Disorders - psychosis disorders
Harvey, R. C., Shields, G. E., James, A. C.
OBJECTIVES: Few studies discuss the effectiveness and side effects of the use of antipsychotics in the pediatric population, despite the poor prognosis associated with the disorder, including high suicide risk. This study explores the efficacy of trialled antipsychotics for early-onset schizophrenia in order to determine which treatments are potentially efficacious in this population. METHODS: A systematic literature review was performed to identify trials conducted in children and adolescents with schizophrenia that reported symptom control (efficacy) using the positive and negative syndrome scale (PANSS), a medical scale frequently used for assessing the schizophrenia symptom severity in trials. A Bayesian random effects network-meta-analysis was performed, synthesizing data for relevant outcomes, including mean change from baseline in PANSS scores (including positive and negative subscales), weight gain and treatment discontinuation due to adverse events. RESULTS: Eleven studies were identified in the systematic review, and ten were included in the network meta-analysis. All treatments showed a greater reduction in PANSS scores at 6 weeks vs placebo; however, not all results were statistically significant. Haloperidol had the greatest reduction vs placebo; and treatment ranking probabilities suggested that haloperidol had the highest probability of being the best treatment in the network for reducing total PANSS scores. All treatments showed a trend of greater odds of discontinuing treatment due to adverse events vs placebo. However, pairwise comparisons were statistically non-significant. Nine out of thirteen treatments showed a trend of increased weight compared with placebo, but no pairwise comparisons were statistically significant. CONCLUSIONS: The analysis demonstrates that many of the treatments are efficacious in controlling symptoms, although side effects resulting from treatment should be considered; weight gain is commonly observed, and treatment discontinuation due to adverse events is variable between studies. The lack of high-quality studies in this population highlights a need for further research.
Value in Health, 18(3) : A115-A116
- Year: 2015
- 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)
McFarlane, W. R., Levin, B., Travis, L., Lucas, F., Lynch, S., Verdi, M., Williams, D., Adelsheim, S., Calkins, R., Carter, C. S., Cornblatt, B., Taylor, S. F., Auther, A. M., McFarland, B., Melton, R., Migliorati, M., Niendam, T., Ragland, J., Sale, T., Salvador, M., Spring, E.,
[Correction Notice: An Erratum for this article was reported in Vol 41(2) of Schizophrenia Bulletin (see record 2015-07862-028). In the original article, Figure 2, "Regression-Discontinuity Outcome," was incorrectly displayed on page 38. The correct version is present in the erratum.] Objective: To test effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national sample of at-risk youth. Methods: In a risk-based allocation study design, 337 youth (age 12-25) at risk of psychosis were assigned to treatment groups based on severity of positive symptoms. Those at clinically higher risk (CHR) or having an early first episode of psychosis (EFEP) were assigned to receive Family-aided Assertive Community Treatment (FACT); those at clinically lower risk (CLR) were assigned to receive community care. Between-groups differences on outcome variables were adjusted statistically according to regression-discontinuity procedures and evaluated using the Global Test Procedure that combined all symptom and functional measures. Results: A total of 337 young people (mean age: 16.6) were assigned to the treatment group (CHR + EFEP, n = 250) or comparison group (CLR, n = 87). On the primary variable, positive symptoms, after 2 years FACT, were superior to community care (2 df, p < .0001) for both CHR (p = .0034) and EFEP (p < .0001) subgroups. Rates of conversion (6.3% CHR vs 2.3% CLR) and first negative event (25% CHR vs 22% CLR) were low but did not differ. FACT was superior in the Global Test (p = .0007; p = .024 for CHR and p = .0002 for EFEP, vs CLR) and in improvement in participation in work and school (p = .025). Conclusion: FACT is effective in improving positive, negative, disorganized and general symptoms, Global Assessment of Functioning, work and school participation and global outcome in youth at risk for, or experiencing very early, psychosis. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Schizophrenia Bulletin, 41(1) : 30-43
- Year: 2015
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
, First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
McFarlane, W. R., Levin, B., Travis, L., Lucas, F. L., Lynch, S., Verdi, M., Williams, D., Adelsheim, S., Calkins, R., Carter, C. S., Cornblatt, B., Taylor, S. F., Auther, A. M., McFarland, B., Melton, R., Migliorati, M., Niendam, T., Ragland, J. D., Sale, T., Salvador, M., Spring, E.
OBJECTIVE: To test effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national sample of at-risk youth.
