Disorders - Psychosis Disorders
Arango, C., Mayoral, M.
Early specialized care may improve short-term outcomes in firstepisode psychosis. We implemented a psychoeducational group program (PIENSA) and showed that it helped adolescent patients and their families manage crises, improved patients' negative symptoms, and increased their involvement in social activities in the short-term. However, it was unclear whether the benefits persist over time. Objective(s): To investigate whether the beneficial effects of a structured psychoeducational group program for adolescents with earlyonset psychosis and their families, observed immediately after the intervention, were maintained two years later. Method(s): The current study examines the two-year longitudinal efficacy of a randomized controlled trial based on a structured psychoeducational problem-solving group intervention for adolescents with early-onset psychosis and their families (PE) compared with a nonstructured group intervention (NS). We analyzed whether the differences found between PE and NS after the intervention persisted two years later. Result(s): At the two-year follow-up, 89% of patients were able to be reassessed. In the PE group, 13% of patients visited the Emergency Department as compared with 50% in the NS group (p = 0.019). However, no statistically significant differences were found between the two groups in terms of negative symptoms or number and duration of hospitalizations. Conclusion(s): A psychoeducational group intervention showed sustained effects on diminishing the number of Emergency Department visits two years after the intervention. However, improvement in negative symptoms is not maintained. We will present the new actions implemented by the PIENSA team in order to enhance the long-term effects of our intervention.
Early Intervention in Psychiatry, 12 (Supplement 1) : 41
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Problem solving therapy (PST)
Firth, J.
Background: Extensive research has established that nutritional deficiencies are common in long-term schizophrenia. Randomised controlled trials (RCTs) also demonstrate that adjunctive nutritional interventions can improve outcomes in long-term schizophrenia. Therefore, we examined nutritional deficiencies and clinical correlates in first-episode of psychosis (FEP), in order to design a nutritional intervention for young patients in early stages of illness. Method(s): We reviewed all studies examining blood nutrient levels and outcomes of supplementation in FEP: Meta-analytic techniques compared nutrient levels in FEP to healthy controls, and systematic synthesis was applied to all clinical correlates of nutritional deficiencies in FEP. Additionally, we conducted an independent systematic review of all nutrient-based treatment trials in FEP to date. Result(s): A total of 28 studies examined blood levels of six vitamins and ten dietary minerals in FEP, across 2,612 individuals. Random effects meta-analyses comparing FEP to healthy control groups showed large, significant deficits for Vitamin-D, Vitamin-C, and folate. Lower levels of folate and vitamin-D were associated with more severe symptoms in FEP. Our separate systematic review of 8 experimental studies indicated that supplementation with certain amino acids and antioxidants may also improve treatment outcomes in FEP. Conclusion(s): Our meta-analysis was the first to examine the extent and clinical correlates of nutritional deficits in FEP. Results showed that vitamin D and folate deficits exist from illness onset, even prior to antipsychotic treatment - and are associated with more severe psychiatric symptoms. Our upcoming RCT (the 'NATURE' trial) will assess if targeting these deficiencies can improve recovery in FEP.
Early Intervention in Psychiatry, 12 (Supplement 1) : 69
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Vitamins and supplements
Vinogradov, S., Ramsay, I., Biagianti, B., Loewy, R., Fisher, M., Mathalon, D., Ma, S., Ragland, D., Niendam, T., Carter, C.
The cognitive deficits that characterize patients with schizophrenia are present in the prodrome, worsen as the illness progresses, and predict functional outcome. Cognitive dysfunction thus must be a primary target for aggressive early intervention in in early phases of schizophrenia. We report on behavioral and imaging data from a randomized controlled trial of targeted auditory-system training (AT) in participants with recent onset schizophrenia (N = 144, mean age 21 years). These findings begin to point to personalized psychiatry approaches. 1. Auditory training subjects demonstrated significant improvements in Global Cognition, Verbal Memory, and Problemsolving compared to computer games control subjects. Traininginduced cognitive gains at 40 hours showed significant associations with improved auditory processing speed at 20 hours. 2. Global Cognition showed durable improvements at 6-month follow-up. Within the AT group, Global Cognition improvement after training was significantly correlated with positive symptom improvement at 6-month follow-up. 3. Baseline auditory MMN was significantly reduced in participants and associated with worse Global Cognition. MMN did not show changes after AT and exhibited trait-like stability. Greater deficits in double-deviant MMN predicted greater gains in Global Cognition in response to AT. 4. Change in Global Cognition was significantly related to change in left thalamus volume in the AT group. Greater symptom severity at baseline reduced the likelihood of response to AT both with respect to improved cognition and change in thalamic volume. 5. A model selection and regression analytic approach (LASSO) identified baseline Global Cognition, education, and gender in a model predictive of improvement on cognition following AT.
Early Intervention in Psychiatry, 12 (Supplement 1) : 42
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Devoe, D. J., Peterson, A., Addington, J.
Objective: Youth at clinical high risk (CHR) for psychosis often demonstrate significant negative symptoms, which have been reported to be predictive of conversion to psychosis and a reduced quality of life but treatment options for negative symptoms remain inadequate. Therefore, we conducted a systematic review and network meta-analysis of all intervention studies examining negative symptom outcomes in youth at CHR for psychosis.
Method: The authors searched PsycINFO, Medline, Embase, CINAHL, and EBM from inception to December 2016. Studies were selected if they included any intervention that reported follow-up negative symptoms in youth at CHR for psychosis. Treatment comparisons were evaluated using both pairwise and network meta-analyses. Due to the differences in negative symptom scales the effect sizes were reported as the standardized mean difference (SMD).
Results: Of 3027 citations, 32 studies met our inclusion criteria, including a total of 2463 CHR participants. The null hypothesis was not rejected for any of the 11 treatments. N-methyl-D-aspartate-receptor (NMDAR) modulators trended toward a significant reduction in negative symptoms compared to placebo (SMD = -0.54; 95% CI = -1.09 to 0.02; I2 = 0%, P = .06). In respective order of descending effectiveness as per the treatment hierarchy, NMDAR modulators were more effective than family therapy, need-based interventions, risperidone, amisulpride, cognitive behavioral therapy, omega-3, olanzapine, supportive therapy, and integrated psychological interventions.
Conclusions: Efficacy and effectiveness were not confirmed for any negative symptom treatment. Many studies had small samples and the majority were not designed to target negative symptoms.
Schizophrenia Bulletin, 44(4) : 807-823
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Grossman, M., Bowie, C. R.
Social cognition has gained widespread acceptance as a major contributor to functional outcomes in psychotic illness, yet limited research has examined the role of motivation in the context of this model. Cross-sectional research has reported significant associations between domains of social cognition and motivation, with correlations in the moderate range. Motivational difficulties in psychosis may undermine an individual's ability to put forth adequate effort on tasks of social cognition; however, the directionality of this relationship remains unclear. For the present study, individuals with first-episode psychosis (n = 35) and community controls (n = 35) were randomized to a reward condition in which they received $0.25 per correct response on the TASIT, a measure of theory of mind (ToM), or a nonreward condition in which they completed the TASIT without any feedback. A mixed-model ANOVA demonstrated a significant Group x Condition interaction, F(1,65) = 6.96, p = .01. Post-hoc analyses revealed that community controls showed no difference in their ToM performance across conditions, whereas first-episode patients who received monetary reinforcement displayed clinically and statistically significant improvement in ToM performance relative to those who did not receive monetary reinforcement. Results from this study suggest that social cognitive performance may underrepresent actual ability for patients in the early stages of psychosis. Moreover, ToM performance appears to be directly influenced by performancecontingent incentives, corrective feedback, and/or a combination of these factors. Future research is needed to identify the most salient motivational factor, and further disentangle what is driving performance differences between conditions, which seems to be uniquely observed in first-episode patients.
Early Intervention in Psychiatry, 12 (Supplement 1) : 137
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Contingency management
Loewy, R., Fisher, M., Carter, C., Ragland, J. D., Niendam, T., Stuart, B., Schlosser, D., Vinogradov, S.
Cognitive deficits in early psychosis predict functional outcomes and should be aggressively targeted for early intervention. We have recently conducted two parallel studies of targeted cognitive training of auditory/verbal processing in early psychosis: one with adolescents and young adults at clinical high risk (CHR) for psychosis and a second with young adults with recent-onset schizophrenia (ROS). Both studies were double-blind randomized controlled trials in which participants performed 40 hours of auditory training (AT) or commercial computer games (CG) via laptop computer. They were assessed on symptoms, functioning and an abbreviated MATRICS-recommended neurocognitive battery at baseline, post-training and 6-month followup. In a modified Intent-To-Treat (ITT) analysis with 147 randomized ROS participants there were significant condition-by-time interactions for Global Cognition (p = 0.007), Verbal Memory (p = . 042) and a trend towards significance for Problem Solving (p = .054). Planned contrasts revealed gains for the AT group compared to CG group from baseline to follow-up in Global Cognition (p = .001) and PANSS Positive symptoms (p = .0017). In a similar modified ITT analysis, 83 randomized CHR participants demonstrated a significant condition-bytime interaction in Verbal Memory, with the AT group showing more improvement from baseline to post-training than the CG group (p = .04). Analysis of the CHR 6-month follow-up data is currently underway. Neuroscience-informed cognitive training represents a promising treatment approach for cognitive dysfunction in adolescents and young adults in the early phases of psychosis. Future research should focus on personalization, improving training adherence, and combination with coordinated specialty care interventions to more strongly impact real-world functioning.
Early Intervention in Psychiatry, 12 (Supplement 1) : 74
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Addington, J., Devoe, D.
The main focus of psychological treatment for youth at clinical high risk (CHR) of psychosis has been to prevent transition to full-blown psychosis and less often attenuated psychotic symptoms. However, in addition to the attenuated psychotic symptoms, these young people often present with negative symptoms, as well as other comorbid disorders. They typically have cognitive difficulties that are intermediate to healthy controls and individuals with full-blown psychosis. Many have poor social and role functioning. Through a series of network and pairwise meta-analyses this presentation reviews all treatment studies to date including cognitive behavior therapy (CBT), family intervention, cognitive remediation, integrated psychological treatment and a range of pharmacotherapies and includes outcomes such as transition, attenuated psychotic symptoms, negative symptoms, cognition and social and role functioning. There are some positive results in support of CBT in preventing transition to psychosis and reducing attenuated psychotic symptoms. None of the treatments reviewed appear to have an impact on negative symptoms or social functioning, which is of concern since many of these young people continue to have poorer social functioning even when they do not make the transition to psychosis and attenuated psychotic symptoms have remitted.
Early Intervention in Psychiatry, 12 (Supplement 1) : 10
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Grant, P., Munk, A. J. L., Hennig, J.
BACKGROUND: While individuals at ultra-risk for schizophrenia are characterized by high negative/disorganised but low positive schizotypy, schizophrenia patients are usually high in all three schizotypy facets. Thus, avoiding increases in positive schizotypy in ultra-high risk individuals may constitute of form of schizophrenia-prevention. A possible method of reducing positive schizotypy could be Positive-Psychological intervention (PI).
METHODS: We present results from 2 independent studies, including a 12-month follow-up from study 1, using an easy-to-perform intervention based on Positive Psychology to reduce positive schizotypy.
RESULTS: A PI can significantly and sustainably reduce positive schizotypy compared to a placebo-condition. Furthermore, our results show very high response-rates to said intervention, with responsiveness to the intervention increasing significantly with disorganised schizotypic traits.
CONCLUSIONS: As especially disorganised schizotypy is of relevance for the risk of transition from high benign schizotypy to schizophrenia and is found most closely associated to familial schizophrenia-risk and highly elevated in at-risk mental states, our results are encouraging. We suggest, thus, that positive psychology can not only reduce positive schizotypy, but may be increasingly useful with rising schizophrenia-risk and, thus, be worthy of further investigation regarding it potential in schizophrenia-prevention.
Schizophrenia Research, 199 : 414-419
- Year: 2018
- Problem: Psychosis Disorders
- Type:
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Positive psychology
Lewis, S., Fraccaro, P., Machin, M., Hopkins, R., Sanders, C., He, Z., Stockton-Powdrell, C., Ainsworth, J., Whelan, P., Wykes, T.
Improving recovery from acute symptoms and preventing relapse are two major challenges in psychosis. We previously developed a smartphone-based personalised technology to monitor symptoms in real time, which showed good acceptability, reliability and validity for active remote monitoring of symptoms. We now report an RCT testing its efficacy when embedded into the ICT systems of mental health services. Participants with early psychosis/SMI received a semirandom beep 2-4 times per day on their smartphone app and answer 14 key symptom rating items using a touchscreen slider. Responses are uploaded wirelessly in real time to a central server and build into a graphical readout on the handset. This was built into an end-to-end system in two NHS Hospital Trusts to stream data into ECRs and enable detection by the clinical team of SMI EWS when key symptoms exceeded a personalised severity threshold. 81 people were randomised to either active symptom monitoring or TAU. PANSS positive subscale score showed a significant mean reduction in treatment over 12 weeks in the early psychosis group. EWS alerts generated by the system occurred in 92% of cases and blind comparison with electronic case record data suggested good sensitivity and lower specificity, with clear indications of how to adjust the gain of the system to improve future event-detection efficiency. When the symptom-monitoring system was built into clinical management workflows to enable personalised alerts of symptom deterioration, it was shown to have potential use in promoting earlier intervention for relapse.
Early Intervention in Psychiatry, 12 (Supplement 1) : 31
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS)
Vidarsdottir, O. G., Magnusdottir, B. B., Roberts, D., Twamley, E. W., Sigurdsson, E., Gudmundsdottir, B.
Introduction: Cognitive remediation, combined with evidence based psychiatric rehabilitation programs, is effective for improving cognitive deficits found in psychosis but generalization to everyday functioning remains a challenge. The objective of this study was to integrate three cognitive remediation approaches: Neuropsychological Educational Approach to Remediation (NEAR), Compensatory Cognitive Training (CCT), and Social Cognition and Interaction Training (SCIT), and evaluate the effects on cognition, functional outcome, and clinical symptoms. Method(s): We conducted a randomized, wait-list control trial of an Integrative Cognitive Remediation (ICR) in 49 patients with primary psychotic disorder seeking service at an early intervention center in Iceland (mean age: 24; 86% males). Participants were randomized to receive standard treatment (N = 24) or standard treatment plus a 12-week group-based ICR (N = 25). Neurocognition (verbal memory, reasoning, working memory, processing speed, cognitive flexibility, inhibition, planning), social cognition (theory of mind, emotion recognition and attributional style), functional outcome, and clinical symptoms were assessed at baseline and post-treatment. Result(s): The ICR group showed significant improvements in verbal memory, cognitive flexibility, theory of mind and a significant reduction in hostile attributional style, compared to those receiving standard treatment alone. No significant ICR associated effects were seen in functional outcomes or clinical symptoms. Post-hoc analyses suggest a dose-response effect. ICR was well tolerated and received high treatment satisfaction ratings. Conclusion(s): ICR is feasible and effective in improving neurocognition and social cognition in psychosis. Findings will be discussed in context of continuing to improve comprehensive cognitive remediation interventions for early psychosis with discussion on factors associated with treatment response.
Early Intervention in Psychiatry, 12 (Supplement 1) : 74
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Chien, W. T., Bressington, D., Chan, S. W. C.
Introduction: Recent research in Western countries has indicated that family interventions in schizophrenia and other psychotic disorders can reduce patient relapse and improve medication compliance. Few studies have addressed Chinese and Asian populations. This study tested the long-term effects of a 9-month family-led mutual support group for Chinese people with schizophrenia in Hong Kong, compared with psycho-education and standard psychiatric care. Methods: A randomized controlled trial of Chinese families of patients with recent-onset psychosis (<=5 years of illness) was conducted between August 2012 and January 2017, with a 4-year follow-up. Two hundred and one Chinese families of adult outpatients with recent-onset psychosis were randomly selected from the computerized patient lists and randomly assigned to either mutual support, psycho-education, or standard care group (n = 70 per group). Family caregivers were mainly the parent, spouse, or child of the patients. Mutual support and psycho-education group consisted of 16 two-hour group sessions and patients participated in three sessions. The standard care group and the two treatment groups received the routine psychiatric outpatient care. Results: Patients and families in the mutual support group reported consistently greater improvements in overall functioning [family functioning, F (2, 203) = 8.13, p = 0.003; patient functioning, F (2, 203) = 6.01, p = 0.008] and reductions in duration of hospitalizations [F (2, 203) = 6.51, p = 0.005] over the 4-year follow-up. There were not any significant increases of medication dosages or service use by both the family support and psycho-education groups over time. Conclusions: The peer-led family support group can be an effective psychosocial intervention in early psychosis indicating long-term benefits on both patient and family functioning and re-hospitalizations. Clinical Trial Registration: NCT00940394: https://register.clinicaltrials.gov.
Frontiers in psychiatry Frontiers Research Foundation, 9 : 710
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions
Puig, O.
Early-onset schizophrenia (EOS), defined as the manifestation of psychotic symptoms prior to 18 years of age, is a less common and phenotypically more severe form of the disorder, and implies generalized neurocognitive impairment. Cognitive remediation therapy (CRT) is a strategy-learning approach targeting cognitive deficits with the ultimate goal of improving functional outcome. The height neural plasticity during childhood and adolescence suggests that they may be "sensitive periods" to treatment effects but it is also possible that having EOS may confer damage that reduces the ability of the brain to benefit from CRT. Objective(s): To examine the efficacy of CRT in improving cognition and functional outcomes in a sample of symptomatically stable but cognitively disabled adolescents with EOS. Method(s): Randomized, controlled trial of individually delivered CRT plus treatment-as-usual (n = 25) compared with treatment-as-usual (TAU, n = 25). Clinical symptoms and cognitive and functional performance were assessed before and after treatment in both groups and after 3 months in the CRT group. Result(s): After CRT, significant improvements were found in verbal memory and executive functions. The derived cognitive composite score showed an improvement after the treatment and this change was reliable in more than two-thirds of the treated patients. Improvements were also found after CRT in daily living and adaptive functioning, and in family burden. Cognitive but not functional changes were maintained after 3 months. Conclusion(s): Cognitive and functional improvements can be achieved through CRT in adolescents with EOS but additional strategies may be needed to enhance the durability of functional gains.
Early Intervention in Psychiatry, 12 (Supplement 1) : 41
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy