Disorders - Psychosis Disorders
Drake, R., Day, C., Picucci, R., Warburton, J., Larkin, W., Husain, N., Reeder, C., Wykes, T., Marshall, M.
Background: Cognitive remediation (CR) preceding cognitive-behavioural therapy for psychosis (CBTp) was trialled within routine clinical services, with the hypothesis that following first-episode non-affective psychosis CR would enhance CBTp efficacy by improving neuropsychological performance. Method: A total of 61 patients with DSM-IV non-affective psychoses waiting for routine CBTp were randomized to computerized CR over 12 weeks, supported by a trained support worker, or time-matched social contact (SC). Primary outcome was the blind-rated Psychotic Symptoms Rating Scale (PSYRATS). Secondary outcomes included measures of CBTp progress, cognition, symptoms, insight and self-esteem: all at baseline, after CR (12 weeks) and after CBTp (42 weeks). PSYRATS and global neuropsychological efficacy were tested using mixed-effects models with a groupxtime interaction term. Measures of CBTp progress and some neuropsychological measures were modelled by regression. Results: There was no significant difference between the CR and SC groups in PSYRATS (groupxtime coefficient 0.3, 95% confidence interval -0.4 to 1.1, p = 0.39). However, after CR CBTp was shorter [median 7 sessions, interquartile range (IQR) 2-12 after CR; median 13, IQR 4-18 after SC; model p = 0.011] and linked to better insight (p = 0.02). Global cognition did not improve significantly more after CR (p = 0.20) but executive function did (Wisconsin Card Sort, p = 0.012). Conclusions: CBTp courses preceded by CR were far shorter but achieved the same outcome as CBTp preceded by an active control, consistent with neuropsychological improvement enhancing CBTp. CR was delivered by staff with minimal training, offering the potential to reduce the costs of CBTp considerably. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Psychological Medicine, 44(9) : 1889-1899
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Cognitive remediation therapy
Dang, J., Zhang, J., Guo, Z., Lu, W., Cai, J., Shi, Z., Zhang, C.
In this pilot study, we aimed to examine whether iPad-assisted cognitive training could be beneficial in ameliorating some of the cognitive impairment that accompany schizophrenia. Totally, 20 first-episode schizophrenia patients were randomly assigned to an experiment group (with cognitive training) or to a control group (without cognitive training). The N-back task was assessed at baseline and after intervention, to see what effects iPad-assisted training might have (week 4). The experimental group exhibited significant improvement in the accuracy rate at 2-back, and reaction time at 0, 1 and 2-back tasks. These findings suggest that iPad- or other technically-assisted cognitive training may potentially be a valid strategy for pursuing cognitive rehabilitation among those with schizophrenia. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Archives of Psychiatric Nursing, 28(3) : 197-199
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Emsley, R., Chiliza, B., Asmal, L., du-Plessis, S., Phahladira, L., van-Niekerk, E., van-Rensburg, S. J., Harvey, B. H.
Background: While antipsychotics are effective in the maintenance treatment of schizophrenia they have safety and tolerability risks. We investigated whether a combination of omega-3 polyunsaturated fatty acids (omega-3 PUFAs) and a metabolic antioxidant, alpha-lipoic acid (alpha-LA), is effective in preventing relapse after antipsychotic discontinuation in subjects who were successfully treated for 2-3years after a first-episode of schizophrenia, schizo-affective or schizophreniform disorder. Methods: In this randomized, double-blind, placebo controlled study antipsychotic treatment was tapered and discontinued and participants received either omega-3 PUFAs (eicosapentaenoic acid 2g/day and docosahexaenoic acid 1g/day)+alpha-LA 300mg/day or placebo. Subjects were followed up for two years, or until relapse. Results: Recruitment was terminated prematurely due to the high relapse rates in both treatment groups as well as the severity of some of the relapse episodes. Of the 33 participants, 19/21(90%) randomized to omega-3 PUFAs+alpha-LA relapsed and one (5%) completed two years without relapse (p = 0.6); and 9/12 (75%) randomized to placebo relapsed and none completed two years without relapse. Mean times to relapse were 39.8+/-25.4 and 38.3+/-26.6weeks for the omega-3 PUFAs+alpha-LA and placebo groups, respectively (p = 0.9). There were no significant differences between the groups in relapse symptom severity. Conclusions: We found no evidence that omega-3 PUFAs+alpha-LA could be a suitable alternative to maintenance antipsychotic treatment in relapse prevention, in this small study. Antipsychotic discontinuation after a single episode of schizophrenia carries a very high risk of relapse, and treatment guidelines endorsing this practice should be revised. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Schizophrenia Research, 158(1-3) : 230-235
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Relapse prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
, Vitamins and supplements
Craig, T., Shepherd, G., Rinaldi, M., Smith, J., Carr, S., Preston, F., Singh, S.
Background: Individual placement and support (IPS) is effective in helping patients return to work but is poorly implemented because of clinical ambivalence and fears of relapse. Aims: To assess whether a motivational intervention (motivational interviewing) directed at clinical staff to address ambivalence about employment improved patients' occupational outcomes. Method: Two of four early intervention teams that already provided IPS were randomised to receive motivational interviewing training for clinicians, focused on attitudinal barriers to employment. The trial was registered with the International Standard Randomised Controlled Trial Register (ISRCTN71943786). Results: Of 300 eligible participants, 159 consented to the research. Occupational outcomes were obtained for 134 patients (85%) at 12-month follow-up. More patients in the intervention teams than in the IPS-only teams achieved employment by 12 months (29/68 v. 12/66). A random effects logistic regression accounting for clustering by care coordinator, and adjusted for participants' gender, ethnicity, educational and employment history and clinical status scores, confirmed superiority of the intervention (odds ratio = 4.3, 95% CI 1.5-16.6). Conclusions: Employment outcomes were enhanced by addressing clinicians' ambivalence about their patients returning to work. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
British Journal of Psychiatry, 205(2) : 145-150
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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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
Choi, J., Corcoran, C., Dixon, L., Fiszdon, J., Javitt, D.
Deficits in processing speed (PS) have been shown to correlate with social aptitude during critical stages of psychological development in CHR, and have been variably identified as risk markers for psychosis. We examined the feasibility of improving PS, the sustainability of training effects, and the association of PS with concurrent social function. This was a doubleblind RCT for 21 participants randomized to 30 hours of Processing Speed Training (PST) or Active Control matched for the same dose and duration of treatment. PST is a tablet-based program designed to improve reaction time and visual scanning efficiency by inhibiting the selection of nonessential targets and discriminating figure-ground details. Pupil dilation is measured as an index of cognitive load, and training exercises are continually titrated based on pupil dilation to provide a tailored and optimal level of cognitive load. Moderate to large effect sizes were found for PST at post (0.76-0.82) and 2 months (0.52-0.61) on motorical and non-motorical PS measures. PST also showed moderate effects at 2 months on overall social adjustment (0.29) and engaging in new social situations (0.52). Changes in PS from baseline to 2 months were correlated with changes in overall social adjustment and avoidance of new social situations (r = - 0.32-0.38, p < 0.05). This was a pilot that experimentally isolated, controlled and exaggerated speeded response subprocesses. This is the first study to test focal PS training in CHR to address social morbidity. Focused PST appears to be a promising pathway to improving co-morbidity and mitigating a risk factor for psychosis.
Early Intervention in Psychiatry, 8 : 109
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Christensen, T., Vesterager, L., Krarup, G., Olsen, B., Melau, M., Gluud, C., Nordentoft, M.
Objective: This randomised clinical trial assessed the effects of a 16-week cognitive remediation programme (NEUROCOM) combined with an early intervention service (EIS) vs. EIS alone. Method: One hundred and seventeen patients with first episode psychosis were randomly assigned to 4 months cognitive remediation combined with EIS vs. EIS alone. Statistical analysis of effect was based on intention to treat. Results: A total of 98 patients (83.8%) participated in post-training assessments at 4 months and 92 (78.6%) in 12-month follow-up assessments. No effects were found on the primary outcome measure functional capacity. At the post-training assessment, the intervention group had improved significantly on Rosenberg Self-Esteem Scale (Cohen's d = 0.54, P = 0.01), Positive and Negative Symptoms Scale (PANSS), General Psychopathology Scale (Cohen's d = 0.51, P = 0.05) and the verbal learning domain (Cohen's d = 0.46, P = 0.02). At follow-up assessment, the intervention group retained the significant improvements on the verbal learning domain (Cohen's d = 0.58, P < 0.05). Furthermore, significant improvements were observed on the working memory domain (Cohen's d = 0.56, P = 0.01) and PANSS positive symptoms (Cohen's d = 0.44, P = 0.04), while improvement on the composite score was marginally significant (Cohen's d = 0.34, P = 0.05). Conclusion: In accordance with other cognitive remediation programmes, this programme demonstrates some immediate and long-term effect on cognitive functioning, symptoms and self-esteem. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Acta Psychiatrica Scandinavica, 130(4) : 300-310
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Other service delivery and improvement interventions
Amminger, G. P., Schlogelhofer, M., Klier, C., McGorry, P., Schafer, M.
Background: We have shown that a 12-week intervention with long-chain omega-3 polyunsaturated fatty acids (PUFAs) reduced the risk of progression to psychotic disorder in young people with subthreshold psychotic states for a 12-month period (Amminger et al., 2010, Arch Gen Psychiatry). Now we have completed a longer-term follow-up of this trial to determine the longer-term efficacy of omega-3-PUFAs in individuals at ultra-high risk (UHR) for psychosis. Methods: Randomized, double-blind trial of 1.2 g/day omega-3 PUFAs or placebo in 81 UHR individuals. At longer-term follow-up participants, next of kin, and those involved in assessing outcomes or data entry were blind to group assignments. The primary outcome measure was transition to psychotic disorder. Secondary outcomes included functional, symptomatic and vocational measures. Analyses were performed on an intent-totreat basis. Results: The median duration of follow-up in the sample was 6.7 years. The transition to psychosis rate was 9.8% (4/41) in the omega-3 group and 40% (16/40) in the placebo group. The survival times were significantly different between the treatment groups, with a more rapid conversion time for the placebo group compared with the omega-3 group (log rank test: χ2 = 9.84, p = 0.002). Functioning was significantly more improved in the omega-3 PUFA group than in the placebo group. Conclusions: A brief intervention with omega-3 PUFAs prevented psychosis for almost up to 7 years after baseline in the UHR individuals who participated in the trial.
Early Intervention in Psychiatry, 8 : 41
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Calvo, A., Moreno, M., Ruiz-Sancho, A., Rapado-Castro, M., Moreno, C., Sanchez-Gutierrez, T., Arango, C., Mayoral, M.
Objective: The present study aims to assess the efficacy of a structured psychoeducational group intervention for adolescents with early-onset psychosis and their families. The intervention was implemented in parallel in 2 separate groups by focusing specifically on problem-solving strategies and structured psychosis-related information to manage daily life difficulties associated with the disease, to mitigate crises, and to prevent relapses. Method: We performed a 9-month, randomized, rater-blinded clinical trial involving 55 adolescent patients with early-onset psychosis and either or both of their parents. A psychoeducational problem-solving group intervention (n = 27) was compared with a nonstructured group intervention (n = 28). The primary outcomes were number of hospitalizations, days of hospitalization, and visits to the emergency department. The secondary outcome measures were clinical variables and family environment. Results: Assessments were performed before and after the intervention. At the end of the group intervention, 15% of patients in the psychoeducational group and 39% patients in the nonstructured group had visited the emergency department (chi2 = 3.62, df = 1, p = .039). The improvement in negative symptoms was more pronounced in the psychoeducational group (12.84 [7.87]) than in the nonstructured group (15.81 [6.37]) (p = .039). Conclusion: A parallel psychoeducational group intervention providing written instructions in a structured manner could help adolescents with early-onset psychosis and their parents to manage crises by implementing problem-solving strategies within the family, thus reducing the number of visits to the emergency department. Negative symptoms improved in adolescents in the psychoeducational group. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 53(6) : 688-696
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation
Holzer, L., Urben, S., Passini, C. M., Jaugey, L., Herzog, M. H., Halfon, O., Pihet, S.
BACKGROUND: Computer assisted cognitive remediation (CACR) was demonstrated to be efficient in improving cognitive deficits in adults with psychosis. However, scarce studies explored the outcome of CACR in adolescents with psychosis or at high risk. AIMS: To investigate the effectiveness of a computer-assisted cognitive remediation (CACR) program in adolescents with psychosis or at high risk. METHOD: Intention to treat analyses included 32 adolescents who participated in a blinded 8-week randomized controlled trial of CACR treatment compared to computer games (CG). Cognitive abilities, symptoms and psychosocial functioning were assessed at baseline and posttreatment. RESULTS: Improvement in visuospatial abilities was significantly greater in the CACR group than in CG. Other cognitive functions, psychotic symptoms and psychosocial functioning improved significantly, but at similar rates, in the two groups. CONCLUSION: CACR can be successfully administered in this population; it proved to be effective over and above CG for the most intensively trained cognitive ability.
Behavioural and Cognitive Psychotherapy, 42(4) : 421-434
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, At risk (indicated or selected prevention)
, First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Agid, O., Schulze, L., Arenovich, T., Sajeev, G., McDonald, K., Foussias, G., Fervaha, G., Remington, G.
Clinicians treating schizophrenia routinely employ high doses and/or antipsychotic switching to achieve response. However, little is actually known regarding the value of these interventions in early schizophrenia. Data were gathered from a treatment algorithm implemented in patients with first-episode schizophrenia that employs two antipsychotic trials at increasing doses before clozapine. Patients were initially treated with either olanzapine or risperidone across three dose ranges, (low, full, high), and in the case of suboptimal response were switched to the alternate antipsychotic. We were interested in the value of (a) high dose treatment and (b) antipsychotic switching. A total of 244 patients were evaluated, with 74.5% (184/244) responsive to Trial 1, and only 16.7% (10/60) responsive to Trial 2. Percentage of response for subjects switched from olanzapine to risperidone was 4.0% (1/25) vs. 25.7% (9/35) for those switched from risperidone to olanzapine. High doses yielded a 15.5% response (14.6% for risperidone vs. 16.7% for olanzapine).The present findings concur with other research indicating that response rate to the initial antipsychotic trial in first-episode schizophrenia is robust; thereafter it declines notably. In general, the proportion of responders to antipsychotic switching and high dose interventions was low. For both strategies olanzapine proved superior to risperidone, particularly in the case of antipsychotic switching (i.e. risperidone to olanzapine vs. vice versa). It remains to be established whether further antipsychotic trials are associated with even greater decrements in rate of response. Findings underscore the importance of moving to clozapine when treatment resistance has been established. (copyright) 2013 Elsevier B.V. and ECNP.