METHODS: In a risk-based allocation study design, 337 youth (age 12-25) at risk of psychosis were assigned to treatment groups based on severity of positive symptoms. Those at clinically higher risk (CHR) or having an early first episode of psychosis (EFEP) were assigned to receive Family-aided Assertive Community Treatment (FACT); those at clinically lower risk (CLR) were assigned to receive community care. Between-groups differences on outcome variables were adjusted statistically according to regression-discontinuity procedures and evaluated using the Global Test Procedure that combined all symptom and functional measures.
RESULTS: A total of 337 young people (mean age: 16.6) were assigned to the treatment group (CHR + EFEP, n = 250) or comparison group (CLR, n = 87). On the primary variable, positive symptoms, after 2 years FACT, were superior to community care (2 df, p < .0001) for both CHR (p = .0034) and EFEP (p < .0001) subgroups. Rates of conversion (6.3% CHR vs 2.3% CLR) and first negative event (25% CHR vs 22% CLR) were low but did not differ. FACT was superior in the Global Test (p = .0007; p = .024 for CHR and p = .0002 for EFEP, vs CLR) and in improvement in participation in work and school (p = .025).
CONCLUSION: FACT is effective in improving positive, negative, disorganized and general symptoms, Global Assessment of Functioning, work and school participation and global outcome in youth at risk for, or experiencing very early, psychosis.
Copyright © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
Schizophrenia Bulletin, 41(1) : 30-43
- Year: 2015
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
, Family therapy, Psychoeducation, Individual placement and support (IPS), vocational interventions
, Other service delivery and improvement interventions
Lin, J., Chan, S. K., Lee, E. H., Chang, W. C., Tse, M., Su, W. W., Sham, P., Hui, C. L., Joe, G., Chan, C. L., Khong, P. L., So, K. F., Honer, W. G., Chen, E. Y.
Impairments of attention and memory are evident in early psychosis, and are associated with functional disability. In a group of stable, medicated women patients, we aimed to determine whether participating in aerobic exercise or yoga improved cognitive impairments and clinical symptoms. A total of 140 female patients were recruited, and 124 received the allocated intervention in a randomized controlled study of 12 weeks of yoga or aerobic exercise compared with a waitlist group. The primary outcomes were cognitive functions including memory and attention. Secondary outcome measures were the severity of psychotic and depressive symptoms, and hippocampal volume. Data from 124 patients were included in the final analysis based on the intention-to-treat principle. Both yoga and aerobic exercise groups demonstrated significant improvements in working memory (P<0.01) with moderate to large effect sizes compared with the waitlist control group. The yoga group showed additional benefits in verbal acquisition (P<0.01) and attention (P=0.01). Both types of exercise improved overall and depressive symptoms (all P0.01) after 12 weeks. Small increases in hippocampal volume were observed in the aerobic exercise group compared with waitlist (P=0.01). Both types of exercise improved working memory in early psychosis patients, with yoga having a larger effect on verbal acquisition and attention than aerobic exercise. The application of yoga and aerobic exercise as adjunctive treatments for early psychosis merits serious consideration. This study was supported by the Small Research Funding of the University of Hong Kong (201007176229), and RGC funding (C00240/762412) by the Authority of Research, Hong Kong.
npj Schizophrenia, 1(0) : 15047
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Mind-body exercises (e.g. yoga, tai chi, qigong)
, Physical activity, exercise
Lin, J., Geng, X., Su, W., Chan, K. W., Lee, E. H. M., Chang, W. C., Honer, W. G., Chen, E. Y. H.
Background: Impairments of attention and memory are evident in early psychosis, and often lead to severe, longstanding functional disability. Effective non-pharmacological interventions are needed due to the unsuccessful results of pharmacological interventions. Aims: To determine whether yoga is effective for cognitive impairments, and the neural mechanism underlying these effects. Methods: It was a randomized controlled study of 12-week of yoga and aerobic exercise (walking and cycling) intervention vs wait-list control for female early psychotic patients. Memory was measured with Hong Kong List Learning Test and Digit Span test, and attention was measured with Letter Cancellation test. Cognitive data analysis was based on the Intention-to-Treat method using a mixed-model analysis. Seed based functional connectivity was applied using posterior cingulate cortex (PCC) as seed with AFNI. Cortical thickness analyses were performed using FreeSurfer. Results from yoga and control groups were presented. Results: A total of 140 women were recruited and randomized into three groups. 95 completed the study, and 115 were included for cognitive data analysis. For imaging data, 42 participants were used for cortical thickness analyses; and 60 were included for neural connectivity analyses. Yoga group demonstrated significant improvements in working memory, verbal acquisition and attention (P=.01). Cortical thickness increased in the postcentral gyrus (P<.01); connectivity between PCC and bilateral inferior parietal gyrus increased after yoga intervention (P<.005). Conclusions: Yoga has been found to be effective for memory and attention in early psychotic patients. The increases of thickness and neural connectivity indicate the possible neural mechanisms underlying the improvements of cognition.
