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Mayer SF, Corcoran C, Kennedy L, Leucht S, Bighelli I. Cognitive behavioural therapy added to standard care for first-episode and recent-onset psychosis. Cochrane Database Syst Rev 2024; 3:CD015331. [PMID: 38470162 PMCID: PMC10929366 DOI: 10.1002/14651858.cd015331.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) can be effective in the general population of people with schizophrenia. It is still unclear whether CBT can be effectively used in the population of people with a first-episode or recent-onset psychosis. OBJECTIVES To assess the effects of adding cognitive behavioural therapy to standard care for people with a first-episode or recent-onset psychosis. SEARCH METHODS We conducted a systematic search on 6 March 2022 in the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ClinicalTrials.gov, ISRCTN, and WHO ICTRP. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing CBT added to standard care vs standard care in first-episode or recent-onset psychosis, in patients of any age. DATA COLLECTION AND ANALYSIS Two review authors (amongst SFM, CC, LK and IB) independently screened references for inclusion, extracted data from eligible studies and assessed the risk of bias using RoB2. Study authors were contacted for missing data and additional information. Our primary outcome was general mental state measured on a validated rating scale. Secondary outcomes included other specific measures of mental state, global state, relapse, admission to hospital, functioning, leaving the study early, cognition, quality of life, satisfaction with care, self-injurious or aggressive behaviour, adverse events, and mortality. MAIN RESULTS We included 28 studies, of which 26 provided data on 2407 participants (average age 24 years). The mean sample size in the included studies was 92 participants (ranging from 19 to 444) and duration ranged between 26 and 52 weeks. When looking at the results at combined time points (mainly up to one year after start of the intervention), CBT added to standard care was associated with a greater reduction in overall symptoms of schizophrenia (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.47 to -0.08, 20 RCTs, n = 1508, I2 = 68%, substantial heterogeneity, low certainty of the evidence), and also with a greater reduction in positive (SMD -0.22, 95% CI -0.38 to -0.06, 22 RCTs, n = 1565, I² = 52%, moderate heterogeneity), negative (SMD -0.20, 95% CI -0.30 to -0.11, 22 RCTs, n = 1651, I² = 0%) and depressive symptoms (SMD -0.13, 95% CI -0.24 to -0.01, 18 RCTs, n = 1182, I² = 0%) than control. CBT added to standard care was also associated with a greater improvement in the global state (SMD -0.34, 95% CI -0.67 to -0.01, 4 RCTs, n = 329, I² = 47%, moderate heterogeneity) and in functioning (SMD -0.23, 95% CI -0.42 to -0.05, 18 RCTs, n = 1241, I² = 53%, moderate heterogeneity, moderate certainty of the evidence) than control. We did not find a difference between CBT added to standard care and control in terms of number of participants with relapse (relative risk (RR) 0.82, 95% CI 0.57 to 1.18, 7 RCTs, n = 693, I² = 48%, low certainty of the evidence), leaving the study early for any reason (RR 0.87, 95% CI 0.72 to 1.05, 25 RCTs, n = 2242, I² = 12%, moderate certainty of the evidence), adverse events (RR 1.29, 95% CI 0.85 to 1.97, 1 RCT, n = 43, very low certainty of the evidence) and the other investigated outcomes. AUTHORS' CONCLUSIONS This review synthesised the latest evidence on CBT added to standard care for people with a first-episode or recent-onset psychosis. The evidence identified by this review suggests that people with a first-episode or recent-onset psychosis may benefit from CBT additionally to standard care for multiple outcomes (overall, positive, negative and depressive symptoms of schizophrenia, global state and functioning). Future studies should better define this population, for which often heterogeneous definitions are used.
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Affiliation(s)
- Susanna Franziska Mayer
- Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, München, Germany
| | | | - Liam Kennedy
- Department of Old Age Psychiatry, Carew House, St Vincent's Hospital, Dublin, Ireland
| | - Stefan Leucht
- Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, München, Germany
- German Center for Mental Health (DZPG), Munich, Germany
| | - Irene Bighelli
- Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, München, Germany
- German Center for Mental Health (DZPG), Munich, Germany
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Kim SW, Hyun S, Kim JK, Kim H, Jhon M, Kim JW, Park C, Lee JY, Kim JM. Effectiveness of group metacognitive training and cognitive-behavioural therapy in a transdiagnostic manner for young patients with psychotic and non-psychotic disorders. Early Interv Psychiatry 2023; 17:29-38. [PMID: 35338567 DOI: 10.1111/eip.13288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/01/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM To investigate group metacognitive training and cognitive-behavioural therapy (MCT/CBT) prospectively in a young population with various psychiatric disorders, including psychotic and mood disorders. METHODS This was a prospective study to investigate the effectiveness of group MCT/CBT on quality of life, psychotic symptoms, depression, self-esteem, perceived stress, social function and social cognition. The objective measures included the Positive and Negative Syndrome Scale (PANSS), clinical global impression (CGI), personal and social performance scale for social functioning, a computerized continuous performance test for sustained attention and a computerized emotional recognition test for social cognition. Self-report measures administered included the Subjective Well-being under Neuroleptics for quality of life, Ambiguous Intentions Hostility Questionnaire for suspiciousness, Drug Attitude Inventory, Beck Depression Inventory, Perceived Stress Scale, Brief Resilience Scale, Rosenberg Self-esteem Scale and visual analogue scale for the EQ-5D. RESULTS Among 110 young patients with early psychosis and mood disorders who participated, 82 (74.5%) completed the study. Social functioning, quality of life, self-esteem, resilience, depression, suspiciousness, social cognition, sustained attention and scores on the PANSS and CGI improved significantly after completing group MCT/CBT. Perceived stress, resilience and suspiciousness improved significantly only in participants with a non-psychotic disorder. Improvements in subjective well-being of the participants were associated with increases in self-esteem and resilience and decreases in depression and perceived stress. CONCLUSIONS Our study showed that group transdiagnostic MCT/CBT for young patients with mental illness improved subjective wellbeing, self-esteem, resilience, social cognition and social functioning and significantly diminished suspiciousness, perceived stress and depression.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Sumi Hyun
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Jae-Kyoung Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Cheol Park
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Peace & Harmony Psychiatry Clinic, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Bornheimer LA, Li Verdugo J, Thompson S. Depression Mediates the Relationships between Hallucinations, Delusions, and Social Isolation in First-Episode Psychosis. SOCIAL WORK RESEARCH 2022; 46:332-341. [PMID: 36420428 PMCID: PMC9673164 DOI: 10.1093/swr/svac025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/12/2021] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
Social isolation is common among individuals with schizophrenia spectrum and other psychotic disorders. Research indicates that social isolation relates to poorer mental health outcomes, depression, and negative symptoms, with less known about its relationship with positive symptoms. This study examined depression as a mediator in the relationships between positive symptoms (i.e., hallucinations and delusions) and social isolation among an early treatment phase sample in the United States. Data were obtained from the Recovery After an Initial Schizophrenia Episode project of the National Institute of Mental Health's Early Treatment Program. Participants (N = 404) included adults between ages 15 and 40 in a first episode of psychosis. Data were analyzed using structural equation modeling in Mplus (Version 8). The study showed that delusions (b = .095, SE = 0.04, p < .05) and hallucinations (b = .076, SE = 0.03, p < .01) were directly related to depression, and that both delusions (b = .129, SE = 0.06, p < .05) and depression (b = .254, SE = 0.09, p < .05) were directly related to social isolation. Findings of this study determined that depression functioned as a mediator in the relationships between positive symptoms and social isolation. Targeting psychosis symptomatology and depression in treatment, improving social skills and social support networks, and considering the role of stigma in social isolation are of great importance in the prevention of poorer mental health outcomes.
