Disorders - Psychosis Disorders
Larrison, Abigail L., Babin, Shelly L., Xing, Yuan, Patel, Saumil S., Wassef, Adel A., Sereno, Anne B.
Objective: Methods: Results: Conclusions: Valproic acid (VPA) has been suggested as a potential adjunct therapy in schizophrenia for the treatment of clinical symptoms and cognitive deficits. Here, we investigate the effects of VPA on clinical symptoms and saccadic eye movements while controlling for multiple medication effects.Remitted and first-episode schizophrenia patients taking haloperidol were given adjunct VPA for approximately 2 weeks and tested using a measure of clinical symptoms (Positive and Negative Syndrome Scale) and saccadic eye movement tasks over three testing periods. The effects of VPA were compared with schizophrenia patients medicated with equivalent doses of haloperidol alone (HAL group) and normal controls.Schizophrenia patients had higher error rates on the antisaccade task (AS task) compared with normal controls. Adjunct VPA did not affect AS task error rates but was associated with an increase in response times for both saccade and AS tasks, with a significantly greater and dose-dependent increase in response times for the AS task. There were no differences in clinical improvement between VPA and HAL schizophrenia patient groups when controlling for haloperidol medication state.These results suggest that adjuvant VPA therapy results in both sensorimotor and cognitive slowing but does not either help or further impair inhibitory control in schizophrenia, as measured by the elevated AS task errors.
Copyright © 2011 John Wiley & Sons, Ltd.
Human Psychopharmacology, 26(7) : 517-525
- Year: 2011
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
, Relapse prevention
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Anticonvulsants/mood stabilisers (excl. lithium)
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)
Scoriels, Linda, Barnett, Jennifer H., Murray, Graham K., Cherukuru, Srinivasarao, Fielding, Mark, Cheng, Frances, Lennox, Belinda R., Sahakian, Barbara J., Jones, Peter B.
Background: Emotional impairments are important determinants of functional outcome in psychosis, and current treatments are not particularly effective. Modafinil is a wake-promoting drug that has been shown to improve emotion discrimination in healthy individuals and attention and executive function in schizophrenia. We aimed to establish whether modafinil might have a role in the adjuvant treatment of emotional impairments in the first episode of psychosis, when therapeutic endeavor is arguably most vital. Methods: Forty patients with a first episode of psychosis participated in a randomized, double-blind, placebo-controlled crossover design study testing the effects of a single dose of 200 mg modafinil on neuropsychological performance. Emotional functions were evaluated with the emotional face recognition test, the affective go-no go task, and the reward and punishment learning test. Visual analogue scales were used throughout the study to assess subjective mood changes. Results: Modafinil significantly improved the recognition of sad facial expressions (z = 2.98, p = .003). In contrast, there was no effect of modafinil on subjective mood ratings, on tasks measuring emotional sensitivity to reward or punishment, or on interference of emotional valence on cognitive function, as measured by the affective go-no go task. Conclusions: Modafinil improves the analysis of emotional face expressions. This might enhance social function in people with a first episode of psychosis. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Biological Psychiatry, 69(5) : 457-464
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Zhang, J., Gallego, J., Robinson, D., Malhotra, A., Kane, J., Correll, C.
Background: Although early treatment choice in first episode schizophrenia is considered important, no meta-analysis has compared individual first-generation antipsychotics (FGAs) with second-generation antipsychotics (SGAs). Methods: Meta-analysis of randomized, head-to-head trials comparing SGAs with FGAs in first episode schizophrenia. Primary outcomes were total psychopathology change, response rate and all-cause discontinuation. Secondary outcomes included specificcause discontinuation, psychopathology ratings and adverse effects. Results: Pooling data by antipsychotic class across 13 trials (n=2509), SGAs were not different from FGAs regarding total psychopathology change, response rates, positive symptoms, Clinical Global Impressions, patient's choice discontinuation, long-term remission, and metabolic changes. Conversely, SGAs significantly outperformed FGAs regarding negative symptoms, depression, global cognition, lower discontinuation due to any cause, inefficacy and intolerability, and less EPS, akathisia, use of anticholinergics and benzodiazepines, being associated with significantly greater weight gain (p values: <0.05-0.01). Concerning individual SGA comparisons with an FGA, amisulpride and olanzapine outperformed FGAs in 8 and 9 out of 13 efficacy outcomes, respectively, risperidone in 4, quetiapine in 3, and clozapine and ziprasidone in 1, each. Weight gain occurred significantly more with olanzapine, clozapine and risperidone. Olanzapine caused significantly greater cholesterol increase, whereas amisulpride and ziprasidone were associated with lower triglycerides and glucose changes, respectively (p values: <0.05-0.01). Discussion: Amisulpride and olanzapine and, to a lesser degree, risperidone and quetiapine were superior to FGAs in first episode schizophrenia, but weight and metabolic problems were also greater with olanzapine. Clinicians need to individualize treatment decisions, weighing different aspects of efficacy, tolerability, availability and cost.
* ABSTRACT ONLY*
Neuropsychopharmacology, 36 : S175
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
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