Disorders - psychosis disorders
Revell, E. R., Neill, J. C., Harte, M., Khan, Z., Drake, R. J.
Neurocognitive impairment predicts disability in schizophrenia, making intervention theoretically attractive as a means to minimise chronic disability. Many trials confirm that cognitive remediation (CR) produces meaningful, durable improvements in cognition and functioning but fewer focus on the early stages. We systematically reviewed CR trials in early schizophrenia to determine its efficacy on global cognition, functioning and symptoms. Two reviewers independently searched electronic databases to identify randomised controlled trials investigating CR following a first episode of psychosis. Eleven trials with 615 participants were identified. Random effect models revealed a non-significant effect of CR on global cognition (effect size=0.13, 95% CI -0.04, 0.31; p0.14), p<0.05 in sensitivity analysis (effect size 0.19; CI 0.00, 0.38). One of seven neurocognitive domains showed a significant positive effect (verbal learning and memory) and five others showed borderline significant benefits. There was a significant effect on functioning (0.18; CI 0.01, 0.36; p<0.05) and symptoms (0.19; CI 0.02, 0.36; p<0.05). CR's effect on functioning and symptoms was larger in trials with adjunctive psychiatric rehabilitation and small group interventions. CR's effect sizes in early illness were smaller than those in chronic schizophrenia, perhaps because of participants' reduced scope for improvement, though trials' small number and size produces uncertain estimates of effect. However, significant benefits were seen in functioning and symptoms and moderator analyses indicate factors that may increase CR's effect. Findings here, theoretical considerations and trials in chronic schizophrenia suggest that targeting social cognition might also enhance its efficacy.; Copyright © 2015 Elsevier B.V. All rights reserved.
Schizophrenia Research, 168(1-2) : 213-222
- Year: 2015
- Problem: Psychosis Disorders
- Type: Systematic reviews
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Stage: First episode (psychosis only)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Srihari, V. H., Tek, C., Kucukgoncu, S., Phutane, V. H., Breitborde, N. J., Pollard, J., Ozkan, B., Saksa, J., Walsh, B. C., Woods, S. W.
Objective: This study sought to determine the effectiveness of a comprehensive first-episode service, the clinic for Specialized Treatment Early in Psychosis (STEP), in an urban U.S. community mental health center by comparing it with usual treatment. Methods: This pragmatic randomized controlled trial enrolled 120 patients with first-episode psychosis within five years of illness onset and 12 weeks of antipsychotic exposure. Referrals were mostly from inpatient psychiatric units, and enrollees were randomly allocated to STEP or usual treatment. Main outcomes included hospital utilization (primary); the ability to work or attend age-appropriate schooling-or to actively seek these opportunities (vocational engagement); and general functioning. Analysis was by modified intent to treat (excluding only three who withdrew consent) for hospitalization; for other outcomes, only data for completers were analyzed. Results: After one year, STEP participants had less inpatient utilization compared with those in usual treatment: no psychiatric hospitalizations, 77% versus 56% (risk ratio [RR] = 1.38, 95% confidence interval [CI] = 1.08-1.58); mean hospitalizations, .33 +/- .70 versus .68 +/- .92 (p = .02); and mean bed-days, 5.34 +/- 13.53 versus 11.51 +/- 15.04 (p = .05). For every five patients allocated to STEP versus usual treatment, one additional patient avoided hospitalization over the first year (number needed to treat = 5; CI = 2.7-26.5). STEP participants also demonstrated better vocational engagement (91.7% versus 66.7%; RR = 1.40, CI = 1.18-1.48) and showed salutary trends in global functioning measures. Conclusions: This trial demonstrated the feasibility and effectiveness of a U.S. public-sector model of early intervention for psychotic illnesses. Such services can also support translational research and are a relevant model for other serious mental illnesses. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Psychiatric Services, 66(7) : 705-712
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Psychoeducation, Case management
Subotnik, K. L., Casaus, L. R., Ventura, J., Luo, J. S., Hellemann, G. S., Gretchen-Doorly, D., Marder, S., Nuechterlein, K. H.
Importance: Long-acting, injectable, second-generation antipsychotic medication has tremendous potential to bring clinical stability to persons with schizophrenia. However, long-acting medications are rarely used following a first episode of schizophrenia.; Objective: To compare the clinical efficacy of the long-acting injectable formulation of risperidone with the oral formulation in the early course of schizophrenia.; Design, Setting, and Participants: A randomized clinical trial performed at a university-based research clinic, between 2005 and 2012. Eighty-six patients with recent onset of schizophrenia were randomized to receive long-acting injectable risperidone or oral risperidone. Half of each group was simultaneously randomized to receive cognitive remediation to improve cognitive functioning or healthy-behaviors training to improve lifestyle habits and well-being. An intent-to-treat analysis was performed between October 4, 2012, and November 12, 2014.; Interventions: A 12-month trial comparing the long-acting injectable vs oral risperidone and cognitive remediation vs healthy-behaviors training.; Main Outcomes and Measures: Psychotic relapse and control of breakthrough psychotic symptoms.; Results: Of the 86 patients randomized, 3 refused treatment in the long-acting injectable risperidone group. The psychotic exacerbation and/or relapse rate was lower for the long-acting risperidone group compared with the oral group (5% vs 33%; χ21 = 11.1; P < .001; relative risk reduction, 84.7%). Long-acting injectable risperidone better controlled mean levels of hallucinations and delusions throughout follow-up (β = -0.30; t68 = -2.6, P = .01). The cognitive remediation and healthy-behaviors training groups did not differ significantly regarding psychotic relapse, psychotic symptom control, or hospitalization rates, and there were no significant interactions between the 2 medications and the 2 psychosocial treatments. Discontinuations owing to inadequate clinical response were more common in the oral group than in the long-acting risperidone group (χ21 = 6.1; P = .01). Adherence to oral risperidone did not appear to differ before randomization but was better for the long-acting risperidone group compared with the oral group (t80 = 5.3; P < .001). Medication adherence was associated with prevention of exacerbation and/or relapse (χ21 =11.1; P = .003) and control of breakthrough psychotic symptoms (β = 0.2; t79 = 2.1; P = .04).; Conclusions and Relevance: The use of long-acting injectable risperidone after a first episode of schizophrenia has notable advantages for clinical outcomes. The key clinical advantages are apparently owing to the more consistent administration of the long-acting injectable. Such formulations should be offered earlier in the course of illness.; Trial Registration: clinicaltrials.gov Identifier: NCT00333177.;
JAMA Psychiatry, 72(8) : 822-829
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Psychological Interventions (any)
, Cognitive remediation therapy
Trampush, J.W., Lencz, T., DeRosse, P., John, M., Gallego, J. A., Petrides, G., Hassoun, Y., Zhang, J-P., Addington, J., Kellner, C. H., Tohen, M., Burdick, K. E., Goldberg, T. E., Kane, J. M., Robinson, D. G., Malhotra, A. K.
First-episode schizophrenia (FES) spectrum disorders are associated with pronounced cognitive dysfunction across all domains. However, less is known about the course of cognitive functioning, following the first presentation of psychosis, and the relationship of cognition to clinical course during initial treatment. The present longitudinal study examined the magnitude of neurocognitive impairment, using the MATRICS Consensus Cognitive Battery, in patients experiencing their first episode of psychosis at baseline and after 12 weeks of randomized antipsychotic treatment with either aripiprazole or risperidone. At baseline, FES patients evidenced marked impairments in cognitive functioning. Notably, performance on the mazes task of planning and reasoning significantly predicted the likelihood of meeting stringent criteria for positive symptom remission during the first 12 weeks of the trial. Performance on indices of general cognitive function, working memory, and verbal learning improved over time, but these improvements were mediated by improvements in both positive and negative symptoms. We did not detect any differential effects of antipsychotic medication assignment (aripiprazole vs risperidone) on cognitive functioning. Our results suggest that a brief paper-and-pencil measure reflecting planning/reasoning abilities may index responsivity to antipsychotic medication. However, improvements in cognitive functioning over time were related to clinical symptom improvement, reflecting "pseudospecificity."; © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: [email protected].
Schizophrenia Bulletin, 41(6) : 1237-1247
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Robinson, D.G., Gallego, J. A., John, M., Petrides, G., Hassoun, Y., Zhang, J-P., Lopez, L., Braga, R. J., Sevy, S. M., Addington, J., Kellner, C. H., Tohen, M., Naraine, M., Bennett, N., Greenberg, J., Lencz, T., Correll, C. U., Kane, J. M., Malhotra, A. K.,
Research findings are particularly important for medication choice for first-episode patients as individual prior medication response to guide treatment decisions is unavailable. We describe the first large-scale double-masked randomized comparison with first-episode patients of aripiprazole and risperidone, 2 commonly used first-episode treatment agents. One hundred ninety-eight participants aged 15-40 years with schizophrenia, schizophreniform disorder, schizoaffective disorder or psychotic disorder Not Otherwise Specified, and who had been treated in their lifetime with antipsychotics for 2 weeks or less were randomly assigned to double-masked aripiprazole (5-30 mg/d) or risperidone (1-6 mg/d) and followed for 12 weeks. Positive symptom response rates did not differ (62.8% vs 56.8%) nor did time to response. Aripiprazole-treated participants had better negative symptom outcomes but experienced more akathisia. Body mass index change did not differ between treatments but advantages were found for aripiprazole treatment for total and low-density lipoprotein cholesterol, fasting glucose, and prolactin levels. Post hoc analyses suggested advantages for aripiprazole on depressed mood. Overall, if the potential for akathisia is a concern, low-dose risperidone as used in this trial maybe a preferred choice over aripiprazole. Otherwise, aripiprazole would be the preferred choice over risperidone in most situations based upon metabolic outcome advantages and some symptom advantages within the context of similar positive symptom response between medications.; © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: [email protected].
Schizophrenia Bulletin, 41(6) : 1227-1236
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Ruggeri, M., Bonetto, C., Lasalvia, A., Fioritti, A., deGirolamo, G., Santonastaso, P., Pileggi, F., Neri, G., Ghigi, D., Giubilini, F., Miceli, M., Scarone, S., Cocchi, A., Torresani, S., Faravelli, C., Cremonese, C., Scocco, P., Leuci, E., Mazzi, F., Pratelli, M., Bellini, F., Tosato, S., DeSanti, K., Bissoli, S., Poli, S., Ira, E., Zoppei, S., Rucci, P., Bislenghi, L., Patelli, G., Cristofalo, D., Meneghelli, A.
Integrated multi-element psychosocial interventions have been suggested to improve the outcomes of first-episode psychosis (FEP) patients, but they have been studied primarily in experimental settings and in nonepidemiologically representative samples. Thus, we performed a cluster-randomized controlled trial, comparing an integrated multi-element psychosocial intervention, comprising cognitive behavioral therapy, family intervention, and case management, with treatment as usual (TAU) for FEP patients in 117 community mental health centers (CMHCs) in a large area of northern Italy (10 million inhabitants). The randomized units (clusters) were the CMHCs, and the units of observation the patients (and, when available, their family members). The primary hypotheses were that add-on multicomponent intervention: (1) results in greater improvements in symptoms, as assessed with positive and negative syndrome scale and (2) reduces in-hospital stay, based on days of hospitalization over the 9-month follow-up. Four hundred and forty-four FEP patients received the intervention or TAU and were assessed at baseline and 9 months. Based on the retention rates of patients (and families) in the experimental arm, multi-element psychosocial interventions can be implemented in routine mental health services. Regarding primary outcomes, patients in the experimental arm showed greater reductions in overall symptom severity, while no difference could be found for days of hospitalization. Among the secondary outcomes, greater improvements were detected in the experimental arm for global functioning, emotional well-being, and subjective burden of delusions. No difference could be found for service disengagement and subjective burden of auditory hallucinations. These findings support feasibility and effectiveness of early interventions for psychosis in generalist mental health services.; © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
Schizophrenia Bulletin, 41(5) : 1192-1203
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions, Case management
Sarpal, D. K., Robinson, D. G., Lencz, T., Argyelan, M., Ikuta, T., Karlsgodt, K., Gallego, J. A., Kane, J. M., Szeszko, P. R., Malhotra, A. K.
Importance: Previous evidence has implicated corticostriatal abnormalities in the pathophysiology of psychosis. Although the striatum is the primary target of all efficacious antipsychotics, the relationship between its functional connectivity and symptomatic reduction remains unknown.; Objective: To explore the longitudinal effect of treatment with second-generation antipsychotics on functional connectivity of the striatum during the resting state in patients experiencing a first episode of psychosis.; Design, Setting, and Participants: This prospective controlled study took place at a clinical research center and included 24 patients with first-episode psychosis and 24 healthy participants matched for age, sex, education, and handedness. Medications were administered in a double-blind randomized manner.; Interventions: Patients were scanned at baseline and after 12 weeks of treatment with either risperidone or aripiprazole. Their symptoms were evaluated with the Brief Psychiatric Rating Scale at baseline and follow-up. Healthy participants were scanned twice within a 12-week interval.; Main Outcomes and Measures: Functional connectivity of striatal regions was examined via functional magnetic resonance imaging using a seed-based approach. Changes in functional connectivity of these seeds were compared with reductions in ratings of psychotic symptoms.; Results: Patients had a median exposure of 1 day to antipsychotic medication prior to being scanned (mean [SD] = 4.5 [6.1]). Eleven patients were treated with aripiprazole and 13 patients were treated with risperidone. As psychosis improved, we observed an increase in functional connectivity between striatal seed regions and the anterior cingulate, dorsolateral prefrontal cortex, and limbic regions such as the hippocampus and anterior insula (P < .05, corrected for multiple comparisons). Conversely, a negative relationship was observed between reduction in psychosis and functional connectivity of striatal regions with structures within the parietal lobe (P < .05, corrected for multiple comparisons).; Conclusions and Relevance: Our results indicated that corticostriatal functional dysconnectivity in psychosis is a state-dependent phenomenon. Increased functional connectivity of the striatum with prefrontal and limbic regions may be a biomarker for improvement in symptoms associated with antipsychotic treatment.;
JAMA Psychiatry, 72(1) : 5-13
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Sanz-Fuentenebro, F. J., Taboada, D., Molina, V.
Background: Clozapine may be potentially valuable in first-episode patients with psychosis, as an initial treatment seeking to limit early on clinical and cognitive deterioration. Nevertheless, until recently its restricted use has limited the study of this possibility. Methods: Our research group is developing a multicentric and open label study, on the differential efficacy between clozapine and risperidone in first-episode schizophrenia. Here we present clinical outcome results after one-year follow-up. For clinical assessment, we employed the Positive and Negative Syndrome Scale (PANSS), and the Udvalg for KliniskeUndersøgelser (UKU) Side Effects Rating Scale; applied at weeks 1, 2, 3, 4, 6, 8, 10 and 12, and months 6 and12. Results: Out of 33 patients included, 16 were randomized to clozapine and 17 to risperidone; 7 patients dropped the study by their will, and three other patients due to lack of response Patients initially assigned to clozapine remained on this treatment for a longer period than patients assigned to risperidone (71,31 vs 45,88, t 1,838, p=0,76). By last observation carried forward (LOCF) analysis, patients on clozapine and risperidone displayed similar clinical improvements in Positive symptoms (58,92 vs 50,60: t=1.02, p=0,31), although larger improvement in Total (44.64 vs 28,93: t=1,97, p=0.058), and Negative (18.72 vs -19,12, t 2.13, p=0,041) symptoms scores were found in the clozapine group. At the 12-month point we observed a marginal improvement in negative symptom in patients on clozapine (mean change -8.2, sd 10.3, z=-1.66, p=0.09), and marginal increase (mean change -0.4, sd 9.52, z=0.27, p=0.78) in this subscale in the risperidone group. We found an inverse, significant association between Subjective secondary effects, as measured with the UKU scale, and negative (Spearman's rho=-0.65, p=0.02) symptoms improvement in at 12 months. Discussion: Our data, although preliminary, suggest that clozapine may have a slightly superior efficacy in the initial year of treatment of firstepisode treatment-naïve patients with schizophrenia. The worsening of negative symptoms in the risperidone group seems attributable to secondary effects of the drug. Taken together with the larger attrition in this group, a better tolerability is suggested for clozapine. The larger improvements in Total and Negative symptom scores with clozapine may point to a superior efficacy in the earlier stages of illness, to be confirmed upon inclusion of a larger number of cases and follow-up completion.
Schizophrenia Research, 153 : S117-S118
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Vinogradov, S., Fisher, M., Herman, A., Brown, E., Nagarajan, S.
Background: Schizophrenia is characterized by dysfunction in the distributed neural systems that subserve auditory processing and verbal memory. In patients with schizophrenia, we find that intensive "neuroplasticity-based" computerized cognitive training of auditory and verbal learning processes drives significant improvement in verbal memory and global cognition. We predicted that cognitive outcomes would be significantly related to evidence of target engagement during training. Methods: We performed two double-blind randomized controlled trials of cognitive training: one in a sample of middle-aged adults with schizophrenia (average age of 40 years); and one in a sample of young recent-onset individuals (average age of 20 years). In addition to neurocognitive and clinical outcome measures, we assessed target engagement, defined as behavioral and magnetoencephalographic (MEG) evidence of plasticity in the fronto-temporal networks targeted by this form of training. Results: Improvements in auditory processing speed after exposure to 20 hours of training were significantly associated with better cognition after completion of training; faster auditory processing speed was also associated with gains in quality of life 6 months later. Increases in prefrontal high-gamma band activation during an auditory working memory task were associated with better cognition after training, and with fewer negative symptoms at 6 months. Conclusions: Our data indicate that it is possible to define specific behavioral and neural system targets for neuroplasticity-based cognitive training; that it is possible to develop indices of target engagement during exposure to the treatment; and that the degree of target engagement has predictive value for determining realworld outcomes after treatment.
Biological Psychiatry, 75(9) : 8S
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Rinaldi, M., Craig, T., Singh, S., Smith, J., Shepherd, G.
Background: Supported employment (SE) has been shown in numerous controlled trials to be the most effective intervention for helping patients return to paid employment but is poorly implemented in practice because of scepticism and ambivalence of clinical staff. Objectives: To see whether a motivational intervention directed at clinical staff can improve occupational outcomes for patients following a first episode of psychosis Methods: Two of four early intervention teams in the UK that offer supported employment (SE) as part of their clinical service were randomised to receive additional motivational training (MT) for clinicians focused on attitudinal barriers to employment. Occupational outcomes of patients in these teams were evaluated at 6 and 12 months. Results: 159/300 patients in these teams consented to the research. Occupational outcomes were obtained for 149 (94%) at 6 months and 136 (85%) at 12-month follow-up. More patients in the MT intervention teams than in the SE only teams achieved employment by 6 months (25/76 vs. 9/73). A random effects logistic regression accounting for clustering by care coordinator and adjusted for the participant's sex, ethnicity, educational and employment history, PANSS and GAF scores confirmed superiority of the MT + MI intervention (OR 4.5; 95% CI 2.2-12.4). Comparable results were obtained for 12-month outcomes. Conclusions: Occupational outcomes of an SE programme were enhanced by addressing clinical ambivalence about supporting their patients back into work.
Early Intervention in Psychiatry, 8 : 121
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy, Individual placement and support (IPS), vocational interventions
Ritsner, M. S., Bawakny, H., Kreinin, A.
Aims: Management of recent-onset schizophrenia (SZ) and schizoaffective disorder (SA) is challenging owing to frequent insufficient response to antipsychotic agents. This study aimed to test the efficacy and safety of the neurosteroid pregnenolone in patients with recent-onset SZ/SA. Methods: Sixty out- and inpatients who met DSM-IV criteria for SZ/SA, with suboptimal response to antipsychotics were recruited for an 8-week, double-blind, randomized, placebo-controlled, two-center add-on trial, that was conducted between 2008 and 2011. Participants were randomized to receive either pregnenolone (50 mg/day) or placebo added on to antipsychotic medications. The primary outcome measures were the Positive and Negative Symptoms Scale and the Assessment of Negative Symptoms scores. Secondary outcomes included assessments of functioning, and side-effects. Results: Analysis was by linear mixed model. Fifty-two participants (86.7%) completed the trial. Compared to placebo, adjunctive pregnenolone significantly reduced Positive and Negative Symptoms Scale negative symptom scores with moderate effect sizes (d = 0.79). Significant improvement was observed in weeks 6 and 8 of pregnenolone therapy among patients who were not treated with concomitant mood stabilizers (arms x visit x mood stabilizers; P = 0.010). Likewise, pregnenolone significantly reduced Assessment of Negative Symptoms scores compared to placebo (d = 0.57), especially on blunted affect, avolition and anhedonia domain scores. Other symptoms, functioning, and side-effects were not significantly affected by adjunctive pregnenolone. Antipsychotic agents, benzodiazepines and sex did not associate with pregnenolone augmentation. Pregnenolone was well tolerated. Conclusions: Thus, add-on pregnenolone reduces the severity of negative symptoms in recent-onset schizophrenia and schizoaffective disorder, especially among patients who are not treated with concomitant mood stabilizers. Further studies are warranted. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Psychiatry & Clinical Neurosciences, 68(6) : 432-440
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
, Other biological interventions
Stain, H., Bucci, S., Halperin, S., Emsley, R., Shall, U., Lewin, T., Carr, V., Crittenden, K., Clark, V., Startup, M.
Background: This will be the first presentation of the treatment outcomes for the Australian DEPTh trial of cognitive behavioral therapy (CBT) for youth at ultra high risk (UHR) for psychosis. The DEPTh protocol is based on the EDIE model (Morrison et al., 2004, 2012), but employed an active control condition, Non-Directive Refl ective Listening (NDRL). Method: This is a single blind RCT of CBT compared to NDRL plus standard care conducted at two sites (urban-Newcastle, rural-Orange) with a 6-month treatment phase (weekly sessions) and a 12-month follow-up from randomization in young people meeting UHR criteria. Assessments were conducted at baseline, 6 months and 12 months. Measurement domains included symptoms, substance use, functioning and quality of life. Intention-to-treat analysis was performed using regression models. Results: There were 57 youth randomized to either treatment or active control (N = 30: CBT; N = 27: NDRL), with the majority of participants female (60%) and an average age of 16.3 years. Attrition rates were high, with 40% and 53% of youth lost to follow-up at 6 months and 12 months respectively. At baseline and at 6 months the CBT group showed more distress associated with sub-clinical psychotic symptoms than the NDRL group. This effect disappeared at 12 months. No other group differences were found at either 6 or 12 months. Discussion: High attrition rates at the time of follow up assessments made analyses underpowered. We will discuss the rates of engagement in the intervention itself and the characteristics of our sample in order to inform future treatment trials with young people.
Early Intervention in Psychiatry, 8 : 15
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions