Cognitive Behavior Therapy in First-Episode Psychosis With a Focus on Depression, Anxiety, and Self-Esteem

Self-esteem in individuals at ultra-high risk for psychosis: A systematic review and meta-analysis

AIM

Low self-esteem (LSE) has been reported among individuals with psychosis and is hypothesized to act as a risk and maintenance factor for the disorder. However, the extent to which LSE also characterizes individuals deemed at ultra-high risk (UHR) for psychosis (who present features consistent with the prodromal phase of illness), has yet to be quantified using meta-analysis. This is important given that LSE is a potentially modifiable target for early intervention services aiming to reduce the risk of psychosis transition in this population.

METHODS

We searched Medline, Embase, PsycINFO and Web of Science Core Collection for studies examining self-esteem in UHR and healthy individuals. Random-effects models were used to examine group differences in self-esteem (Hedges'g) with exploratory meta-regression analyses employed to investigate the effect of study characteristics (mean age of UHR group, the proportion of male participants in the UHR group and study quality) on standardized mean differences.

RESULTS

Six studies were eligible for inclusion. Significant differences in self-esteem were observed, with individuals at UHR showing reduced self-esteem relative to healthy controls (g = -1.33 [-1.73 to -0.94] P < .001).However, there was evidence of substantial heterogeneity (I²  = 75%). Exploratory meta-regression analyses indicated a significant effect of the mean age of the UHR group on effect sizes (B = -0.26, P = .02).

CONCLUSIONS

UHR youth present with lower levels of self-esteem than healthy individuals, a difference that appears to be more pronounced with advancing age. We discuss clinical implications and provide recommendations for future studies.

Efficacy of a brief mindfulness intervention upon anxiety in early psychosis patients

AIM

To examine the efficacy of a brief mindfulness intervention in reducing anxiety in early psychosis patients, and to determine whether symptom burden mitigates therapeutic response.

METHODS

Our study included patients who had experienced an initial episode of psychosis, with less than 30 months of antipsychotic exposure. First, the prescriber completed the COMPASS Clinician Rating Form (measuring symptom burden), and patients completed the POMS questionnaire (measuring anxiety). A 3-minute mindfulness exercise was administered, and patients again completed the POMS scale. The differences between the pre- and postintervention anxiety scores were analysed using a paired t test.

RESULTS

A total of 20 subjects participated. The mean Anxiety Subscale of the POMS scores decreased from 4.6 to 1.7. The change was statistically significant, and not influenced by symptom burden.

CONCLUSIONS

A brief mindfulness exercise, conducted in a routine office visit, produced a significant reduction in state anxiety for early psychosis patients, regardless of symptom burden.

Is There More to Insight Into Illness in Schizophrenia Than Cognition? A Study Applying the Dynamic Wisconsin Card Sorting Test

Impaired insight is common in schizophrenia. Etiological models focusing on single determinants have not succeeded in explaining insight deficits. More complex models seem promising. This study tests Startup’s (1996) model of insight and cognition, predicting a curvilinear relationship and specific insight–cognition configurations. Patients with schizophrenia diagnoses (N = 248) were assessed with the Dynamic Wisconsin Card Sorting Test (WCSTdyn) and measures of psychopathology and premorbid intelligence. In a regression model connecting insight and WCSTdyn, the linear and quadratic term accounted for a small but significant proportion of variance. Cluster analysis yielded two cognitively high-functioning groups differing in insight and a group with impaired cognition and reduced insight. Results support Startup’s framework of multiple barriers to insight. Cognitive deficits seem to be one insight-limiting factor, but motivational influences on insight cannot be excluded. Research on therapeutic interventions should take these different pathways into account.

Subjective distress in a representative sample of outpatients with psychotic disorders

BACKGROUND

The affective burden of psychotic disorder has been increasingly recognised. However, subjective reports of distress and its covariates, especially those related to service use, remain under-investigated in patients with psychosis.

METHODS

This study investigated subjective distress and its covariates in a representative sample of 401 outpatients with a confirmed diagnosis of psychotic disorders in Brazil. Distress was assessed using the corresponding domain of a standardised measure of need - the Camberwell Assessment of Need.

RESULTS

Distress was reported as a need by 165 (41%) patients, being met in 78 (20%) and unmet in 87 (22%). Hierarchical logistic regression showed that the presence of distress as a need was predicted by attendance at psychotherapy (OR=3.49, CI=1.62-7.53), presence of suicidal ideation (OR=2.89, CI=1.75-4.79), non-attendance at psychosocial rehabilitation (OR=2.84, CI=1.31-6.19), and higher psychopathology (OR=1.09, CI=1.06-1.12). An unmet need was predicted by family not accompanying patients to treatment (OR=2.60, CI=1.05-6.44) and higher psychopathology (OR=1.05, CI=1.02-1.09).

LIMITATION

The use of a cross-sectional design and a single questionnaire domain to evaluate distress are the main limitations.

CONCLUSIONS

Subjective distress is a common unmet need in psychosis, and can be treated. The main clinical implication is that subjective distress in psychosis may be impacted on by family engagement and psychosocial interventions.

Self-esteem and fear of negative evaluation as mediators between family socioeconomic status and social anxiety in Chinese emerging adults

AIMS

The social causation hypothesis suggests that the stress in connection with a depressing social position results in the development of mental disorders. This study examines the psychological mechanisms underlying the link between family socioeconomic status (SES) and social anxiety in Chinese emerging adults.

METHODS

A self-administered questionnaire was given to a representative sample (N = 717) of undergraduate students (17-23 years old) at three universities in China. Correlational and structural equation modeling analyses were employed to test the hypothesized three-path effect of self-esteem and fear of negative evaluation (FNE) as mediators between family SES and social anxiety.

RESULTS

Findings suggest the following: (1) the emerging adults belonging to families with low SES are at an increased risk of social anxiety, and (2) lower family SES caused lower self-esteem, which, in turn, serves to enhance the levels of FNE, thereby increasing social anxiety.

CONCLUSION

In addressing the prevention and treatment of social anxiety, we conclude that preventive efforts toward improving self-esteem may help reduce social anxiety in individuals with low family SES.