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Affiliation(s)
- Lindsay A Bornheimer
- PhD, is an assistant professor, School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI 48109-1106, USA
| | - Juliann Li Verdugo
- MSW, is a project coordinator, is a research assistant, School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Sara Thompson
- MSW, is a research assistant, School of Social Work, University of Michigan, Ann Arbor, MI, USA
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Gergov V, Milic B, Löffler-Stastka H, Ulberg R, Vousoura E, Poulsen S. Psychological Interventions for Young People With Psychotic Disorders: A Systematic Review. Front Psychiatry 2022; 13:859042. [PMID: 35401253 PMCID: PMC8987205 DOI: 10.3389/fpsyt.2022.859042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Psychotic disorders are commonly accompanied by intense psychological burden, and psychological interventions are usually needed in order to reduce the symptoms and help in maintaining or improving the level of psychological and social functioning after the onset of psychosis. The evidence-base for treating young people at risk for psychosis and adults with psychotic disorders is accumulating. Yet, pervasive systematic literature reviews that would include patients from the full age range being the most essential period for the risk of developing a psychotic disorder, a wide range of psychological interventions, and various types of clinical trials, have been lacking. The aim of this systematic review is to fill the gap by presenting the current research evidence from clinical trials on the effectiveness of psychological interventions for treating young people (12-30) with psychotic disorders. METHODS A systematic search was conducted in PubMed and PsycINFO followed by a 3-step screening process based on the PICOS strategy. Risk of bias of the included studies was assessed by the Mixed Methods Appraisal Tool (MMAT). Extracted data from the included studies is reported using a narrative synthesis. RESULTS Of the 1,449 publications screened, 40 from 25 studies were included in the review. Of these, 10 studies reported results from cognitive or behavioral therapy, nine from cognitive remediation therapy (CRT), and six from other types of therapies (i.e., integrative interventions combining psychoeducation and family/group interventions). All but one study found the target interventions to be effective, but the results mostly did not differ significantly from the control conditions in reducing symptoms and improving functioning, preventing relapses and hospitalization, or improving psychological or family variables. The most consistent findings were from CRT, showing more improvement in cognitive functioning compared to control conditions while not being superior in reducing symptom severity. Integrative interventions might be effective in treating young people suffering from psychotic disorders. CONCLUSION There is some evidence that psychological interventions are effective for young people with psychotic disorders. However, with regard to symptom severity, psychotherapy does not outperform control conditions, and the results do not strongly favor any specific type of treatment. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020166756], identifier [CRD42020166756].
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Affiliation(s)
- Vera Gergov
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- *Correspondence: Vera Gergov,
| | - Branka Milic
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Eleni Vousoura
- Department of Psychiatry, University of Athens, Athens, Greece
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Ventriglio A, Ricci F, Magnifico G, Chumakov E, Torales J, Watson C, Castaldelli-Maia JM, Petito A, Bellomo A. Psychosocial interventions in schizophrenia: Focus on guidelines. Int J Soc Psychiatry 2020; 66:735-747. [PMID: 32597274 DOI: 10.1177/0020764020934827] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Schizophrenia is a lifelong condition with acute exacerbations and varying degrees of functional disability. Acute and long-term treatments are based on antipsychotic drugs, even if some domains of personal and social functioning are not addressed by psychopharmacotherapy. In fact, psychosocial interventions show a positive impact on patient's functioning and clinical outcome. In addition, psychosocial interventions are significantly associated with a lower number of relapses and hospitalizations in schizophrenia. METHODS An analytical review of the International Guidelines on Psychosocial Interventions in Schizophrenia has been performed; we included the National Institute for Health and Care Excellence (NICE) guidelines, the Scottish Intercollegiate Guidelines Network (SIGN) guidelines, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines, the Schizophrenia Patient Outcomes Research Team (PORT) guidelines and the American Psychiatric Association (APA) guidelines. RESULTS The international guidelines recommend psychosocial interventions as supportive treatments alongside pharmaceutical or psychotherapeutic ones. CONCLUSION More research studies need to be conducted and included in the updated version of the international guidelines to confirm the effectiveness of psychosocial interventions in the long-term outcome of schizophrenia.
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Affiliation(s)
| | - Fabiana Ricci
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Magnifico
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Egor Chumakov
- Saint Petersburg State University, Saint Petersburg, Russia.,St. Petersburg Psychiatric Hospital № 1 named after P.P. Kashchenko, Saint Petersburg, Russia
| | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, Asunción, Paraguay
| | | | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, Brazil.,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | - Annamaria Petito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Abstract
BACKGROUND Psychosis is an illness characterised by alterations in thoughts and perceptions resulting in delusions and hallucinations. Psychosis is rare in adolescents but can have serious consequences. Antipsychotic medications are the mainstay treatment, and have been shown to be effective. However, there is emerging evidence on psychological interventions such as cognitive remediation therapy, psycho-education, family therapy and group psychotherapy that may be useful for adolescents with psychosis. OBJECTIVES To assess the effects of various psychological interventions for adolescents with psychosis. SEARCH METHODS We searched the Cochrane Schizophrenia Group's study-based Register of Trials including clinical trials registries (latest, 8 March 2019). SELECTION CRITERIA All randomised controlled trials comparing various psychological interventions with treatment-as-usual or other psychological treatments for adolescents with psychosis. For analyses, we included trials meeting our inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We independently and reliably screened studies and we assessed risk of bias of the included studies. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous data, we used mean differences (MDs) and the 95% CIs. We used a random-effects model for analyses. We created a 'Summary of findings' table using GRADE. MAIN RESULTS The current review includes 7 studies (n = 319) assessing a heterogenous group of psychological interventions with variable risk of bias. Adverse events were not reported by any of the studies. None of the studies was sponsored by industry. Below, we summarise the main results from four of six comparisons, and the certainty of these results (based on GRADE). All scale scores are average endpoint scores. Cognitive Remediation Therapy (CRT) + Treatment-as-Usual (TAU) versus TAU Two studies compared adding CRT to participants' TAU with TAU alone. Global state (CGAS, high = good) was reported by one study. There was no clear difference between treatment groups (MD -4.90, 95% CI -11.05 to 1.25; participants = 50; studies = 1, very low-certainty). Mental state (PANSS, high = poor) was reported by one study. Scores were clearly lower in the TAU group (MD 8.30, 95% CI 0.46 to 16.14; participants = 50; studies = 1; very low-certainty). Clearly more participants in the CRT group showed improvement in cognitive functioning (Memory digit span test) compared to numbers showing improvement in the TAU group (1 study, n = 31, RR 0.58, 95% CI 0.37 to 0.89; very low-certainty). For global functioning (VABS, high = good), our analysis of reported scores showed no clear difference between treatment groups (MD 5.90, 95% CI -3.03 to 14.83; participants = 50; studies = 1; very low-certainty). The number of participants leaving the study early from each group was similar (RR 0.93, 95% CI 0.32 to 2.71; participants = 91; studies = 2; low-certainty). Group Psychosocial Therapy (GPT) + TAU versus TAU One study assessed the effects of adding GPT to participants' usual medication. Global state scores (CGAS, high = good) were clearly higher in the GPT group (MD 5.10, 95% CI 1.35 to 8.85; participants = 56; studies = 1; very low-certainty) but there was little or no clear difference between groups for mental state scores (PANSS, high = poor, MD -4.10, 95% CI -8.28 to 0.08; participants = 56; studies = 1, very low-certainty) and no clear difference between groups for numbers of participants leaving the study early (RR 0.43, 95% CI 0.15 to 1.28; participants = 56; studies = 1; very low-certainty). Cognitive Remediation Programme (CRP) + Psychoeducational Treatment Programme (PTP) versus PTP One study assessed the effects of combining two types psychological interventions (CRP + PTP) with PTP alone. Global state scores (GAS, high = good) were not clearly different (MD 1.60, 95% CI -6.48 to 9.68; participants = 25; studies = 1; very low-certainty), as were mental state scores (BPRS total, high = poor, MD -5.40, 95% CI -16.42 to 5.62; participants = 24; studies = 1; very low-certainty), and cognitive functioning scores (SPAN-12, high = good, MD 2.40, 95% CI -2.67 to 7.47; participants = 25; studies = 1; very low-certainty). Psychoeducational (PE) + Multifamily Treatment (MFT) Versus Nonstructured Group Therapy (NSGT, all long-term) One study compared (PE + MFT) with NSGT. Analysis of reported global state scores (CGAS, high = good, MD 3.38, 95% CI -4.87 to 11.63; participants = 49; studies = 1; very low-certainty) and mental state scores (PANSS total, high = poor, MD -8.23, 95% CI -17.51 to 1.05; participants = 49; studies = 1; very low-certainty) showed no clear differences. The number of participants needing hospital admission (RR 0.84, 95% CI 0.36 to 1.96; participants = 49; studies = 1) and the number of participants leaving the study early from each group were also similar (RR 0.52, 95% CI 0.10 to 2.60; participants = 55; studies = 1; low-certainty). AUTHORS' CONCLUSIONS Most of our estimates of effect for our main outcomes are equivocal. An effect is suggested for only four outcomes in the SOF tables presented. Compared to TAU, CRT may have a positive effect on cognitive functioning, however the same study reports data suggesting TAU may have positive effect on mental state. Another study comparing GPT with TAU reports data suggesting GPT may have a positive effect on global state. However, the estimate of effects for all the main outcomes in our review should be viewed with considerable caution as they are based on data from a small number of studies with variable risk of bias. Further data could change these results and larger and better quality studies are needed before any firm conclusions regarding the effects of psychological interventions for adolescents with psychosis can be made.
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Affiliation(s)
- Soumitra S Datta
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Rhea Daruvala
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Ajit Kumar
- Latrobe Regional Hospital, Victoria, Australia
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Sönmez N, Romm KL, Østefjells T, Grande M, Jensen LH, Hummelen B, Tesli M, Melle I, Røssberg JI. Cognitive behavior therapy in early psychosis with a focus on depression and low self-esteem: A randomized controlled trial. Compr Psychiatry 2020; 97:152157. [PMID: 31935529 DOI: 10.1016/j.comppsych.2019.152157] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients in early phases of psychosis often struggle with depressive symptoms and low self-esteem. The main aims of the present study were to examine whether cognitive behavior therapy (CBT) compared to treatment as usual (TAU) would reduce depressive symptoms (primary outcome) and increase self-esteem (secondary outcome). Furthermore, we wanted to examine whether CBT reduces symptoms measured with the PANSS (positive, negative, cognitive, or excited symptoms) or increases general functioning compared to TAU. METHODS A total of 63 early psychosis patients were included and randomly assigned to receive either CBT (maximum 26 sessions) or TAU for a period of up to six months. A linear mixed model was used for longitudinal analysis, with a focus on whether patients in the CBT group or the TAU group changed differently to one another between the baseline and 15-month follow-up. RESULTS There were no differences between the CBT group and TAU group regarding improvements in depressive symptoms measured with the Calgary Depression Scale for Schizophrenia (P = 0.188) or self-esteem measured with the Rosenberg Self-Esteem Scale (P = 0.580). However, patients in the CBT group improved significantly more on negative symptoms (P = 0.002) and social functioning (P = 0.001). CONCLUSIONS We did not find CBT to be more effective than TAU in reducing depressive symptoms or increasing self-esteem in patients with early psychosis. However, CBT seems to improve negative symptoms and functioning. These results still need to be replicated in further studies as the present one was merely an exploratory analysis. ClinicalTrials.gov Identifier: NCT01511406.
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Affiliation(s)
- Nasrettin Sönmez
- Diakonhjemmet Hospital, Forskningsveien 7, 0373 Oslo, Norway; Department of Research and Education, Clinic of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Kristin Lie Romm
- Department of Research and Education, Clinic of Mental Health and Addiction, Oslo University Hospital, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Tiril Østefjells
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Department for Specialised Inpatient Treatment, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway
| | - Marit Grande
- Grande, Sandviksveien 157, 1337 Sandvika, Norway
| | - Lene Hunnicke Jensen
- Early Intervention in Psychosis Unit, Vestre Viken Hospital Trust, Drammen, Norway
| | - Benjamin Hummelen
- Department of Research and Education, Clinic of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Martin Tesli
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403 Oslo, Norway
| | - Ingrid Melle
- Department of Research and Education, Clinic of Mental Health and Addiction, Oslo University Hospital, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Jan Ivar Røssberg
- Department of Research and Education, Clinic of Mental Health and Addiction, Oslo University Hospital, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway.
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Jones C, Hacker D, Xia J, Meaden A, Irving CB, Zhao S, Chen J, Shi C. Cognitive behavioural therapy plus standard care versus standard care for people with schizophrenia. Cochrane Database Syst Rev 2018; 12:CD007964. [PMID: 30572373 PMCID: PMC6517137 DOI: 10.1002/14651858.cd007964.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is a psychosocial treatment that aims to re-mediate distressing emotional experiences or dysfunctional behaviour by changing the way in which a person interprets and evaluates the experience or cognates on its consequence and meaning. This approach helps to link the person's feelings and patterns of thinking which underpin distress. CBT is now recommended by the National Institute for Health and Care Excellence (NICE) as an add-on treatment for people with a diagnosis of schizophrenia. This review is also part of a family of Cochrane CBT reviews for people with schizophrenia. OBJECTIVES To assess the effects of cognitive behavioural therapy added to standard care compared with standard care alone for people with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (up to March 6, 2017). This register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register. SELECTION CRITERIA We selected all randomised controlled clinical trials (RCTs) involving people diagnosed with schizophrenia or related disorders, which compared adding CBT to standard care with standard care given alone. Outcomes of interest included relapse, rehospitalisation, mental state, adverse events, social functioning, quality of life, and satisfaction with treatment.We included studies fulfilling the predefined inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We complied with the Cochrane recommended standard of conduct for data screening and collection. Where possible, we calculated relative risk (RR) and its 95% confidence interval (CI) for binary data and mean difference (MD) and its 95% confidence interval for continuous data. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE. MAIN RESULTS This review now includes 60 trials with 5,992 participants, all comparing CBT added to standard care with standard care alone. Results for the main outcomes of interest (all long term) showed no clear difference between CBT and standard care for relapse (RR 0.78, 95% CI 0.61 to 1.00; participants = 1538; studies = 13, low-quality evidence). Two trials reported global state improvement. More participants in the CBT groups showed clinically important improvement in global state (RR 0.57, 95% CI 0.39 to 0.84; participants = 82; studies = 2 , very low-quality evidence). Five trials reported mental state improvement. No differences in mental state improvement were observed (RR 0.81, 95% CI 0.65 to 1.02; participants = 501; studies = 5, very low-quality evidence). In terms of safety, adding CBT to standard care may reduce the risk of having an adverse event (RR 0.44, 95% CI 0.27 to 0.72; participants = 146; studies = 2, very low-quality evidence) but appears to have no effect on long-term social functioning (MD 0.56, 95% CI -2.64 to 3.76; participants = 295; studies = 2, very low-quality evidence, nor on long-term quality of life (MD -3.60, 95% CI -11.32 to 4.12; participants = 71; study = 1, very low-quality evidence). It also has no effect on long-term satisfaction with treatment (measured as 'leaving the study early') (RR 0.93, 95% CI 0.77 to 1.12; participants = 1945; studies = 19, moderate-quality evidence). AUTHORS' CONCLUSIONS Relative to standard care alone, adding CBT to standard care appears to have no effect on long-term risk of relapse. A very small proportion of the available evidence indicated CBT plus standard care may improve long term global state and may reduce the risk of adverse events. Whether adding CBT to standard care leads to clinically important improvement in patients' long-term mental state, quality of life, and social function remains unclear. Satisfaction with care (measured as number of people leaving the study early) was no higher for participants receiving CBT compared to participants receiving standard care. It should be noted that although much research has been carried out in this area, the quality of evidence available is poor - mostly low or very low quality and we still cannot make firm conclusions until more high quality data are available.
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Affiliation(s)
- Christopher Jones
- University of BirminghamSchool of PsychologyEdgbastonBirminghamUKB15 2TT
| | - David Hacker
- Birmingham and Solihull Mental Health Foundation NHS TrustBirminghamUK
| | - Jun Xia
- The University of NottinghamCochrane Schizophrenia GroupTriumph RoadNottinghamUKNG7 2TU
| | - Alan Meaden
- Birmingham and Solihull Mental Health Foundation NHS TrustBirminghamUK
| | - Claire B Irving
- The University of NottinghamCochrane Schizophrenia GroupTriumph RoadNottinghamUKNG7 2TU
| | - Sai Zhao
- The Ingenuity Centre, The University of NottinghamSystematic Review Solutions LtdTriumph RoadNottinghamUKNG7 2TU
| | - Jue Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineDepartment of Clinical Psychology600 Wan Ping Nan RoadShanghaiChina200030
| | - Chunhu Shi
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthManchesterGreater ManchesterUKM13 9PL
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9
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Laws KR, Darlington N, Kondel TK, McKenna PJ, Jauhar S. Cognitive Behavioural Therapy for schizophrenia - outcomes for functioning, distress and quality of life: a meta-analysis. BMC Psychol 2018; 6:32. [PMID: 30016999 PMCID: PMC6050679 DOI: 10.1186/s40359-018-0243-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/19/2018] [Indexed: 12/14/2022] Open
Abstract
Background The effect of cognitive behavioural therapy for psychosis (CBTp) on the core symptoms of schizophrenia has proven contentious, with current meta-analyses finding at most only small effects. However, it has been suggested that the effects of CBTp in areas other than psychotic symptoms are at least as important and potentially benefit from the intervention. Method We meta-analysed RCTs investigating the effectiveness of CBTp for functioning, distress and quality of life in individuals diagnosed with schizophrenia and related disorders. Data from 36 randomised controlled trials (RCTs) met our inclusion criteria- 27 assessing functioning (1579 participants); 8 for distress (465 participants); and 10 for quality of life (592 participants). Results The pooled effect size for functioning was small but significant for the end-of-trial (0.25: 95% CI: 0.14 to 0.33); however, this became non-significant at follow-up (0.10 [95%CI -0.07 to 0.26]). Although a small benefit of CBT was evident for reducing distress (0.37: 95%CI 0.05 to 0.69), this became nonsignificant when adjusted for possible publication bias (0.18: 95%CI -0.12 to 0.48). Finally, CBTp showed no benefit for improving quality of life (0.04: 95% CI: -0.12 to 0.19). Conclusions CBTp has a small therapeutic effect on functioning at end-of-trial, although this benefit is not evident at follow-up. Although CBTp produced a small benefit on distress, this was subject to possible publication bias and became nonsignificant when adjusted. We found no evidence that CBTp increases quality of life post-intervention. Electronic supplementary material The online version of this article (10.1186/s40359-018-0243-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Nicole Darlington
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
| | | | - Peter J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Barcelona, Spain
| | - Sameer Jauhar
- Centre of Affective Disorders, Institute of Psychiatry, London, UK
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10
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Hamilton JE, Srivastava D, Womack D, Brown A, Schulz B, Macakanja A, Walker A, Wu MJ, Williamson M, Cho RY. Treatment Retention Among Patients Participating in Coordinated Specialty Care for First-Episode Psychosis: a Mixed-Methods Analysis. J Behav Health Serv Res 2018; 46:415-433. [PMID: 29873034 DOI: 10.1007/s11414-018-9619-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Young adults experiencing first-episode psychosis have historically been difficult to retain in mental health treatment. Communities across the United States are implementing Coordinated Specialty Care to improve outcomes for individuals experiencing first-episode psychosis. This mixed-methods research study examined the relationship between program services and treatment retention, operationalized as the likelihood of remaining in the program for 9 months or more. In the adjusted analysis, male gender and participation in home-based cognitive behavioral therapy were associated with an increased likelihood of remaining in treatment. The key informant interview findings suggest the shared decision-making process and the breadth, flexibility, and focus on functional recovery of the home-based cognitive behavioral therapy intervention may have positively influenced treatment retention. These findings suggest the use of shared decision-making and improved access to home-based cognitive behavioral therapy for first-episode psychosis patients may improve outcomes for this vulnerable population.
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Affiliation(s)
- Jane E Hamilton
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center Houston, 1941 East Road, Suite 1204, Houston, TX, 77054, USA.
| | | | - Danica Womack
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ashlie Brown
- Harris Center for Mental Health and IDD, Houston, TX, USA
| | - Brian Schulz
- Harris Center for Mental Health and IDD, Houston, TX, USA
| | | | - April Walker
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Mon-Ju Wu
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center Houston, 1941 East Road, Suite 1204, Houston, TX, 77054, USA
| | | | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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11
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Dixon LB, Goldman HH, Srihari VH, Kane JM. Transforming the Treatment of Schizophrenia in the United States: The RAISE Initiative. Annu Rev Clin Psychol 2018; 14:237-258. [PMID: 29328779 PMCID: PMC8990328 DOI: 10.1146/annurev-clinpsy-050817-084934] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
The schizophrenia spectrum disorders are neurodevelopmental illnesses with a lifetime prevalence near 1%, producing extensive functional impairment and low expectations for recovery. Until recently, treatment in the United States has largely attempted to stabilize individuals with chronic schizophrenia. The identification and promotion of evidence-based practices for schizophrenia via the Patient Outcomes Research Team, combined with international studies supporting the value of early intervention, provided the foundation for the Recovery After an Initial Schizophrenia Episode (RAISE) project. The RAISE studies further supported the value of reducing the duration of untreated psychosis and providing a multi-element treatment called coordinated specialty care (CSC) to improve outcomes for patients in usual treatment settings. Although CSC programs have proliferated rapidly in the United States, many challenges remain in the treatment and recovery of individuals with schizophrenia in the aftermath of RAISE.
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Affiliation(s)
- Lisa B Dixon
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY 10032, USA;
| | - Howard H Goldman
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA
| | - John M Kane
- Zucker Hillside Hospital and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA
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12
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Christianson L. Improving functional outcomes in college and university students with schizophrenia in the Western world. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:61-68. [PMID: 28777705 DOI: 10.1080/07448481.2017.1360306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Retrospective research from patients with schizophrenia suggests that remission becomes increasingly less likely the longer psychosis goes untreated. Yet symptoms of schizophrenia are insidious and disease evolution varies between patients, requiring an ongoing diagnostic process. One way of justifying early treatment is by focusing on functionality rather than symptomatology. Most patients are diagnosed with schizophrenia between the ages of 17 and 25-when many young adults are undergraduates or pursuing post-graduate education. The extent to which schools partner with mental health services has implications for the short-term success of students' recovery and their future employability. Translating study findings on schizophrenia to the college setting remains an important area of investigation.
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Affiliation(s)
- Laura Christianson
- a Pritzker School of Medicine , University of Chicago , Chicago , Illinois , USA
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13
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Stouten LH, Veling W, Laan W, van der Helm M, van der Gaag M. Psychosocial functioning in first-episode psychosis and associations with neurocognition, social cognition, psychotic and affective symptoms. Early Interv Psychiatry 2017; 11:23-36. [PMID: 25585960 DOI: 10.1111/eip.12210] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022]
Abstract
AIM Most studies on the determinants of psychosocial functioning in first-episode psychosis used few predictors. This study examines the effects of multiple cognitive domains and multiple symptoms on psychosocial functioning. METHODS A total of 162 patients with a first-episode psychosis were assessed within 3 months after referral to an early psychosis treatment department. Four psychopathological subdomains (positive and negative symptoms, depression and anxiety) and five subdomains of psychosocial functioning (work/study, relationships, self-care, disturbing behaviour and general psychosocial functioning) were measured. Neurocognitive and social cognitive factors were identified through principal component analyses (PCA) of a 15-measure cognitive battery. Stepwise backward regression models were computed to identify the determinants of psychosocial functioning. RESULTS The three neurocognitive and four social cognitive factors identified through PCA were largely independent of psychopathology. The strongest associations were between cognitive factors and anxiety. Higher levels of negative symptoms, poor general neurocognition and poor general social cognition showed strongest associations with impaired psychosocial functioning, followed by low verbal processing speed and low emotion processing speed. Together, these factors accounted for 39.4% of the variance in psychosocial functioning. CONCLUSIONS The results suggest that negative symptoms, impaired neurocognition and poor social cognition are related to psychosocial problems in patients with first-episode psychosis. None of the affective or positive symptoms had a marked impact on psychosocial functioning.
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Affiliation(s)
- Luyken H Stouten
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Wim Veling
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Winfried Laan
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Mischa van der Helm
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Mark van der Gaag
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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14
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Early psychosis research at Orygen, The National Centre of Excellence in Youth Mental Health. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1-13. [PMID: 26498752 DOI: 10.1007/s00127-015-1140-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 10/13/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Specialised early intervention (SEI) programs have offered individuals with psychotic disorders and their families new hope for improving illness trajectories and outcomes. The Early Psychosis Prevention and Intervention Centre (EPPIC) was one of the first SEI programs developed in the world, providing services for young people experiencing their first episode of psychosis. METHODS We conducted a narrative synthesis of controlled and uncontrolled studies that have been conducted at EPPIC. DISCUSSION The history of the EPPIC model is first described. This is followed by a discussion of clinical research emerging from EPPIC, including psychopharmacological, psychotherapeutic trials and outcome studies. Neurobiological studies are also described. Issues pertaining to the conduct of clinical research and future research directions are then described. Finally, the impact of the EPPIC model on the Australian environment is discussed.
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15
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Azrin ST, Goldstein AB, Heinssen RK. Early Intervention for Psychosis: The Recovery After an Initial Schizophrenia Episode Project. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20151103-05] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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16
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Yang YY, Lu CL, Lo SM, Peng CH, Liu YP. Early antipsychotic intervention and schizophrenia. Med Hypotheses 2015; 85:367-70. [DOI: 10.1016/j.mehy.2015.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/09/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
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17
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Saksa JR, Cohen SJ, Srihari VH, Woods SW. Cognitive Behavior Therapy for Early Psychosis: A Comprehensive Review of Individual vs. Group Treatment Studies. Int J Group Psychother 2015; 59:357-83. [DOI: 10.1521/ijgp.2009.59.3.357] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Dixon LB, Goldman HH, Bennett ME, Wang Y, McNamara KA, Mendon SJ, Goldstein AB, Choi CWJ, Lee RJ, Lieberman JA, Essock SM. Implementing Coordinated Specialty Care for Early Psychosis: The RAISE Connection Program. Psychiatr Serv 2015; 66:691-8. [PMID: 25772764 PMCID: PMC5637730 DOI: 10.1176/appi.ps.201400281] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The RAISE (Recovery After an Initial Schizophrenia Episode) Connection Program Implementation and Evaluation Study developed tools necessary to implement and disseminate an innovative team-based intervention designed to promote engagement and treatment participation, foster recovery, and minimize disability among individuals experiencing early psychosis. This article describes the treatment model and reports on service utilization and outcomes. It was hypothesized that individuals' symptoms and functioning would improve over time. METHODS A total of 65 individuals in RAISE Connection Program treatment across two sites (Baltimore and New York City) were enrolled and received services for up to two years. Primary outcomes, including social and occupational functioning and symptoms, were evaluated. Trajectories for individuals' outcomes over time were examined with linear and quadratic mixed-effects models with repeated measures. RESULTS Measures of occupational and social functioning improved significantly over time, symptoms declined, and rates of remission improved. Visits were most frequent during the first three months, with a mean±SD of 23.2±11.5 unduplicated staff encounters per quarter. Such encounters decreased to 8.8±5.2 in the final quarter of year 2. CONCLUSIONS The overall project was successful in that the treatment program was delivered and tools useful to other clinical settings were produced. The strengths of this study lie in the demonstrated feasibility of delivering the coordinated specialty care model and the associated high rates of engagement among individuals who are typically difficult to engage in treatment. Notwithstanding the lack of a built-in comparison group, participant outcomes were promising, with improvements comparable to those seen with other successful interventions.
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Affiliation(s)
- Lisa B Dixon
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Howard H Goldman
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Melanie E Bennett
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Yuanjia Wang
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Karen A McNamara
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Sapna J Mendon
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Amy B Goldstein
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Chien-Wen J Choi
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Rufina J Lee
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Jeffrey A Lieberman
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
| | - Susan M Essock
- Dr. Dixon, Ms. Mendon, Ms. Choi, Dr. Lieberman, and Dr. Essock are with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Dixon, Dr. Lieberman, and Dr. Essock are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Goldman, Dr. Bennett, and Dr. McNamara are with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Dr. Wang is with the Division of Biostatistics, Mailman School of Public Health, Columbia University, New York City. Dr. Goldstein is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Lee is with the Silberman School of Social Work, Hunter College, City University of New York, New York City. This article is part of a special section on RAISE and other early intervention services. Marcela Horvitz-Lennon, M.D., M.P.H., served as guest editor of the special section
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Lecomte T, Leclerc C, Wykes T, Nicole L, Abdel Baki A. Understanding process in group cognitive behaviour therapy for psychosis. Psychol Psychother 2015; 88:163-77. [PMID: 25065676 DOI: 10.1111/papt.12039] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/12/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Group cognitive behaviour therapy for psychosis (GCBTp) has shown to be effective in diminishing symptoms, as well as in improving other psychosocial dimensions such as self-esteem. But little is known regarding the processes that generate these therapeutic improvements and might be harnessed to further improve its effectiveness. OBJECTIVES The current study aimed at investigating these processes, particularly those linked to interpersonal relationships. DESIGN The participants were all assessed at baseline, were given 24 sessions of GCBTp over the course of 3 months and were assessed again at post-treatment as well as 6 months later (9 months from baseline). METHOD Sixty-six individuals with early psychosis took part in a study of GCBTp where therapist alliance and group cohesion were assessed at three time points during the therapy, and punctual (each session) self-perceptions on symptoms and optimism were collected. RESULTS Improvements in symptoms (BPRS), self-esteem (SERS-SF) and in self-perceived therapeutic improvements (CHOICE) were linked to specific aspects of the alliance, group cohesion, as well as optimism. The variables retained were not always overall scores, suggesting the importance of the variables at key moments during the therapy. CONCLUSIONS The results clearly demonstrate the importance of the alliance and group cohesion, together significantly explaining improvements measured at post-therapy or follow-up. PRACTITIONER POINTS This study has attempted to focus mostly on relational aspects, as well as on self-perceptions, in the context of a GCBTp for individuals with early psychosis. This study also showed that these therapeutic relationships are especially useful when they are more stable and at specific moments during the therapy, namely when more difficult psychological work is done.
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Affiliation(s)
- Tania Lecomte
- Department of Psychology, University of Montreal, Québec, Canada
| | - Claude Leclerc
- Department of Nursing, University of Quebec at Trois-Rivieres, Québec, Canada
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, University of London, UK
| | - Luc Nicole
- Programme PEP (Premiers Episodes Psychotiques), Montreal University Institute of Mental Health (IUSMM), Montreal, Québec, Canada
| | - Amal Abdel Baki
- Programme JAP (Jeunes Adultes Psychotiques), Montreal University Hospital Center (CHUM), Montreal, Québec, Canada
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Armijo J, Méndez E, Morales R, Schilling S, Castro A, Alvarado R, Rojas G. Efficacy of community treatments for schizophrenia and other psychotic disorders: a literature review. Front Psychiatry 2013; 4:116. [PMID: 24130534 PMCID: PMC3793168 DOI: 10.3389/fpsyt.2013.00116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 09/11/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Chile, the clinical guidelines "for the treatment of people from first episode of schizophrenia" aim to support individuals with schizophrenia to live independently, establishment occupational goals, and gain an adequate quality of life and social interaction. This requires the implementation of a treatment model that integrates psychosocial and pharmacological dimensions. Community intervention strategies ensure the achievement of these goals. OBJECTIVES This study compiles and synthesizes available scientific evidence from the last 14 years on the effectiveness of community intervention strategies for schizophrenia and related psychotic disorders. METHODOLOGY An electronic search was carried out using PUBMED, LILACS, and Science Direct as databases. Criteria of inclusion: (i) randomized clinical trials, (ii) Community-based interventions, (iii) diagnosis of schizophrenia or related psychotic disorder (section F2 of ICD-10). EXCLUSION CRITERIA (i) treatments exclusively pharmacological, (ii) interventions carried out in inpatient settings, (iii) bipolar affective disorder or substance-induced psychosis (greater than 50% of sample). RESULTS Sixty-six articles were reviewed. Community strategies for integrated treatment from the first outbreak of schizophrenia significantly reduced negative and psychotic symptoms, days of hospitalization, and comorbidity with substance abuse and improved global functioning and adherence to treatment. In other stages, there were improved outcomes in negative and positive symptoms and general psychopathology. Psychoeducation for patients and families reduced the levels of self-stigma and domestic abuse, as well as improved knowledge of the disease and treatment adherence. Training focused on cognitive, social, and labor skills has been shown to improve yields in social functioning and employment status. CONCLUSION Community-based intervention strategies are widely supported in the treatment of patients with schizophrenia.
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Affiliation(s)
- Julio Armijo
- Adult Psychiatry, José Horwitz Barak Psychiatric Hospital, Universidad de Santiago de Chile , Santiago , Chile
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Akroyd MJ. You can't spell schizophrenia without an 'I': how does the early intervention in psychosis approach relate to the concept of schizophrenia as an ipseity disturbance? Early Interv Psychiatry 2013; 7:238-46. [PMID: 23574612 DOI: 10.1111/eip.12046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 02/09/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Operational approaches to psychiatric diagnosis have increased reliability, but the cost has been the reduction of diagnostic concepts to tick-box lists of objective symptoms. Some blame this for growing disillusionment among younger clinicians in mental health. A renewed emphasis on the human subject and subjective experience could be one way to remedy this. While true for psychiatry in general, it is particularly true in psychiatry's 'sacred symbol' of psychiatry, schizophrenia. Greater understanding of schizophrenia will be of most relevance to those who have yet to develop the disorder, such as those targeted by Early Intervention in Psychosis services. A promising direction in the understanding of schizophrenia is the notion of fundamental disturbance in the sense of self ('ipseity disturbance'). METHOD I intend to examine the relationship between the concept of schizophrenia as an ipseity disturbance and the Early Intervention in Psychosis service model through consideration of three main areas: symptoms of schizophrenia as understood by the ipseity disturbance concept; implications of the ipseity disturbance concept for the notion of a schizophrenia prodrome; and the ways in which the Early Intervention in Psychosis service model reflects or could be informed by the ipseity disturbance concept. RESULTS AND CONCLUSIONS I argue that explicit consideration of schizophrenia as an ipseity disturbance could lead to better identification of those at highest risk, and more appropriately tailored interventions.
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Gleeson JFM, Cotton SM, Alvarez-Jimenez M, Wade D, Gee D, Crisp K, Pearce T, Spiliotacopoulos D, Newman B, McGorry PD. A randomized controlled trial of relapse prevention therapy for first-episode psychosis patients: outcome at 30-month follow-up. Schizophr Bull 2013; 39:436-48. [PMID: 22130905 PMCID: PMC3576162 DOI: 10.1093/schbul/sbr165] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The effectiveness of a novel 7-month psychosocial treatment designed to prevent the second episode of psychosis was evaluated in a randomized controlled trial at 2 specialist first-episode psychosis (FEP) programs. An individual and family cognitive behavior therapy for relapse prevention was compared with specialist FEP care. Forty-one FEP patients were randomized to the relapse prevention therapy (RPT) and 40 to specialist FEP care. Participants were assessed on an array of measures at baseline, 7- (end of therapy), 12-, 18-, 24-, and 30-month follow-up. At 12-month follow-up, the relapse rate was significantly lower in the therapy condition compared with specialized treatment alone (P = .039), and time to relapse was significantly delayed for those in the relapse therapy condition (P = .038); however, such differences were not maintained. Unexpectedly, psychosocial functioning deteriorated over time in the experimental but not in the control group; these differences were no longer statistically significant when between-group differences in medication adherence were included in the model. Further research is required to ascertain if the initial treatment effect of the RPT can be sustained. Further research is needed to investigate if medication adherence contributes to negative outcomes in functioning in FEP patients who have reached remission, or, alternatively, if a component of RPT is detrimental.
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Affiliation(s)
- John F. M. Gleeson
- School of Psychology, Australian Catholic University, Level 2, 115 Victoria Parade Fitzroy, VIC 3065, Australia,To whom correspondence should be addressed; tel: +61-3-9953-3108, fax: +61-3-9953-3205,
| | - Sue M. Cotton
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
| | - Darryl Wade
- Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Australia
| | | | | | | | - Daniela Spiliotacopoulos
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
| | - Belinda Newman
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
| | - Patrick D. McGorry
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
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On the HORYZON: moderated online social therapy for long-term recovery in first episode psychosis. Schizophr Res 2013; 143:143-9. [PMID: 23146146 DOI: 10.1016/j.schres.2012.10.009] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 08/28/2012] [Accepted: 10/07/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Early intervention services have demonstrated improved outcomes in first episode psychosis (FEP); however, recent evidence shows that treatment benefits may not be sustainable over time. These findings have resulted in repeated recommendations for the implementation of longer term treatment programs. An Internet-based intervention specifically designed for young people with psychosis may provide a cost-effective alternative to prevent loss of treatment benefits from early intervention. METHODS Our multi-disciplinary team has developed a highly novel online intervention (HORYZONS) in regular consultation with stakeholders within a specialist early psychosis program. HORYZONS integrates: i) peer-to-peer social networking, ii) individually tailored interactive psychosocial interventions, and iii) expert interdisciplinary and peer-moderation in a coherent platform designed to improve long-term outcomes in FEP. The acceptability, safety and initial clinical benefits of HORYZONS were examined through a 1-month pilot study with 20 participants with FEP. RESULTS There were no dropouts during the pilot study. Seventy per cent of participants utilised the system for at least 3weeks, 95% used the social networking features, and 60% completed at least 3 therapy modules. System usage was high during the study. There were no incidents and the majority of participants reported feeling safe, empowered and more socially connected using HORYZONS. Analysis revealed a significant reduction in depressive symptoms at follow-up. CONCLUSIONS Our results indicate that HORYZONS is feasible, engaging and safe and may augment social connectedness and empowerment in FEP. These findings have significant implications for the enhancement of specialist FEP services. The potential of HORYZONS to improve long-term recovery is worthy of further investigation.
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Lecomte T, Leclerc C, Wykes T. Group CBT for early psychosis--are there still benefits one year later? Int J Group Psychother 2012; 62:309-21. [PMID: 22468576 DOI: 10.1521/ijgp.2012.62.2.309] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Our team recently conducted a randomized controlled trial comparing group cognitive behavior therapy for psychosis (CBTp) to group social skills training for symptom management and a wait-list control group, for early psychosis. The results at post-therapy and six months provided considerable empirical support for the efficacy of the group CBTp. The results of the one-year follow-up are described here. Given the high attrition rates, mostly in the comparison and control conditions, imputations were not possible, so that only the results of those having completed more than 50% of the group CBTp are presented. Significant improvements at 12 months were found for social support and insight. Negative symptoms remained low, whereas positive symptoms went back to pre-therapy levels. Challenges regarding attrition with this clientele are discussed.
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Affiliation(s)
- Tania Lecomte
- Department of Psychology at the University of Montreal, Canada.
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TCC pour premiers épisodes de psychose : pourquoi la thérapie de groupe obtient les meilleurs résultats ? ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.jtcc.2012.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Murru A, Pacchiarotti I, Nivoli AMA, Grande I, Colom F, Vieta E. What we know and what we don't know about the treatment of schizoaffective disorder. Eur Neuropsychopharmacol 2011; 21:680-90. [PMID: 21565468 DOI: 10.1016/j.euroneuro.2011.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 02/24/2011] [Accepted: 03/02/2011] [Indexed: 11/17/2022]
Abstract
Schizoaffective disorder (SAD) is a chronic, severe and disabling illness consisting on the concurrent presentation of symptoms of schizophrenia and affective disorders (depression and/or mania). Evidence for the treatment of SAD mostly derives from studies based on mixed samples (i.e. schizophrenic and schizoaffective patients) or on extrapolations from studies on schizophrenia or bipolar disorder. The objective of the present review is to systematically consider and summarize the best evidence-based approaches to the treatment of SAD and extensively point out the gap between treatment research and clinical practice of this disorder. The complex problem of controlling the pleomorphic presentation of SAD's syndromic construct is reflected in the lack of evidence on key topics, including: diagnostic consistency, pharmacological approaches (mood stabilizers, antidepressants, both in acute and maintenance treatment as well as their possible combination), and the adjunctive role of psychosocial and biophysical interventions. Finally, treatment strategies for SAD, both unipolar and bipolar type, are proposed.
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Affiliation(s)
- A Murru
- Bipolar Disorders Programme, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Álvarez-Jiménez M, Parker AG, Hetrick SE, McGorry PD, Gleeson JF. Preventing the second episode: a systematic review and meta-analysis of psychosocial and pharmacological trials in first-episode psychosis. Schizophr Bull 2011; 37:619-30. [PMID: 19900962 PMCID: PMC3080698 DOI: 10.1093/schbul/sbp129] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The majority of first-episode psychosis (FEP) patients reach clinical remission; however, rates of relapse are high. This study sought to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the effectiveness of pharmacological and non-pharmacological interventions to prevent relapse in FEP patients. METHODS Systematic review and meta-analysis of RCTs. RESULTS Of 66 studies retrieved, 18 were eligible for inclusion. Nine studies investigated psychosocial interventions and 9 pharmacological treatments. The analysis of 3 RCTs of psychosocial interventions comparing specialist FEP programs vs treatment as usual involving 679 patients demonstrated the former to be more effective in preventing relapse (odds ratio [OR]=1.80, 95% confidence interval [CI]=1.31-2.48; P<.001; number needed to treat [NNT]=10). While the analysis of 3 different cognitive-behavioral studies not specifically intended at preventing relapse showed no further benefits compared with specialist FEP programs (OR=1.95, 95% CI=0.76-5.00; P=.17), the combination of specific individual and family intervention targeted at relapse prevention may further improve upon these outcomes (OR=4.88, 95% CI=0.97-24.60; P=.06). Only 3 small studies compared first-generation antipsychotics (FGAs) with placebo with no significant differences regarding relapse prevention although all individual estimates favored FGAs (OR=2.82, 95% CI=0.54-14.75; P=.22). Exploratory analysis involving 1055 FEP patients revealed that relapse rates were significantly lower with second-generation antipsychotics (SGAs) compared with FGAs (OR=1.47, 95% CI=1.07-2.01; P<.02; NNT=10). CONCLUSIONS Specialist FEP programs are effective in preventing relapse. Cognitive-based individual and family interventions may need to specifically target relapse to obtain relapse prevention benefits that extend beyond those provided by specialist FEP programs. Overall, the available data suggest that FGAs and SGAs have the potential to reduce relapse rates. Future trials should examine the effectiveness of placebo vs antipsychotics in combination with intensive psychosocial interventions in preventing relapse in the early course of psychosis. Further studies should identify those patients who may not need antipsychotic medication to be able to recover from psychosis.
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Affiliation(s)
- Mario Álvarez-Jiménez
- Department of Psychiatry, “Marques de Valdecilla” Public Foundation–Research Institute (FMV-IFIMAV) Av. Valdecilla s/n, 39009, Santander, Spain,ORYGEN Youth Health Research Centre, 35 Poplar Road, Parkville, Melbourne, Victoria 3054, Australia,ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia,To whom correspondence should be addressed; tel: 03-9342-2800, e-mail:
| | - Alexandra G. Parker
- ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah E. Hetrick
- ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D. McGorry
- ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - John F. Gleeson
- ORYGEN Youth Health Research Centre and Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia,Department of Psychology, The University of Melbourne and Northwestern Mental Health Program, Melbourne, Victoria, Australia
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Penn DL, Uzenoff SR, Perkins D, Mueser KT, Hamer R, Waldheter E, Saade S, Cook L. A pilot investigation of the Graduated Recovery Intervention Program (GRIP) for first episode psychosis. Schizophr Res 2011; 125:247-56. [PMID: 20817484 PMCID: PMC3010489 DOI: 10.1016/j.schres.2010.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 08/03/2010] [Accepted: 08/05/2010] [Indexed: 10/19/2022]
Abstract
The Graduated Recovery Intervention Program (GRIP) is a new individual cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. The purposes of this study were to evaluate the feasibility and tolerability of the GRIP intervention, and to compare the effectiveness of GRIP versus treatment as usual (TAU) for improving specific clinical and psychosocial outcomes. Forty-six individuals with first episode psychosis were randomized to GRIP+TAU or TAU alone. Primary outcomes focused on social and role functioning, and quality of life. Secondary outcomes included psychotic symptoms, depression, substance use, social support, attitudes toward medications, well-being, and hospitalizations. The results indicate that GRIP was well-tolerated, as evidenced by good attendance and low drop-out rates, and well-received (based on positive feedback from participants). Although the majority of mixed model analyses were not statistically significant, examination of within-group changes and effect sizes suggests an advantage for GRIP over TAU in improving functional outcomes. These advantages and the fact that the GRIP intervention demonstrated feasibility and tolerability suggest that this intervention is worthy of further investigation.
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Affiliation(s)
- David L. Penn
- University of North Carolina-Chapel Hill, Department of Psychology,University of North Carolina-Chapel Hill, Department of Psychiatry,University of North Carolina-Chapel Hill, Outreach and Support Intervention Services Program
| | - Sarah R. Uzenoff
- University of North Carolina-Chapel Hill, Department of Psychology
| | - Diana Perkins
- University of North Carolina-Chapel Hill, Department of Psychiatry,University of North Carolina-Chapel Hill, Outreach and Support Intervention Services Program
| | | | - Robert Hamer
- University of North Carolina-Chapel Hill, Department of Psychiatry
| | - Evan Waldheter
- University of North Carolina-Chapel Hill, Department of Psychology
| | - Sylvia Saade
- University of North Carolina-Chapel Hill, Department of Psychiatry,University of North Carolina-Chapel Hill, Outreach and Support Intervention Services Program
| | - Liz Cook
- University of North Carolina-Chapel Hill, Department of Psychiatry
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Marois MJ, Gingras N, Provencher MD, Mérette C, Emond C, Bourbeau J, Jomphe V, Roy MA. [Cognitive-behavioural therapy in early psychosis: an open study in a clinical setting]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:51-61. [PMID: 21324243 DOI: 10.1177/070674371105600109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Meta-analysis results confirm that cognitive-behavioural therapy in psychosis (CBTp) is efficient for persistent symptoms. However, external validity remains unexplored. CBTp in early psychosis (in the first 5 years after diagnosis) seems especially relevant, given a possible impact on long-term course. However, the few studies that experimented with CBTp with this population had poor results. They all introduced therapy during an acute psychotic phase and most of them performed a limited number of sessions. Therefore, our introductory open study aimed to evaluate the efficiency of a 25-session Australian CBTp program, introduced during a stable phase in Quebec patients with early psychosis. METHOD The Active Cognitive Psychotherapy for Early Psychosis program was offered to 20 patients aged 14 years or older, at a rate of 1 weekly session during 6 months. RESULTS The acceptance rate was 75%, the mean session compliance rate was 84%, and participants were satisfied with the program. Pre- and post-CBTp analyses indicated statistically significant improvements of psychotic symptomatology, which were maintained at 6-month follow-up. Self-criticism improvement was also statistically significant, post-CBTp. CONCLUSION CBTp seems to be appropriate in our clinical settings, including with adolescents. Moreover, the treatment dosage used seems to foster session compliance.
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Affiliation(s)
- Marie-Josée Marois
- Programme de Dépistage et intervention précoce des psychoses, Centre de pédopsychiatrie de Québec, Centre hospitalier universitaire de Québec, 1 avenuedu Sacré-Coeur, Québec, QC.
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Farhall J, Freeman NC, Shawyer F, Trauer T. An effectiveness trial of cognitive behaviour therapy in a representative sample of outpatients with psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 48:47-62. [DOI: 10.1111/j.2044-8260.2009.tb00456.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry 2010; 197:350-6. [PMID: 21037211 PMCID: PMC2966501 DOI: 10.1192/bjp.bp.109.074526] [Citation(s) in RCA: 260] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Early intervention services for psychosis aim to detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments. AIMS To evaluate the effectiveness of early intervention services, cognitive-behavioural therapy (CBT) and family intervention in early psychosis. METHOD Systematic review and meta-analysis of randomised controlled trials of early intervention services, CBT and family intervention for people with early psychosis. RESULTS Early intervention services reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission. CONCLUSIONS For people with early psychosis, early intervention services appear to have clinically important benefits over standard care. Including CBT and family intervention within the service may contribute to improved outcomes in this critical period. The longer-term benefits of this approach and its component treatments for people with early and established psychosis need further research.
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Affiliation(s)
- Victoria Bird
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists' Research and Training Unit, Standon House, 21 Mansell Street, London E1 8AA, UK.
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Francey SM, Nelson B, Thompson A, Parker AG, Kerr M, Macneil C, Fraser R, Hughes F, Crisp K, Harrigan S, Wood SJ, Berk M, McGorry PD. Who needs antipsychotic medication in the earliest stages of psychosis? A reconsideration of benefits, risks, neurobiology and ethics in the era of early intervention. Schizophr Res 2010; 119:1-10. [PMID: 20347270 DOI: 10.1016/j.schres.2010.02.1071] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 02/18/2010] [Accepted: 02/26/2010] [Indexed: 12/14/2022]
Abstract
In recent years, early intervention services have attempted to identify people with a first episode of psychosis as early as possible, reducing the duration of untreated psychosis and changing the timing of delivery of interventions. The logic of early intervention is based partly on accessing people in a more treatment responsive stage of illness in which psychosocial damage is less extensive, and partly on remediating a putatively active process of neuroprogression that leads to pathophysiological, symptomatic and structural changes, hence improving symptomatic and functional outcomes. However, as in other areas of health care, earlier identification of new patients may mean that different treatment approaches are indicated. The corollary of early detection is that the sequence and complexion of treatment strategies for first episode psychosis has been revaluated. Examples include the minimal effective dosage of antipsychotic medication and the content of psychosocial interventions. With the substantial reductions of DUP now seen in many early psychosis services, based on clinical staging and stepped care principles, it is even possible that the immediate introduction of antipsychotic medication may not be necessary for all first episode psychosis cases, but that potentially safer interventions, which may be more acceptable to many patients, such as comprehensive psychosocial intervention, may constitute effective treatment at least for a subgroup of patients. In this paper, we review this theoretical background and describe a randomised controlled trial currently underway at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne designed to test outcomes for first episode psychosis patients in response to two different treatments: intensive psychosocial intervention plus antipsychotic medication versus intensive psychosocial intervention plus placebo. This is a theoretically and pragmatically novel study in that it will provide evidence as to whether intensive psychosocial intervention alone is sufficient for a subgroup of first episode psychosis patients in a specialised early intervention service, and provide a test of the heuristic clinical staging model. By experimentally manipulating duration of untreated psychosis, the study will also provide a methodologically strong test of the effect of delaying the introduction of antipsychotic medication, as well as helping to disentangle the effects of antipsychotic medications and the putative neurobiological processes associated with brain changes and symptom profiles in the early phase of psychotic disorders. The study has been carefully crafted to satisfy critical ethical demands in this challenging research domain.
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Affiliation(s)
- S M Francey
- Orygen Youth Health, 35 Poplar Road Locked Bag 10, Parkville, Victoria 3052, Australia
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Hickie IB. Deserved national recognition for an international clinical scientist. Early Interv Psychiatry 2010; 4:105-7. [PMID: 20536964 DOI: 10.1111/j.1751-7893.2010.00181.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dixon LB, Dickerson F, Bellack AS, Bennett M, Dickinson D, Goldberg RW, Lehman A, Tenhula WN, Calmes C, Pasillas RM, Peer J, Kreyenbuhl J. The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull 2010; 36:48-70. [PMID: 19955389 PMCID: PMC2800143 DOI: 10.1093/schbul/sbp115] [Citation(s) in RCA: 518] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Schizophrenia Patient Outcomes Research Team (PORT) psychosocial treatment recommendations provide a comprehensive summary of current evidence-based psychosocial treatment interventions for persons with schizophrenia. There have been 2 previous sets of psychosocial treatment recommendations (Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull. 1998;24:1-10 and Lehman AF, Kreyenbuhl J, Buchanan RW, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull. 2004;30:193-217). This article reports the third set of PORT recommendations that includes updated reviews in 7 areas as well as adding 5 new areas of review. Members of the psychosocial Evidence Review Group conducted reviews of the literature in each intervention area and drafted the recommendation or summary statement with supporting discussion. A Psychosocial Advisory Committee was consulted in all aspects of the review, and an expert panel commented on draft recommendations and summary statements. Our review process produced 8 treatment recommendations in the following areas: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. Reviews of treatments focused on medication adherence, cognitive remediation, psychosocial treatments for recent onset schizophrenia, and peer support and peer-delivered services indicated that none of these treatment areas yet have enough evidence to merit a treatment recommendation, though each is an emerging area of interest. This update of PORT psychosocial treatment recommendations underscores both the expansion of knowledge regarding psychosocial treatments for persons with schizophrenia at the same time as the limitations in their implementation in clinical practice settings.
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Affiliation(s)
- Lisa B Dixon
- VA Capitol Health Care Network Mental Illness Research Education and Clinical Center, Baltimore, MD, USA.
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Nelson B, Sass LA. Medusa’s Stare: A Case Study of Working With Self-Disturbance in the Early Phase of Schizophrenia. Clin Case Stud 2009. [DOI: 10.1177/1534650109351931] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present therapeutic case study demonstrates how concepts from phenomenological psychiatry can be applied to treatment of the early phase of schizophrenia. The case described here is of a 22-year-old man seen at a youth mental health service who experienced a catatonic episode with residual cognitive symptoms. The notion of a disturbed basic sense of self— based on the ipseity-hyperreflexivity model and the concept of ontological anxiety—formed the basis of the clinical formulation and treatment. These concepts highlight the patient’s vulnerabilities and difficulties in interpersonal contact. In addition they help to clarify potential dangers inherent in “objectifying” the patient, in stimulating excessive self-reflection, and in encouraging interpersonal engagement that is overly intense. Alternative strategies guided by a phenomenological appreciation of the centrality of a disturbed basic sense of self (disturbed ipseity) are described. These include certain forms of empathic understanding, including use of phenomenological concepts to help the patient comprehend their difficulties, encouraging a “second person” perspective, prominent use of the therapeutic relationship, and strategies that engender a form of immersion or absorption in present activity.
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Morrison AP. Cognitive behaviour therapy for first episode psychosis: Good for nothing or fit for purpose? PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2009. [DOI: 10.1080/17522430903026393] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jackson C, Trower P, Reid I, Smith J, Hall M, Townend M, Barton K, Jones J, Ross K, Russell R, Newton E, Dunn G, Birchwood M. Improving psychological adjustment following a first episode of psychosis: A randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms. Behav Res Ther 2009; 47:454-62. [DOI: 10.1016/j.brat.2009.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 12/22/2008] [Accepted: 02/13/2009] [Indexed: 10/21/2022]
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Crespo-Facorro B, Pérez-Iglesias R, González-Blanch C, Mata I. Treatment of the first episode of schizophrenia: an update on pharmacologic and psychological interventions. Curr Psychiatry Rep 2008; 10:202-9. [PMID: 18652787 DOI: 10.1007/s11920-008-0034-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This review emphasizes the recent findings on different pharmacologic and psychological interventions in the treatment of first-episode schizophrenia. Most controlled studies demonstrate that first- and second-generation antipsychotics produce a similar reduction in symptom severity and an overall equal likelihood of clinical response. The cognitive improvements found across atypical antipsychotics were similar and consistent in magnitude with practice effects observed in healthy controls. However, the differential effect of low doses of haloperidol on cognitive function compared with that of second-generation antipsychotics is still debated. The different pattern of metabolic side effects induced by long-term use of antipsychotics is a crucial concern when selecting an antipsychotic treatment for a first-episode patient. More long-term studies are necessary to elucidate the metabolic effects of the different antipsychotic drugs. Cognitive-behavioral therapy and family interventions seem to be effective adjunctive treatments in early phases of schizophrenia in some patients.
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Affiliation(s)
- Benedicto Crespo-Facorro
- Department of Psychiatry, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n 39008, Santander, Spain.
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Jackson HJ, McGorry PD, Killackey E, Bendall S, Allott K, Dudgeon P, Gleeson J, Johnson T, Harrigan S. Acute-phase and 1-year follow-up results of a randomized controlled trial of CBT versus Befriending for first-episode psychosis: the ACE project. Psychol Med 2008; 38:725-735. [PMID: 18005494 DOI: 10.1017/s0033291707002061] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The ACE project involved 62 participants with a first episode of psychosis randomly assigned to either a cognitive behaviour therapy (CBT) intervention known as Active Cognitive Therapy for Early Psychosis (ACE) or a control condition known as Befriending. The study hypotheses were that: (1) treating participants with ACE in the acute phase would lead to faster reductions in positive and negative symptoms and more rapid improvement in functioning than Befriending; (2) these improvements in symptoms and functioning would be sustained at a 1-year follow-up; and (3) ACE would lead to fewer hospitalizations than Befriending as assessed at the 1-year follow-up. METHOD Two therapists treated the participants across both conditions. Participants could not receive any more than 20 sessions within 14 weeks. Participants were assessed by independent raters on four primary outcome measures of symptoms and functioning: at pretreatment, the middle of treatment, the end of treatment and at 1-year follow-up. An independent pair of raters assessed treatment integrity. RESULTS Both groups improved significantly over time. ACE significantly outperformed Befriending by improving functioning at mid-treatment, but it did not improve positive or negative symptoms. Past the mid-treatment assessment, Befriending caught up with the ACE group and there were no significant differences in any outcome measure and in hospital admissions at follow-up. CONCLUSIONS There is some preliminary evidence that ACE promotes better early recovery in functioning and this finding needs to be replicated in other independent research centres with larger samples.
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Affiliation(s)
- H J Jackson
- Departments of Psychology and Psychiatry, University of Melbourne and ORYGEN Research Centre, Parkville, Australia.
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Abstract
The focus of this review is the research and clinical work in early psychosis and early intervention which over the past 10-15 years has had a tremendous impact on the field of schizophrenia. Unparalleled progress has been made in programme and service development with a wide range of reported research results, outcome studies, treatment approaches and new initiatives. Traditional areas are being explored in the first episode that can add to our knowledge of schizophrenia. New areas that have a specific relevance for early intervention such as the duration of untreated psychosis and pathways to care are being widely studied. Despite the criticism of the lack of randomized controlled trials, there is a wealth of positive outcome from both effectiveness studies and limited controlled trials. However, there are still many unanswered issues which are in developing stages or which require further investigation.
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Affiliation(s)
- Jean Addington
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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