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Galbusera L, Endres R, Scholz T, Jirku E, Thoma S. Therapeutic stance towards persons with psychosis - a Grounded Theory study. Int J Qual Stud Health Well-being 2024; 19:2333064. [PMID: 38552196 PMCID: PMC10984242 DOI: 10.1080/17482631.2024.2333064] [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] [Received: 02/24/2023] [Accepted: 03/17/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE Over the last decades, psychotherapy of psychosis has increasingly gained attention. The quality of the therapeutic alliance has been shown to have an impact on therapy outcome. Yet, little is know about the influence of the therapeutic stance on the alliance. In this study, we explore psychotherapists' stance towards persons with psychosis with the aim of better understanding its characteristic-hindering and helpful-aspects. METHOD 6 semi-structured interviews with psychotherapists from three different schools (CBT, PD, ST) were analysed with Grounded Theory. Credibility was checked through external and peer-researcher-supported debriefing. RESULTS 4 core categories were generated and interrelated in a theoretical model. Therapists' stance was initially characterized by insecurity. Diffent ways of dealing with insecurity yielded different stances: a monological and an open one. A helpful stance was conceived as stemming from openness and was characterized by a dialogical structure. A co-presence (or "dosing") of you and I was conceived as its core aspect. CONCLUSION These findings specify the interpersonal dynamics arising from different stances and their impact on the therapeutic alliance and process. Research is still needed to further understand the characteristics of helpful and hindering therapeutic stances, which should also inform the training of psychotherapists.
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Affiliation(s)
- Laura Galbusera
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School, Rüdersdorf, Germany
| | - Ralph Endres
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School, Rüdersdorf, Germany
| | | | - Emilia Jirku
- Department for Social Psychiatry, University Medicine Halle (Saale), Halle, Germany
| | - Samuel Thoma
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School, Rüdersdorf, Germany
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Vaswani-Bye A, McCain C, Blank JM, Tennison ME, Kopelovich SL. A Thematic Analysis Investigating the Inaugural Psychosis REACH Family Ambassador Peer Training Program. Neuropsychiatr Dis Treat 2024; 20:233-245. [PMID: 38348058 PMCID: PMC10860596 DOI: 10.2147/ndt.s432255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/15/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose Caregivers of loved ones with psychosis are tasked with navigating a barren care landscape for their loved ones and for themselves. The dearth of resources they face has a negative impact on outcomes for caregivers and their loved ones. The Psychosis REACH program, based on principles from Cognitive Behavioral Therapy for psychosis was developed as a community-based resource for families to address this care gap. A role for family peers called the Psychosis REACH Family Ambassadors (pRFAs) was developed to reinforce skill learning for caregivers by utilizing a task-sharing approach. This qualitative study sought to better understand pRFAs' experiences in the inaugural training cohort of this program. Patients and Methods Eleven pRFAs participated in semi-structured interviews with research coordinators via teleconference. Questions assessed the quality of the training, challenges and facilitators experienced in their role, and ways in which the program could be improved and expanded. Using thematic analysis, members of the research team coded interviews individually, discussed codes until consensus was reached, and iteratively developed themes based on codes that clustered based on meaning or content. Results This process identified 5 key themes: The development of hope and recovery, the development of solidarity networks, the challenges of navigating boundaries, preferred pedagogical strategies, and the need for more support. Conclusion Overall, the themes developed from this qualitative analysis demonstrate the value and feasibility of developing a caregiver peer network of pRFAs trained in recovery-oriented care and CBTp-informed skills to support other caregivers. Additionally, they highlight the challenges associated with being in the role of a pRFA and further efforts needed to align training content and learning management systems to the needs of pRFA trainees. These findings highlight the importance of expanding access to family peer training programs for the wellbeing of caregivers and loved ones with psychosis alike.
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Affiliation(s)
- Akansha Vaswani-Bye
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Chris McCain
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer M Blank
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Mackenzie E Tennison
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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3
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Ehrt-Schäfer Y, Rusmir M, Vetter J, Seifritz E, Müller M, Kleim B. Feasibility, Adherence, and Effectiveness of Blended Psychotherapy for Severe Mental Illnesses: Scoping Review. JMIR Ment Health 2023; 10:e43882. [PMID: 38147373 PMCID: PMC10777283 DOI: 10.2196/43882] [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] [Received: 10/29/2022] [Revised: 07/06/2023] [Accepted: 10/29/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Blended psychotherapy (bPT) combines face-to-face psychotherapy with digital interventions to enhance the effectiveness of mental health treatment. The feasibility and effectiveness of bPT have been demonstrated for various mental health issues, although primarily for patients with higher levels of functioning. OBJECTIVE This scoping review aims to investigate the feasibility, adherence, and effectiveness of bPT for the treatment of patients with severe mental illnesses (SMIs). METHODS Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, we conducted searches in PubMed, MEDLINE, Embase, PsycINFO, and PsycArticles for studies published until March 23, 2023. RESULTS Out of 587 screened papers, we incorporated 25 studies encompassing 23 bPT interventions, involving a total of 2554 patients with SMI. The intervention formats and research designs exhibited significant variation. Our findings offer preliminary evidence supporting the feasibility of bPT for SMI, although there is limited research on adherence. Nevertheless, the summarized studies indicated promising attrition rates, spanning from 0% to 37%, implying a potential beneficial impact of bPT on adherence to SMI treatment. The quantity of evidence on the effects of bPT for SMI was limited and challenging to generalize. Among the 15 controlled trials, 4 concluded that bPT interventions were effective compared with controls. However, it is noteworthy that 2 of these studies used the same study population, and the control groups exhibited significant variations. CONCLUSIONS Overall, our review suggests that while bPT appears promising as a treatment method, further research is necessary to establish its effectiveness for SMI. We discuss considerations for clinical implementation, directions, and future research.
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Affiliation(s)
- Yamina Ehrt-Schäfer
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Milan Rusmir
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Johannes Vetter
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Mario Müller
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Boyer L, Fernandes S, Brousse Y, Yon DK, Tran B, Auquier P, Fond G. Enhancing patient experience assessment with psychological care in severe mental disorders: A study of the PREMIUM program. Asian J Psychiatr 2023; 90:103804. [PMID: 37913651 DOI: 10.1016/j.ajp.2023.103804] [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] [Received: 08/21/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
Incorporating the experiences of patients with severe mental disorders (SMD) into clinical practice offers valuable insights for optimizing psychological care's effectiveness with more patient-centered and personalized interventions. The study aimed to develop a patient-reported experience measure regarding psychological care (PREMIUM-PSY) using adaptive testing and investigate its association with quality of life. In a multicenter study involving 443 patients with SMD, PREMIUM-PSY demonstrated both validity and efficiency (6-item average). Positive patient experiences were associated with enhanced mental and physical quality of life (β = 3.15[2.17;4.12], p < 0.001 and β = 1.18[0.04;2.32], p = 0.042), suggesting PREMIUM-PSY's potential for optimizing psychological care outcomes.
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Affiliation(s)
- Laurent Boyer
- AP-HM, Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Marseille, France.
| | - Sara Fernandes
- AP-HM, Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Marseille, France
| | - Yann Brousse
- AP-HM, Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Marseille, France
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Bach Tran
- AP-HM, Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Marseille, France; Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Viet Nam
| | - Pascal Auquier
- AP-HM, Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Marseille, France
| | - Guillaume Fond
- AP-HM, Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Marseille, France
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Shen H, Zhang L, Li Y, Zheng D, Du L, Xu F, Xu C, Liu Y, Shen J, Li Z, Cui D. Mindfulness-based intervention improves residual negative symptoms and cognitive impairment in schizophrenia: a randomized controlled follow-up study. Psychol Med 2023; 53:1390-1399. [PMID: 36468948 PMCID: PMC10009398 DOI: 10.1017/s0033291721002944] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 07/03/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Residual negative symptoms and cognitive impairment are common for chronic schizophrenia patients. The aim of this study was to investigate the efficacy of a mindfulness-based intervention (MBI) on negative and cognitive symptoms of schizophrenia patients with residual negative symptoms. METHODS In this 6-week, randomized, single-blind, controlled study, a total of 100 schizophrenia patients with residual negative symptoms were randomly assigned to the MBI or control group. The 6-week MBI group and the control group with general rehabilitation programs maintained their original antipsychotic treatments. The scores for the Positive and Negative Syndrome Scale (PANSS), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Symptom Checklist 90 (SCL-90) were recorded at baseline and week 6 to assess psychotic symptoms, cognitive performance, and emotional state, respectively. RESULTS Compared with general rehabilitation programs, MBI alleviated the PANSS-negative subscore, general psychopathology subscore, and PANSS total score in schizophrenia patients with residual negative symptoms (F = 33.77, pBonferroni < 0.001; F = 42.01, pBonferroni < 0.001; F = 52.41, pBonferroni < 0.001, respectively). Furthermore, MBI improved RBANS total score and immediate memory subscore (F = 8.80, pBonferroni = 0.024; F = 11.37, pBonferroni = 0.006), as well as SCL-90 total score in schizophrenia patients with residual negative symptoms (F = 18.39, pBonferroni < 0.001). CONCLUSIONS Our results demonstrate that MBI helps schizophrenia patients with residual negative symptoms improve clinical symptoms including negative symptom, general psychopathology symptom, and cognitive impairment. TRIAL REGISTRATION ChiCTR2100043803.
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Affiliation(s)
- Hui Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhuan Li
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Denise Zheng
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lizhao Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Med-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feikang Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuchen Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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Israel P, Ruud T, Weimand B. Carer involvement in the assessment of personal recovery: A naturalistic study of assertive community treatment in Norway. Front Psychiatry 2023; 14:1135135. [PMID: 37051169 PMCID: PMC10083239 DOI: 10.3389/fpsyt.2023.1135135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/22/2023] [Indexed: 04/14/2023] Open
Abstract
Background The user and carer movements have come a long way in becoming embedded in mainstream mental health services for individuals with serious mental illness. However, implementing recovery-oriented practice continues to be plagued by an individualistic clinical focus. The carers do not feel integrated despite policies and best intentions. The implementation of Assertive Community Treatment (ACT) provided an opportunity to involve the carers and compare their assessment of personal recovery with the users. Aims The aims of this study were to examine (i) how family carers and users differed in their assessment of personal recovery, (ii) whether familial and personal relationships influenced how carers assess personal recovery of users, and (iii) if the experience of family carers with the ACT team was associated with personal recovery. Methods The naturalistic, explorative study recruited 69 users and 36 family carers from 12 Norwegian ACT teams. The users and carers assessed the user's personal recovery. Family carers also reported their experience and satisfaction with the ACT teams. Analyses included independent and paired sample T-tests and correlation analysis. Results Family carers were significantly more conservative than the users' assessment of the intrapsychic and interpersonal subscales of personal recovery. The pattern held true whether the family carers were matched to the users or part of the total sample. Lastly, there was a significant negative correlation between the family carer's experience of cooperation with the ACT team and their assessment of the user's intrapersonal process of recovery. Conclusions The results of our study were consistent with previous research on carer involvement in MHS. However, it is the first study that engaged carers and assessed personal recovery of the users of ACT services. Discrepancy between carers and users is the rule. Clinicians are encouraged to embrace the discrepancy and diversity carers bring and learn the methodology of multi-informant assessments. There also is a need to address, update, and integrate the personal, familial, and relational aspects of recovery. Modification of recovery measures such as QPR and their creative use with carers has the potential to generate valuable third-party information and to involve them meaningfully in mental health services.
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Affiliation(s)
- Pravin Israel
- Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
- *Correspondence: Pravin Israel
| | - Torleif Ruud
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health, Department of Special Psychiatry, Akershus University Hospital, Lørenskog, Norway
| | - Bente Weimand
- Division of Mental Health, Department of Special Psychiatry, Akershus University Hospital, Lørenskog, Norway
- Department of Health, Social, and Welfare Studies, University of South-Eastern Norway, Kongsberg, Norway
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Valencia M, Medina R, Calixto E, Rodríguez N. Cerebral, Psychosocial, Family Functioning and Disability of Persons with Schizophrenia. Neuropsychiatr Dis Treat 2022; 18:2069-2082. [PMID: 36133029 PMCID: PMC9484561 DOI: 10.2147/ndt.s370449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/30/2022] [Indexed: 11/23/2022] Open
Abstract
The human brain is the most cognitively capable of mammalian brains, endowed as it is with an overdeveloped cerebral cortex that, in parallel, renders it vulnerable to mental disorders. Schizophrenia is the expression of the dysregulation of the neuronal activity of cortical and subcortical regions due to modifications in the levels of the various neurotransmitters, especially of dopamine, with a reciprocal, intimate relationship among genes with environmental and psychosocial factors. If the dopaminergic system increases the function prefrontal cortex will be reduced: this is the main reason of social, occupational and familiar disruption. The present article describes the function of the brain in schizophrenia and its relation with anatomical, physiological, and genetic changes, in addition to identifying, psychosocial and family factors that can be determinant in the functionality of the patient. A review of national and international bibliography was conducted bearing in mind the following variables: functioning at the cerebral level; psychosocial functioning, familial functioning, disability, and functionality in persons with schizophrenia. Due to the variety of the issues included in this review, it can be concluded that schizophrenia is the product of a complex array of symptoms, deficits and disabilities. It was identified that there is a reciprocal confluence of diverse genetic, psychosocial, familial, environmental, educative, and social factors which affect the functionality of persons with this disorder. The latter makes it necessary to study the patient taking into consideration all of these components in an integral manner.
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Affiliation(s)
- Marcelo Valencia
- Department of Innovation and Global Health, Epidemiologic and Psychosocial Research Direction; National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Rafael Medina
- Institute Jaliscience of Mental Health, Guadalajara, Jalisco, Mexico
| | - Eduardo Calixto
- Neurobiology Department, Neurosciences Direction, National Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico
| | - Noemí Rodríguez
- Institute Jaliscience of Mental Health, Guadalajara, Jalisco, Mexico
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Giummarra MJ, Randjelovic I, O’Brien L. Interventions for social and community participation for adults with intellectual disability, psychosocial disability or on the autism spectrum: An umbrella systematic review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:935473. [PMID: 36189003 PMCID: PMC9397886 DOI: 10.3389/fresc.2022.935473] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022]
Abstract
Objective This umbrella systematic review examined the effectiveness, facilitators, and barriers of interventions for social, community and civic participation for adults on the autism spectrum, or with intellectual or psychosocial disability. Data Sources Eight databases were searched to identify eligible reviews defined by the: Sample (≥50% adults on the autism spectrum or with intellectual or psychosocial disability), Phenomena of Interest (interventions in community settings that aimed to improve social, community or civic participation, or capacity to participate), Design (any), Evaluation (any method that evaluated impacts on participation or capacity to participate), and Research type (reviews as journal articles, dissertations or in grey literature, in English, published 2010-2020). Review Methods Rapid review methods were used. One researcher screened 27,890 records and 788 potentially eligible full texts. A second reviewer independently screened 20% of records, and ambiguous full text publications. Study quality was extracted, and review quality was assessed with the Assessing Methodological Quality of Systematic Reviews (AMSTAR) checklist. Data from 522 studies in 57 eligible systematic reviews were extracted for narrative synthesis. The Corrected Covered Area (CCA) was calculated to indicate overlap between reviews. Results There was a pooled sample of 28,154 study participants, predominantly from studies in North America, the UK and Europe. There was very low overlap between reviews (CCA = 0.3%). Reviews were predominantly low quality: 77.2% of reviews met <50% of AMSTAR criteria. Most studies were low (45.4%) or moderate (38.3%) quality. Three broad intervention categories improved participation, inclusion and belonging outcomes: (1) interventions to help people identify and connect with participation opportunities (e.g., person centred planning); (2) participation opportunities or activities (e.g., joining a community group, sports or outdoor activities, or arts-based activities); and (3) supports to build skills and capacity to participate socially and in the community. Conclusions The evidence highlighted that improved social and community participation requires purposeful strategies that identify meaningful participation preferences (e.g., where, when, how, and with whom) and provide support to build capacity or enable ongoing participation. Community capacity building, peer support and advocacy may also be needed to make the community more accessible, and to enable people to exercise genuine choice.
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Affiliation(s)
- Melita J. Giummarra
- Research and Evaluation Branch, Digital Design and Strategy Division, National Disability Insurance Agency, Melbourne Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ivana Randjelovic
- Research and Evaluation Branch, Digital Design and Strategy Division, National Disability Insurance Agency, Melbourne Victoria, Australia
| | - Lisa O’Brien
- Research and Evaluation Branch, Digital Design and Strategy Division, National Disability Insurance Agency, Melbourne Victoria, Australia
- Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
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9
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Kapadia SV. Adapting AVATAR Therapy: Using Available Digital Technology for People Living with Auditory Verbal Hallucinations in Low- and Middle-Income Countries. Indian J Psychol Med 2022; 44:405-408. [PMID: 35949640 PMCID: PMC9301740 DOI: 10.1177/02537176221090106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Cowan T, Strauss GP, Raugh IM, Le TP, Cohen AS. How do social factors relate to blunted facial affect in schizophrenia? A digital phenotyping study using ambulatory video recordings. J Psychiatr Res 2022; 150:96-104. [PMID: 35366600 PMCID: PMC10036138 DOI: 10.1016/j.jpsychires.2022.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 01/05/2023]
Abstract
Clinical interviews and laboratory-based emotional induction paradigms provide consistent evidence that facial affect is blunted in many individuals with schizophrenia. Although it is clear that blunted facial affect is not a by-product of diminished emotional experience in schizophrenia, factors contributing to blunted affect remain unclear. The current study used a combination of ambulatory video recordings that were evaluated via computerized facial affect analysis and concurrently completed ecological momentary assessment surveys to assess whether blunted affect reflects insufficient reactivity to affective or contextual factors. Specifically, whether individuals with schizophrenia require more intense affective experiences to produce expression, or whether they are less reactive to social factors (i.e. being in the presence of others, social motivation). Participants included outpatients with schizophrenia (n = 33) and healthy controls (n = 31) who completed six days of study procedures. Multilevel linear models were evaluated using both Null-Hypothesis Statistical Testing and Bayesian analyses. Individuals with schizophrenia displayed comparable expression of positive and negative emotion to controls during daily life, and no evidence was found for a different intensity of experience required for expression in either group. However, social factors differentially influenced facial expression in schizophrenia compared to controls, such that individuals with schizophrenia did not modulate their expressions based on social motivation to the same extent as controls. These findings suggest that social motivation may play an important role in determining when blunting occurs.
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Affiliation(s)
- Tovah Cowan
- Department of Psychology, Louisiana State University, United States; Center for Computation and Technology, Louisiana State University, United States
| | | | - Ian M Raugh
- Department of Psychology, University of Georgia, United States
| | - Thanh P Le
- Department of Psychology, Louisiana State University, United States
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, United States; Center for Computation and Technology, Louisiana State University, United States.
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11
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Strachan LP, Paulik G, McEvoy PM. A narrative review of psychological theories of post-traumatic stress disorder, voice hearing, and other psychotic symptoms. Clin Psychol Psychother 2022; 29:1791-1811. [PMID: 35578567 PMCID: PMC10084244 DOI: 10.1002/cpp.2754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most voice hearers report childhood trauma. Many voice hearers report comorbid post-traumatic stress symptoms and that the content of their voices (auditory verbal hallucinations) is directly (voices repeat phrases spoken by perpetrators) or indirectly (voice content and trauma is thematically similar) related to their trauma. The factors that maintain trauma-related voices are unknown, and there is limited research in this area. This study aimed to identify potential maintaining factors of trauma-related voices by reviewing models of post-traumatic stress disorder (PTSD) and positive symptoms of psychosis. METHOD Models of PTSD and positive symptoms were reviewed to identify potential factors that are unique and common to both sets of symptoms. RESULTS We reviewed 10 models of PTSD, 4 models of positive symptoms, and 2 trauma-informed models of voice hearing. One model provided a theoretical explanation of different types of trauma-related voices. Twenty-one factors were extracted from 16 theoretical models. No existing model incorporated all these factors. DISCUSSION Existing PTSD and positive symptom models present a range of common and unique factors. There may be value in extending existing integrative models to include a broader range of potential factors that could explain different pathways to, and expressions of, trauma-related voices. A future research agenda is presented to investigate how such an extension could lead to more complete individualized case formulations and targeted treatments.
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Affiliation(s)
- Laura P Strachan
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia.,Perth Voices Clinic, Murdoch, Western Australia, Australia.,School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Peter M McEvoy
- School of Population Health, Curtin University, Perth, Western Australia, Australia.,enAble Institute, Curtin University, Perth, Western Australia, Australia.,Centre for Clinical Interventions, Perth, Western Australia, Australia
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12
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Kim K, Jeon HJ, Myung W, Suh SW, Seong SJ, Hwang JY, Ryu JI, Park SC. Clinical Approaches to Late-Onset Psychosis. J Pers Med 2022; 12:381. [PMID: 35330384 PMCID: PMC8950304 DOI: 10.3390/jpm12030381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 12/10/2022] Open
Abstract
Psychosis can include schizophrenia, mood disorders with psychotic features, delusional disorder, active delirium, and neurodegenerative disorders accompanied by various psychotic symptoms. Late-onset psychosis requires careful intervention due to the greater associated risks of secondary psychosis; higher morbidity and mortality rates than early-onset psychosis; and complicated treatment considerations due to the higher incidence of adverse effects, even with the black box warning against antipsychotics. Pharmacological treatment, including antipsychotics, should be carefully initiated with the lowest dosage for short-term efficacy and monitoring of adverse side effects. Further research involving larger samples, more trials with different countries working in consortia, and unified operational definitions for diagnosis will help elaborate the clinical characteristics of late-onset psychosis and lead to the development of treatment approaches.
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Affiliation(s)
- Kiwon Kim
- Department of Psychiatry, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 05355, Korea; (K.K.); (S.W.S.); (S.J.S.); (J.Y.H.)
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Irwon-ro, Gangnam-gu, Seoul 06351, Korea;
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gumi-ro, 173 beon-gil Bundang-gu, Seongnam-si 13619, Korea;
| | - Seung Wan Suh
- Department of Psychiatry, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 05355, Korea; (K.K.); (S.W.S.); (S.J.S.); (J.Y.H.)
| | - Su Jeong Seong
- Department of Psychiatry, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 05355, Korea; (K.K.); (S.W.S.); (S.J.S.); (J.Y.H.)
| | - Jae Yeon Hwang
- Department of Psychiatry, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 05355, Korea; (K.K.); (S.W.S.); (S.J.S.); (J.Y.H.)
| | - Je il Ryu
- Department of Neurosurgery, College of Medicine, Hanyang University, Gyungchun-ro 153, Guri-si 11923, Korea
- Department of Neurosurgery, Hanyang University Guri Hospital, Gyungchun-ro 153, Guri-si 11923, Korea
| | - Seon-Cheol Park
- Department of Psychiatry, College of Medicine, Hanyang University, Gyungchun-ro 153, Guri-si 11923, Korea
- Department of Psychiatry, Hanyang University Guri Hospital, Gyungchun-ro 153, Guri-si 11923, Korea
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Gallos IK, Mantonakis L, Spilioti E, Kattoulas E, Savvidou E, Anyfandi E, Karavasilis E, Kelekis N, Smyrnis N, Siettos CI. The relation of integrated psychological therapy to resting state functional brain connectivity networks in patients with schizophrenia. Psychiatry Res 2021; 306:114270. [PMID: 34775295 DOI: 10.1016/j.psychres.2021.114270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/22/2021] [Accepted: 10/31/2021] [Indexed: 01/05/2023]
Abstract
Functional brain dysconnectivity measured with resting state functional magnetic resonance imaging (rsfMRI) has been linked to cognitive impairment in schizophrenia. This study investigated the effects on functional brain connectivity of Integrated Psychological Therapy (IPT), a cognitive behavioral oriented group intervention program, in 31 patients with schizophrenia. Patients received IPT or an equal intensity non-specific psychological treatment in a non-randomized design. Evidence of improvement in executive and social functions, psychopathology and overall level of functioning was observed after treatment completion at six months only in the IPT treatment group and was partially sustained at one-year follow up. Independent Component Analysis and Isometric Mapping (ISOMAP), a non-linear manifold learning algorithm, were used to construct functional connectivity networks from the rsfMRI data. Functional brain dysconnectivity was observed in patients compared to a group of 17 healthy controls, both globally and specifically including the default mode (DMN) and frontoparietal network (FPN). DMN and FPN connectivity were reversed towards healthy control patterns only in the IPT treatment group and these effects were sustained at follow up for DMN but not FPN. These data suggest the use of rsfMRI as a biomarker for accessing and monitoring the therapeutic effects of cognitive remediation therapy in schizophrenia.
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Affiliation(s)
- I K Gallos
- School of Applied Mathematics and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - L Mantonakis
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece; First Psychiatry Department, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - E Spilioti
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece; First Psychiatry Department, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - E Kattoulas
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece
| | - E Savvidou
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece
| | - E Anyfandi
- First Psychiatry Department, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - E Karavasilis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece
| | - N Kelekis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece
| | - N Smyrnis
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece; Second Psychiatry Department, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece.
| | - C I Siettos
- Dipartimento di Matematica e Applicazioni "Renato Caccioppoli", Università degli Studi di Napoli Federico II, Naples, Italy
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Affect-Logic, Embodiment, Synergetics, and the Free Energy Principle: New Approaches to the Understanding and Treatment of Schizophrenia. ENTROPY 2021; 23:e23121619. [PMID: 34945925 PMCID: PMC8700589 DOI: 10.3390/e23121619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
This theoretical paper explores the affect-logic approach to schizophrenia in light of the general complexity theories of cognition: embodied cognition, Haken's synergetics, and Friston's free energy principle. According to affect-logic, the mental apparatus is an embodied system open to its environment, driven by bioenergetic inputs of emotions. Emotions are rooted in goal-directed embodied states selected by evolutionary pressure for coping with specific situations such as fight, flight, attachment, and others. According to synergetics, nonlinear bifurcations and the emergence of new global patterns occur in open systems when control parameters reach a critical level. Applied to the emergence of psychotic states, synergetics and the proposed energetic understanding of emotions lead to the hypothesis that critical levels of emotional tension may be responsible for the transition from normal to psychotic modes of functioning in vulnerable individuals. In addition, the free energy principle through learning suggests that psychotic symptoms correspond to alternative modes of minimizing free energy, which then entails distorted perceptions of the body, self, and reality. This synthetic formulation has implications for novel therapeutic and preventive strategies in the treatment of psychoses, among these are milieu-therapeutic approaches of the Soteria type that focus on a sustained reduction of emotional tension and phenomenologically oriented methods for improving the perception of body, self, and reality.
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15
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Bonner AC, Biglan A, Drugan-Eppich K. The Dismal State of Federal Funding for Experimental Evaluations of Interventions to Reduce Greenhouse Gas Emissions. Perspect Behav Sci 2021; 46:5-34. [PMID: 37006600 PMCID: PMC10050258 DOI: 10.1007/s40614-021-00316-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/27/2022] Open
Abstract
The threats of climate change to human well-being are well-documented and are growing in number and intensity. Despite the international community investing heavily in technological innovation and policy initiatives to solve the problem, emissions continue to rise. Experts are recognizing that eliminating emissions cannot be achieved without modifying the human behavior of which emissions are a function. However, little attention has been allocated to expanding the use of strategies developed by the behavioral-science community to reduce emissions on large scales. One possible reason is that federal funding has not been arranged to select such research. Therefore, we conducted an analysis of six sources of information about federal funding to fight climate change (the Government Accountability Office, the National Science Foundation, the Environmental Protection Agency, the Department of Energy, the National Institutes of Health, and the Center for Disease Control) and examined the extent to which they are funding behavioral science research to reduce emissions. Our results show an appalling lack of funding for behavioral science research to reduce emissions, especially experimental evaluations of strategies for reducing them. Implications and recommendations for funding of future research are discussed.
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16
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Kopelovich SL, Stiles B, Monroe-DeVita M, Hardy K, Hallgren K, Turkington D. Psychosis REACH: Effects of a Brief CBT-Informed Training for Family and Caregivers of Individuals With Psychosis. Psychiatr Serv 2021; 72:1254-1260. [PMID: 34015942 DOI: 10.1176/appi.ps.202000740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychosis Recovery by Enabling Adult Carers at Home (Psychosis REACH) is a training for families of individuals with psychosis that consists of recovery-oriented psychosis psychoeducation, caregiver self-care, and skills training informed by cognitive-behavioral therapy for psychosis (CBTp). The authors assessed the effects of a 1-day and a 4-day training on the natural supports (i.e., family and other caregivers) of individuals with psychotic disorders. METHODS Attendees of a 1-day (N=168) and a 4-day (N=29) Psychosis REACH training were surveyed at three timepoints: pretraining, posttraining, and 4-month follow-up. Longitudinal changes across the full sample were evaluated by paired-sample t tests or a one-way repeated-measures analysis of variance (ANOVA). Two-way mixed ANOVAs were conducted with training condition, time, and the training condition × time interactions entered into the model. RESULTS Reductions were noted in self-perceived depression, anxiety, negative aspects of the caregiving experience, and expressed emotion. Trainees also showed more prosocial attitudes toward psychosis immediately and at 4 months after the training. CONCLUSIONS This evaluation of the launch of Psychosis REACH in the United States suggests that the training can improve the mental health, attitudinal, and relational outcomes of family and caregivers of individuals with psychosis. Given the dearth of CBTp and family interventions for psychosis in mental health services in the United States, short-term, intensive training that supplements clinical services has intuitive appeal as a means of surmounting the barriers that have plagued family interventions.
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Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Bryan Stiles
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Kate Hardy
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Kevin Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
| | - Douglas Turkington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Kopelovich, Stiles, Monroe-DeVita, Hallgren); Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (Hardy); Northumberland Tyne and Wear National Health Service Foundation Trust, Newcastle Upon Tyne, United Kingdom (Turkington)
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17
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Lam AHY, Leung SF, Chien WT. Mindfulness-based psychoeducation for schizophrenia spectrum disorders: a qualitative analysis of participants' experiences. Contemp Nurse 2021; 57:387-406. [PMID: 34661495 DOI: 10.1080/10376178.2021.1994864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mindfulness-based psychoeducation program (MBPP) has been proposed as a new approach to improve the overall outcomes for individuals with schizophrenia spectrum disorders. However, to date, limited studies have examined the participants' experiences of MBPP for schizophrenia. The aim of this study was to explore the experiences of individuals with schizophrenia spectrum disorders (SSDs) who underwent an 8-week MBPP with respect to their perception of the benefits and unusual challenges of mindfulness training and self-practices. Twenty-four (n = 24) individuals with SSDs were invited to participate in an 8-week MBPP. A total of eight participants were invited for semi-structured interview one week after the final class of MBPP. The semi-structured interview was conducted in Cantonese and data were transcribed by the first author. Of the eight participants, five participants had unusual experiences and three participants had a positive experience with MBPP. They were included to provide more candid understanding on the constituents of diverse experience towards MBPP. An interview guide was developed to understand the patients' perceptions of MBPP, the challenege in self-practising mindfulness, and the changes in how they coped with their illness during and after taking part in MBPP. Qualitative data from the semi-structured interview were recorded by a research assistant and the transcripts were proof-read by the participants to ensure accuracy. The Software NVivo 12 Pro was used to manage the qualitative data from the semi-structured interview. Thematic analysis was adopted to identify the major themes from the qualitative data. Five themes emerged: developing a state of mindfulness, empowering illness management, learning a new way to regulate emotion, encountering barriers in self-practising mindfulness and preference for bodily mindfulness. The findings provide comprehensive knowledge and deeper insights into treatment processes of mindfulness psychoeducation as an intervention for schizophrenia spectrum disorders. IMPACT STATEMENT This study establishes a body of knowledge regarding people with schizophrenia spectrum disorders who received mindfulness psychoeducation intervention. The results suggest that patients can develop a new way to regulate emotion and manage their illness through mindfulness psychoeducation. The perceived negative experience of some patients also warrants closer attention in mindfulness practice, especially for individuals with schizophrenia spectrum disorders. Further research could focus on factors leading to the negative consequences of mindfulness practice and the ways to minimize the negative consequeces.
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Affiliation(s)
- Angie Ho Yan Lam
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
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18
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Rampino A, Falcone RM, Giannuzzi A, Masellis R, Antonucci LA, Torretta S. Strategies for Psychiatric Rehabilitation and their Cognitive Outcomes in Schizophrenia: Review of Last Five-year Studies. Clin Pract Epidemiol Ment Health 2021; 17:31-47. [PMID: 34249137 PMCID: PMC8227533 DOI: 10.2174/1745017902117010031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/15/2021] [Accepted: 02/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cognitive deficits are core features of Schizophrenia, showing poor response to antipsychotic treatment, therefore non-pharmacological rehabilitative approaches to such a symptom domain need to be identified. However, since not all patients with Schizophrenia exhibit the same cognitive impairment profile, individualized rehabilitative approaches should be set up. OBJECTIVES We explored the last five-year literature addressing the issue of cognitive dysfunction response to rehabilitative methodologies in Schizophrenia to identify possible predictors of response and individualized strategies to treat such a dysfunction. CONCLUSION A total of 76 studies were reviewed. Possible predictors of cognitive rehabilitation outcome were identified among patient-specific and approach-specific variables and a general overview of rehabilitative strategies used in the last five years has been depicted. Studies suggest the existence of multifaced and multi-domain variables that could significantly predict pro-cognitive effects of cognitive rehabilitation, which could also be useful for identifying individual-specific rehabilitation trajectories over time.An individualized rehabilitative approach to cognitive impairment in Schizophrenia is possible if taking into account both patient and approach specific predictors of outcomes.
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Affiliation(s)
- Antonio Rampino
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
- Azienda Ospedaliero-Universitaria Policlinico di Bari, 70124 Bari, Italy
| | - Rosa M. Falcone
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Arianna Giannuzzi
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Rita Masellis
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Linda A. Antonucci
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, 70122 Bari, Italy
| | - Silvia Torretta
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
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Bjørkedal STB, Eplov LF, Møller T. The missing link-participants' perspectives on transfer from psychosocial interventional contexts to everyday community life: a qualitative synthesis of interventional studies. BMC Psychol 2021; 9:62. [PMID: 33906685 PMCID: PMC8077941 DOI: 10.1186/s40359-021-00567-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/19/2021] [Indexed: 12/26/2022] Open
Abstract
Background The aim of this study was to illuminate participants’ experiences with transfer in (1) Illness Management and Recovery (IMR); and (2) two programs based on peer support: Turning Points, and Learn to Tackle Anxiety and Depression (LTAD); and whether peer support within these programs influenced the process of transfer beyond the interventional context. Furthermore, we investigated participants’ experiences with a community-based intervention [Individual Placement and Support (IPS)] to explore perspectives on mechanisms that may eliminate challenges in the transfer process. Methods The study was based on semi-structured interviews with participants with mental illness, from four different psychosocial interventions with and without peer support and across interventional settings. The material partly consists of secondary analyses of existing data sets of anonymised, transcribed interviews investigating participants' experience from two psychosocial interventions: Illness Management and Recovery (n = 15), and Individual Placement and Support (n = 12). Additionally, we conducted semi-structured interviews with persons who had participated in one of two peer-led programs: Turning Points and Learn How to Tackle Anxiety and Depression (n = 12). The analysis was guided by a hermeneutic-phenomenological approach to illuminate transfer processes and was based on the template method described by Nigel King. Results Applying a transfer perspective on rehabilitation interventions identified everyday life situations where capacities learned during the interventions were utilized and conditions were highlighted that promoted or hindered transfer. Experiential knowledge and peer-exchange made transferal pathways between the interventional context and everyday life. Illness intrusiveness and uncertainty, together with environmental obstacles, generated transferal gaps. Individualized support could partly address these gaps. Conclusion Findings from this qualitative study illuminate how peer-support in group-based rehabilitation interventions increased social functioning and developed better self-care strategies that can be transferred to daily life. Interventions situated in mental health settings, e.g. outpatient clinics, had limited impact on participation in broader community life. Advancing rehabilitation services in mental health may benefit from tailoring services to address illness fluctuation and combining group sessions with individualized support together with acknowledging and overcoming environmental obstacles.
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Affiliation(s)
- Siv Therese Bogevik Bjørkedal
- CORE: Copenhagen Research Center for Mental Health. Team for Inclusion and Recovery, Gentofte Hospitalsvej 15, opg. 3A, 2900, Hellerup, Denmark.
| | - Lene Falgaard Eplov
- CORE: Copenhagen Research Center for Mental Health. Team for Inclusion and Recovery, Gentofte Hospitalsvej 15, opg. 3A, 2900, Hellerup, Denmark
| | - Tom Møller
- CKO University Hospital of Copenhagen Rigshospitalet Dep. 8513, 2100, Copenhagen East, Denmark
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20
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Pilot study of a group worry intervention for recent onset psychosis. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Worry is common among individuals with psychosis and has been found to be a causal factor in the development of paranoia. Previous research has shown that a cognitive behavioural therapy protocol targeting worry helps to reduce persecutory delusions and associated distress in a population experiencing longstanding psychotic symptoms. However, there has yet to be a published adaptation of the protocol for individuals experiencing a recent onset of psychosis. The current study aims to examine the feasibility of adapting the worry intervention for recent onset psychosis in a group setting. Six young adults with a recent onset of psychosis, aged 18–32 years, participated in a pilot study of an 8-week group intervention covering cognitive behavioural strategies for managing worry, including worry periods, worry postponement techniques, mindfulness and relaxation, and problem solving. Pre- and post-intervention data were collected on worry, anxiety, depressive symptoms, psychotic symptoms, and perceived recovery from psychosis. In addition, qualitative feedback from group members was gathered during a post-intervention focus group. Feasibility of the group appeared promising, despite high participant attrition. All components of the intervention were successfully implemented, and group members provided positive feedback regarding acceptability of the group. Contrary to prediction, there was not a consistent decrease in worry from pre- to post-intervention. Findings from secondary symptom measures were mixed and may have been related to participants’ subjective experience of the group. Specifically, participants who experienced high levels of group cohesion seemed to benefit more from the intervention.
Key learning aims
(1)
To gain awareness of the gaps in treatment for early psychosis.
(2)
To understand the role of worry in psychosis.
(3)
To learn about the feasibility of implementing a group worry intervention for recent onset psychosis.
(4)
To consider the impact of group cohesion and symptom severity on treatment engagement.
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21
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Feyaerts J, Henriksen MG, Vanheule S, Myin-Germeys I, Sass LA. Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspective. Lancet Psychiatry 2021; 8:237-249. [PMID: 33485408 DOI: 10.1016/s2215-0366(20)30460-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Delusions are commonly conceived as false beliefs that are held with certainty and which cannot be corrected. This conception of delusion has been influential throughout the history of psychiatry and continues to inform how delusions are approached in clinical practice and in contemporary schizophrenia research. It is reflected in the full psychosis continuum model, guides psychological and neurocognitive accounts of the formation and maintenance of delusions, and it substantially determines how delusions are approached in cognitive-behavioural treatment. In this Review, we draw on a clinical-phenomenological framework to offer an alternative account of delusion that incorporates the experiential dimension of delusion, emphasising how specific alterations to self-consciousness and reality experience underlie delusions that are considered characteristic of schizophrenia. Against that backdrop, we critically reconsider the current research areas, highlighting empirical and conceptual issues in contemporary delusion research, which appear to largely derive from an insufficient consideration of the experiential dimension of delusions. Finally, we suggest how the alternative phenomenological approach towards delusion could offer new ways to advance current research and clinical practice.
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Affiliation(s)
- Jasper Feyaerts
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium.
| | - Mads G Henriksen
- Center for Subjectivity Research, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark; Mental Health Center Amager, Copenhagen, Denmark; Mental Health Center Glostrup, Brøndbyvester, Denmark
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Louis A Sass
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
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Mc Glanaghy E, Turner D, Davis GA, Sharpe H, Dougall N, Morris P, Prentice W, Hutton P. A network meta-analysis of psychological interventions for schizophrenia and psychosis: Impact on symptoms. Schizophr Res 2021; 228:447-459. [PMID: 33578368 DOI: 10.1016/j.schres.2020.12.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/30/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evidence for the effectiveness of psychological interventions for schizophrenia/psychosis is growing, however there is no consensus on the psychological intervention most likely to reduce symptoms. METHODS A network meta-analysis was conducted to identify all randomised controlled trials (RCTs) of psychological interventions for adults with schizophrenia/psychosis. A systematic review of the literature using MEDLINE, PsycINFO, EMBASE and CENTRAL led to an analysis of 90 RCTs with 8440 randomised participants across 24 psychological intervention, and control groups. Psychological interventions were categorised and rated for treatment fidelity and risk of bias. Data for total symptoms were extracted and network meta-analysis, using a frequentist approach, was undertaken using Stata SE v15 to compare the direct and indirect evidence for the effectiveness of each psychological intervention. FINDINGS Psychological interventions were more likely to reduce symptoms than control groups, and one intervention, mindfulness-based psychoeducation, was consistently ranked as most likely to reduce total symptoms. Subgroup analyses identified differential effectiveness in different settings and for different subgroups. INTERPRETATION Mindfulness-based psychoeducation was consistently ranked as most likely to reduce symptoms; however all studies were based in China. More RCTs in a variety of cultural contexts would help to elucidate whether these findings generalise internationally. A number of psychological interventions could potentially be more effective than interventions recommended by NICE guidelines, such as CBT and family therapy, and additional RCTs and meta-analyses are needed to generate more conclusive evidence in this regard.
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Affiliation(s)
- Edel Mc Glanaghy
- School of Health in Social Science, University of Edinburgh, UK; School of Health and Social Care, Edinburgh Napier University, UK; NHS Forth Valley, UK.
| | | | - Georgina A Davis
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Helen Sharpe
- School of Health in Social Science, University of Edinburgh, UK
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Paul Morris
- School of Health in Social Science, University of Edinburgh, UK
| | | | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, UK
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Laskowski A, Lincoln TM. Network meta-analysis on the comparative efficacy of family interventions for psychotic disorders: a protocol. BMJ Open 2021; 11:e039777. [PMID: 33472774 PMCID: PMC7818829 DOI: 10.1136/bmjopen-2020-039777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Family interventions are effective and are strongly recommended for psychotic disorders. However, there is a variety of intervention types, and their differential efficacy is widely unclear. The aim of the planned network meta-analysis (NMA) is to compare the efficacy of family interventions that differ in content (eg, psychoeducation, mutual support, skills training) and format (eg, number of sessions, inclusion of patients, form of delivery). METHODS AND ANALYSIS We will include randomised controlled trials comparing psychosocial interventions directed at the adult relatives, friends or non-professional carers of people with a diagnosis of a psychotic disorder (schizophrenia spectrum) to any kind of control condition. The main outcomes will be global clinical state for the patients and coping with psychosis as well as attitudes towards psychosis for the relatives. Additional outcomes will be severity of symptoms, functioning, burden and compliance/drop-out. We conducted a comprehensive search of Cochrane Central Register of Controlled Trials, MEDLINE(R), PsycINFO, Cumulative Index to Nursing & Allied Health Literature (8 August 2019) and reference lists of review articles. Full-text assessment of eligibility, data extraction and risk-of-bias assessment will be done by two independent reviewers. An NMA will be conducted for any of the planned outcomes and intervention characteristics for which sufficient and appropriate data are available. The analyses will make use of a random effects model within a frequentist framework. Estimates for all pairwise treatment effects will be obtained using standardised mean differences for continuous outcomes and risk ratios for dichotomous outcomes. Interventions will be ranked according to their relative efficacy. We will address the assumption of transitivity, heterogeneity and inconsistency using theoretical and statistical approaches. The possibility of publication bias and the strength of evidence will also be examined. ETHICS AND DISSEMINATION There are no ethical concerns. Results will be published in peer-reviewed journals and presented at practitioners' conferences. PROSPERO REGISTRATION NUMBER CRD42020148728.
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Affiliation(s)
- Alina Laskowski
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany
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24
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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: 21] [Impact Index Per Article: 4.2] [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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25
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Onwumere J, Grice S, Kuipers E. Delivering Cognitive‐Behavioural Family Interventions for Schizophrenia. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12179] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Juliana Onwumere
- Institute of Psychiatry, Psychology & Neuroscience, King's College London,
| | - Sarah Grice
- Institute of Psychiatry, Psychology & Neuroscience, King's College London,
- South London & Maudsley NHS Foundation Trust, and
| | - Elizabeth Kuipers
- Institute of Psychiatry, Psychology & Neuroscience, King's College London,
- In affiliation with the Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neurosciences
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26
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Aran G, Hicks C, Demand A, Johnson AL, Beaman J, Bailey Y, Haught M, Lane A, Sinnett P, Vassar M. Treating schizophrenia: the quality of evidence behind treatment recommendations and how it can improve. BMJ Evid Based Med 2020; 25:138-142. [PMID: 31672699 DOI: 10.1136/bmjebm-2019-111233] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the methodological and reporting quality of systematic reviews that comprise the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia and to determine the extent to which results from Cochrane systematic reviews published after guideline development would alter or confirm current recommendations. PARTICIPANTS Systematic reviews that underpinned recommendations in the APA guidelines and Cochrane systematic reviews. MAIN OUTCOME Three independent reviewers scored all systematic reviews referenced in the guideline for quality and reporting using AMSTAR and PRISMA checklist, respectively. Items in both tools were individually graded and compared to identify consistently low-performing areas within the systematic reviews. Post hoc analysis of the Cochrane systematic reviews since the latest revision of APA's guidelines were performed to determine whether their findings were congruent with recent recommendations. RESULTS The mean score of the 57 reviews on the PRISMA checklist was 70%. The mean AMSTAR score was 6.8, correlating with a moderate quality score. Post hoc analysis revealed that 171 Cochrane reviews had been published since the APA guideline release. Only half of the reviews of pharmacological interventions confirmed current recommendations. CONCLUSIONS AND RELEVANCE The methodological quality of the systematic reviews included in the APA guideline was deficient in key areas. Our study brings to light the importance of using high-quality evidence in the development of clinical practice guidelines. An updated APA guideline (last updated in 2009) is necessary to provide the highest quality treatment recommendations for clinicians in the management of schizophrenia. TRIAL REGISTRATION NUMBER UMIN-CTR, UMIN000023099.
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Affiliation(s)
- Greg Aran
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Chandler Hicks
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Alexander Demand
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Austin L Johnson
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jason Beaman
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
- Department of Psychiatry, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Yakiji Bailey
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Melissa Haught
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Aaron Lane
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Philip Sinnett
- Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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27
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The association of GABRB2 SNPs with cognitive function in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2020; 270:443-449. [PMID: 30706170 DOI: 10.1007/s00406-019-00985-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/09/2019] [Indexed: 12/21/2022]
Abstract
Cognitive impairment is one of the core symptoms of schizophrenia. Multiple domains of cognition are affected in patients with schizophrenia, which has a major effect on the functional outcome. Recent studies indicate that SNPs in the gamma-aminobutyric acid type A receptor beta 2 subunit (GABRB2) gene are associated with the risk of schizophrenia, however, the effect of these SNPs on cognitive function in patients with schizophrenia has not been explored. In this study, we first performed a case-control analysis of three SNPs (rs187269 allele A vs. G, rs252944 allele C vs. G, and rs194072 allele A vs. G) in 100 patients and 90 controls, then conducted a meta-analysis and found the SNP rs194072 was associated with schizophrenia (OR = 0.86, P = 0.0119), and survived after Bonferroni correction. The haplotype analysis suggested that the haplotype ACA, comprising the three SNPs (rs187269, rs252944 and rs194072) was also significantly associated with schizophrenia (P = 0.049).Then, we performed an association analysis of three SNPs (rs187269, rs252944 and rs194072) in GABRB2 gene with cognitive performance in patients with first episode schizophrenia. We found that the allele G of rs187269 in the GABRB2 gene was significantly associated with better cognitive flexibility (P = 0.005), a major aspect of executive function, in patients with first episode schizophrenia. The haplotype ACA was significantly associated with cognitive flexibility in patients with schizophrenia (P = 0.023). Our study showed that SNPs in GABRB2 may have a significant effect on cognitive function in patients with schizophrenia, suggesting that modulating GABRB2 may have therapeutic potential to improve cognitive function of patients with schizophrenia.
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28
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Kwakernaak S, van Mens K, Cahn W, Janssen R. Using machine learning to predict mental healthcare consumption in non-affective psychosis. Schizophr Res 2020; 218:166-172. [PMID: 32146025 DOI: 10.1016/j.schres.2020.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/28/2019] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The main goal of the study was to predict individual patients' future mental healthcare consumption, and thereby enhancing the design of an efficient demand-oriented mental healthcare system by focusing on a patient population associated with intensive mental healthcare consumption. Factors that affect the mental healthcare consumption of service users with non-affective psychosis were identified, and subsequently used in a prognostic model to predict future healthcare consumption. METHOD This study was a secondary analysis of an existing dataset from the GROUP study. Based on mental healthcare consumption, patients with non-affective psychosis were divided into two groups: low (N = 579) and high (N = 488) intensive mental healthcare consumers. Three different techniques from the field of machine learning were applied on crosssectional data to identify risk factors: logistic regression, classification tree and a random forest. Subsequently, the same techniques were applied longitudinally in order to predict future healthcare consumption. RESULTS Identified variables that affected healthcare consumption were the number of psychotic episodes, paid employment, engagement in social activities, previous healthcare consumption, and met needs. Analyses showed that the random forest method is best suited to model risk factors, and that these relations predict future healthcare consumption (AUC 0.71, PPV 0.65). CONCLUSIONS Machine learning techniques provide valuable information for identifying risk factors in psychosis. They may thus help clinicians optimize allocation of mental healthcare resources by predicting future healthcare consumption.
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Affiliation(s)
- Sascha Kwakernaak
- Altrecht Mental Health Care; Tilburg University, Department of Tranzo Scientific Center for Care and Welfare, The Netherlands.
| | - Kasper van Mens
- Altrecht Mental Health Care; Trimbos Institute, the Netherlands
| | | | - Wiepke Cahn
- Altrecht Mental Health Care; University Medical Center Utrecht, Department of Psychiatry, Rudolf Magnus Institute of Neuroscience
| | - Richard Janssen
- Tilburg University, Department of Tranzo Scientific Center for Care and Welfare, The Netherlands; Erasmus University Rotterdam, Department of Health Care Governance
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29
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Obeid S, Hallit S, Sacre H, Kazour GR. Effectiveness of integrated psychological therapy on cognitive function among Lebanese patients with schizophrenia: a pilot study. Int J Psychiatry Clin Pract 2020; 24:43-52. [PMID: 31661346 DOI: 10.1080/13651501.2019.1682615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: The integrated term emphasises the need for cognitive therapy to always be embedded into an extended treatment concept adapted to cognitive resources and deficits and to patient rehabilitation. One of the first approaches is integrated psychological therapy (IPT).Aim: To assess the effect of the IPT Programme compared to the Treatment as Usual (TaU) in terms of cognitive performance and social skills among a group of schizophrenic patients.Methods: This randomised controlled study enrolled 20 patients in each group. Patients attended 60-min sessions, 3 days/week.Results: When considering the TaU group, the bivariate results showed that significantly higher means of attention scores, lower means in social dysfunction and aggression, social adaptation scores were found after IPT compared to before. The effect size for all tests was found to be weak. When considering the IPT group, significantly higher means attention score, lower means cognitive disorders, social dysfunction, aggression and social adaptation scores were found after IPT compared to before. The effect size for all tests was found to be high.Conclusion: The therapeutic combination of the IPT programme with medical treatment has shown additional beneficial effects on the schizophrenic patients' treatment, enabling them, as far as possible, to reintegrate into the community.KEY POINTSIn cases, a significantly higher GZ-F and KL scores and a lower SDAS-9 and SDAS-6 scores were found post-IPT respectively.In controls, a significant increase in the GZ-F and KL subscales and a decrease in all other scales was found post-IPT respectively.This therapeutic combination of the integrative programme with medical treatment has shown additive beneficial effects in patients with schizophreniaThe treatment approach would allow them, as far as possible, to reintegrate within the community.
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Affiliation(s)
- Sahar Obeid
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Science, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Souheil Hallit
- INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Hala Sacre
- INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Gisèle Rouphaël Kazour
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Human Sciences, Lebanese University, Beirut, Lebanon
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30
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Lam AHY, Leung SF, Lin JJ, Chien WT. The Effectiveness of a Mindfulness-Based Psychoeducation Programme for Emotional Regulation in Individuals with Schizophrenia Spectrum Disorders: A Pilot Randomised Controlled Trial. Neuropsychiatr Dis Treat 2020; 16:729-747. [PMID: 32210567 PMCID: PMC7075335 DOI: 10.2147/ndt.s231877] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/29/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Emotion dysregulation has emerged as a transdiagnostic factor that potentially exacerbates the risk of early-onset, maintenance, and relapse of psychosis. Mindfulness is described as the awareness that emerges from paying attention to the present moment without judgment. It gently pulls the mind out of the negative emotions induced by the disparity between expectation and reality by focusing on the present moment, instead of worrying about the future or regretting the past. However, only a few research has ever focused on the efficacy of using a mindfulness-based intervention to improve emotion regulation in schizophrenia spectrum disorders. PURPOSE The purpose of this study was to examine the effectiveness of a Mindfulness-Based Psychoeducation Programme (MBPP) on the emotion regulation of individuals with schizophrenia, in particular, to access emotion regulation strategies. The objective of this study was to find out whether MBPP is feasible for improving emotion regulation strategies, in terms of rumination, cognitive reappraisal, and expressive suppression, with a sustainable effect at a three-month follow-up. PATIENTS AND METHODS A single-blinded pilot randomised controlled trial with repeated-measures designs was adopted. Forty-six participants diagnosed with schizophrenia and its subtypes were randomised in either the 8-week mindfulness-based psychoeducation programme or treatment-as-usual (control) group. RESULTS The results of the Generalised Estimating Equations test indicated that the MBPP group showed a significant improvement in reappraisal at a three-month follow-up (β = -6.59, Wald's χ 2=4.55, p=0.033), and a significant reduction in rumination across time. However, the Generalised Estimating Equations indicated no significant difference in rumination and expressive suppression in the MBPP group. Two participants reported having unwanted experiences, including feelings of terror and distress during the mindfulness practice. CONCLUSION The MBPP appeared to be effective for improving emotion regulation, which will contribute to future large-scale RCT to confirm the treatment effects in more diverse groups of schizophrenic patients.
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Affiliation(s)
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | | | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
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31
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Knott V, Wright N, Shah D, Baddeley A, Bowers H, de la Salle S, Labelle A. Change in the Neural Response to Auditory Deviance Following Cognitive Therapy for Hallucinations in Patients With Schizophrenia. Front Psychiatry 2020; 11:555. [PMID: 32595542 PMCID: PMC7304235 DOI: 10.3389/fpsyt.2020.00555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/01/2020] [Indexed: 12/28/2022] Open
Abstract
Adjunctive psychotherapeutic approaches recommended for patients with schizophrenia (SZ) who are fully or partially resistant to pharmacotherapy have rarely utilized biomarkers to enhance the understanding of treatment-effective mechanisms. As SZ patients with persistent auditory verbal hallucinations (AVH) frequently evidence reduced neural responsiveness to external auditory stimulation, which may impact cognitive and functional outcomes, this study examined the effects of cognitive behavioral therapy for voices (CBTv) on clinical and AVH symptoms and the sensory processing of auditory deviants as measured with the electroencephalographically derived mismatch negativity (MMN) response. Twenty-four patients with SZ and AVH were randomly assigned to group CBTv treatment or a treatment as usual (TAU) condition. Patients in the group CBTv condition received treatment for 5 months while the matched control patients received TAU for the same period, followed by 5 months of group CBTv. Assessments were conducted at baseline and at the end of treatment. Although not showing consistent changes in the frequency of AVHs, CBTv (vs. TAU) improved patients' appraisal (p = 0.001) of and behavioral/emotional responses to AVHs, and increased both MMN generation (p = 0.001) and auditory cortex current density (p = 0.002) in response to tone pitch deviants. Improvements in AVH symptoms were correlated with change in pitch deviant MMN and current density in left primary auditory cortex. These findings of improved auditory information processing and symptom-response attributable to CBTv suggest potential clinical and functional benefits of psychotherapeutical approaches for patients with persistent AVHs.
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Affiliation(s)
- Verner Knott
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Nicola Wright
- Schizophrenia Program, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Dhrasti Shah
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Ashley Baddeley
- Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Hayley Bowers
- Schizophrenia Program, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Sara de la Salle
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Alain Labelle
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Schizophrenia Program, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
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32
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Nucifora FC, Woznica E, Lee BJ, Cascella N, Sawa A. Treatment resistant schizophrenia: Clinical, biological, and therapeutic perspectives. Neurobiol Dis 2019; 131:104257. [PMID: 30170114 PMCID: PMC6395548 DOI: 10.1016/j.nbd.2018.08.016] [Citation(s) in RCA: 168] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/07/2018] [Accepted: 08/26/2018] [Indexed: 12/16/2022] Open
Abstract
Treatment resistant schizophrenia (TRS) refers to the significant proportion of schizophrenia patients who continue to have symptoms and poor outcomes despite treatment. While many definitions of TRS include failure of two different antipsychotics as a minimum criterion, the wide variability in inclusion criteria has challenged the consistency and reproducibility of results from studies of TRS. We begin by reviewing the clinical, neuroimaging, and neurobiological characteristics of TRS. We further review the current treatment strategies available, addressing clozapine, the first-line pharmacological agent for TRS, as well as pharmacological and non-pharmacological augmentation of clozapine including medication combinations, electroconvulsive therapy, repetitive transcranial magnetic stimulation, deep brain stimulation, and psychotherapies. We conclude by highlighting the most recent consensus for defining TRS proposed by the Treatment Response and Resistance in Psychosis Working Group, and provide our overview of future perspectives and directions that could help advance the field of TRS research, including the concept of TRS as a potential subtype of schizophrenia.
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Affiliation(s)
- Frederick C Nucifora
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA.
| | - Edgar Woznica
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Brian J Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Nicola Cascella
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Akira Sawa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
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The Optimal Length of Hospitalization for Functional Recovery of Schizophrenia Patients, a Real-World Study in Chinese People. Psychiatr Q 2019; 90:661-670. [PMID: 31327081 DOI: 10.1007/s11126-019-09658-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study investigated the relationship between the activities of daily living and the length of hospitalization to determine the optimal length of hospitalization for patients with schizophrenia. We collected information from all schizophrenia patients discharged in Peking University Huilongguan Clinical Medical School from January 1, 2015 to December 31, 2015. A total of 1967 patients were enrolled in this study. The Chinese version of the modified Barthel index (MBI-C) was used to assess patients' actual performance on activities of daily living. We used the paired samples t-test to compare MBI-C scores at admission and discharge and performed correlation analysis to find the trend of MBI-C change with length of hospitalization. The average length of hospitalization was 73.3 ± 42.2 days. There were significant differences between the MBI-C scores at the time of discharge from hospital compared with those at the time of admission to the hospital (93.4 ± 11.2 vs. 88.7 ± 11.8; P < 0.001). Taking the length of hospitalization as the grouping boundary value, the correlation analysis of the subgroup found that below a minimum of 20 days, the improvement in the MBI-C scores increased with the increase of length of hospitalization, and above a maximum of 50 days, the improvement in the MBI-C scores decreased with the increase of length of hospitalization. The optimal length of hospitalization for patients with schizophrenia may lie between 20 and 50 days, with regard to the recovery of daily living function.
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Mouncey PR, Wade D, Richards-Belle A, Sadique Z, Wulff J, Grieve R, Emerson LM, Brewin CR, Harvey S, Howell D, Hudson N, Khan I, Mythen M, Smyth D, Weinman J, Welch J, Harrison DA, Rowan KM. A nurse-led, preventive, psychological intervention to reduce PTSD symptom severity in critically ill patients: the POPPI feasibility study and cluster RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
High numbers of patients experience severe acute stress in critical care units. Acute stress has been linked to post-critical care psychological morbidity, including post-traumatic stress disorder (PTSD). Previously, a preventive, complex psychological intervention [Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI)] was developed by this research team, to be led by nurses, to reduce the development of PTSD symptom severity at 6 months.
Objectives
The objectives were to (1) standardise and refine the POPPI intervention, and, if feasible, (2) evaluate it in a cluster randomised clinical trial (RCT).
Design
Two designs were used – (1) two feasibility studies to test the delivery and acceptability (to patients and staff) of the intervention, education package and support tools, and to test the trial procedures (i.e. recruitment and retention), and (2) a multicentre, parallel-group, cluster RCT with a baseline period and staggered roll-out of the intervention.
Setting
This study was set in NHS adult, general critical care units.
Participants
The participants were adult patients who were > 48 hours in a critical care unit, receiving level 3 care and able to consent.
Interventions
The intervention comprised three elements – (1) creating a therapeutic environment in critical care, (2) three stress support sessions for patients identified as acutely stressed and (3) a relaxation and recovery programme for patients identified as acutely stressed.
Main outcome measures
Primary outcome – patient-reported symptom severity using the PTSD Symptom Scale – Self Report (PSS-SR) questionnaire (to measure clinical effectiveness) and incremental costs, quality-adjusted life-years (QALYs) and net monetary benefit at 6 months (to measure cost-effectiveness). Secondary outcomes – days alive and free from sedation to day 30; duration of critical care unit stay; PSS-SR score of > 18 points; depression, anxiety and health-related quality of life at 6 months; and lifetime cost-effectiveness.
Results
(1) A total of 127 participants were recruited to the intervention feasibility study from two sites and 86 were recruited to the RCT procedures feasibility study from another two sites. The education package, support tools and intervention were refined. (2) A total of 24 sites were randomised to the intervention or control arms. A total of 1458 participants were recruited. Twelve sites delivered the intervention during the intervention period: > 80% of patients received two or more stress support sessions and all 12 sites achieved the target of > 80% of clinical staff completing the POPPI online training. There was, however, variation in delivery across sites. There was little difference between baseline and intervention periods in the development of PTSD symptom severity (measured by mean PSS-SR score) at 6 months for surviving patients in either the intervention or the control group: treatment effect estimate −0.03, 95% confidence interval (CI) −2.58 to 2.52; p = 0.98. On average, the intervention decreased costs and slightly improved QALYs, leading to a positive incremental net benefit at 6 months (£835, 95% CI −£4322 to £5992), but with considerable statistical uncertainty surrounding these results. There were no significant differences between the groups in any of the secondary outcomes or in the prespecified subgroup analyses.
Limitations
There was a risk of bias because different consent processes were used and as a result of the lack of blinding, which was mitigated as far as possible within the study design. The intervention started later than anticipated. Patients were not routinely monitored for delirium.
Conclusions
Among level 3 patients who stayed > 48 hours in critical care, the delivery of a preventive, complex psychological intervention, led by nurses, did not reduce the development of PTSD symptom severity at 6 months, when compared with usual care.
Future work
Prior to development and evaluation of subsequent psychological interventions, there is much to learn from post hoc analyses of the cluster RCT rich quantitative and qualitative data.
Trial registration
This trial is registered as ISRCTN61088114 and ISRCTN53448131.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 23, No. 30. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Dorothy Wade
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alvin Richards-Belle
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jerome Wulff
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Lydia M Emerson
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, UK
| | - Chris R Brewin
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Harvey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - David Howell
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Hudson
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Imran Khan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Monty Mythen
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust and University College London, London, UK
| | - Deborah Smyth
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - John Weinman
- Institute of Pharmaceutical Science, King’s College London, London, UK
| | - John Welch
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
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Shields GE, Buck D, Elvidge J, Hayhurst KP, Davies LM. Cost-Effectiveness Evaluations of Psychological Therapies for Schizophrenia and Bipolar Disorder: A Systematic Review. Int J Technol Assess Health Care 2019; 35:317-326. [PMID: 31328702 PMCID: PMC6707812 DOI: 10.1017/s0266462319000448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This review aims to assess the cost-effectiveness of psychological interventions for schizophrenia/bipolar disorder (BD), to determine the robustness of current evidence and identify gaps in the available evidence. METHODS Electronic searches (PsycINFO, MEDLINE, Embase) identified economic evaluations relating incremental cost to outcomes in the form of an incremental cost-effectiveness ratio published in English since 2000. Searches were concluded in November 2018. Inclusion criteria were: adults with schizophrenia/BD; any psychological/psychosocial intervention (e.g., psychological therapy and integrated/collaborative care); probability of cost-effectiveness at explicitly defined thresholds reported. Comparators could be routine practice, no intervention, or alternative psychological therapies. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms. Results were summarized qualitatively. The protocol was registered on the PROSPERO database (CRD42017056579). RESULTS Of 3,864 studies identified, 12 met the criteria for data extraction. All were integrated clinical and economic randomized controlled trials. The most common intervention was cognitive behavioral therapy (CBT, 6/12 studies). The most common measure of health benefit was the quality-adjusted life-year (6/12). Follow-up ranged from 6 months to 5 years. Interventions were found to be cost-effective in most studies (9/12): the probability of cost-effectiveness ranged from 35-99.5 percent. All studies had limitations and demonstrated uncertainty (particularly related to incremental costs). CONCLUSIONS Most studies concluded psychological interventions for schizophrenia/BD are cost-effective, including CBT, although there was notable uncertainty. Heterogeneity across studies makes it difficult to reach strong conclusions. There is a particular need for more evidence in the population with BD and for longer-term evidence across both populations.
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Affiliation(s)
| | - Deborah Buck
- Personal and Social Services Research Unit, University of Manchester
| | - Jamie Elvidge
- National Institute for Health and Care Excellence, United Kingdom
| | | | - Linda Mary Davies
- Centre for Health Economics, Division of Population Health, University of Manchester
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Svien H, Burlingame GM. Trends in Modern Group Psychotherapy for Schizophrenia. Int J Group Psychother 2019; 69:347-352. [PMID: 38449203 DOI: 10.1080/00207284.2019.1584528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Olagunju AT, Clark SR, Baune BT. Long-acting atypical antipsychotics in schizophrenia: A systematic review and meta-analyses of effects on functional outcome. Aust N Z J Psychiatry 2019; 53:509-527. [PMID: 30957510 DOI: 10.1177/0004867419837358] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Impairment in psychosocial function is common in schizophrenia. Long-acting injectable atypical antipsychotics are thought to enhance psychosocial function by boosting adherence. However, no systematic review has examined the effects of long-acting injectable atypical antipsychotics on psychosocial function in clinical trials. METHODS We searched major databases including Medline/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and Clinical Trial Registries for randomised controlled trials that compared long-acting injectable atypical antipsychotics to placebo, oral antipsychotic medications or long-acting injectable atypical antipsychotics for all years till 2018, with no language limits. We performed a systematic review of findings on change in psychosocial function and its predictors in the included reports. Data on change in psychosocial functioning were meta-analysed using a random-effects model. RESULTS A total of 26 studies were included in systematic review, and 19 studies with 8616 adults, 68.1% males were meta-analysed. Long-acting injectable atypical antipsychotics were superior to placebo (standardised mean difference = 0.39; 95% confidence interval = [0.32, 0.47]; p < 0.001; I2 = 0%; 9 studies) and oral antipsychotic medications (standardised mean difference = 0.16; 95% confidence interval = [0.01, 0.31]; p = 0.04; I2 = 77%; 10 studies) for improved psychosocial function and superiority was maintained in short- and long trials. Poor psychosocial function was predicted by longer treatment duration, severe symptoms, poor cognition and poor insight. Functioning was assessed by either a single or a combination of measures, but was not the primary outcome in most studies. Other sources of bias include poor blinding and reporting of randomisation. CONCLUSION Long-acting injectable atypical antipsychotics are beneficial for recovery of psychosocial function in comparison with placebo, but the magnitude of superiority over oral antipsychotic treatment was small. Severe psychopathology at baseline predicted poor psychosocial function. Future effectiveness trials in which post-randomisation involvement is kept to a minimum, and psychosocial function is included as primary outcome a priori, are needed to capture the real-world impact of long-acting injectable atypical antipsychotics and to address methodological biases.
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Affiliation(s)
- Andrew T Olagunju
- 1 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,2 Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Scott R Clark
- 1 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Bernhard T Baune
- 1 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,3 Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia.,4 The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,5 University Hospital for Psychiatry and Psychotherapy, University of Münster, Münster, Germany
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Gabrielian S, Hamilton AB, Gelberg L, Koosis ER, Johnson A, Young AS. Identifying Social Skills That Support Housing Attainment and Retention Among Homeless Persons With Serious Mental Illness. Psychiatr Serv 2019; 70:374-380. [PMID: 30784380 PMCID: PMC6494674 DOI: 10.1176/appi.ps.201800508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE By combining supportive services with independent housing, permanent supportive housing (PSH) programs effectively address homelessness. Yet, many persons with serious mental illness struggle to attain and retain housing in these programs. Social skills-which facilitate social interactions and instrumental tasks-predict premature exit from PSH. This project aimed to build consensus on a set of social skills that supports independent housing attainment and retention among homeless persons with serious mental illness, with a clinical focus on PSH programs. METHODS Guided by the RAND/University of California, Los Angeles, appropriateness method, the set of social skills was developed by using literature review; key informant interviews (N=12), a national consensus panel of experts in psychosocial rehabilitation and homelessness (N=11), and two focus groups with homeless persons with serious mental illness (N=17). RESULTS These methods identified 24 social skills in seven domains: finding and renting an apartment, using one's time well, getting closer to people, managing finances, avoiding problems with drugs and alcohol, solving interpersonal problems, and managing one's health. Expert panelists and focus group participants agreed that these social skills were feasible for inclusion in social skills training and could strongly affect housing outcomes in PSH settings. CONCLUSIONS Consensus was reached about a set of social skills relevant to housing attainment and retention for persons with serious mental illness engaged in PSH. Next steps include modifying social skills training interventions to this skill set, making contextual modifications relevant to the setting and context of PSH, and studying the effectiveness and implementation of the adapted intervention in PSH.
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Affiliation(s)
- Sonya Gabrielian
- Center of Innovation, Health Services Research and Development Service, U.S. Department of Veterans Affairs (VA) Greater Los Angeles, Los Angeles (Gabrielian, Hamilton, Gelberg, Koosis, Young); Department of Psychiatry (Gabrielian, Hamilton, Young) and Department of Family Medicine (Gelberg), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles; Department of Psychiatry, University of Pennsylvania, Philadelphia (Johnson)
| | - Alison B Hamilton
- Center of Innovation, Health Services Research and Development Service, U.S. Department of Veterans Affairs (VA) Greater Los Angeles, Los Angeles (Gabrielian, Hamilton, Gelberg, Koosis, Young); Department of Psychiatry (Gabrielian, Hamilton, Young) and Department of Family Medicine (Gelberg), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles; Department of Psychiatry, University of Pennsylvania, Philadelphia (Johnson)
| | - Lillian Gelberg
- Center of Innovation, Health Services Research and Development Service, U.S. Department of Veterans Affairs (VA) Greater Los Angeles, Los Angeles (Gabrielian, Hamilton, Gelberg, Koosis, Young); Department of Psychiatry (Gabrielian, Hamilton, Young) and Department of Family Medicine (Gelberg), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles; Department of Psychiatry, University of Pennsylvania, Philadelphia (Johnson)
| | - Ella R Koosis
- Center of Innovation, Health Services Research and Development Service, U.S. Department of Veterans Affairs (VA) Greater Los Angeles, Los Angeles (Gabrielian, Hamilton, Gelberg, Koosis, Young); Department of Psychiatry (Gabrielian, Hamilton, Young) and Department of Family Medicine (Gelberg), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles; Department of Psychiatry, University of Pennsylvania, Philadelphia (Johnson)
| | - Axeline Johnson
- Center of Innovation, Health Services Research and Development Service, U.S. Department of Veterans Affairs (VA) Greater Los Angeles, Los Angeles (Gabrielian, Hamilton, Gelberg, Koosis, Young); Department of Psychiatry (Gabrielian, Hamilton, Young) and Department of Family Medicine (Gelberg), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles; Department of Psychiatry, University of Pennsylvania, Philadelphia (Johnson)
| | - Alexander S Young
- Center of Innovation, Health Services Research and Development Service, U.S. Department of Veterans Affairs (VA) Greater Los Angeles, Los Angeles (Gabrielian, Hamilton, Gelberg, Koosis, Young); Department of Psychiatry (Gabrielian, Hamilton, Young) and Department of Family Medicine (Gelberg), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles; Department of Psychiatry, University of Pennsylvania, Philadelphia (Johnson)
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An Overview of the Evidence for Psychological Interventions for Psychosis: Results From Meta-Analyses. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i1.31407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There are numerous psychological approaches to psychosis that differ in focus, specificity and formats. These include psychodynamic, humanistic, cognitive-behavioural and
third-wave-approaches, psychoeducation, various types of training-based approaches and family interventions.
We briefly describe the main aims and focus of each of these approaches, followed by a review of their evidence-base in regard to improvement in symptoms, relapse and
functioning. We conducted a systematic search for meta-analyses dating to 2017 for each of the approaches reviewed. Where numerous meta-analyses for an approach were available,
we selected the most recent, comprehensive and methodologically sound ones.
We found convincing short- and long-term evidence for cognitive behavioural approaches if the main aim is to reduce symptom distress. Evidence is also strong for psychoeducative
family interventions that include skills training if the main aim is to reduce relapse and rehospitalisation. Acceptance and commitment therapy, mindfulness-based approaches,
meta-cognitive and social skills training, as well as systemic family interventions, were also found to be efficacious, depending on the outcome of interest, but meta-analyses
for these approaches were based on a comparatively lower number of outcome studies and a narrower selection of outcome measures. We found no convincing evidence for
psychodynamic approaches, humanistic approaches or patient-directed psychoeducation (without including the family).
An array of evidence-based psychological therapies is available for psychotic disorders from which clinicians and patients can choose, guided by the strength of the evidence and
depending on the outcome area focused on. Increased effort is needed in terms of dissemination and implementation of these therapies into clinical practice.
Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms.
Meta-analyses show convincing evidence for family interventions if the main target is relapse.
Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed.
The array of effective approaches allows clinicians and patients to select the most appropriate one.
Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms.
Meta-analyses show convincing evidence for family interventions if the main target is relapse.
Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed.
The array of effective approaches allows clinicians and patients to select the most appropriate one.
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Treatment dropout in a family-based partial hospitalization program for eating disorders. Eat Weight Disord 2019; 24:163-168. [PMID: 30027396 DOI: 10.1007/s40519-018-0543-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 07/06/2018] [Indexed: 12/20/2022] Open
Abstract
Treatment dropout is a significant challenge in the treatment of eating disorders. In day hospital/partial hospitalization program settings, little is known about factors associated with treatment dropout. The purpose of the present study was to assess factors associated with treatment dropout in a partial hospitalization program for adolescents and young adults with anorexia nervosa. Patients and parents completed self-report and interview-based measures at baseline and at end of treatment in the partial hospitalization program. Few factors were found that differentiated the two groups. Those who dropped out had lower body weight at end of treatment, were less likely to have purged in the previous month, and had fathers who scored higher on the criticism subscale of expressed emotion. Patients who are purging may be seen as having more severe symptoms, thus possibly reducing the chances of parents prematurely discontinuing treatment. Parental criticism is a potentially modifiable factor in treatment. Further research is needed to identify effective ways to reduce parental criticism, and to identify additional modifiable factors associated with treatment dropout to reduce dropout rates in this population.Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.
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Wessels H, Wagner M, Kuhr K, Berning J, Pützfeld V, Janssen B, Bottlender R, Maurer K, Möller HJ, Gaebel W, Häfner H, Maier W, Klosterkötter J, Bechdolf A. Predictors of treatment response to psychological interventions in people at clinical high risk of first-episode psychosis. Early Interv Psychiatry 2019; 13:120-127. [PMID: 28675695 DOI: 10.1111/eip.12460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/26/2017] [Accepted: 05/14/2017] [Indexed: 01/20/2023]
Abstract
AIM Psychological interventions, such as cognitive behavioural therapy (CBT) and supportive counselling (SC), are used to treat people with schizophrenia and people at clinical high risk (CHR) of psychosis. However, little information is available on predictors of treatment response. This study aims to identify such predictors of psychological interventions in CHR. METHODS A total of 128 help-seeking CHR outpatients were randomized into two groups-integrated psychological intervention (IPI), including CBT, and SC-for 12 months. Multiple regression analysis was used to identify demographic, symptomatic and functional variables that predict improvement in positive (PANSS Positive), negative (PANSS Negative) and basic symptoms (Basic symptom total score) and improvement in functioning (GAF) at 1-year follow up. RESULTS In the merged group (IPI + SC), people who lived independently, were younger and presented with higher baseline functioning showed more improvement in symptomatic outcomes at follow up. Negative symptoms at baseline predicted less improvement in positive and basic symptoms. Being married or cohabiting and living in the primary family were found to correlate with good functioning at 1-year follow up. CONCLUSIONS Younger CHR individuals and those who are functioning well may particularly benefit from early intervention. Treatment might need to be modified for low-functioning CHR and those who already display higher scores of negative symptoms. Registration number: NCT00204087.
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Affiliation(s)
- Helen Wessels
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Kathrin Kuhr
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Julia Berning
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Verena Pützfeld
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Birgit Janssen
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany
| | - Ronald Bottlender
- Department of Psychiatry and Psychotherapy, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Kurt Maurer
- Central Institute of Mental Health, Mannheim, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University Munich, Munich, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany
| | - Heinz Häfner
- Central Institute of Mental Health, Mannheim, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum am Urban, Berlin, Germany
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Haram A, Fosse R, Jonsbu E, Hole T. Impact of Psychotherapy in Psychosis: A Retrospective Case Control Study. Front Psychiatry 2019; 10:204. [PMID: 31031656 PMCID: PMC6470395 DOI: 10.3389/fpsyt.2019.00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The need for psychological therapies for psychosis has become apparent since long-term antipsychotic drug treatment has a range of adverse side effects, with moderate therapeutic effects at best. Aims: To investigate whether the psychotherapeutic approach, dialogue therapy (DT) is associated with improvements of symptoms and functioning beyond standard psychiatric treatment (ST) in both schizophrenia and other psychosis. Methods: A retrospective case-control design, comparing 54 patients with different psychoses who received DT with 54 patients in a control group receiving ST was carried out. The groups were matched on diagnosis, age, sex, and treatment start. Outcome measures were Global assessment of functioning (GAF) scores, medications at follow up, and hospital stays after completed outpatient treatment. Results: Mean time in treatment from inclusion to follow-up was 3 years and 5 months. At follow-up, GAF functioning (GAF-F) and GAF symptom (GAF-S) scores both were significantly higher in the DT group than the ST group. Effect sizes (Cohen's d) were large; 1.8 for GAF-S and 2.1 for GAF-F. At follow-up, the use of psychoactive drugs was significantly reduced despite a shorter time in psychotherapy in the DT group compared to the ST group. Days of hospitalizations after end of treatment in the study period were significantly reduced in both groups compared to the period before start of treatment. Conclusions: The findings from this exploratory study are consistent with the possibility that dialogue therapy may lead to improvements in symptoms and functioning compared to standard treatment in psychosis.
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Affiliation(s)
- Annbjørg Haram
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Egil Jonsbu
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Hole
- Clinic of Medicine and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Honary M, Fisher NR, McNaney R, Lobban F. A Web-Based Intervention for Relatives of People Experiencing Psychosis or Bipolar Disorder: Design Study Using a User-Centered Approach. JMIR Ment Health 2018; 5:e11473. [PMID: 30530457 PMCID: PMC6303674 DOI: 10.2196/11473] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Relatives of people experiencing bipolar mood episodes or psychosis face a multitude of challenges (eg, social isolation, limited coping strategies, and issues with maintaining relationships). Despite this, there is limited informational and emotional support for people who find themselves in supporting or caring roles. Digital technologies provide us with an opportunity to offer accessible tools, which can be used flexibly to provide evidence-based information and support, allowing relatives to build their understanding of mental health problems and learn from others who have similar experiences. However, to design tools that are useful to relatives, we first need to understand their needs. OBJECTIVE The aim of this study was to use a user-centered design approach to develop an accessible Web-based intervention, based on the Relatives Education And Coping Toolkit (REACT) booklet, to support the informational and emotional needs of relatives of people experiencing psychosis or bipolar disorder. METHODS We engaged relatives of people with experiences of bipolar disorder or psychosis in workshops to identify their needs and design requirements for developing a Web-based version of a paper-based toolkit. We used a 2-phase qualitative approach to explore relatives' views on content, design, and functionalities, which are considered to be engaging and useful in a Web-based intervention. In phase 1, we consulted 24 relatives in 2 workshops to better understand their existing support infrastructure, their barriers for accessing support, unmet needs, and relatives' views on online support. On the basis of the results of these workshops, we developed a set of design considerations to be explored in a smaller workshop. Workshop 3 then involved working with 2 digitally literate relatives to design a usable and acceptable interface for our Web-based toolkit. Finally, in phase 2, we conducted a heuristic evaluation to assess the usability of the toolkit. RESULTS Our findings indicated that relatives require technologies that (1) they can place their trust in, particularly when discussing a highly sensitive topic, (2) enable learning from the lived experiences of others while retaining confidentiality, and (3) they can work through at their own pace in a personalized manner. CONCLUSIONS Our study highlights the need for providing a trustworthy, supportive tool where relatives can engage with people who have similar experiences to their own. Our heuristic evaluation showed promise in terms of perceived usability of the REACT Web-based intervention. Through this work, we emphasize the need to involve stakeholders with various characteristics, including users with limited computer literacy or experience in online support.
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Affiliation(s)
- Mahsa Honary
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Naomi Ruth Fisher
- Spectrum Center for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Roisin McNaney
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Fiona Lobban
- Spectrum Center for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Adery LH, Ichinose M, Torregrossa LJ, Wade J, Nichols H, Bekele E, Bian D, Gizdic A, Granholm E, Sarkar N, Park S. The acceptability and feasibility of a novel virtual reality based social skills training game for schizophrenia: Preliminary findings. Psychiatry Res 2018; 270:496-502. [PMID: 30326433 PMCID: PMC6314809 DOI: 10.1016/j.psychres.2018.10.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/16/2018] [Accepted: 10/07/2018] [Indexed: 11/25/2022]
Abstract
Social impairment is a core feature of schizophrenia that presents a major barrier toward recovery. Some of the psychotic symptoms are partly ameliorated by medication but the route to recovery is hampered by social impairments. Since existing social skills interventions tend to suffer from lack of availability, high-burden and low adherence, there is a dire need for an effective, alternative strategy. The present study examined the feasibility and acceptability of Multimodal Adaptive Social Intervention in Virtual Reality (MASI-VR) for improving social functioning and clinical outcomes in schizophrenia. Out of eighteen patients with schizophrenia who enrolled, seventeen participants completed the pre-treatment assessment and 10 sessions of MASI-VR, but one patient did not complete the post-treatment assessments. Therefore, the complete training plus pre- and post-treatment assessment data are available from sixteen participants. Clinical ratings of symptom severity were obtained at pre- and post-training. Retention rates were very high and training was rated as extremely satisfactory for the majority of participants. Participants exhibited a significant reduction in overall clinical symptoms, especially negative symptoms following 10 sessions of MASI-VR. These preliminary results support the feasibility and acceptability of a novel virtual reality social skills training program for individuals with schizophrenia.
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Affiliation(s)
- Laura H Adery
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Megan Ichinose
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | - Joshua Wade
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Heathman Nichols
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Esube Bekele
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Dayi Bian
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Alena Gizdic
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Nilanjan Sarkar
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN, USA; Global Academy for Future Civilizations, Kyung Hee University, Seoul, Korea.
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Greenwood K, Alford K, O’Leary I, Peters E, Hardy A, Cavanagh K, Field AP, de Visser R, Fowler D, Davies M, Papamichail A, Garety P. The U&I study: study protocol for a feasibility randomised controlled trial of a pre-cognitive behavioural therapy digital 'informed choice' intervention to improve attitudes towards uptake and implementation of CBT for psychosis. Trials 2018; 19:644. [PMID: 30458850 PMCID: PMC6247503 DOI: 10.1186/s13063-018-3023-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/26/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND At least 40% of people with psychosis have persistent distressing symptoms despite optimal medication treatment. Cognitive behaviour therapy for psychosis (CBTp) is the only NICE-recommended individual therapy for psychosis, with effects on symptoms, distress and quality of life. Yet <10% of service-users receive it and 94% of trusts struggle to provide it. Of those offered it, 22-43% refuse or do not attend. We have developed a new pre-CBTp informed choice intervention to address knowledge and attitudes that influence uptake and implementation and now want to test it in a feasibility trial. METHODS The design is a two-arm, feasibility randomised controlled trial (RCT), with 1:1 randomisation, stratified by participant group and site. Participants are 40 psychosis patients and 40 clinicians, who are ambivalent towards uptake or implementation of CBTp. Sites are community and inpatient services in Sussex and London. The intervention is a pre-CBT digital psychoeducation intervention designed to address identified knowledge and attitudinal barriers to uptake and implementation of CBTp, incorporating behaviour change mechanisms, and supported by animated introductory, patient and clinician stories. The comparator is the NHS choices website for CBT. The primary aim is to assess clinical feasibility (recruitment, randomisation, acceptability, use, delivery, outcome measurement, retention). A secondary aim is a preliminary evaluation of efficacy. Outcomes will be assessed at baseline, post intervention, and one-month follow-up (blind to treatment arm). The primary efficacy outcome is likelihood of offering/taking up CBTp. Secondary outcomes include knowledge and attitudes towards CBTp, illness perceptions, empowerment, psychological wellbeing (patients only) and CBTp implementation (clinicians only). Use of the intervention and CBT behaviours during the follow-up period will be recorded and captured in a feedback questionnaire. Use, acceptability and experience of outcome assessment will be explored in qualitative interviews with participants (n = 6 per group). The efficacy evaluation will report descriptive data, key model parameters and 95% highest probability density intervals in a Bayesian growth model. DISCUSSION This is the first feasibility trial of a digital 'informed choice' decision aid for the implementation of CBTp. If the trial proves feasible and demonstrates preliminary evidence of efficacy, a large multi-site trial will be warranted. TRIAL REGISTRATION ISRCTN registry, ISRCTN53107879 . Registered prospectively on 2 August 2017.
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Affiliation(s)
- Kathryn Greenwood
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Katie Alford
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RP UK
| | - Ian O’Leary
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- PICuP Clinic, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8NZ UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX UK
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Andy P. Field
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Richard de Visser
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - David Fowler
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Matthew Davies
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
| | - Alexandra Papamichail
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX UK
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Caponnetto P, Maglia M, Auditore R, Bocchieri M, Caruso A, DiPiazza J, Polosa R. Improving neurocognitive functioning in schizophrenia by addition of cognitive remediation therapy to a standard treatment of metacognitive training. Ment Illn 2018; 10:7812. [PMID: 30746055 PMCID: PMC6342025 DOI: 10.4081/mi.2018.7812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/04/2018] [Indexed: 11/23/2022] Open
Abstract
Cognitive dysfunctions are a common clinical feature of schizophrenia and represent important indicators of outcome among patients who are affected. Therefore, a randomized, controlled, monocentric, singleblind trial was carried out to compare two different rehabilitation strategies adopted for the restoration and recovery of cognitive functioning of residential patients with schizophrenia. A sample of 110 residential patients were selected and, during the experimental period, a group of 55 patients was treated with sets of domain-specific exercises (SRT+CRT), whereas an equal control group was treated with sets of nondomain- specific exercises (SRT+PBO) belonging to the Cogpack® software. The effects on the scores (between T0 and T1) of the variables treatment and time and of the interaction time X treatment were analyzed: for the total BACS, the main effect of the between-factors variable treatment is statistically significant (F=201.562 P=0.000), as well as the effect of the within-factors variable “time” (F=496.68 P=0.000).The interaction of these two factors is also statistically significant (F=299.594 P=0.000). The addition of cognitive remediation therapy (CRT) to a standard treatment of metacognitive training (MCT) resulted in a significant improvement in global neurocognitive functioning and has reported positive effects with regard to the strengthening of verbal and working memory, selective and sustained attention at T1. A relevant result is the statistically significance of “time X treatment” for all the tests administered: we can assume that the domain-specific cognitive training amplifies the effects of SRT, as the primary and secondary goals of the present study were achieved.
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Affiliation(s)
- Pasquale Caponnetto
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Marilena Maglia
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Roberta Auditore
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Marta Bocchieri
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Antonio Caruso
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Jennifer DiPiazza
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
| | - Riccardo Polosa
- CTA Villa Chiara Psychiatric Rehabilitation and Research, University of Catania, Italy
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Olagunju AT, Clark SR, Baune BT. Clozapine and Psychosocial Function in Schizophrenia: A Systematic Review and Meta-Analysis. CNS Drugs 2018; 32:1011-1023. [PMID: 30155842 DOI: 10.1007/s40263-018-0565-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Clozapine has unique efficacy for symptoms in treatment-resistant schizophrenia; however, symptomatic remission is not necessary nor sufficient for functional improvement. No study has pooled the effect of clozapine on psychosocial function across clinical trials. OBJECTIVE We conducted a systematic review and meta-analysis to compare the effects of clozapine with other antipsychotics on psychosocial function, and described the predictors of functional outcome. METHODS We searched MEDLINE/PubMed, PsychINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Central Register of controlled trials and clinical trial registries till April 2018, with no language limits. Eligible studies were randomised controlled trials of clozapine vs. typical or atypical antipsychotics among adults with treatment-resistant schizophrenia. We included studies with flexible or fixed doses of antipsychotics within the therapeutic range to reflect naturalistic care. Effect sizes of studies were pooled using generic inverse variance and random-effects models and presented as standard mean differences. Study quality was assessed in accordance with the Cochrane Collaboration guideline, and subgroup analyses were carried out to identify potential moderators and methodological biases. RESULTS Nine studies with 1279 participants (69.7% male) were included. Clozapine showed beneficial effects on psychosocial function, but both short-term trials [n = 3; comparing 99 people taking clozapine with 97 controls (standardised mean difference = 0.04; 95% confidence interval - 0.24, 0.32; p = 0.77; I2 = 0%)] and long-term trials [n = 5; comparing 415 people taking clozapine with 427 controls (standardised mean difference = 0.05; 95% confidence interval - 0.16, 0.27; p = 0.64; I2 = 50%)] showed no superiority of clozapine to other antipsychotics in this regard. Only one study explored the predictors of psychosocial function. Baseline severity of illness, illicit drug use, extrapyramidal side effects, sex and cognition explained the variability in functional outcome. A range of scales measured psychosocial function, and the quality of reporting varied across trials. CONCLUSIONS Clozapine does not appear superior to other antipsychotics for improvement of psychosocial function. Standardisation of psychosocial function measurement is needed to improve the quality of evidence. Further exploration of the predictors of good psychosocial outcomes with clozapine treatment may improve personalisation of care.
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Affiliation(s)
- Andrew T Olagunju
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Level 6, 57 North Terrace, Adelaide, SA, 5000, Australia.,Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Scott R Clark
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Level 6, 57 North Terrace, Adelaide, SA, 5000, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, Level 6, 57 North Terrace, Adelaide, SA, 5000, Australia. .,Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville, Melbourne, VIC, Australia.
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Using fMRI and machine learning to predict symptom improvement following cognitive behavioural therapy for psychosis. NEUROIMAGE-CLINICAL 2018; 20:1053-1061. [PMID: 30343250 PMCID: PMC6197386 DOI: 10.1016/j.nicl.2018.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/20/2018] [Accepted: 10/09/2018] [Indexed: 12/29/2022]
Abstract
Cognitive behavioural therapy for psychosis (CBTp) involves helping patients to understand and reframe threatening appraisals of their psychotic experiences to reduce distress and increase functioning. Whilst CBTp is effective for many, it is not effective for all patients and the factors predicting a good outcome remain poorly understood. Machine learning is a powerful approach that allows new predictors to be identified in a data-driven way, which can inform understanding of the mechanisms underlying therapeutic interventions, and ultimately make predictions about symptom improvement at the individual patient level. Thirty-eight patients with a diagnosis of schizophrenia completed a social affect task during functional MRI. Multivariate pattern analysis assessed whether treatment response in those receiving CBTp (n = 22) could be predicted by pre-therapy neural responses to facial affect that was either threat-related (ambiguous ‘neutral’ faces perceived as threatening in psychosis, in addition to angry and fearful faces) or prosocial (happy faces). The models predicted improvement in psychotic (r = 0.63, p = 0.003) and affective (r = 0.31, p = 0.05) symptoms following CBTp, but not in the treatment-as-usual group (n = 16). Psychotic symptom improvement was predicted by neural responses to threat-related affect across sensorimotor and frontal-limbic regions, whereas affective symptom improvement was predicted by neural responses to fearful faces only as well as prosocial affect across sensorimotor and frontal regions. These findings suggest that CBTp most likely improves psychotic and affective symptoms in those endorsing more threatening appraisals and mood-congruent processing biases, respectively, which are explored and reframed as part of the therapy. This study improves our understanding of the neurobiology of treatment response and provides a foundation that will hopefully lead to greater precision and tailoring of the interventions offered to patients. Machine learning models using neuroimaging data can predict response to CBTp. Neural responses to social threat predicted improvement in psychotic symptoms. Activation related to different social stimuli predicted distinct symptom domains. Predictors included activity in the hippocampus, frontal, and sensorimotor regions.
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Regev D, Cohen-Yatziv L. Effectiveness of Art Therapy With Adult Clients in 2018-What Progress Has Been Made? Front Psychol 2018; 9:1531. [PMID: 30210388 PMCID: PMC6124538 DOI: 10.3389/fpsyg.2018.01531] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
In the year 2000, an important art therapy literature review addressed an essential question-does art therapy work? It discussed 17 articles dealing with the issue of the effectiveness of art therapy. Two decades later, this research field has extended its scope and is flourishing. Several current reviews of research work have described the broad range of methods implemented today, which includes qualitative and quantitative studies; other reviews have focused on art therapy with specific populations, or by age group. The aim of this systematic literature review is to contribute to the ongoing discussion in the field by exploring the latest studies dealing with the effectiveness of art therapy with a broad scope of adult clients. We conducted a comprehensive search in four databases and review of every quantitative article that has addressed outcome measures in the art therapy field from 2000 to 2017. This paper presents the latest 27 studies in the field that examine the effectiveness of art therapy with adult clients and divides them into seven clinical categories: cancer patients, clients coping with a variety of medical conditions, mental health clients, clients coping with trauma, prison inmates, the elderly, and clients who have not been diagnosed with specific issues but face ongoing daily challenges. It underscores the potential effects of art therapy on these seven clinical populations, and recommends the necessary expansions for future research in the field, to enable art therapy research to take further strides forward.
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Affiliation(s)
- Dafna Regev
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
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50
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Frantz I, Pedersen A, Lincoln TM. Psychotherapeutische Behandlungsansätze bei Psychosen. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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