. The sooner people started the combined treatment after that first episode the better they did the study found. The average time between the first episode and receiving medical care  for those who do get it  is currently about a year and half. The more holistic approach that the study tested is based in part on programs in Australia Scandinavia and elsewhere that have improved patients lives in those countries for decades. This study is the first test of the approach in this country  in the real world as researchers described it meaning delivered through the existing infrastructure by community mental health centers. The drugs used to treat schizophrenia called antipsychotics work extremely well for some people eliminating psychosis with few side effects but most who take them find that their bad effects whether weight gain extreme drowsiness httphealth.nytimes.comhealthguidessymptomsdrowsinessoverview.htmlinlinenytclassifier or emotional numbing are hard to live with. Nearly three quarters of people prescribed medications for the disorder stop taking them within a year and a half studies find.   https_id As for medications I have had every side effect out there from chills and shakes to lockjaw and lactation said Maggie  who asked that her last name be omitted. She received a treatment similar to the new approach as part of a related trial did well and is now attending nursing school.   https Doctors praised the study results. Im very favorably impressed they were able to pull this study off so successfully and it clearly shows the importance of early intervention said Dr. William T. Carpenter a professor of psychiatry at the University of Maryland School of Medicine who was not involved in the study. Dr. Mary E. Olson an assistant professor of psychiatry at the University of Massachusetts Medical School who has worked to promote approaches to psychosis that are less reliant on drugs said the combined treatment had a lot in common with Open Dialogue a Finnish program developed in the s. These are zeitgeist ideas and I think its thrilling that this trial got such good results Dr. Olson said. In the new study doctors used the medications as part of a package of treatments and worked to keep the doses as low as possible minimizing their bad effects. The sprawling research team led by Dr. John M. Kane chairman of the psychiatry department at Hofstra North ShoreLIJ School of Medicine randomly assigned  community care clinics in  states to provide either treatment as usual or the combined package. The team trained staff members at the selected clinics to deliver that package and it included three elements in addition to the medication. First help with work or school such as assistance in deciding which classes or opportunities are most appropriate given a persons symptoms. Second education for family members to increase their understanding of the disorder. And finally oneonone talk therapy in which the person with the diagnosis learns tools to build social relationships reduce substance use and help manage the symptoms which include mood problems as well as hallucinations httphealth.nytimes.comhealthguidessymptomshallucinationsoverview.htmlinlinenytclassifier and delusions. For example some patients can learn to defuse the voices in their head  depending on the severity of the episode  by ignoring them or talking back. The team recruited  people with firstepisode psychosis mostly diagnosed in their late teens or s. About half got the combined approach and half received treatment as usual. Clinicians monitored both groups using standardized checklists that rate symptom severity and quality of life like whether a person is working and how well he or she is getting along with family members. The group that started on the combined treatment scored on average more poorly on both measures at the beginning of the trial. Over two years both groups showed steady improvement. But by the end those who had been in the combined program had more symptom relief and were functioning better as well.The researchers expect to have lowered average doses in the combined program but had not yet finished analyzing that data. One way to think about it is if you look at the people who did the best  those we caught earliest after their first episode  their improvement by the end was easily noticeable by friends and family Dr. Kane said. The gains for those in typical treatment were apparent to doctors but much less obvious. Dr. Kenneth Duckworth medical director for the National Alliance on Mental Illness an advocacy group called the findings a gamechanger for the field in the way it combines multiple individualized therapies suited to the stage of the psychosis. The study begun in  almost collapsed under the weight of its ambition. The original proposal called for two parallel trials each including hundreds of firstepisode patients. But that plan was changed due in part to recruiting problems said people familiar with the project. Its been a long haul Dr. Heinssen added but its worth noting that it usually takes about  years for a new discovery to make it into clinical practice or thats the number people throw around. But this process only took seven years. Correction October   An article on Tuesday about a study of the treatment of firstepisode schizophrenia referred incorrectly to the conclusions of the study. Though it studied a program intended to reduce medication dosages the researchers do not yet know for sure if dosages were lowered or by how much. Therefore the study did not conclude that schizophrenia patients who received smaller doses of antipsychotic medication and a bigger emphasis on oneonone talk therapy and family support made greater strides in recovery. The study did conclude that the alternative treatment program as a whole led to better outcomes. The article also erroneously attributed a statement to Dr. Robert K. Heinssen who oversaw the research. It was scientists familiar with the project  not Dr. Heinssen  who said that the studys original proposal calling for two nearly identical trials was changed in part because of recruiting problems. Dr. Heinssen said that one trial was redirected but did not say why. And because of an editing error the article misidentified the institution where Dr. Heinssen is director of services and intervention research. It is the National Institute of Mental Health not the Centers for Medicare  Medicaid. Correction October   An article on Oct.  about a study of the treatment of firstepisode schizophrenia using information from a patient advocacy organization referred incorrectly to the experience of one woman who had been treated for the disorder. The yearold woman identified only as Maggie was not a participant in the study that researchers published in The American Journal of Psychiatry on Oct.  she received treatment in a related trial."