Updated Schizophrenia PORT Treatment Recommendations

Abstract

When the original report on the Schizophrenia Patient Outcomes Research Team (PORT) was published in this journal (Lehman, Steinwachs et al. 1998), it marked the first systematic, practice-oriented review of treatment approaches for one of the most disabling illnesses. In the intervening years, study has contributed to major changes in approaches to schizophrenia treatment—at least to the early stages of such change. Now, the Schizophrenia PORT sequel has been released (Lehman et al. 2004). Like a good sequel, it builds on a familiar story line, but adds twists, with information about new somatic treatments and further evidence about psychosocial interventions. It is exceptional work—representative of the best that medical science has to offer mental health care. At the same time, the updated treatment recommendations are still limited by the constraints and biases of medical science. updated PORT treatment recommendations, with these strengths and limits, are a welcome contribution, but not the breakthrough approach to schizophrenia treatment and mental health care that is needed. Commenting on the original study, I noted: The Schizophrenia PORT has accomplished a great deal for schizophrenia research by demonstrating that a body of knowledge does exist, that it is possible to delineate valid versus inappropriate treatments, and that much current care does not match these standards (Hogan, 1998, p. 29). I still believe that praise was appropriate. However, advances in research have value (beyond satisfying intellectual curiosity) only when they are able to contribute to improved patient care. From this more important but unquestionably more challenging standard, how do we judge this work and how does the new work contribute? How have developments in mental health care, policy, and science in the intervening years shaped our assessment of the original work? And how do the updated treatment recommendations affect the worth and value of the overall project? Recent Developments in Mental Health Care, Policy, and Science