Disorders - Psychosis Disorders
Srihari, V., Phutane, V., Breitborde, N., Tek, C., Woods, S.
Objective: To determine the effectiveness and costs of an early intervention service (STEP) based in an urban U.S. community mental health center. Methods: This randomized controlled trial enrolled 'first-episode psychosis' patients within 5 years of illness onset and with less than 12 weeks of antipsychotic exposure. 120 participants were referred mostly from area inpatient psychiatric units and emergency rooms and randomized to either STEP care or referral to community providers (TAU). Main outcomes included hospital utilization (primary), ability to work or attend age-appropriate schooling on a part-time basis ('vocational engagement'), and cost of care. Cost-effectiveness analysis relied on assessing costrelated events from administrative datasets and structured assessments and multiplying these events by estimated mean unit costs. Results: Over the first year, STEP care resulted in a significant reduction in inpatient utilization (67%) compared to the TAU group (43%) and significant improvement in levels of vocational engagement (31%) compared to TAU (12%). The cost of the outpatient EI service was easily offset by reduced inpatient utilization. Conclusions: This trial demonstrates the feasibility and cost-effectiveness of an EI service implemented in the U.S. public sector. Data from this study will be critical in informing both service reform and health policy targeting serious mental illness in this country.
Early Intervention in Psychiatry, 6 : 106
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Urben, S., Pihet, S., Jaugey, L., Halfon, O., Holzer, L.
Objective: To investigate short-term outcomes of a computer-assisted cognitive remediation (CACR) for adolescents with psychotic disorders or at high risk for psychosis. Method: Cognitive abilities and clinical status were assessed at baseline (N = 32) and at 6-month follow-up (N = 22) after enrolment in either a CACR (treatment group) or a computer games (control group) program (8 weeks). Results: With regard to the cognitive abilities, no amelioration was found in the control group while, in the CACR group, significant improvements in inhibition (p = 0.040) and reasoning (p = 0.005) were observed. Furthermore, symptom severity decreased significantly in the control group (p = 0.046) and marginally in the CACR group (p = 0.088). Improvements in cognitive abilities were not associated with symptoms' amelioration. Finally, increase in reasoning abilities was related to the median effective work time in sessions of CACR (R = 0.64, p = 0.024). Conclusion: At follow-up, enhanced cognitive abilities (reasoning and inhibition), which are necessary for executing higher-order goals or adapting behaviour to the ever-changing environment, were reported in adolescents participants of the CACR. Thus, further studies are needed to confirm and extend these interesting results. (copyright) 2012 John Wiley & Sons A/S.
Acta Neuropsychiatrica, 24(6) : 328-335
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Valencia, Marcelo, Juarez, Francisco, Ortega, Hector
This study describes an integrated treatment approach that was implemented to enhance functional recovery in first-episode psychotic patients. Patients were randomized to two treatment conditions: either to an integrated treatment approach: pharmacotherapy, psychosocial treatment, and psychoeducation (experimental group: N = 39) or to medication alone (control group: N = 34). Patients were evaluated at baseline and after one year of treatment. Functional recovery was assessed according to symptomatic and functional remission. At the end of treatment, experimental patients showed a 94.9% of symptomatic remission compared to 58.8% of the control group. Functional remission was 56.4% for the experimental group and 3.6% for the control group, while 56.4% of the experimental group met both symptomatic and functional remission criteria and were considered recovered compared to 2.9% of the control group.;
Schizophrenia Research & Treatment, 2012 : 962371-962371
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
VanDerGaag, M., Nieman, D. H., Rietdijk, J., Dragt, S., Ising, H. K., Klaassen, R. M. C., Koeter, M., Cuijpers, P., Wunderink, L., Linszen, D. H.
Background: Evidence for the effectiveness of treatments for subjects at ultrahigh risk (UHR) for developing psychosis remains inconclusive. Objective: A new cognitive behavioral intervention specifically targeted at cognitive biases (ie, Cognitive Behavioral Therapy [CBT] for UHR patients plus treatment as usual [TAU] called CBTuhr) is compared with TAU in a group of young help-seeking UHR subjects. Methods: A total of 201 patients were recruited at 4 sites and randomized. In most cases, CBTuhr was an add-on therapy because most people were seeking help for a comorbid disorder. The CBT was provided for 6 months, and the follow-up period was 18 months. Results: In the CBTuhr condition, 10 patients transitioned to psychosis compared with 22 in the TAU condition ((chi) (1) 5.575, P . 03). The number needed to treat (NNT) was 9 (95% confidence interval [CI]: 4.7-89.9). At 18-month follow-up the CBTuhr group was significantly more often remitted from an at-risk mental state, with a NNT of 7 (95% CI: 3.7-71.2). Intention-to-treat analysis, including 5 violations against exclusion criteria, showed a statistical tendency ((chi) (1) 3.338, P . 06). Conclusions: Compared with TAU, this new CBT (focusing on normalization and awareness of cognitive biases) showed a favorable effect on the transition to psychosis and reduction of subclinical psychotic symptoms in subjects at UHR to develop psychosis. (copyright) The Author 2012.
Schizophrenia Bulletin, 38(6) : 1180-1188
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Weiden, Peter J., Schooler, Nina R., Weedon, Jeremy C., Elmouchtari, Abdel, Sunakawa-McMillan, Ayako
Background: Because long-acting injectable (LAI) antipsychotics are largely reserved for persistently ill patients, little is known about the use of LAIs early in the course of illness for first-episode outpatients.; Method: A prospective, open-label, randomized controlled trial was conducted in which outpatients with first-episode DSM-IV schizophreniform disorder, schizophrenia, or schizoaffective disorder were enrolled from December 2004 to March 2007. Participants were randomly assigned at a 2:1 ratio to a recommendation of changing to LAI risperidone microspheres (RLAI) (n = 26) or continuing oral antipsychotic treatment (n = 11) for up to 104 weeks. Primary outcomes were time until initial nonadherence (medication gap of ≥ 14 days) and medication attitudes as assessed with the Rating of Medication Influences scale. Patients randomly assigned to an RLAI recommendation could decline the recommendation, so analysis defined treatment groups by intent-to-treat and as-actually-treated.; Results: Eighty-one percent of patients (30/37) stopped medication within 104 weeks. There was a trend toward an initial adherence benefit favoring RLAI acceptors at 12 weeks (P = .058), but no significant difference between RLAI and oral antipsychotic treatment in time to initial nonadherence during the overall study (P = .188). Medication attitudes did not differ between groups.; Conclusions: Acceptance of RLAI was associated with an initial adherence benefit that was not sustained over time. Early introduction of LAI therapy did not adversely affect adherence attitudes. The small size of the study and low power limit interpretation, but the few patients who remained adherent into a second year were all receiving RLAI. Nonadherence was almost universal in our first-episode cohort, but nonadherence was more easily detected among first-episode patients treated with LAI therapy than it was with oral antipsychotics.; Trial Registration: ClinicalTrials.gov identifier: NCT00220714.; © Copyright 2012 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 73(9) : 1224-1233
- Year: 2012
- 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)
Riedel, Michael, Mayr, Andreas, Seemuller, Florian, Maier, Wolfgang, Klingberg, Stefan, Heuser, Isabella, Klosterkötter, Joachim, Gastpar, Markus, Schmitt, Andrea, Sauer, Heinrich, Schneider, Frank, Gaebel, Wolfgang, Jager, Markus, Moller, Hans-Jurgen, Schennach-Wolff, Rebecca
Objective: To evaluate depressive symptoms regarding their association with the acute outcome in first-episode schizophrenia comparing risperidone and haloperidol.; Method: A total of 274 patients were analysed within a double-blind randomized controlled trial and treated with risperidone or haloperidol. The patients were grouped according to their baseline HAMD-21 total score in a "depressed" (HAMD-21 ≥16) or "non-depressed" (HAMD-21 <16) patient subgroup. PANSS, HAMD-21, GAF, SOFAS and AIMS ratings were performed. Early response was defined as an initial 20% reduction of the PANSS total score from admission to week 2, response as an at least 50% reduction of the PANSS total score from admission to discharge and remission according to the consensus criteria.; Results: A total of 124 patients were classified as depressive at baseline with 22 patients still being depressive at discharge. The depressed and non-depressed patients did not significantly differ regarding the treatment with risperidone and haloperidol (P = 0.2270). The depressive patients suffered from significantly more suicidal tendencies (P = 0.0165), had significantly less insight into their illness (P = 0.0152) and featured significantly worse functioning (P = 0.0066). Patients with depressive symptoms achieved remission significantly less often than non-depressed patients.; Conclusion: The importance of a specific and adequate treatment of depressive symptoms is highlighted.;
World Journal of Biological Psychiatry, 13(1) : 30-38
- Year: 2012
- 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)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Piskulic, D., Barbato, M., Addington, J.
Background: Deficits in cognition often precede the onset of full-blown psychosis, making cognition an excellent treatment target. The primary aim of the project is to reduce cognitive deterioration and improve cognition among youths at CHR using cognitive remediation and to test the efficacy of the PositScience Brain Fitness (BF) auditory training program in improving cognition of individuals at clinical high risk of psychosis (CHR). Methods: This is a longitudinal, randomized controlled pilot trial of cognitive remediation in 36 CHR persons. Participants are randomised to 40 hours of either the BF or a control treatment consisting of video games (VG). The primary outcome is cognitive function, which is assessed using the MATRICS consensus cognitive battery. The secondary outcome is social and role functioning. All assessments are performed at baseline, post treatment and 12 months after baseline. Results: A preliminary data analysis on 12 CHR individuals suggests that for the participants in the treatment group (n = 6), there was a non signifi- cant trend for improvements on tests of working memory (M = 44.8, SD = 10.17) and reasoning and problem solving (M = 50.6, SD = 8.75) at the completion of treatment compared to baseline (M = 39.3, SD = 16.44 and M = 44.6, SD = 14.10, respectively). More detailed data will be available at the time of this presentation. Discussion: The PositScience auditory training program appears to be a feasible treatment option in youth at CHR of psychosis. Preliminary data suggests that this may be an effective treatment of cognitive dysfunction in the putatively prodromal stage of psychosis.
Early Intervention in Psychiatry, 6 : 89
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Morrison, Anthony P., French, Paul, Stewart, Suzanne L. K., Birchwood, Max, Fowler, David, Gumley, Andrew I., Jones, Peter B., Bentall, Richard P., Lewis, Shon W., Murray, Graham K., Patterson, Paul, Brunet, Kat, Conroy, Jennie, Parker, Sophie, Reilly, Tony, Byrne, Rory, Davies, Linda M., Dunn, Graham
Objective: To determine whether cognitive therapy is effective in preventing the worsening of emerging psychotic symptoms experienced by help seeking young people deemed to be at risk for serious conditions such as schizophrenia.; Design: Multisite single blind randomised controlled trial.; Setting: Diverse services at five UK sites.; Participants: 288 participants aged 14-35 years (mean 20.74, SD 4.34 years) at high risk of psychosis: 144 were assigned to cognitive therapy plus monitoring of mental state and 144 to monitoring of mental state only. Participants were followed-up for a minimum of 12 months and a maximum of 24 months.; Intervention: Cognitive therapy (up to 26 (mean 9.1) sessions over six months) plus monitoring of mental state compared with monitoring of mental state only.; Main Outcome Measures: Primary outcome was scores on the comprehensive assessment of at risk mental states (CAARMS), which provides a dichotomous transition to psychosis score and ordinal scores for severity of psychotic symptoms and distress. Secondary outcomes included emotional dysfunction and quality of life.; Results: Transition to psychosis based on intention to treat was analysed using discrete time survival models. Overall, the prevalence of transition was lower than expected (23/288; 8%), with no significant difference between the two groups (proportional odds ratio 0.73, 95% confidence interval 0.32 to 1.68). Changes in severity of symptoms and distress, as well as secondary outcomes, were analysed using random effects regression (analysis of covariance) adjusted for site and baseline symptoms. Distress from psychotic symptoms did not differ (estimated difference at 12 months -3.00, 95% confidence interval -6.95 to 0.94) but their severity was significantly reduced in the group assigned to cognitive therapy (estimated between group effect size at 12 months -3.67, -6.71 to -0.64, P=0.018).; Conclusions: Cognitive therapy plus monitoring did not significantly reduce transition to psychosis or symptom related distress but reduced the severity of psychotic symptoms in young people at high risk. Most participants in both groups improved over time. The results have important implications for the at risk mental state concept.; Trial Registration: Current Controlled Trials ISRCTN56283883.;
BMJ, 344 : e2233-e2233
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Seida, J. C., Schouten, J. R., Boylan, K., Newton, A. S., Mousavi, S. S., Beaith, A., Vandermeer, B., Dryden, D. M., Carrey, N.
BACKGROUND AND OBJECTIVE: Despite increasing on-label and offlabel use of antipsychotics, prescribing antipsychotics to children remains controversial due to uncertainty of their relative benefits and safety. We systematically reviewed the effectiveness and safety of first- (FGA) and second-generation antipsychotics (SGA) for patients aged (less-than or equal to)24 years with psychiatric and behavioral conditions. METHODS: We searched 10 databases from January 1987 to February 2011, gray literature, trial registries, and reference lists. Two reviewers independently selected studies, assessed methodologic quality, and graded the evidence. One reviewer extracted, and a second verified, data. We summarized findings qualitatively and conducted metaanalyses when appropriate. RESULTS: Sixty-four trials and 17 cohort studies were included. Most trials had a high risk of bias; cohort studies had moderate quality. All comparisons of FGAs versus SGAs, FGAs versus FGAs, and FGAs versus placebo had low or insufficient strength of evidence. There was moderate strength of evidence for the following comparisons. Olanzapine caused more dyslipidemia and weight gain, but fewer prolactin-related events, than risperidone. Olanzapine caused more weight gain than quetiapine. Compared with placebo, SGAs improved clinical global impressions (schizophrenia, bipolar and disruptive behavior disorders) and diminished positive and negative symptoms (schizophrenia), behavior symptoms (disruptive behavior disorders), and tics (Tourette syndrome). CONCLUSIONS: This is the first comprehensive review comparing the effectiveness and safety across the range of antipsychotics for children and young adults. The evidence on the comparative benefits and harms of antipsychotics is limited. Some SGAs have a better side effect profile than other SGAs. Additional studies using head-to-head comparisons are needed. Copyright (copyright) 2012 by the American Academy of Pediatrics.
Pediatrics, 129(3) : e771-e784
- Year: 2012
- Problem: Bipolar Disorders, Psychosis Disorders
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Yung, A., Amminger, P., Berger, G., Thompsom, A., Phillips, L., Nelson, B., Francey, S., Yuen, H. P., McGorry, P.
Background: Cognitive therapy (CT) and/or low-dose antipsychotic administered to individuals deemed as being at ultra high risk (UHR) for psychotic disorder may prevent or delay the onset of full blown illness. However, it is unclear which of these treatments are most effective. Method: In order to examine these issues, we conducted a randomized controlled trial of CT plus risperidone (CT+Risp); CT plus placebo (CT+Plac); and supportive therapy plus placebo (Supp+Plac) in UHR young people. Results 12-month transition rates were: CT+Risp, 10.7%; CT+Plac, 9.6%; ST+Plac, 21.8%. There were no statistically significant differences between the three groups in transition rates. Symptoms and functioning in all three groups improved over the course of the trial. Discussion: The unexpectedly low, and essentially equivalent, transition rates in all three groups fail to support the use of antipsychotic medications as a first-line therapy for UHR patients. Other treatments such as CT, supportive therapy and neuroprotective agents including fish oil need further examination. Ethical issues associated with labeling of UHR people as such and types and duration of treatment also need further discussion.
Early Intervention in Psychiatry, 6 : 11
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Supportive therapy
Zhang, Y., Dai, G.
Background There are no direct comparisons of paliperidone extended-release (ER), aripiprazole and ziprasidone in efficacy and metabolic influence in patients with first-episode schizophrenia. Objective The present study examined the efficacy and metabolic influence of paliperidone ER, aripiprazole and ziprasidone in patients with first-episode schizophrenia in China. Methods Subjects were recruited from outpatient and 254 patients entered the trial. These patients received treatment randomly with paliperidone ER, aripiprazole and ziprasidone and were assessed at baseline, 13, 26 and 52 weeks, respectively with Positive and Negative Syndrome Scale (PANSS), 7-item Clinical Global Impressions-Severity (CGI-S), anthropometric (weight, body mass index and waist circumference) and metabolic (fasting blood glucose, HbA1c, cholesterol, high density lipoproteins (HDL), low density lipoproteins and triglycerides) measures. Results A total of 203 patients completed the trial. Paliperidone group had significant greater reduction in PANSS than aripiprazole group and ziprasidone group from 13 weeks, although the a reduction in PANSS of each group was more than 20%. There was no difference in CGI-S among the three groups, and all three groups had a significant reduction from baseline in CGI-S. Aripiprazole group increased in weight and body mass index despite no statistical change in waist circumference. Other two groups showed no changes in anthropometric measure. At the end of the study, two glucose metabolic indices (fasting blood glucose and HbA1c) of aripiprazole group were significantly higher than that of baseline. In lipid metabolism, aripiprazole group reduced triglycerides significantly and had no changes in other indices. Paliperidone group reduced HDL and increased triglycerides despite no changes in glucose metabolism. Ziprasidone group also had no significant changes in glucose metabolism, but reduced cholesterol, low density lipoproteins and increased HDL. Furthermore, 22 subjects in three groups reached the diagnostic criteria of metabolic syndrome. Conclusions Paliperidone ER, aripiprazole and ziprasidone are effective in treating first-episode schizophrenia, and the ranking of efficacy from high to low is paliperidone ER > aripiprazole > ziprasidone. Paliperidone ER can impair lipid metabolism potentially but had no influence on glucose metabolism. Aripiprazole can damage glucose metabolism and has little influence on lipid metabolism. Ziprasidone is considered an atypical antipsychotic with no evidence of harm to glucose and lipid metabolism. Copyright (copyright) 2012 John Wiley & Sons, Ltd. Copyright (copyright) 2012 John Wiley & Sons, Ltd.
Human Psychopharmacology, 27(6) : 605-614
- Year: 2012
- 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)
Zhang, Zhang-Jin, Chen, Yun-Chun, Wang, Hua-Ning, Wang, Huai-Hai, Xue, Yun-Yun, Feng, Shu-Fang, Tan, Qing-Rong
Objective: Previous studies have demonstrated the effectiveness of electroconvulsive therapy (ECT) in pharmacotherapy-resistant neuropsychiatric conditions. This study aimed to evaluate the efficacy and safety of ECT in adolescents with first-episode psychosis. Method: This case - control study was conducted in inpatients aged 13 - 20 years with first-episode psychosis. Every three similar age and same gender patients consecutively recruited were randomly allocated to control and ECT group at a ratio of 1:2, while they had antipsychotic treatment. ECT treatment was performed for 3 sessions per week with a maximum of 14 sessions. The endpoint was discharge from hospital. Clinical outcomes were measured using hospital stay days, the Positive and Negative Syndrome Scale (PANSS) and response rate. Polysomnography (PSG) was conducted at baseline and at week 2. Safety and tolerability were also evaluated. Results: Between March 2004 and November 2009, 112 eligible patients were allocated to control (n = 38) and ECT (n = 74) group. Additional ECT treatment significantly reduced hospital stay compared to controls (23.2 ± 8.2 days versus 27.3 ± 9.3 days, mean ± SD, P = 0.018). Survival analysis revealed that the ECT-treated group had a significantly higher cumulative response rate than controls (74.3% versus 50%, relative risk (RR) = 1.961, P = 0.001). Additional ECT also produced significantly greater improvement in sleep efficiency, rapid eye movement (REM) latency and density than control condition. The PSG improvement significantly correlated with reduction in scores on overall PANSS, positive symptoms, and general psychopathology. No patients discontinued ECT treatment regimen during hospital stay. The incidence of most adverse events was not different in the two groups, but ECT-treated group had more complaints of transient headache and dizziness than controls. Conclusions: ECT is an effective and safe intervention used in adolescents with first-episode psychosis. Its antipsychotic effects are associated with improved PSG variables. ECT can be considered as an early psychosis intervention. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Schizophrenia Research, 137(1-3) : 97-103
- Year: 2012
- 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)
, Electroconvulsive therapy (ECT)