European Psychiatry, 30 : 789
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Mind-body exercises (e.g. yoga, tai chi, qigong)
, Physical activity, exercise
Lin, J. J. X., Lee, E. H. M., Chang, W. C., Chan, S. K. W., Tse, M., Phong, P. L., Chan, C. L. W., Honer, W., Chen, E. Y. H.
Background: The current study aims to explore the effects of aerobic exercise and mind-body exercise (yoga) on cognitive function and clinical symptom in female patients with early psychosis. The potential neuromechanism underlying the clinical consequences was also investigated. Methods: Female patients (n=120) diagnosed with schizophrenia spectrum disorders and psychotic disorder were recruited from outpatient clinic. They were randomized into integrated yoga therapy group, aerobic exercise programme group, and waiting list as the control group. Both interventions were held three times weekly for 12 weeks. Neuro-cognition and clinical symptom were compared between baseline and 12 weeks among the three groups using repeated measures ANOVA . Structural MRI data was collected in 60 patients and analysed using FreeSurfer V5.1 and Qdec V1.4. Results: Both yoga and aerobic exercise improved verbal memory (p<0.01) and working memory (p<0.01) with moderate to large effect sizes compared to control group. Additionally, yoga group showed enhanced attention and visual-motor coordination (p<0.05). Both yoga and aerobic exercise reduced overall symptom (p<0.05) and depressive symptom (p<0.05) after 12 weeks. Furthermore, yoga increased cortical thickness in post-central gyrus (p<0.001) and aerobic exercise increased cortical thickness in superior frontal gyrus (p<0.001). Conclusion: Both types of exercise improved cognition in early psychosis patients, with yoga having a superior effect on attention and visual-motor coordination. Observed increments in the cortical thicknesses may indicate improved neurogenesis. The present study indicates possible interventions for cognitive impairments in the patients with early psychosis, which are non-invasive and mostly safe.
Schizophrenia Bulletin, 41 : S320
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Mind-body exercises (e.g. yoga, tai chi, qigong)
, Physical activity, exercise
Kuzmanovic, A., Zivkovic, N., Djokic, G., Curcic, D., Zoric, K., Djordjevic, M.
Schizophrenia is a chronic illness with a lifetime prevalence of 0.30-0.66%.The first episode of schizophrenia typically occurs in the late teenage years or the early 20 s. Early recognition is very often difficult because of the nature of the disorder and its premorbid problems in language, cognitive ability, and behaviour. Although there is no cure, schizophrenia is highly treatable. Successful first episode schizophrenia (FES) treatment is crucial to minimize personal, social and vocational deterioration. Aripiprazole is a third-generation antipsychotic, is a potent, high-affinity, partial D2 receptor and 5-HT1A receptor agonist and a potent 5-HT2A antagonist, and has a lower risk of metabolic side effects with second-generation antipsychotics. Aripiprazole has widely been recommended as a first-line treatment for schizophrenia. Objective: Purpose of this study is to estimate efficacy of aripiprazole in treatment of first episode schizophrenia. Methods: This prospective clinical study included 60 patients with FES diagnosed by ICD-10 criteria for FES, who are randomly divided into Haloperidol (30 patients) group and Aripiprazole group (30 patients). Antipsychotics were tested, and patients were observed for 6 months in hospital and extra hospital (outpatients) conditions, according to specially designed protocol, which included Positive and Negative Symptom Schedule Scale (PANSS) and Global Clinical Impression Scale (CGI 1-4). Control group was treated with haloperidol 5-20 mg/24 h (average dose 11.83 mg/24 h) and experimental group was treated with aripiprazole 5-30 mg/24 h (average dose 13.16 mg/24 h). Statistical analyses were made with SPSS 15.0 for windows. Results: Average pretrial PANSS score was 106.8 in Aripiprazole group and 107.5 in Haloperidol group. Average PANSS score after 180 days was 53.9 in A group and 55.5 in H group. There is no statistical difference in pretrial scores between groups, for PANSS score (p = 0.741) and CGI 1 (p = 0.763), CGI 2 (p = 1.000), and CGI 3 (p = 1.000) scores. There is statistical significance in PANSS score reduction after 180 days in both groups (p <0.001). There is statistical significance in CGI 1-4 score reduction after 180 days in both groups (p<0.001). There is no statistical difference in PANSS score reduction between O and H group after 180 days (p = 0.146). Results of CGI 1-4 scores reduction between groups are as follow: CGI 1 (severity of illness subscore), A vs. H, p = 0.132 after 180 days with no statistical significance; CGI 2 (global improvement subscore), A vs. H, p = 0.179 after 180 days with no statistical significance; CGI 3 (efficancy index), A vs. H, p = 0.161 after 180 days with no statistical significance; CGI 4 (adverse effects subscore), A vs. H, p<0.001 after 180 days with high statistical significance. Percentage of adverse effects is significantly lower in Aripiprazole (13.3%) than in Haloperidol (53.3%) group. Conclusion: Aripiprazole has the same or slightly better efficacy in treatment of FES comparing to haloperidol, with statisticaly significant lower adverse effects rate.
European Neuropsychopharmacology, 25 : S498-S499
- Year: 2015
- 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)
Malla, A., Joober, R., Iyer, S., Lutgens, D., Abadi, S.
Objective: Specialized Early Intervention (SEI) services for first episode psychosis (FEP) lead to a better clinical and functional outcome at 2 years following treatment. At the end of 5 years, however, these benefits are not maintained if patients are transferred to regular care. The objective of this randomized controlled trial is to evaluate the effect of 5 years of SEI versus 2 years of SEI followed up by 3 years of routine care on outcome at 5 years. Methods: A total of 220 patients were recruited following an initial 2 years of treatment in a SEI and were randomized to either a further 3 years of specialized early intervention for a total of 5 years (experimental condition,N = 111) or to routine treatment (Control condition, N = 109) in the community. SEI included modified assertive case management, rational pharmacotherapy, family intervention, cognitive behavioural therapy and substance abuse treatment and monitoring. Assessments were conducted blind to the treatment assignment. Results: Preliminary results based on all patients randomized suggest that a significantly higher proportion of patients dropped out in the routine care (control) compared to those treated at SEI for the entire period (experimental) (56/110, 51 % and 19/108, 17.3 %, respectively) and lower proportion of control group completed 18 out of 36 months of the study compared to the SEI group (49 vs. 82 %); blind was broken in 16 % of cases only; significantly higher proportion of patients have completed the study. Additional data will be presented on rate and length of remission and difficulties associated with transferring patients to routine care. Conclusion: Providing specialized early intervention throughout the 'critical period's 5 years may solidify the benefits of treatment such that they are sustained in the long term. Findings from this study will have implications for best practices in first episode psychosis.
European Archives of Psychiatry and Clinical Neuroscience, 1) : S48
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy, Case management
, Other service delivery and improvement interventions
Manli, H., Liang, Y., Jianbo, H., Yi, H., Jinkai, C., Pingbo, J., Yi, X.
Purpose: This randomized, 13-week study was conducted to evaluate the efficacy and safety of paliperidone palmitate (PP) intramuscular injections with oral olanzapine in han Chinese firstepisode schizophrenia patients. Methods: Eligible patients were randomized to receive PP or olanzapine. Efficacy assessments (PANSS score) and weightrelated (weight, BMI, waist circumferences, hip circumferences, waist/hip ratio and subcutaneous fat) were assessed at baseline, during weeks 1, 5, 9, and at the end of the study or early withdrawal. Lipid metabolic, glucose-insulin metabolic and prolactin were evaluated at baseline and the endpoint or early withdrawal. Results: The PANSS total score was significantly lower in PP group in week 1 (t = 2.009, p = 0.049). The mean (SD) decrease of PANSS total score was significant in week 1 (PP: -15.07±10.51, olanzapine: -8.72±6.47, t = 2.734, p = 0.009) but not at the endpoint (PP: -32.71±19.49, olanzapine:- 36.62.72±18.42, t = -0.777, p = 0.441). Response rate at endpoint was no significant difference between the two groups. Both group showed significant increases in weight-related paramaters, with no significant difference between the two groups. Fasting LDL, cholesterol, triglyceride, glucose, insulin and HOMA-IR showed a significant increase only in olanzapine group. HbA1c and HOMAβ showed no increase in both group and no difference between the two groups. Both group showed an increase in prolactin level, with significantly greater increase in PP group (F = 8.848, p = 0.004). Conclusions: The PP shows the faster efficacy, but comparable efficacy at the endpoint compared to the olanzapine in first-episode schizophrenia patients. This study reinforced the necessity of regularly monitoring metabolic parameters in schizophrenia patients taking atypical antipsychotics, including PP and olanzapine.
European Neuropsychopharmacology, 25 : S486-S487
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Service Delivery & Improvement, Other service delivery and improvement interventions
Marshall, M., Barrowclough, C., Drake, R., Husain, N., Lobban, F., Lovell, K., Wearden, A., Bradshaw, T., Day, C., Fitzsimmons, M., Pedley, R., Piccuci, R., Picken, A., Larkin, W., Tomenson, B., Warburton, J., Gregg, L.,
Background: Schizophrenia represents a substantial cost to the NHS and society because it is common (lifetime prevalence around 0.5 - 1%); it begins in adolescence or early adulthood and often causes lifelong impairment. The first 3 years are a 'critical period' in which the course of the illness is determined. Hence under the NHS Plan, specialist early intervention in psychosis services were established to care for people who develop psychosis between the ages of 14 and 35 years for the first 3 years of their illness. However, there has been a lack of evidence-based treatments specifically designed for the early years. This is important because emerging evidence has shown that in the critical period it is vital to avoid relapse and prevent deterioration in physical health, as both can drastically reduce the chances of a full recovery.; Objectives: To develop and evaluate three phase-specific interventions to prevent relapse and/or deterioration in physical health in people with first-episode psychosis. The interventions were (1) cognitive remediation (CR) to improve meta-cognition and insight and enhance engagement in cognitive therapy [evaluated in the IMproving PArticipation in Cognitive Therapy (IMPACT) trial]; (2) a healthy-living intervention to control weight in people taking antipsychotic medication after a first episode of psychosis [evaluated in the INTERvention to Encourage ACTivity, Improve Diet, and Reduce Weight Gain (InterACT trial)]; and (3) integrated motivational interviewing and cognitive - behavioural therapy (MiCBT) to reduce cannabis use [evaluated in the Rethinking Choices After Psychosis (ReCAP) trial]. The trials were conducted to explore the case for larger definitive trials with relapse as a primary outcome measure. However, as small trials do not have sufficient power to detect significant reductions in relapse, each was focused on a relevant primary outcome for which there was sufficient power to detect a significant difference. In all three trials relapse was a secondary outcome in the hope of detecting trends towards lower relapse rates in the presence of effective interventions or a general trend across all three studies towards lower relapse rates.; Design: Three exploratory randomised controlled trials (RCTs) accompanied by qualitative work employing grounded theory and framework analysis to inform the interventions and determine acceptability (InterACT and ReCAP trials).; Setting: Five early-intervention services in the north-west of England.; Participants: Early-intervention service users aged 16 - 35 years who had recently experienced a first episode of psychosis. Participants in the IMPACT trial were drawn from a waiting list of people referred for routine CBT; those in the InterACT trial were required to have a body mass index (BMI) of ≥ 25 kg/m(2) (or ≥ 24 kg/m(2) for service users from the South Asian community); and those in the ReCAP trial met Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) criteria for cannabis abuse or dependence.; Interventions: The IMPACT trial involved 13 sessions of CR over 12 weeks; the InterACT trial involved eight face-to-face sessions plus optional group activities over 12 months; and the ReCAP trial involved MiCBT in brief (12 sessions over 4.5 months) and long (24 sessions over 9 months) forms.; Main Outcome Measures: The primary outcome in the IMPACT trial was psychotic symptoms assessed by the Psychotic Symptom Rating Scales (PSYRATS). BMI was the primary outcome in the InterACT trial and cannabis use (measured by timeline follow-back) was the primary outcome in the ReCAP trial. Relapse was a secondary outcome across all three trials.; Results: In the IMPACT trial there was no beneficial effect of CR on psychotic symptoms; however, the amount of CBT required was significantly less after CR. In the InterACT trial a small reduction in BMI in the intervention group was not statistically significant. For participants taking olanzapine or clozapine the effect size was larger although not significan . Outcome data from the ReCAP trial are not yet available. Retention in all three trials was good, indicating that the interventions were acceptable.; Conclusions: Early-intervention services provided a good setting to conduct trials. The IMPACT trial found that CR delivered by relatively unskilled workers improved the efficiency of subsequent CBT. Across the three trials there was little evidence that any intervention reduced relapse.; Trial Registration: Current Controlled Trials ISRCTN17160673 (IMPACT); Current Controlled Trials ISRCTN22581937 (InterACT); Current Controlled Trials ISRCTN88275061 (ReCAP).; Funding: This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 3, No. 2. See the NIHR Journals Library website for further project information.; Copyright © Queen's Printer and Controller of HMSO 2015. This work was produced by Marshall et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
Programme Grants for Applied Research Journal, :
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
McEwen, S., Ventura, J., Subotnik, K. L., Sturdevant, Y., Turner, L., Ghermezi, L., Nuechterlein, K. H.
Background: Depressive symptoms are a common feature in schizophrenia and are associated with increased rates of suicide and relapse, poorer social functioning, low motivation, and poor adherence to psychosocial interventions. Recently, there has been a growing interest in the impact of physical exercise on mental health. Studies suggest exercise may be an effective adjunctive treatment to combat depression during the early phase of schizophrenia. Additionally, exercise has few side effects and is an intervention method that is low cost, simple to implement, and less demanding of staff training compared to many other psychosocial interventions. Methods: Sixteen patients with a recent first episode of schizophrenia from the UCLA Aftercare Research Program were randomly assigned to cognitive training (CT, N=8) or to cognitive training plus exercise (CT&E, N=8). Both groups completed computer-based neurocognitive and social cognitive training 4 hours/week. The CT&E group completed 2 hours/week of exercise in the clinic and two 30-min exercise sessions per week at home. To examine acute changes in mood we used the self-report Positive and Negative Affect Scale (PANAS, Likert Scale: 1-5) before and after a single exercise session (CT&E group) or before and after a cognitive training session (CT group) in the clinic. To examine the long-term outcome effects of exercise on mood, the Brief Psychiatric Rating Scale (BPRS, Scale: 1-7) was completed by a clinician at study baseline and at 8-week follow-up. Results: Patients in the CT&E group experienced increased positive affect after their exercise session (M=+3.9, SD=7.0), whereas the CT group experienced decreased positive affect after a cognitive training session (M=-2.1, SD=5.6) (Cohen's d effect size=.94). Patients in the CT&E group also experienced a greater decrease in negative affect (M=-2.8, SD=5.3) than the CT group (M=0.0, SD=2.4) (Cohen's d=-.74). Regarding tonic mood states, the CT&E group had a greater reduction in depressive symptoms (M=-1.38, SD=1.69) than the CT group (M=-.13, SD=.99) (Cohen's d=-.90) at 2-month follow-up. Conclusion: These results indicate that regular physical exercise leads to acute increases in positive affect and reductions in negative affect. These preliminary data suggest that exercise is a low risk, non-pharmacological means of producing clinical improvements in mood in first-episode schizophrenia patients. This study is ongoing at the UCLA Aftercare Research Program.
Schizophrenia Bulletin, 41 : S182-S183
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive remediation therapy, Physical activity, exercise
Mendella, P. D., Burton, C. Z., Tasca, G. A., Roy, P., St-Louis, L., Twamley, E. W.
Cognitive training or remediation now has multiple studies and meta-analyses supporting its efficacy in improving cognition and functioning in people with schizophrenia. However, relatively little is known about cognitive training outcomes in early psychosis. We conducted a pilot randomized controlled trial of Compensatory Cognitive Training (CCT) compared to Treatment as Usual (TAU) in 27 participants with first-episode psychosis who had received treatment for psychosis for less than six months. Assessments of cognition (MATRICS Consensus Cognitive Battery; MCCB) and functional capacity (UCSD Performance-Based Skills Assessment-Brief; UPSA-B) were administered at baseline and following the 12-week treatment. The CCT condition, compared to TAU, was associated with significant improvements on the MCCB composite score, as well as MCCB subtests measuring processing speed (Trail Making) and social cognition (Mayer-Salovey-Caruso Emotional Intelligence Test), with large effects on these three outcome measures. There were no significant CCT-associated effects on the UPSA-B or on positive, negative, or depressive symptoms. CCT treatment of cognitive impairments in first-episode schizophrenia is feasible and can result in large effect size improvements in global cognition, processing speed, and social cognition. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Schizophrenia Research, 162(1-3) : 108-111
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy