Disorders - Psychosis Disorders
Ando, S., Nishida, A., Koike, S., Yamasaki, S., Ishikura, S., Aono, E., Harima, H., Wakeshima, T., Asukai, N., Okazaki, Y.
Background: First episode psychosis is easy to relapse during the five years since onset. Disengagement was suggested to be an important factor for exacerbation of psychiatric symptoms. The objectives of this study were: 1) to examine whether the early intervention program prevents disengagement from treatment, 2) to investigate the effectiveness of the early intervention program for psychosis in Japan. Method: This study is a retrospective comparative cohort study based on medical records to investigate the effectiveness of a specialized early intervention program for patients with psychosis. Study setting was the outpatient unit in Tokyo Metropolitan Matsuzawa Hospital. The early intervention program included cognitive behavioral therapeutic (CBT) approaches, psycho-educational approaches, family interventions, and pharmacological therapy in accordance with the guidelines for early psychosis. The patients in the control group received treatment as usual. Both groups were followed up for twelve months. Outcome measurement included disengagement from treatment, re-admission, and use of typical antipsychotics. Result: Disengagement rate was lower in the intervention group than in the control group. Although there was no statistical significant difference in re-admission rate and use of typical antipsychotics, both rates were lower in the intervention group. Conclusion: This study showed the effectiveness of the specialized treatment program in prevention of disengagement from treatment.
Early Intervention in Psychiatry, 6 : 95
- Year: 2012
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Barrio, P., Hidalgo, D., Garcia, M., Batalla, A., Castellvi, P., Pons, A., Parellada, E.
Introduction: Long-acting injectable antipsychotics in early-onset schizophrenia improve treatment adherence, and this may lead to decreased rates of hospital admission, better rates of clinical remission and better psychosocial adjustment. Objectives: To compare clinical remission rates, number of hospital readmissions and personal and social functioning after two years between patients with early-onset schizophrenia (EOS;(less-than or equal to) 2 years), either in treatment with long-acting injectable risperidone (LAIR) or oral antipsychotics (OA). Methods: This is a case-control study comparing patients with EOS who initiated LAIR between 2004-2008 (n=26 cases) with a control group with EOS matched for age and sex (n=26 controls) treated with OA. The PANSS was administered at baseline; after two years the PANSS, the Personal and Social Functioning Scale (PSP) and the Andreasen remission criteria were administered. Results: The PANSS score comparison at baseline showed no significant differences between LAIR and OA groups (79.9 vs. 88.5, respectively; CI 95%: -21.6, 4.3; p=0.185). There were statistical significant differences after two years of treatment in the PANSS scores (47.7 vs. 66.2, respectively; CI 95%: -27.2, -9.8; p< 0.001), the PSP scores (72.4 vs. 59.7, respectively; CI 95%: 4.9, 20.7; p=0.002) and the clinical remission rates (65.4% vs. 38.5, respectively; p=0.05). Although no statistically significant, there were differences between hospital readmission rates (19,5% vs. 42.3%, respectively). Conclusions: Despite case-control studies limitations, data suggest that treatment with LAIR instead of OA in EOS might improve clinical, remission and social functioning rates. This improved effectiveness might be due to a greater treatment adherence achieved with LAIR.
European Psychiatry, 27 :
- Year: 2012
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Frazier, J. A., Giuliano, A. J., Johnson, J. L., Yakutis, L., Youngstrom, E. A., Breiger, D., Sikich, L., Findling, R. L., McClellan, J., Hamer, R. M., Vitiello, B., Lieberman, J. A., Hooper, S. R.
OBJECTIVE: To assess neurocognitive outcomes following antipsychotic intervention in youth enrolled in the National Institute of Mental Health (NIMH)-funded Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS). METHOD: Neurocognitive functioning of youth (ages 8 to 19 years) with schizophrenia or schizoaffective disorder was evaluated in a four-site, randomized, double-blind clinical trial comparing molindone, olanzapine, and risperidone. The primary outcomes were overall group change from baseline in neurocognitive composite and six domain scores after 8 weeks and continued treatment up to 52 weeks. Age and sex were included as covariates in all analyses. RESULTS: Of 116 TEOSS participants, 77 (66%) had post-baseline neurocognitive data. No significant differences emerged in the neurocognitive outcomes of the three medication groups. Therefore, the three treatment groups were combined into one group to assess overall neurocognitive outcomes. Significant modest improvements were observed in the composite score and in three of six domain scores in the acute phase, and in four of six domain scores in the combined acute and maintenance phases. Partial correlation analyses revealed very few relationships among Positive and Negative Syndrome Scale (PANSS) baseline or change scores and neurocognition change scores. CONCLUSIONS: Antipsychotic intervention in youth with early-onset schizophrenia spectrum disorders (EOSS) led to modest improvement in measures of neurocognitive function. The changes in cognition were largely unrelated to baseline symptoms or symptom change. Small treatment effect sizes, easily accounted for by practice effects, highlight the critical need for the development of more efficacious interventions for the enduring neurocognitive deficits seen in EOSS. Clinical trial registry information-Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS); http://www.clinicaltrials.gov; NCT00053703. Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Journal of the American Academy of Child and Adolescent Psychiatry, 51(5) : 496-505
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Chen, E. Y. H., Tang, J. Y., Hui, C. L., Chiu, C. P., Lam, M. M., Law, C. W., Yew, C. W., Wong, G. H., Chung, D. W., Tso, S., Chan, K. P., Yip, K. C., Hung, S. F., Honer, W. G.
Aim: Although phase-specific early intervention for first-episode psychosis has been implemented in many different parts of the world, limited medium-term outcome data are available in non-Western populations with relatively low mental health resources. The study aimed to determine the effectiveness of phase-specific early intervention in first-episode psychosis. Method: In this cohort study, we compared the 3-year outcome of 700 first-episode psychosis patients who received phase-specific early intervention with that of 700 patients matched for age, sex and diagnosis who received standard psychiatric care prior to early intervention. Using a structured data acquisition procedure, we determined functional outcome, symptom levels, relapse, recovery, suicidal behaviour and service utilization from clinical records. Results: Patients in the early intervention group had longer full-time employment or study (P<0.001), fewer days of hospitalization (P<0.001), less severe positive symptoms (P=0.006), less severe negative symptoms (P=0.001), fewer suicides (P=0.009) and fewer disengagements (P=0.002) than the historical control group. Additionally, more patients in the early intervention group experienced a period of recovery (P=0.001), but the two groups had similar rates of relapse (P=0.08) and durations of untreated psychosis (P=0.72). Conclusions: The 3-year outcome in phase-specific early intervention compared favourably with that of standard psychiatric care, particularly with respect to functional outcome and reduction in hospitalizations, suicides and disengagements. However, intervention did not appear to reduce the rate of relapse. (copyright) 2011 Blackwell Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 5(4) : 315-323
- Year: 2011
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Addington, Jean, Epstein, Irvin, Liu, Lu, French, Paul, Boydell, Katherine M., Zipursky, Robert B.
Background: Method: Results: Conclusions: There has been increasing interest in early detection during the prodromal phase of a psychotic disorder. To date a few treatment studies have been published with some promising results for both pharmacological treatments, using second generation antipsychotics, and psychological interventions, mainly cognitive behavioral therapy. The purpose of this study was to determine first if cognitive behavioral therapy (CBT) was more effective in reducing the rates of conversion compared to a supportive therapy and secondly whether those who received CBT had improved symptoms compared to those who received supportive therapy.Fifty-one individuals at clinical high risk of developing psychosis were randomized to CBT or a supportive therapy for up to 6 months. The sample was assessed at 6, 12 and 18 months post baseline on attenuated positive symptoms, negative symptoms, depression, anxiety and social functioning.Conversions to psychosis only occurred in the group who received supportive therapy although the difference was not significant. Both groups improved in attenuated positive symptoms, depression and anxiety and neither improved in social functioning and negative symptoms. There were no differences between the two treatment groups. However, the improvement in attenuated positive symptoms was more rapid for the CBT group.There are limitations of this trial and potential explanations for the lack of differences. However, both the results of this study and the possible explanations have significant implications for early detection and intervention in the pre-psychotic phase and for designing future treatments.
Copyright © 2010 Elsevier B.V. All rights reserved.
Schizophrenia Research, 125(1) : 54-61
- Year: 2011
- 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)
, Supportive therapy
Bonsack, C., Gibellini-Manetti, S., Favrod, J., Montagrin, Y., Besson, J., Bovet, P., Conus, P.
Background: Cannabis use has a negative impact on psychosis. Studies are needed to explore the efficacy of psychological interventions to reduce cannabis use in psychosis. Our aim is to study the efficacy of a specific motivational intervention on young cannabis users suffering from psychosis. Methods: Participants (aged less than 35 years) were randomly assigned to treatment as usual (TAU) alone, or treatment as usual plus motivational intervention (MI + TAU). TAU was comprehensive and included case management, early intervention and mobile team when needed. Assessments were completed at baseline and at 3, 6 and12 months follow-up. Results: Sixty-two participants (32 TAU and 30 MI + TAU) were included in the study. Cannabis use decreased in both groups at follow-up. Participants who received MI in addition to TAU displayed both a greater reduction in number of joints smoked per week and greater confidence to change cannabis use at 3 and 6 months follow-up, but differences between groups were nonsignificant at 12 months. Conclusions: MI is well accepted by patients suffering from psychosis and has a short-term impact on cannabis use when added to standard care. However, the differential effect was not maintained at 1-year follow-up. MI appears to be a useful active component to reduce cannabis use which should be integrated in routine clinical practice. (copyright) 2011 S. Karger AG, Basel.
Psychotherapy & Psychosomatics, 80(5) : 287-297
- Year: 2011
- Problem: Psychosis Disorders, Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy
Boonstra, Geartsje, Burger, Huibert, Grobbee, Diederick E., Kahn, R S.
Objective: To assess the effect of withdrawal of antipsychotic treatment on relapse risk in remitted first-episode schizophrenia patients. Methods: First-episode 1-year stable and remitted outpatients with a schizophrenic disorder were randomly allocated to continuation of their antipsychotic regimen for at least 6 months (N = 9), or gradual withdrawal (N = 11). Primary outcome was the difference in cumulative relapse-free survival at 9 months. Results: Recruitment was terminated prematurely on 26 October 2005. The cumulative relapse-free survival was 88% (SE = 0.12) in the continuation and 18% (SE = 0.12) in the discontinuation group (P = 0.001) at 9 months follow-up. Conclusions: Discontinuation of antipsychotic medication markedly increases the risk of relapse in stable remitted first-episode schizophrenia patients. In future studies the topics of safety monitoring and sampling of patients should receive extra attention. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
International Journal of Psychiatry in Clinical Practice, 15(2) : 128-134
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Relapse prevention, First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
, Medication dose reduction/discontinuation
Bechdolf, A., Tecic, T., Lehmkuhl, G., Walger, P., Mueller, K., Wiedemann, G., Stoesser, D., Klingberg, S.
Objective: Treatment as usual (TAU) supplemented by cognitivebehavioral therapy (CBT) leads to greater clinical improvement in adult patients with schizophrenia than TAU alone. Until now no cognitive-behavioral therapy for patients with nullearly onset psychosisnull (EOP, a first episode of psychosis between 14 and 18 years) has been developed. The present project's goal is to develop a modified cognitive-behavioral treatment (mCBT) for patients with EOP and to evaluate the acceptance, tolerability and efficacy. Methods: 49 patients were screened of which 25 were included in a randomised controlled trial. Thirteen patients were randomised into the intervention group (mCBT + TAU) and 12 into the control group (TAU). MCBT was delivered in 20 individual sessions (plus five sessions with relatives) over a period of 9 months. Assessments were performed at baseline and monthly during treatment until treatment stopped using the PANSS Positive-Scale, Global Functioning Scale (GAF) and Quality of Life (MSLQ). Results: The average age was 17.2 years. There were no significant differences between groups regarding demographic and clinical features at intake. Eighty percent of planned sessions were conducted. At the descriptive level by the end of treatment more patients in mCBT + TAU were in remission than in TAU (75% vs. 50%). Differences in GAF between groups (62.3 vs. 58.9, P = 0.13) were in favour of mCBT. MSLQ Scores descriptively revealed advantage for the intervention group (67.4 vs. 61.6, P = 0.18). The effect sizes in the mCBT group were moderate for GAF (d = 0.35) and MSLQ (d = 0.45). Conclusion: The pilot study has shown that mCBT is feasible, acceptable and tolerable in adolescents with schizophrenia. The effect sizes for mCBT were moderate in several secondary outcome parameters but no statistically significant differences between the treatment groups emerged It is likely that due to the small sample size a statistical significant difference could not be detected.
European Archives of Psychiatry & Clinical Neuroscience, 261 : S14
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Alvarez-Jimenez, Mario, Parker, Alexandra G., Hetrick, Sarah E., McGorry, Patrick D., Gleeson, John F.
Objective: The majority of first-episode psychosis (FEP) patients reach clinical remission; however, rates of relapse are high. This study sought to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the effectiveness of pharmacological and non-pharmacological interventions to prevent relapse in FEP patients. Methods: Systematic review and metaanalysis of RCTs. Results: Of 66 studies retrieved, 18 were eligible for inclusion. Nine studies investigated psychosocial interventions and 9 pharmacological treatments. The analysis of 3 RCTs of psychosocial interventions comparing specialist FEP programs vs treatment as usual involving 679 patients demonstrated the former to be more effective in preventing relapse (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.31–2.48; P < .001; number needed to treat [NNT] = 10). While the analysis of 3 different cognitive-behavioral studies not specifically intended at preventing relapse showed no further benefits compared with specialist FEP programs (OR = 1.95, 95% CI = 0.76–5.00; P = .17), the combination of specific individual and family intervention targeted at relapse prevention may further improve upon these outcomes (OR54.88, 95% CI = 0.97–24.60; P = .06). Only 3 small studies compared first-generation antipsychotics (FGAs) with placebo with no significant differences regarding relapse prevention although all individual estimates favored FGAs (OR = 2.82, 95% CI = 0.54–14.75; P = .22). Exploratory analysis involving 1055 FEP patients revealed that relapse rates were significantly lower with second generation antipsychotics (SGAs) compared with FGAs (OR = 1.47, 95% CI = 1.07–2.01; P < .02; NNT = 10). Conclusions: Specialist FEP programs are effective in preventing relapse. Cognitive-based individual and family interventions may need to specifically target relapse to obtain relapse prevention benefits that extend beyond those provided by specialist FEP programs. Overall, the available data suggest that FGAs and SGAs have the potential to reduce relapse rates. Future trials should examine the effectiveness of placebo vs antipsychotics in combination with intensive psychosocial interventions in preventing relapse in the early course of psychosis. Further studies should identify those patients who may not need antipsychotic medication to be able to recover from psychosis. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Schizophrenia Bulletin, 37(3) : 619-630
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
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Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Bola, John, Kao, Dennis, Soydan, Haluk
Background: Objectives: Search Strategy: Selection Criteria: Data Collection and Analysis: Main Results: Authors' Conclusions: Long-term treatment with antipsychotic medications in early episode schizophrenia spectrum disorders is common, but both short and long-term effects on the illness are unclear. There have been numerous suggestions that people with early episodes of schizophrenia appear to respond differently than those with multiple prior episodes. The number of episodes may moderate response to drug treatment.To assess the effects of antipsychotic medication treatment on people with early episode schizophrenia spectrum disorders.We searched the Cochrane Schizophrenia Group register (July 2007) as well as references of included studies. We contacted authors of studies for further data.Studies with a majority of first and second episode schizophrenia spectrum disorders comparing initial antipsychotic medication treatment with placebo, milieu, or psychosocial treatment.Working independently, we critically appraised records from 681studies, of which five studies met inclusion criteria. John Rathbone from the Schizophrenia Group supported us with the data extraction. We calculated risk ratios (RR) and their 95% confidence intervals (CI) where possible. For continuous data, we calculated mean difference (MD). We calculated numbers needed to treat/harm (NNT/NNH) where appropriate.Five studies with a combined N = 998 met inclusion criteria. Four studies (N = 724) provided leaving the study early data and results suggested that individuals treated with a typical antipsychotic medication are less likely to leave the study early than those treated with placebo (Chlorpromazine: 3 RCTs N = 353, RR 0.4 CI 0.3 to 0.5, NNT 3.2, Fluphenaxine: 1 RCT N = 240, RR 0.5 CI 0.3 to 0.8, NNT 5; Thioridazine: 1 RCT N = 236, RR 0.44 CI 0.3 to 0.7, NNT 4.3, Trifulperazine: 1 RCT N = 94, RR 0.96 CI 0.3 to 3.6). Two studies (Cole 1964; May 1976) contributed data to assessment of side effects and present a general pattern of more frequent side effects among individuals treated with typical antipsychotic medications compared to placebo. Rappaport 1978 suggested a higher rehospitalisation rate for those receiving chlorpromazine compared to placebo (N = 80, RR 2.29 CI 1.3 to 4.0, NNH 2.9). However, a higher attrition in the placebo group is likely to have introduced a survivor bias into this comparison, as this difference becomes non-significant in a sensitivity analysis on intent-to-treat participants (N = 127, RR 1.69 CI 0.9 to 3.0). One study (May 1976) contributes data to a comparison of trifluoperazine to psychotherapy on long-term health in favour of the trifluoperazine group (N = 92, MD 5.8 CI 1.6 to 0.0); however, data from this study are also likely to contain biases due to selection and attrition. One study (Mosher 1995) contributes data to a comparison of typical antipsychotic medication to psychosocial treatment on six-week outcome measures of global psychopathology (N = 89, MD 0.01 CI -0.6 to 0.6) and global improvement (N = 89, MD -0.03 CI -0.5 to 0.4), indicating no between-group differences. On the whole, there is very little useable data in the few studies meeting inclusion criteria.With only a few studies meeting inclusion criteria, and with limited useable data in these studies, it is not possible to arrive at definitive conclusions. The preliminary pattern of evidence suggests that people with early episode schizophrenia treated with typical antipsychotic medications are less likely to leave the study early, but more likely to experience medication-related side effects. Data are too sparse to assess the effects of antipsychotic medication on outcomes in early episode schizophrenia.
Cochrane Database of Systematic Reviews, (6) : CD006374
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Eack, S. M., Pogue-Geile, M. F., Greenwald, D. P., Hogarty, S. S., Keshavan, M. S.
Background: Cognitive rehabilitation has emerged as an effective treatment for addressing cognitive impairments and functional disability in schizophrenia; however, the degree to which changes in various social and non social cognitive processes translate into improved functioning during treatment remains unclear. This research sought to identify the neurocognitive and social cognitive mechanisms of functional improvement during a 2 year trial of cognitive enhancement therapy (CET) for early course schizophrenia. Method: Patients in the early course of schizophrenia were randomly assigned to CET (n = 31) or an enriched supportive therapy control (n = 27) and treated for up to 2 years. A comprehensive neurocognitive assessment battery and the Mayer Salovey Caruso Emotional Intelligence Test (MSCEIT) were completed annually, along with measures of functioning. Mediator analyses using mixed effects growth models were conducted to examine the effects of neurocognitive and social cognitive improvement on functional change. Results: Improvements over 2 years in neurocognition and the emotion management branch of the MSCEIT were found to be significantly related to improved functional outcome in early course schizophrenia patients. Neuro cognitive improvement, primarily in executive functioning, and social cognitive change in emotion management also mediated the robust effects of CET on functioning. Conclusions: Improvements in neurocognition and social cognition that result from cognitive rehabilitation are both significant mediators of functional improvement in early course schizophrenia. Cognitive rehabilitation programs for schizophrenia may need to target deficits in both social and non social cognition to achieve an optimal functional response. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Psychological Medicine, 41(6) : 1253-1261
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy, Supportive therapy
Edwards, J., Cocks, J., Burnett, P., Maud, D., Wong, L., Yuen, H. P., Harrigan, S. M., et-al
Here we report the results of a pilot study investigating the relative and combined effects of a 12 week course of clozapine and CBT in first-episode psychosis patients with prominent ongoing positive symptoms following their initial treatment. Patients from our early psychosis service who met the inclusion criteria (n = 48) were randomized to one of four treatment groups: clozapine, clozapine plus CBT, thioridazine, or thioridazine plus CBT. The degree of psychopathology and functionality of all participants was measured at baseline then again at 6, 12 and 24 weeks, and the treatment outcomes for each group determined by statistical analysis. A substantial proportion (52) of those treated with clozapine achieved symptomatic remission, as compared to 35 of those who were treated with thioridazine. Overall, those who received clozapine responded more rapidly to treatment than those receiving the alternative treatments. Interestingly, during the early treatment phase CBT appeared to reduce the intensity of both positive and negative symptoms and thus the time taken to respond to treatment, as well having as a stabilizing effect over time. (copyright) 2011 J. Edwards et al.
Schizophrenia Research & Treatment, :
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)