Disorders - Psychosis Disorders
Albert, N., Melau, M., Jensen, H., Emborg, C., Jepsen, J. R., Fagerlund, B., Gluud, C., Mors, O., Hjorthoj, C., Nordentoft, M.
OBJECTIVE: To compare the effects of five years of specialised early intervention (SEI) treatment for first episode schizophrenia spectrum disorder with the standard two years of SEI plus three years of treatment as usual.
DESIGN: Randomised, superiority, parallel group trial with blinded outcome assessment. Randomisation was centralised and computerised with concealed randomisation sequence carried out at an external site.
SETTING: Participants were recruited from six OPUS teams in Denmark between 2009 and 2012. OPUS teams provide SEI treatment to all patients diagnosed with a schizophrenia spectrum disorder in Denmark.
PARTICIPANTS: 400 participants (51% women) with a mean age of 25.6 (standard deviation 4.3) were randomised to five years of SEI (experimental intervention; n=197) or to two years of SEI plus three years of treatment as usual (control; n=203).
INTERVENTIONS: OPUS treatment consists of three core elements-modified assertive community treatment, family involvement, and social skill training-with a patient-case manager ratio of no more than 12:1. For participants randomised to five years of OPUS treatment, the treatment was largely unchanged. Participants randomised to the control group were mostly referred to community health centres after two years of SEI treatment.
MAIN OUTCOMES: Follow-up assessments were conducted five years after start of OPUS treatment. Primary outcome was negative symptoms measured on the scale for assessment of negative symptoms (avolition-apathy, anhedonia, alogia, and affective blunting). Secondary outcomes were remission of both negative and psychotic symptoms, psychotic symptoms, suicidal ideation, substance abuse, compliance with medical treatment, adherence with treatment, client satisfaction, days in hospital care, and labour market affiliation.
RESULTS: Levels of negative symptoms did not differ between the intervention group and control group (1.72 v 1.81 points; estimated mean difference -0.10 (95% confidence interval 0.33 to 0.13), P=0.39). Participants receiving five years of OPUS treatment were more likely to remain in contact with specialised mental health services (90.4% v 55.6%, P<0.001), had higher client satisfaction (estimated mean difference 2.57 points (95% confidence interval 1.36 to 3.79), P<0.001), and had a stronger working alliance (estimated mean difference 5.56 points (95% confidence interval 2.30 to 8.82), P=0.001) than the control group.
CONCLUSIONS: This trial tests SEI treatment for up to five years for patients with first episode schizophrenia spectrum disorder; previous trials have found treatment effects for programmes lasting from one to three years. The prolonged SEI treatment had few effects, which could be due to the high level of treatment provided to control participants and the late start of specialised treatment.Trial registration Clinicaltrial.gov NCT00914238.
Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BMJ, 356 : i6681
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Family therapy, Skills training, Case management
, Other service delivery and improvement interventions
Bechdolf, A., Muller, H., Stutzer, H., Lambert, M., Karow, A., Zink, M., Lautenschlager, M., Heinz, A., De-Millas, W., Janssen, B., Gaebel, W., Schneider, F., Juckel, G., Kruger-Ozgurdal, S., Wobrock, T., Wagner, M., Maier, W., Klosterkotter, J.
Background: Although there are encouraging results from clinical trials focusing on second generation antipsychotics, omega-3-fatty acids or psychotherapy for the prevention of psychosis, their empirical evidence remains uncertain and it is unknown whether these interventions are com-parable in reducing the risk of conversion to psychosis in persons at clinical high risk (CHR). Therefore, the present multicenter, prospective, randomized, blinded trial with three parallel groups (PREVENT) was designed to explore the differential preventive effcacy of two approaches 1. cognitive behavioral therapy (CBT) and 2. Aripiprazole (ARI) + clinical management (CM) to 3. placebo (PL) + CM. Methods: Individuals aged 18-49 identifed as CHR by Ultra-High-Risk and/or basic symptoms COGDIS criteria were assessed at baseline, 28 and 52 weeks. The primary outcome was progression to psychosis including transition to psychosis or conversion from early initial prodromal state (defned by COGDIS or decline of functioning in combination with family risk factors or schizotypal disorder) to late initial prodromal state (defned by the presence of attenuated positive symptoms or brief limited intermittent psychotic symptoms). Secondary outcome was transition to psychosis. Results: Of 611 eligible individuals 280 were randomized. The Full analy-sis set comprised 216 individuals [mean age 24.4 (5.1) years; about 66 % male]. In terms of the primary outcome, there was a clinical relevant difference between the three treatment arms (CBT: 19.2 %; AR+CM: 26.8 %; PL+CM: 30.0 %), but no statistical difference (P >.05). Pairwise comparisons showed a statistical trend in favor of CBT compared with CM + PL. With respect to the secondary outcome, there was a reduction in favor of CBT compared to CM + ARI also on a statistical trend level. Drop-out rates differed between the arms over time (P <.05), with indications for more premature terminations in ARI + CM and PL + CM compared to CBT. Conclusion: Pairwise comparisons showed a clinically relevant reduction regarding the primary (about 30%) and secondary outcome (about 40%) in favor of CBT. Lower drop-out rates in CBT could be interpreted as higher adherence and acceptance of psychotherapy within this trial.
Schizophrenia Bulletin, 43(Suppl 1) : S56-S57
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Case management
Biagianti, B., Roach, B., Fisher, M., Loewy, R., Ford, J., Vinogradov, S.
Objective: Schizophrenia patients have heterogeneous impairments of the auditory system that mediate differences in the cognitive gains induced by cognitive training (CT). Mismatch negativity (MMN) is an event-related potential, and its amplitude reduction in schizophrenia has been linked to cognitive deficits. Therefore, MMN may predict an attenuated response to CT or, alternatively, identify schizophrenia patients who benefit the most from CT. Furthermore, to the extent that CT strengthens auditory processing, MMN may also serve as a readout of the underlying auditory system changes induced by CT. Methods: Fifty-six individuals with early illness schizophrenia (ESZ) were randomly assigned to 40 h of CT or computer games (CG). Cognitive assessments and EEG recordings were obtained before and after CT and CG. Changes in these measures were compared between the treatment groups. Baseline and trait-like MMN data were evaluated as predictors of treatment response. MMN data collected from 102 healthy controls (HC) were compared to baseline MMN data from the ESZ group. Results: Compared to HC, ESZ showed significant MMN reductions at baseline (p = .003). Reduced Double-Deviant MMN was associated with greater general cognitive impairment in ESZ individuals (p = .020). Neither ESZ intervention group showed significant change in MMN. We found high correlations in all MMN deviant types (rs = .59-.68, all ps<.001) between baseline and post-training amplitudes irrespective of treatment group, suggesting trait-like stability of the MMN signal. Greater deficits in trait-like Double-Deviant MMN predicted greater cognitive improvements in the CT group (p = .02), but not in CG group. Conclusion: In ESZ, baseline MMN was significantly reduced relative to HC, and associated with general cognitive impairment. MMN did not show changes after CT and exhibited trait-like stability (see Fig. 12). Greater deficits in the Double-Deviant MMN trait predicted greater gains in general cognition in response to CT, suggesting that MMN identifies individuals who stand to gain the most from CT. (Figure Presented).
European Archives of Psychiatry and Clinical Neuroscience, 267(1 (Suppl 1)) : S91-S92
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Biagianti, B., Roach, B. J., Fisher, M., Loewy, R., Ford, J. M., Vinogradov, S., Mathalon, D. H.
BACKGROUND: Individuals with schizophrenia have heterogeneous impairments of the auditory processing system that likely mediate differences in the cognitive gains induced by auditory training (AT). Mismatch negativity (MMN) is an event-related potential component reflecting auditory echoic memory, and its amplitude reduction in schizophrenia has been linked to cognitive deficits. Therefore, MMN may predict response to AT and identify individuals with schizophrenia who have the most to gain from AT. Furthermore, to the extent that AT strengthens auditory deviance processing, MMN may also serve as a readout of the underlying changes in the auditory system induced by AT.
METHODS: Fifty-six individuals early in the course of a schizophrenia-spectrum illness (ESZ) were randomly assigned to 40 h of AT or Computer Games (CG). Cognitive assessments and EEG recordings during a multi-deviant MMN paradigm were obtained before and after AT and CG. Changes in these measures were compared between the treatment groups. Baseline and trait-like MMN data were evaluated as predictors of treatment response. MMN data collected with the same paradigm from a sample of Healthy Controls (HC; n = 105) were compared to baseline MMN data from the ESZ group.
RESULTS: Compared to HC, ESZ individuals showed significant MMN reductions at baseline (p = .003). Reduced Double-Deviant MMN was associated with greater general cognitive impairment in ESZ individuals (p = .020). Neither ESZ intervention group showed significant change in MMN. We found high correlations in all MMN deviant types (rs = .59-.68, all ps < .001) between baseline and post-intervention amplitudes irrespective of treatment group, suggesting trait-like stability of the MMN signal. Greater deficits in trait-like Double-Deviant MMN predicted greater cognitive improvements in the AT group (p = .02), but not in the CG group.
CONCLUSIONS: In this sample of ESZ individuals, AT had no effect on auditory deviance processing as assessed by MMN. In ESZ individuals, baseline MMN was significantly reduced relative to HCs, and associated with global cognitive impairment. MMN did not show changes after AT and exhibited trait-like stability. Greater deficits in the trait aspects of Double-Deviant MMN predicted greater gains in global cognition in response to AT, suggesting that MMN may identify individuals who stand to gain the most from AT.
TRIAL REGISTRATION: NCT00694889. Registered 1 August 2007.
Neuropsychiatric Electrophysiology, 3(2) :
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Cognitive remediation therapy
Cadenhead, K., Addington, J., Bearden, C., Cannon, T., Cornblatt, B., Mathalon, D., McGlashan, T., Perkins, D., Seidman, L., Walker, E., Woods, S., Yao, J.
Background: Omega-3 Fatty Acids (FAs), EPA (eicosapentaenoic acid) and DHA (Docosahexaenoic acid), are essential for normal brain development and may also have neuroprotective properties. Abnormal FA metabolism may play a role in the etiology of psychiatric illness. Reductions in Red Blood Cell (RBC) membrane Polyunsaturated Fatty Acids (PUFAs) have been reported in both chronic patients and unmedicated first episode patients with schizophrenia. Dietary supplementation of EPA and DHA may have beneficial effects in both somatic and mental illness. Studies of Omega 3 supplementation in Clinical High Risk (CHR) populations have had mixed results. One study (Amminger et al) found reduced conversion to psychosis along with improvement in symptoms and functioning in the Omega 3 versus the Placebo group while two studies (McGorry et al and Cadenhead et al unpublished) have failed to replicate these findings. In the current study, we assessed the relationship of dietary Omega 3 and RBC PUFA levels to symptoms, functioning and conversion to psychosis in a sample of CHR subjects participating in a trial of Omega 3 FA versus Placebo. Methods: As part of a 24-week, randomized, double-blind, placebo, fixed dose-controlled study of Omega-3FA versus placebo in 127 CHR subjects, baseline diet was assessed using a systematic checklist of Omega-3FA foods and fasting RBC PUFA composition was assessed. Regular assessments of symptoms and functioning were performed throughout the study. We investigated the relationship between reported Omega 3 FA consumption, RBC PUFA levels and outcome measures as part of this trial. Results: Of the 127 CHR subjects recruited into the trial, 118 completed baseline assessment and 70 completed the 6 month trial. Ten percent of subjects converted to psychosis during the 24 months. The rate of psychotic conversion did not differ in the Omega-3FA (13%) versus Placebo (8%) samples. However, conversion to psychosis was predicted by lower levels of EPA (24-month conversion 16.2% low EPA vs 2.6% high EPA) in the RBC membrane (Wald Statistic 3.72, p<0.05). Greater levels of negative symptoms and low GAF scores were associated with a diet consisting of few Omega 3 fatty acid rich foods and corresponding low EPA in the RBC membrane. The self-reported Omega 3 fatty acids in the diet were significantly correlated with a number of the RBC PUFA composition variables and measures of oxidative stress. Conclusions: The finding of a significant association between baseline diet low in Omega-3FA rich foods and outcome raises the question of whether it is possible to influence both physical and mental health with lifestyle choices including diet. These findings reinforce that early detection of food insecurity is crucial since this factor is modifiable with the potential for significant gains in terms of quality of life, physical and mental health. Longitudinal follow-up will provide insight into whether these indices are risk factors for future psychosis and functional outcome.
Neuropsychopharmacology, 43(Suppl 1) : S422-S423
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Cechnicki, A., Bielanska, A.
Aim: To compare the treatment outcomes of DSM-IV-TR schizophrenia patients in either a Community Treatment Program or an Individual Treatment Program (CTP vs. ITP). The assessment was made after the first hospitalization, and then after three and twelve years. Method: Participants were randomly assigned to CTP (experimental) and ITP (traditional) group, with 40 people in each group. 67 people (84%) participated in all three assessments. The socio-demographic and clinical indicators were the same for both groups. In the first three years only the CTP group participated in day-care treatment, patient and family psychoeducation and community treatment. Later, both groups received this treatment. The following tools were used: Anamnestic and Catamnestic Questionnaire, the GAF scale, the BPRS LA and Lehman's Quality of Life Interview. Results: It was only after twelve years that there was a significant beneficial improvement in the mean GAF score in the CTP group (p = 0.036), which was comparable with the results obtained by Watt and Shepherd for the course of the illness in favorable remission cases (p = 0.038). The difference in the number of relapses was also significantly in favor of the CTP group only after 12 years (p = 0.045), as was the difference in the number of rehospitalizations (p = 0.013). The general severity of symptoms was found to be significantly lower for the CPT group after 3 (p = 0.008) and 12 years (p = 0.030), whereas it was significantly lower in the case of positive syndrome only after 3 years (p = 0.044). Conclusions: 1. A greater number of favorable differences were identified for the CTP group at the twelve-year point than at the conclusion of the experiment. 2. The three-year delay in introducing psycho-social treatment was associated with a poorer long-term outcome for the clinical course of schizophrenia. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Psychiatria Polska, 51(1) : 45-61
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Chang, W., Kwong, V., Chan, G., Jim, O., Lau, E., Hui, C., Chan, S., Lee, E., Chen, E.
Background: Amotivation is prevalent in first-episode psychosis (FEP) patients and is a major determinant of functional outcome. Prediction of amotivation in the early stage of psychosis, however, is under-studied. We aimed to prospectively examine predictors of amotivation in FEP patients in a randomized-controlled trial comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI). Methods: One hundred sixty Chinese patents were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment, onset profiles, baseline symptom severity and treatment characteristics were conducted. Data analysis was based on 156 subjects who completed follow-up assessments. Results: Amotivation at 12-month follow-up was associated with premorbid adjustment, allocated treatment condition, and levels of positive symptoms, disorganization, amotivation, diminished expression (DE) and depression at study intake. Hierarchical multiple regression analysis revealed that Extended EI and lower levels of DE independently predicted better outcome on 12-month amotivation. Conclusion: Our findings indicate a potentially critical therapeutic role of an extended specialized EI on alleviating motivational impairment in FEP patients. The longer-term effect of Extended EI on amotivation merits further investigation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
European Psychiatry, 41 : 37-41
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Case management
, Other service delivery and improvement interventions
Chang, W., Kwong, V., Lau, E., So, H., Wong, C., Chan, G., Jim, O., Hui, C., Chan, S., Ming Lee, E., Chen, E.
Background: Evidence indicates that the positive effects of 2-year early intervention services for psychosis are not maintained after service withdrawal. Optimal duration of early intervention in sustaining initial improved outcomes remains to be determined. Aims: To examine the sustainability of the positive effects of an extended, 3-year, early intervention programme for patients with first-episode psychosis (FEP) after transition to standard care. Method: A total of 160 patients, who had received a 2-year early intervention programme for FEP, were enrolled to a 12-month randomised-controlled trial (ClinicalTrials.gov: NCT01202357) comparing a 1-year extension of the early intervention (3-year specialised treatment) with step-down care (2-year specialised treatment). Participants were followed up and reassessed 2 and 3 years after inclusion to the trial. Results: There were no significant differences between the treatment groups in outcomes on functioning, symptom severity and service use during the post-trial follow-up period. Conclusions: The therapeutic benefits achieved by the extended, 3-year early intervention were not sustainable after termination of the specialised service. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
British Journal of Psychiatry, 211(1) : 37-44
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Case management
, Other service delivery and improvement interventions
Chen, E. Y. H., Hui, C. L. M., Lee, E. H. M., Chang, W. C., Chan, S. K. W., Honer, W. G.
Background: Clinical decision to discontinue antipsychotics in patients remitted from frst-episode psychosis is important. Existing short-term evidence suggests that patients who discontinued antipsychotics had more relapses. Data on long-term outcomes are lacking; with only one open-label study suggesting better long-term recovery outcome in patients who had early medication discontinuation. We compared the long-term clinical and functional outcomes at 10 years of remitted frst-episode psychosis patients who had either discontinued or continued their antipsychotic medications in the early stage of the illness under a randomized controlled trial (RCT). Methods: We followed up 178 frst-episode psychosis patients who participated in a 1-year RCT on medication discontinuation. In the RCT, patients were randomized into receiving either a medication maintenance group (MT) or a placebo discontinuation group (PL). In this follow-up study, 142 subjects were successfully traced and assessed at 10 years on their clinical, functional and cognitive outcomes. Results: There were no differences between patients who were included (n = 142) and excluded (n = 36) from the study with regard to their baseline demographics, clinical and functioning. At 10 years, patients in the PL group had more residual delusion as defned using PANSS P1 item score (15%) than those in the MT group (4%; P =.028). PL group also had more treatment refractory (as defned using residual delusion or on clozapine; 24%) than the MT group (8%; P =.011). Specifcally, PL started to take clo-zapine signifcantly earlier than MT during the follow-up period (P =.04). We found no signifcant differences between MT and PL in terms of func-tioning, cognitive functioning, quality of life, and medication taken after 10 years. Conclusion: This is the frst study to examine the long-term impacts of med-ication discontinuation during early phase of psychotic disorders. Our fnd-ings show that early decision to stop medication in remitted frst-episode psychosis may result in less symptomatic remission and more treatment nonresponsiveness. The decision to discontinue medication during the early phase of psychosis should be considered carefully.
Schizophrenia Bulletin, 43(Suppl 1) : S78-S79
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
, Service Delivery & Improvement, Other service delivery and improvement interventions
Choi, L., Corcoran, C., Fiszdon, J., Stevens, M., Javitt, D., Deasy, M., Haber, L., Dewberry, M., Pearlson, G.
Objective: Among individuals at clinical high risk (CHR) for psychosis, processing speed (PS) has been related to social and role functioning regardless of conversion to schizophrenia. This information processing dysfunction is a gateway to broader behavioral deficits such as difficulty executing social behaviors. We examined the feasibility of improving information processing relevant to social situations in CHR, including its sustainability at 2-month follow-up, and its association with concurrent social function. Method: This was a double-blind RCT in which 62 CHR participants were randomized to Processing Speed Training (PST) or an active control matched for training format and the same dose and duration of treatment. PST is a tablet-based program that uses pupillometry-based neurofeedback to continually adjust training parameters for an optimal neurocognitive load and to improve visual scanning efficiency by inhibiting selection of nonessential targets and discriminating figure-ground details. Results: The PST group showed faster motoric and nonmotoric PS at post training and 2-month follow-up. At 2 month follow-up, the PST group reported better overall social adjustment. Changes in PS from baseline to 2 months were correlated with overall social adjustment and social avoidance in the entire sample. Conclusions and Implications for Practice: This is the first study to test focal neurofeedback-based cognitive training for PS deficits in the putatively prodromal phase of schizophrenia to address associated social morbidity. Targeting PS appears to be a promising pathway to decreasing comorbidity and mitigating a risk factor for psychosis. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Psychiatric Rehabilitation Journal, 40(1) : 33-42
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Behan, C., Masterson, S., Clarke, M.
Aim: Although early intervention in psychosis is an accepted policy internationally, the evidence base for this paradigm, originates mostly from the specialist model. In a real world setting, variations of this model are often implemented. The aim of this paper is to systematically evaluate the evidence for delivering early intervention outside the specialist stand-alone centre. Methods: A systematic search following the PRISMA guidelines was undertaken in Medline, PsycInfo, Embase and the Cochrane trials register. The search was limited to articles in English from 1990 to end of January 2016. Inclusion criteria for the review comprised comparative evaluations of services delivering early intervention in psychosis outside the specialist model. Exclusion criteria included prodromal services, descriptions of services without reference to a comparator and standalone specialist services evaluated in comparison to treatment as usual. Results: There were 637 unique citations. Twenty-eight papers were reviewed at second-stage screening. The majority were excluded as they compared specialist early intervention with treatment as usual, did not evaluate the first episode or had no comparator. Seven peer-reviewed publications and two conference papers fulfilled criteria evaluating models of delivering early intervention other than the specialist model. Conclusions: There is a spaucity of evidence evaluating models other than specialist models in early intervention. Published studies are heterogeneous in design and outcome. Although there have been two recent trials evaluating integrated early intervention in comparison with treatment as usual, it remains unclear whether reported improved outcomes of specialist centres apply to other models. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Early Intervention in Psychiatry, 11(1) : 3-13
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Firth, J., Carney, R., French, P., Elliott, R., Yung, A.
Background: Exercise has previously been shown to reduce symptoms of schizophrenia in long-term patients, along with improving their physical health and cognitive functioning. However, the effects of exercise in frst-episode psychosis (FEP) have not been widely investigated. Methods: Twenty-eight people with FEP participated in 10 weeks of supervised exercise twice weekly, using activities tailored to their own choice. Participant engagement was measured, and various aspects of physical health, mental health, and cognitive functioning were assessed. Participants were assessed at baseline, 10 weeks, and then 6 months after the supervised intervention, and compared to a group of patients with FEP who did not receive an exercise intervention. Results: Over the 10-week intervention, participants achieved 107 minutes (mean average) of moderate-to-vigorous exercise per week. Furthermore, at 10 weeks (ie, immediately postintervention), there were improvements in total symptoms, negative symptoms, waist circumference, verbal memory, social cognition, and social functioning (all P <.05). After 6 months, 55% of participants had continued to exercise. Psychiatric assessments at the 6-month follow-up showed that positive and negative symptoms were still signifcantly lower than preintervention scores. However, post hoc analyses revealed that only those who had maintained regular exercise over the 6 months had continued to show signifcantly reduced symptoms, whereas those who had ceased exercising had regressed to baseline scores. Previously observed benefts of exercise for social functioning were also maintained at the follow-up, although improvements in waist circumference and cognition were lost. Conclusion: Future research should aim to establish sustainable methods for maintaining regular exercise and explore the effectiveness of "step-down" support following supervised interventions in order to improve physical health outcomes and facilitate psychosocial recovery in FEP.
Schizophrenia Bulletin, 43(Suppl 1) : S199
- Year: 2017
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Physical activity, exercise