European Neuropsychopharmacology, 23(9) : 1017-1022
- Year: 2013
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Chang, W. C., Chan, H. K., Jim, T. T., Wong, H. Y., Hui, L. M., Chan, K. W., Lee, H. M., Chen, Y. H.
Background: Literature indicated superior efficacy of early intervention (EI) over standard care (SC) on illness outcome of first-episode psychosis. Yet, optimal duration of EI treatment remains unclear with recent findings suggesting that beneficial effects could not be sustained after discharge from EI program. Methods: Randomized controlled trial was conducted evaluating the efficacy of 1-year extended case management (CM). One hundred sixty patients who had received 2-year specialized EI service (i.e., EASY: Early Assessment Service for Young people with psychosis which is a territory-wide, governmentfunded EI program for individuals aged 15-25 years presenting with firts-episode psychosis in Hong Kong) were recruited. Subjects were randomized to either CM or SC. Symptom and functional outcomes between two treatment groups were compared at 1-year follow-up. Results: No significant differences between two treatment groups (CM:n = 79 SC:n = 77) were observed in socio-demographic, duration of untreated psychosis, premorbid adjustment and baseline characteristics. At 1-year follow-up, subjects in CM group had significantly fewer negative (PAN SS; t = 2.7,p <0.05) and depressive symptoms (CDS; t = 2.8,p = 0.05) than those in SC group. Patients in CM group also had significantly better overall functioning (SOFAS; t = -3.4;p = 0.01), and achieved higher scores on individual domains of RFS including work productivity (t = 2.0, p <0.05), self-care (t = -2.2,p <0.05), immediate (t = -3.2,p <0.01) and extended social functioning (t = -2.9,p <0.01). The two groupds did not differ in relapse and admission rates over 1-year study period. Conclusion: Our findings indicated that 1-year extended specialized case management was more efficacious than standard care in improving clinical and functional outcomes of patients who had received 2-year EI service for psychosis.Further research is required to determine the cost-effectiveness and the longerterm effects of this extended EI service.
Schizophrenia Bulletin, 39 : S324-S325
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Case management
Ayesa-Arriola, R., Rodriguez-Sanchez, J. M., Perez-Iglesias, R., Roiz-Santianez, R., Martinez-Garcia, O., Sanchez-Moreno, J., Tabares-Seisdedos, R., Vazquez-Barquero, J. L., Crespo-Facorro, B.
Introduction: The initially postulated superior neurocognitive effectiveness of second-generation antipsychotics is currently under debate. Methods: A prospective, randomized, open-label study was carried out to compare the long-term neurocognitive effectiveness of haloperidol, olanzapine, and risperidone in the first episode of schizophrenia spectrum disorders. A final sample of 79 patients randomized to haloperidol (N = 28), olanzapine (N = 23), or risperidone (N = 28) who completed clinical and cognitive evaluations at baseline and 3-year follow-up was included in the final analysis. Forty-one healthy individuals were also included in the final analysis. The main outcome measure was cognitive changes at 3-year follow-up. Due to the fact that some of the patients had switched their initially prescribed antipsychotic medication during the course of the study (6 out of 28 in haloperidol group, 18 out of 23 in olanzapine group, and 24 out of 28 in risperidone group continued with the initial study drug at 3-year assessment), we have also conducted a per protocol analysis. Results: Overall, cognitive changes were similar in the three treatment groups and controls, although a greater improvement in Rey Auditory Verbal Learning Test, Digit Symbol, and Iowa Gambling Test was found in the treatment groups. The better performance observed on Rey Auditory Verbal Learning Test and Digit Symbol in olanzapine treatment group was likely explained by the lower prevalence of use of antimuscarinic drugs. These results were essentially similar to those found in the intention-to-treat analysis. Conclusions: The major conclusion of this study is that haloperidol, olanzapine, and risperidone have not demonstrated substantial neurocognitive effectiveness, improving cognitive deficits present in the early phases of the illness. The study also underscores the importance of exploring new drugs for the treatment of cognitive impairments and associated functional disabilities in schizophrenia. (copyright) 2013 Springer-Verlag Berlin Heidelberg.
Psychopharmacology, 227(4) : 615-625
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)