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.

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.

“As a rule, 50% of schizophrenics don’t take their medicine when they are outside a hospital setting,” Liberman said. “The data we have compiled here cuts the non-compliance rate in half, and several hundred hospitals throughout the world have adopted the training methods we have developed here. It’s one of the few things we are now exporting to Japan, for example.”

Liberman, 52, heads all the hospital’s schizophrenic research programs and has been affiliated with Camarillo since the early 1970s, when UCLA first became an equal partner in the hospital’s research.

The hospital’s projects delve into a multitude of research areas.

In one recent project headed by Dr. Michael Foster Green, the “voices,” or auditory hallucinations, heard by schizophrenics were reduced by 59% simply by having patients quietly hum a single note while they were hallucinating. Green’s theory is that the voices are generated by subvocal activity, inaudible vibrations in the voice box.

Green’s research is continuing in the hopes of finding a simple behavioral technique that can substantially reduce auditory hallucinations in the entire schizophrenic population.

In the next few years, Camarillo is expected to once again become a major center for basic drug research, this time involving a new drug called Clozapine, which has shown beneficial results for 50% of schizophrenics who do not respond to the current generation of drugs.

The problem with Clozapine, however, is that it also produces serious side effects, notably a reduction of white blood cells that can lead to death. According to Liberman, the new drug will cost $9,000 a year for patients because it must now be administered during home visits by nurses.

The 1,100 patients at Camarillo are almost evenly divided between those who are mentally ill and those who are developmentally disabled. While Liberman’s focus is on schizophrenia, the hospital’s research staff has also pioneered in work with the mentally retarded.

Paul Satz, a clinical psychologist who supervises the overall research effort at Camarillo, has worked with both groups in the last decade in the area of brain function.

His current areas of interest include the brain damage caused by AIDS, the effects of aging on the brain and the phenomenon of left-handedness in both the general population and among those who are in mental institutions.

“From my work here, as well as at UCLA, I have come to the position that there are at least two types of left-handedness,” said Satz, who is also chief of neuropsychology at the UCLA Neuropsychiatric Institute. “One is natural or genetic, but there is also another group that is pathological.

“Their handedness occurs from early damage to the left hemisphere of the brain,” Satz continued. “There is no way to estimate what percentage this is in the general population, but if you go into the units here at Camarillo, you see significant increases in non-right-handedness.”

In the general U.S. population, Satz said, right-handers make up about 90% of the population. In his work with the mentally retarded and ill at Camarillo, however, Satz has found that only about 40% of the patients are right-handed and about 20% left-handed.

Another group of about 40%, first discovered by Satz, has been found to be “ambiguous-handed,” or equally unskilled with either hand.

While there are few applications of the work on left-handedness, Satz said that there is considerable public interest in any research on the subject, especially among people who are left-handed.

He has uncovered a simple test to determine whether left-handedness in an individual is a natural phenomenon or the result of some early brain injury, he said.

“We think we have found a biological marker for pathological left-handedness,” Satz said. “It’s called right hemihypoplasia, and it produces an ever-so-slight shortening of the right hand or right foot. It’s a useful procedure. You just measure the feet and hands.”

Even in many cases where there has been brain damage in early childhood that causes left-handedness, Satz said the brain can recover so well that there are no other signs of damage. He has found pathological origins for successful left-handed lawyers and doctors only by measuring their feet, Satz said.

“I should stress that there is no cause for alarm by parents if their child is left-handed,” Satz said. “They should leave it alone unless there are some problems. I wouldn’t advise anybody to run out and have their child’s feet measured.

“This is just one of the things we are learning about left-handers. There is much more to be known,” Satz said. “You have to remember that left-handedness was suppressed in this country for a long time. At the turn of the century, because of that, the number of left-handers was only about 4%.

“Even today there are countries that suppress left-handers. In Russia and in Turkey, the prevalence is less than 3% compared to 10 to 13% in the United States. Forcing a child who is left-handed to be right-handed can interfere with speech acquisition. Children should be left to develop alone.”

His research at Camarillo has shown that brain injury early in life increases the incidence of left-handedness and ambiguous-handedness, Satz said. But one unanswered question is what causes left-handedness in nature where there is no brain damage.

“We still don’t know,” Satz said. “It is one of the areas we are just beginning to explore.”

While Camarillo had gained national prominence as a research center in the 1950s, the kind of work done today by Liberman and Satz and their colleagues was threatened in the early 1970s when then-Gov. Ronald Reagan decided to cut out state funding for mental health research at state mental hospitals.

Only the intervention of the California Mental Health Department and UCLA kept the research work at Camarillo alive, and Satz said UCLA’s involvement has been especially important in maintaining the hospital’s reputation.

“There’s probably been more research out of this hospital than any state hospital in the United States over the years,” Satz said. “That’s largely because of the unique partnership here with UCLA and the generous funding we have continued to receive.

“There are no more than a half-dozen centers in the country like this,” he added. “We have both the resources of UCLA and the reservoir of patients here to draw on. For researchers, that combination provides a rare opportunity.”