Disorders - Psychosis Disorders
McFarlane, W. R., Cook, W. L., Woodberry, K. A.
Background: This report describes a randomized clinical trial that compared (a) family-aided assertive community treatment (FACT) and psychotropic medication to (b) medication, family education and family crisis intervention (Comparison)in reducing symptom levels, improving functioning, and preventing the onset of psychosis in young people at clinical high risk (CHR) for psychosis. Methods: CHR subjects were identified via community education about attenuated psychotic symptoms, targeting school counselors, pediatricians, and mental health professionals in a catchment of 340 000 people. Community-referred young people aged 12-35 were assessed using the Structured Interview for Prodromal Syndrome (McGlashan, et al., 2002). The test treatment was a comprehensive, prodrome- specific combination of psychoeducational multifamily group (PMFG), supported education/employment and assertive community treatment. Psychotropic medication was prescribed by symptom indication. Patients received independent assessments at baseline and 24 months, blinded to experimental condition. The outcomes were conversion to psychosis, clinical symptoms and psychosocial functioning. Results: 100 CHR young people (53 males, 47 females, mean age 16.3 years) were identified and randomly assigned to FACT vs. Comparison conditions. By 24 months, conversion to psychosis occurred in 8% of the FACT cohort and 16% in the comparison condition; however, the difference was not statistically significant (P = .22). Positive, negative, disorganized and general symptoms all improved significantly but equally, as did functioning. Mean GAF was 40.2 and 36.4 at baseline and 55.5 and 52.7 at 24 months, respectively, (pre-post, P < .01), but treatment differences were non-significant. 94% and 90% were functioning in expected roles (n.s.). Post-hoc deconstruction analysis found that, controlling for other significant treatment components, PMFG intervention accounted for functional outcomes (B = 0.417, t(56.85)=3.29, P = .002), while antipsychotic and antidepressant medication did not. Conclusion: Outcomes for psychosis onset, symptoms and functioning were equally positive in the 2 test conditions. The PMFG component was individually associated with functional benefit. Less intensive interventions may be effective in the treatment of some CHR youth.
Schizophrenia Bulletin, 37 : 314
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
, Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
Marin Mayor, M., Martinez Martin, N., Verdura Vizcaino, E., Codesal Julian, R. A.
Introduction: Childhood or Early Onset Schizophrenia (EOS), defined as the onset of psychotic symptoms before the thirteenth birthday, represents a rare, clinically severe variant, associated with significant chronic functional impairment and poor response to antipsychotic treatment. Despite of that, in clinical practice, atypical agents have become the treatment of choice in patients with EOS. Aims: To review the different pharmacological strategies, in which an atypical antipsychotic was used in the management of EOS in childhood and adolescence. Methods: We conducted a literature search of articles related to the use of atypical antipsychotics in children and adolescents with EOS in the last 20 years from the Medline database. Results: Several atypical antipsychotics, such as Risperidone, Olanzapine, Quetiapine, Aripiprazol and Clozapine were consistently found to reduce the severity of psychotic symptoms in EOS when compared to placebo. Although Clozapine has demonstrated to be more efficacious than other atypical and typical antipsychotics, it remains the medication of last resort due to its profile of side effects. Finally, in general, children and adolescent have a higher risk of extrapyramidal symptoms, akathisia, prolactin elevation, sedation and metabolic effects of atypical antipsychotics than adults. Conclusions: Antipsychotics are the mainstay of treatment of EOS. Randomized controlled trials suggest a trend to superior efficacy for atypical antipsychotics over classic antipsychotic. Children and adolescents trend to be more sensible to antipsychotic side effects. Clinicians should be aware of this problem and be careful when monitoring this type of treatment.
European Psychiatry, 26 :
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Marshall, Max, Rathbone, John
Background: Objectives: Search Strategy: Selection Criteria: Data Collection and Analysis: Main Results: Authors' Conclusions: Proponents of early intervention have argued that outcomes might be improved if more therapeutic efforts were focused on the early stages of schizophrenia or on people with prodromal symptoms. Early intervention in schizophrenia has two elements that are distinct from standard care: early detection, and phase-specific treatment (phase-specific treatment is a psychological, social or physical treatment developed, or modified, specifically for use with people at an early stage of the illness).Early detection and phase-specific treatment may both be offered as supplements to standard care, or may be provided through a specialised early intervention team. Early intervention is now well established as a therapeutic approach in America, Europe and Australasia.To evaluate the effects of: (a) early detection; (b) phase-specific treatments; and (c) specialised early intervention teams in the treatment of people with prodromal symptoms or first-episode psychosis.We searched the Cochrane Schizophrenia Group Trials Register (March 2009), inspected reference lists of all identified trials and reviews and contacted experts in the field.We included all randomised controlled trials (RCTs) designed to prevent progression to psychosis in people showing prodromal symptoms, or to improve outcome for people with first-episode psychosis. Eligible interventions, alone and in combination, included: early detection, phase-specific treatments, and care from specialised early intervention teams. We accepted cluster-randomised trials but excluded non-randomised trials.We reliably selected studies, quality rated them and extracted data. For dichotomous data, we estimated relative risks (RR), with the 95% confidence intervals (CI). Where possible, we calculated the number needed to treat/harm statistic (NNT/H) and used intention-to-treat analysis (ITT).Studies were diverse, mostly small, undertaken by pioneering researchers and with many methodological limitations (18 RCTs, total n=1808). Mostly, meta-analyses were inappropriate. For the six studies addressing prevention of psychosis for people with prodromal symptoms, olanzapine seemed of little benefit (n=60, 1 RCT, RR conversion to psychosis 0.58 CI 0.3 to 1.2), and cognitive behavioural therapy (CBT) equally so (n=60, 1 RCT, RR conversion to psychosis 0.50 CI 0.2 to 1.7). A risperidone plus CBT plus specialised team did have benefit over specialist team alone at six months (n=59, 1 RCT, RR conversion to psychosis 0.27 CI 0.1 to 0.9, NNT 4 CI 2 to 20), but this was not seen by 12 months (n=59, 1 RCT, RR 0.54 CI 0.2 to 1.3). Omega 3 fatty acids (EPA) had advantage over placebo (n=76, 1 RCT, RR transition to psychosis 0.13 CI 0.02 to 1.0, NNT 6 CI 5 to 96). We know of no replications of this finding.The remaining trials aimed to improve outcome in first-episode psychosis. Phase-specific CBT for suicidality seemed to have little effect, but the single study was small (n=56, 1 RCT, RR suicide 0.81 CI 0.05 to 12.26). Family therapy plus a specialised team in the Netherlands did not clearly affect relapse (n=76, RR 1.05 CI 0.4 to 3.0), but without the specialised team in China it may (n=83, 1 RCT, RR admitted to hospital 0.28 CI 0.1 to 0.6, NNT 3 CI 2 to 6). The largest and highest quality study compared specialised team with standard care. Leaving the study early was reduced (n=547, 1 RCT, RR 0.59 CI 0.4 to 0.8, NNT 9 CI 6 to 18) and compliance with treatment improved (n=507, RR stopped treatment 0.20 CI 0.1 to 0.4, NNT 9 CI 8 to 12). The mean number of days spent in hospital at one year were not significantly different (n=507, WMD, -1.39 CI -2.8 to 0.1), neither were data for 'Not hospitalised' by five years (n=547, RR 1.05 CI 0.90 to 1.2). There were no significant differences in numbers 'not living independently' by one year (n=507, RR 0.55 CI 0.3 to 1.2). At five years significantly fewer participants in the treatment group were 'not living independently' (n=547, RR 0 42 CI 0.21 to 0.8, NNT 19 CI 14 to 62). When phase-specific treatment (CBT) was compared with befriending no significant differences emerged in the number of participants being hospitalised over the 12 months (n=62, 1 RCT, RR 1.08 CI 0.59 to 1.99).Phase-specific treatment E-EPA oils suggested no benefit (n=80, 1 RCT, RR no response 0.90 CI 0.6 to 1.4) as did phase-specific treatment brief intervention (n=106, 1 RCT, RR admission 0.86 CI 0.4 to 1.7). Phase-specific ACE found no benefit but participants given vocational intervention were more likely to be employed (n=41, 1 RCT, RR 0.39 CI 0.21 to 0.7, NNT 2 CI 2 to 4). Phase-specific cannabis and psychosis therapy did not show benefit (n=47, RR cannabis use 1.30 CI 0.8 to 2.2) and crisis assessment did not reduce hospitalisation (n=98, RR 0.85 CI 0.6 to 1.3). Weight was unaffected by early behavioural intervention.There is emerging, but as yet inconclusive evidence, to suggest that people in the prodrome of psychosis can be helped by some interventions. There is some support for specialised early intervention services, but further trials would be desirable, and there is a question of whether gains are maintained. There is some support for phase-specific treatment focused on employment and family therapy, but again, this needs replicating with larger and longer trials.
Cochrane Database of Systematic Reviews, (6) : CD004718
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
Masi, Gabriele, Liboni, Francesca
Schizophrenia in subjects younger than 13 years is defined as very-early-onset schizophrenia, and its prevalence is estimated at 1 in 10‚Äâ000, while early-onset schizophrenia occurs between 13 and 17 years, and its prevalence is about 0.5%. Only a minority of youths show a complete recovery, and the majority of patients present a moderate to severe impairment at the outset. Treatment of schizophrenia always needs both pharmacological and nonpharmacological interventions. Nonpharmacological interventions include counselling for the patients and the family, psychological support, behavioural treatments, social and cognitive rehabilitation, assistance in social and scholastic activities, enhancement of social skills and family support. Pharmacological treatment is necessary for remission and control of positive and negative symptoms. Furthermore, proper pharmacotherapy can greatly increase the efficacy of psychosocial interventions. Available literature on pharmacotherapy in children and adolescents with schizophrenia is critically reviewed, including both first- and second-generation antipsychotics. Data on efficacy and safety are reported for all the marketed atypical antipsychotics (clozapine, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole), based on randomized, placebo-controlled studies and the most relevant open-label or naturalistic studies. Adverse effects of concern are closely analysed, such as extrapyramidal side effects and tardive dyskinesia, metabolic syndrome (including hyperglycaemia and hyperlipidaemia), weight gain, hyperprolactinaemia, hepatotoxicity, seizures, and cardiovascular and haematological adverse effects. Finally, practical guidelines for the management of specific clinical situations are provided: the first phases and the long-term approach to pharmacotherapy, the treatment refractoriness and the use of clozapine in youths, the agitated adolescent and the treatment of negative symptoms and of affective co-morbidity. Current experience indicates that, based on low rates of remission, low effect size of medications and frequent adverse effects, mainly metabolic syndrome, further research is warranted, with both randomized, placebo-controlled studies and long-term, naturalistic follow-up of large samples of patients with different age ranges.
Drugs, 71(2) : 179-208
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
, Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Kishimoto, T., Agarwal, V., Kishi, T., Leucht, S., Kane, J. M., Correll, C. U.
Few controlled trials compared second-generation antipsychotics (SGAs) with first-generation antipsychotics (FGAs) regarding relapse prevention in schizophrenia. We conducted a systematic review/meta-analysis of randomized trials, lasting (greater-than or equal to)6 months comparing SGAs with FGAs in schizophrenia. Primary outcome was study-defined relapse; secondary outcomes included relapse at 3, 6 and 12 months; treatment failure; hospitalization; and dropout owing to any cause, non-adherence and intolerability. Pooled relative risk (RR) ((plus or minus)95% confidence intervals (CIs)) was calculated using random-effects model, with numbers-needed-to-treat (NNT) calculations where appropriate. Across 23 studies (n=4504, mean duration=61.9(plus or minus)22.4 weeks), none of the individual SGAs outperformed FGAs (mainly haloperidol) regarding study-defined relapse, except for isolated, single trial-based superiority, and except for risperidone's superiority at 3 and 6 months when requiring (greater-than or equal to)3 trials. Grouped together, however, SGAs prevented relapse more than FGAs (29.0 versus 37.5%, RR=0.80, CI: 0.70-0.91, P=0.0007, I2=37%; NNT=17, CI: 10-50, P=0.003). SGAs were also superior regarding relapse at 3, 6 and 12 months (P=0.04, P<0.0001, P=0.0001), treatment failure (P=0.003) and hospitalization (P=0.004). SGAs showed trend-level superiority for dropout owing to intolerability (P=0.05). Superiority of SGAs regarding relapse was modest (NNT=17), but confirmed in double-blind trials, first- and multi-episode patients, using preferentially or exclusively raw or estimated relapse rates, and for different haloperidol equivalent comparator doses. There was no significant heterogeneity or publication bias. The relevance of the somewhat greater efficacy of SGAs over FGAs on several key outcomes depends on whether SGAs form a meaningful group and whether mid- or low-potency FGAs differ from haloperidol. Regardless, treatment selection needs to be individualized considering patient- and medication-related factors.Molecular Psychiatry advance online publication, 29 November 2011; doi:10.1038/mp.2011.143.
Molecular Psychiatry, :
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Lloyd-Evans, Brynmor, Crosby, Michelle, Stockton, Sarah, Pilling, Stephen, Hobbs, Lorna, Hinton, Mark, Johnson, Sonia
Background: Long duration of untreated psychosis (DUP) is common and associated with poor outcomes. Strategies to enhance early detection of first-episode psychosis have been advocated. Aims: To evaluate initiatives for early detection of psychosis. Method: Systematic review of available evidence on the effectiveness of early detection initiatives to reduce the DUP. Results: The review included 11 studies which evaluated 8 early detection initiatives. Evidence suggests that general practitioner education campaigns and dedicated early intervention services do not by themselves reduce DUP or generate more treated cases. Evidence for multifocus initiatives is mixed: intensive campaigns targeting the general public as well as relevant professionals may be needed. No studies evaluated initiatives targeting young people or professionals from non-health organisations. Conclusions: How early detection can be achieved is not clear. Evidence is most promising for intensive public awareness campaigns: these require organisation and resourcing at a regional or national level. More good-quality studies are needed to address gaps in knowledge. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
British Journal of Psychiatry, 198(4) : 256-263
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement
Keshavan, M., Eack, S. M.
Background: Schizophrenia is highly disabling, and much of the disability is related to cognitive impairments. Cognitive remediation is effective in improving cognition in patients with schizophrenia but the underlying neurobiologic changes that occur during these treatments and support cognitive improvement are not well known. Methods: We examined differential changes in brain morphology in early course schizophrenia patients during cognitive enhancement therapy vs. supportive therapy. In a randomized controlled trial involving 53 symptomatically stable but cognitively disabled outpatients in the early course of schizophrenia or schizoaffective disorder. Results: Patients who received cognitive enhancement therapy demonstrated significantly greater preservation of gray matter volume over 2 years in the left hippocampus, parahippocampal gyrus, and fusiform gyrus, and significantly greater gray matter increases in the left amygdala compared with those who received enriched supportive therapy. Less gray matter loss in the left parahippocampal and fusiform gyrus and greater gray matter increases in the left amygdala were significantly related to improved cognition and mediated the beneficial cognitive effects of cognitive enhancement therapy. Conclusion: Cognitive enhancement therapy may offer neuroprotective effects in early schizophrenia that are associated with improved long-term cognitive outcomes.
Schizophrenia Bulletin, 37 : 310
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy, Supportive therapy
Morrens, M., Dewilde, B., Sabbe, B., Dom, G., DeCuyper, R., Moggi, F.
Background: About half of all schizophrenic patients have a co-occurring substance use disorder, leading to poorer social and functional outcomes than obtained in non-abusing patients. To improve outcomes, integrated treatments have been designed that address the two conditions simultaneously. Results are, however, conflicting because the available effect studies are hampered by various methodological issues, among which are heterogeneous patient samples. Methods: In this comparative study, two well-described patient samples diagnosed with schizophrenia and co-morbid substance abuse disorders either received an integrated treatment (IDDT) or treatment as usual (TAU). Results: Patients in the IDDT condition showed significant reductions in illicit drug and alcohol use, improvements on all psychiatric symptom domains, reported higher quality of life and improved on social and community functioning. In contrast, patients' improvements in the TAU group were moderate and limited to a few substance use and psychiatric outcomes. The TAU group had significantly higher dropout rates 6 and 12 months after baseline, suggesting that the IDDT programme was more successful in committing patients. Conclusions: Our results suggest that an integrated approach to schizophrenic patients and co-morbid substance use disorders is superior to standard treatment and may be considered as the treatment of choice for this patient group. Copyright (copyright) 2011 S. Karger AG, Basel.
European Addiction Research, 17(3) : 154-163
- Year: 2011
- Problem: Psychosis Disorders, Substance Use Disorders (any)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Case management
, Other service delivery and improvement interventions
Ojeda, N., Pena, J., Bengoetxea, E., Segarra, R., Sanchez, P. M., Elizagarate, E., Garcia, J., Eguiluz, J. I., Garcia, A.
Objective: The efficacy of cognitive remediation in patients with psychosis has been widely recognized for cognitive impairment. However, clinical symptoms, particularly negative symptoms do not show the same pattern of improvement. Therefore, the goal of this study was to test if clinical symptoms improve after cognitive remediation with REHACOP program. Methods: Seventy-two patients with first-episode psychosis (FEP) and schizophrenia were randomly allocated into experimental or control groups. The patients allocated on the experimental group (N = 44) received a cognitive rehabilitation treatment using REHACOP. They attended 36 sessions of 90 min during 3 months. Patients under control condition (N = 28) received Occupational Therapy during the same period of time. Both groups received treatment as usual. Patients underwent clinical and neuropsychological pre- and post treatment assessments. Results: Repeated measures of MANOVA showed that experimental group improved significantly in most cognitive domains, when compared to controls. Group (REHACOP vs.1 Control) null Time (pre vs. post-treatment) interactions were significant for attention (F = 12.36, P<0.001), verbal memory (F = 5.30, P<0.05), processing speed (F = 5.30, P<0.05), and executive functioning (F = 4.13, P<0.05). On the contrary, verbal fluency (F = 3.75, P = 0.56) did not show significant improvement in any of the groups. Regarding clinical symptoms (PANSS), Group null Time interaction was significant for negative symptoms (F = 4.24, P<0.05), showing that experimental group obtained significant improvement when compared to controls. Nevertheless, positive (F = 1.23, P = 0.29), disorganization (F = 0.28, P = 0.60), excitement (F = 1.87, P = 0.18) and emotional distress (F = 0.07, P = 0.79) symptoms did not significantly improved. Conclusion: Our findings with a large sample of patients suggest that REHACOP is an effective cognitive remediation program for minimizing existing cognitive but also negative clinical symptoms. The relevance of this finding is strength by the strong relation that both, cognitive and negative symptoms present with functional outcome in psychosis.
European Archives of Psychiatry & Clinical Neuroscience, 261 : S97
- Year: 2011
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Nordentoft, M., Vesterager, L., Melau, M., Christenseen, T. O.
Background:ARandomised Clinical Trial of Computer-Assisted Cognitive Training plus a Psychosocial Treatment Programme vs. a Psychosocial Treatment Programme for First-Episode Schizophrenia Patients Methods: One-hundred and seventeen patients with first episode schizophrenia spectrum disorders were assessed on cognitive and daily functioning and randomly assigned to either 38 sessions of CT plus psychosocial treatments vs. 38 psychosocial treatments alone. The CT program was based on scaffolding and errorless learning and divided into modules of attention, memory, and executive functioning. Computerized exercises as well as daily tasks were conducted, and competence dialogues built a bridge to everyday life of patients. Examinations were carried to at baseline, post training (after 4 months) and at 10-month follow-up. Intention- to- treat analyses were carried out, and repeated measurements in mixed model with unstructured variance was applied. Outcomes were everyday skills capacity (UPSA-B), neuropsychological tests, self-esteem (Rosenberg SES), association with the labor market, and PANSS symptom severity. Results: CT significantly improved Rosenbergs Self Esteem 1.96 (0.6-3.3) and Panss general score -2.2 (-4.7 to -0.3)post training. At 10-month follow-up the-CT-group significantly differed from control group with regard to Panss positive scale -1.3 (-2.6 to 0.8), Compt 2.3 (0.0-4.6), WMT 3.6 (0.9-6.3) LNS 1.3 (0.3-2.4), HVLTR 2.1 (0.48-3.65) and Trail making B (-5.89 (-12 to 7-0)). Panss negative symptoms were not influenced Conclusion: CT did improve cognition in several areas and psychotic and general symptoms and self esteem in first episode schizophrenia.
Schizophrenia Bulletin, 37 : 223
- Year: 2011
- 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 Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Nordentoft, M., Secher, G., Bertelsen, M., Thorup, A., Austin, S., Albert, N., Jeppesen, P., Krarup, G., Jorgensen, P., Petersen, L.
Objective: Intensive early treatment for first episode psychosis have shown to be effective. It is unknown if the positive effects are sustainable over time. The aim was to determine long term effects of specialised assertive early intervention programme (OPUS) for first episode psychotic patients. Methods: 547 first-episode psychotic patients were enrolled in a single-blinded randomised clinical trial of 2 years of a specialised assertive early-intervention programme versus standard treatment. OPUS treatment consisted of ACT with family involvement and social skills training. Follow-up was 2, 5 and 10 years. 369 patients were interviewed after 2 years, 301 after 5 years and most likely approximately 310 after 10 years. All patients were followed for at least 5 years in the registers. Results: At five-year follow-up, the effect of the treatment seen after 2 years (psychotic dimension: -0.32 95% CI -0.58 to -0.06, P = 0.02, negative dimension: -0.45 95% CI -0.67 to -0.22, P = 0.001) had equalized between treatment groups. A significantly smaller percentage of patients from the experimental group were living in supported housing (4% vs. 10%, OR 2.3, 95% CI 1.1-4.8, P = 0.02) and were hospitalized fewer days (mean days 149 vs. 193, mean difference 44, 95% CI 0.15-88.12, P = 0.05) during the fiveyear period. Results of the 10-year follow-up will be presented. Conclusion: The OPUS treatment improved clinical outcome after 2 years, but the effects were not sustainable up to 5 years after. A difference on supported housing and use of bed days were found after 5 years in favor of the OPUS treatment.
European Archives of Psychiatry & Clinical Neuroscience, 261 : S37-S38
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Palma-Sevillano, Carol, Canete-Crespillo, Jose, Farriols-Hernando, Naria, Cebria-Andreu, Jordi, Michael, Maria, Alonso-Fernandez, Isabel, Fernandez-Vargas, Maria, Segarra-Gutierrez, Gerard
Background and Objectives: The aim of this study is to investigate the relative effectiveness of routine care (RC) in addition to a specific early intervention program (PIPE) compared to routine care alone. Methods: A total of 34 participants in the initial phase of schizophrenia took part in randomized, single-blind controlled trial. Participants were randomized to receive either routine care (RC; n = 13) or routine integrated with Cognitive-Motivational Therapy (PIPE; n = 21). PIPE comprised individual and family Cognitive-Motivational therapy plus routine care for 12 months. In this paper we present preliminary results at 6 months after the beginning of the intervention. Clinical assessments were carried out at pre-treatment, and in this manuscript the results at 3 and 6 months after starting the intervention by external raters are presented, using the Positive and Negative Syndrome Scale, Brief Psychiatry Rating Scale, the Clinical Global Impression Scale, the Global Assessment of Functioning scale, and relapses. Mann-Whitney test and MANOVAs analysis for variance effects were used for the statistical analysis Results: Significant greater clinical effects were observed in those patients treated in RC + PIPE at three months from baseline assessment and at six months in PANSS scale (Mann-Whitney test; p < 0 000). Other benefits of the program included increase in global activity, reduced relapse rates, and reduction of the pharmacological treatment Conclusions: These findings show the effectiveness of a program of routine care integrated with cognitive-motivational interventions (individual and family therapy) over routine psychiatric care alone for patients who are in the initial phase of schizophrenia. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
European Journal of Psychiatry, 25(2) : 68-80
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions