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Xu F, Zhang H. The application of cognitive behavioral therapy in patients with schizophrenia: A review. Medicine (Baltimore) 2023; 102:e34827. [PMID: 37565853 PMCID: PMC10419479 DOI: 10.1097/md.0000000000034827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
The aim of this review is to explore the clinical nursing application of cognitive behavioral therapy (CBT) in patients with schizophrenia. A literature search was conducted using the CINAHL and MEDLINE databases. The database search occurred during the month of December 2022. This article comprehensively summarizes the theoretical basis of CBT in improving schizophrenia in clinical nursing, its application in managing symptoms and improving social function, as well as research progress in this field. There are still inconsistencies in the research results on CBT, but overall, psychological intervention combined with drug treatment is more effective than conventional treatment alone. If social function training can be added at the same time, it is believed that it will have better effects on clinical treatment and can maintain long-lasting effectiveness. Only in this way can patients truly understand and recognize the disease, improve treatment compliance, and ultimately achieve the goal of improving prognosis and quality of life.
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Affiliation(s)
- Feifei Xu
- School of Psychology, Zhejiang Normal University, Jin Hua, China
| | - Hang Zhang
- School of Humanities and International Education Exchange, Anhui University of Chinese Medicine, HeFei, China
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Bighelli I, Wallis S, Reitmeir C, Schwermann F, Salahuddin NH, Leucht S. Effects of psychological treatments on functioning in people with Schizophrenia: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01526-1. [PMID: 36477405 DOI: 10.1007/s00406-022-01526-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
Functioning is recognized as a key treatment goal in alleviating the burden of schizophrenia. Psychological interventions can play an important role in improving functioning in this population, but the evidence on their efficacy is limited. We therefore aimed to evaluate the effect of psychological interventions in functioning for patients with schizophrenia. To conduct this systematic review and meta-analysis, we searched for published and unpublished randomized controlled trials (RCTs) in EMBASE, MEDLINE, PsycINFO, BIOSIS, Cochrane Library, WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and the Study register of the Cochrane Schizophrenia Group. The outcome functioning was measured with validated scales. We performed random-effects pairwise meta-analysis to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). We included 58 RCTs (5048 participants). Psychological interventions analyzed together (SMD = - 0.37, 95% CI - 0.49 to - 0.25), cognitive behavioral therapy (30 RCTs, SMD = - 0.26, 95% CI - 0.39 to - 0.12), and third wave cognitive-behavioral therapies (15 RCTs, SMD = - 0.60, 95% CI - 0.83 to - 0.37) were superior to control in improving functioning, while creative therapies (8 RCTs, SMD = 0.01, 95% CI - 0.38 to 0.39), integrated therapies (4 RCTs, SMD = - 0.21, 95% CI - 1.20 to 0.78) and other therapies (4 RCTs, SMD = - 0.74, 95% CI - 1.52 to 0.04) did not show a benefit. Psychological interventions, in particular cognitive behavioral therapy and third wave cognitive behavioral therapies, have shown a therapeutic effect on functioning. The confidence in the estimate was evaluated as very low due to risk of bias, heterogeneity and possible publication bias.
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Affiliation(s)
- Irene Bighelli
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Sofia Wallis
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Cornelia Reitmeir
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Felicitas Schwermann
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Nurul Husna Salahuddin
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaningerstraße 22, 81675, Munich, Germany
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Lysaker PH, Weiden PJ, Sun X, O’Sullivan AK, McEvoy JP. Impaired insight in schizophrenia: impact on patient-reported and physician-reported outcome measures in a randomized controlled trial. BMC Psychiatry 2022; 22:574. [PMID: 36031632 PMCID: PMC9420291 DOI: 10.1186/s12888-022-04190-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/21/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Impaired insight poses a challenge in the treatment of patients with schizophrenia because of its potential to jeopardize therapeutic engagement and medication adherence. This study explored how insight impairment, graded from none to extreme, is related to patient-reported mental health status, depression, and neurocognition in schizophrenia. METHODS In a post hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study (NCT00014001), insight was measured using the Positive and Negative Syndrome Scale (PANSS) Item G12 (lack of insight). Additional assessments for this analysis included the 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS), physician- and patient-reported Clinical Global Impression-Severity (CGI-S), MATRICS Consensus Cognitive Battery, and Calgary Depression Scale for Schizophrenia. Relationships between patient-reported outcomes and PANSS total and Item G12 ratings were evaluated. RESULTS Among 1431 CATIE study participants in this analysis, increasingly impaired insight at baseline was significantly associated with better patient-reported quality of life (QoL), lower baseline depression, and greater divergence between physician- and patient-reported illness severity. Patients with more severely impaired insight reported milder illness compared with physician reports, particularly those with moderate-severe to extreme impairment (PANSS Item G12 rating ≥ 5), approximately 10% (138/1431) of CATIE participants. For the 90% of patients with PANSS Item G12 ratings < 5, patient-reported QoL decreased with increasing symptoms. SF-12 MCS scores were linearly related to baseline PANSS total score only in patients with PANSS total score < 90 (moderately ill or better), and better symptom scores were associated with higher QoL. No significant relationship between insight and neurocognition was observed. CONCLUSIONS In the small subgroup (10%) of CATIE study patients with schizophrenia and PANSS Item G12 ratings ≥5, moderate-severe-severe/extreme insight impairment was associated with significantly more positive perception of QoL and illness severity by the patient versus the treating physician. This was not observed in the remaining 90% of patients with normal to moderately impaired insight, suggesting that poor insight as a threat to the validity of self-report is uncommon.
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Affiliation(s)
- Paul H. Lysaker
- grid.280828.80000 0000 9681 3540Richard L. Roudebush VA Medical Center and Indiana University School of Medicine, 1481 West 10th Street, Indianapolis, IN 46202 USA
| | - Peter J. Weiden
- grid.422303.40000 0004 0384 9317Alkermes, Inc., Waltham, MA USA
| | - Xiaowu Sun
- grid.422303.40000 0004 0384 9317Alkermes, Inc., Waltham, MA USA
| | | | - Joseph P. McEvoy
- grid.410427.40000 0001 2284 9329Psychiatry and Health Behavior at Augusta University, Augusta, GA USA
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Feasibility and Benefit of Cognitive Behavioural Therapy for Psychosis via Teleconsultation in Indonesia: A Case Study of a 40-Year-Old Schizoaffective Disorder Patient. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Whilst Cognitive Behavioural Therapy for Psychosis (CBTp) has been found to reduce psychotic symptoms, most evidence supporting its implementation originates from studies in Western and high-income countries. Furthermore, questions remain regarding the efficacy of CBTp conducted via teleconsultation. Herein we report an ongoing case in Indonesia involving an individual with schizoaffective disorder, who received 60 sessions of CBTp over seven months. Sessions were delivered via a combination of voice and video calls. The patient, a 40-year-old male, was diagnosed with schizoaffective disorder at the age of 26. He exhibited symptoms of paranoid and religious delusions, hallucinations (auditory, visual, and somatic) and disorganised speech during our intake interview. Negative symptoms were not apparent. In the 14 years prior to our initial consultation, the patient was prescribed antipsychotics and demonstrated good adherence. He had no history of psychotherapy independent of our clinic. Treatment involved CBTp techniques, including psychoeducation, a symptom diary, relaxation, and behavioural experiments. Study outcome was assessed with Psychotic Symptom Rating Scales. Both hallucination and delusion subscale scores improved 53% from 53 at intake to 25 during an assessment administered 6 months later. Results from this study demonstrate that the CBTp is both feasible, and beneficial, when conducted via teleconsultation in Indonesia.
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Cultural adaptation of cognitive behaviour therapy for depression: a qualitative study exploring views of patients and practitioners from India. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Cognitive behaviour therapy (CBT) is an effective treatment for depression. However, culture can influence engagement and treatment efficacy of CBT. Several attempts have been made in Asian countries to develop a culturally adapted CBT for depression. However, research in the Indian context documenting the views on cultural influence of CBT is limited. The present study is an attempt to explore the views of patients and therapists in India by following an evidence-based approach that focuses on three areas for adaptation: (1) awareness of relevant cultural issues and preparation for therapy; (2) assessment and engagement; and (3) adjustments in therapy techniques. Semi-structured interviews with three consultant clinical psychologists/therapists, a focused group discussion with six clinical psychologists, and two patients undergoing CBT for depression were conducted. The data were analysed using a thematic framework analysis by identifying emerging themes and categories. The results highlight therapists’ experiences, problems faced, and recommendations in all three areas of adaptation. The findings highlight the need for adaptation with understanding and acknowledging the culture differences and clinical presentation. Culturally sensitive assessment and formulation with minor adaptation in clinical practice was recommended. Therapists emphasised the use of proverbs, local stories and simplified terminologies in therapy. The findings will aid in providing culturally sensitive treatment to patients with depression in India.
Key learning aims
(1)
To understand the views of Indian patients and therapists based on their experience of CBT.
(2)
To understand the need for cultural adaptation of CBT in India.
(3)
To understand the adaptations by therapists while using CBT in clinical practice.
(4)
To gain perspective on how CBT can be culturally adapted to meet the needs of the Indian population.
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Blay M, Adam O, Bation R, Galvao F, Brunelin J, Mondino M. Improvement of Insight with Non-Invasive Brain Stimulation in Patients with Schizophrenia: A Systematic Review. J Clin Med 2021; 11:jcm11010040. [PMID: 35011780 PMCID: PMC8745271 DOI: 10.3390/jcm11010040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022] Open
Abstract
Patients with schizophrenia are often unaware of their condition and the consequences of their illness. This lack of insight results in impaired functioning, treatment non-adherence and poor prognosis. Here, we aimed to investigate the effects of non-invasive brain stimulation (NIBS) on two forms of insight, clinical and cognitive, in patients with schizophrenia. We conducted a systematic review of the literature registered in the PROSPERO database (CRD42020220323) according to PRISMA guidelines. The literature search was conducted in Medline and Web of Science databases based on studies published up until October 2020 that included pre-NIBS and post-NIBS measurements of clinical and/or cognitive insight in adults with schizophrenia. A total of 14 studies were finally included, and their methodological quality was assessed by using the QualSyst tool. Despite the lack of well-conducted large randomized-controlled studies using insight as the primary outcome, the available findings provide preliminary evidence that NIBS can improve clinical insight in patients with schizophrenia, with a majority of studies using transcranial direct current stimulation with a left frontotemporal montage. Further studies should investigate the effect of NIBS on insight as a primary outcome and how these effects on insight could translate into clinical and functional benefits in patients with schizophrenia.
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Affiliation(s)
- Martin Blay
- Centre Hospitalier le Vinatier, F-69500 Bron, France; (M.B.); (O.A.); (F.G.); (J.B.)
- Université Lyon 1, Lyon University, F-69100 Villeurbanne, France;
| | - Ondine Adam
- Centre Hospitalier le Vinatier, F-69500 Bron, France; (M.B.); (O.A.); (F.G.); (J.B.)
- Université Lyon 1, Lyon University, F-69100 Villeurbanne, France;
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, F-69000 Lyon, France
| | - Rémy Bation
- Université Lyon 1, Lyon University, F-69100 Villeurbanne, France;
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, F-69000 Lyon, France
- Psychiatric Unit, Wertheimer Neurologic Hospital, F-69500 Bron, France
| | - Filipe Galvao
- Centre Hospitalier le Vinatier, F-69500 Bron, France; (M.B.); (O.A.); (F.G.); (J.B.)
| | - Jérôme Brunelin
- Centre Hospitalier le Vinatier, F-69500 Bron, France; (M.B.); (O.A.); (F.G.); (J.B.)
- Université Lyon 1, Lyon University, F-69100 Villeurbanne, France;
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, F-69000 Lyon, France
| | - Marine Mondino
- Centre Hospitalier le Vinatier, F-69500 Bron, France; (M.B.); (O.A.); (F.G.); (J.B.)
- Université Lyon 1, Lyon University, F-69100 Villeurbanne, France;
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, F-69000 Lyon, France
- Correspondence:
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Radstaak M, Hüning L, Bohlmeijer ET. Well-Being Therapy as Rehabilitation Therapy for Posttraumatic Stress Disorder Symptoms: A Randomized Controlled Trial. J Trauma Stress 2020; 33:813-823. [PMID: 32289193 PMCID: PMC7687170 DOI: 10.1002/jts.22500] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 02/04/2023]
Abstract
Many individuals with posttraumatic stress disorder (PTSD) continue to have substantial residual symptoms after completing psychological treatment. Well-being therapy (WBT) has been developed to treat the residual phase of mental disorders, prevent relapse, and promote a full recovery. The present study aimed to compare treatment as usual (TAU) with the long-term effects of WBT as a rehabilitation therapy in adults who successfully completed psychological treatment for PTSD. Participants who did not meet PTSD diagnostic criteria after completing treatment were randomized to WBT (n = 29) or TAU (n = 35) groups. Assessments of well-being, residual PTSD symptoms, and posttraumatic growth were conducted at baseline (T0) and again after 3 months (T1), 6 months (T2), and 1 year (T3). The results of the multilevel analysis revealed that WBT was not more effective than TAU in increasing levels of well-being, γ = 0.02 (SE = 0.11) or posttraumatic growth, γ = 0.10 (SE = 0.13) nor in decreasing PTSD symptoms, γ = -0.04 (SE = 0.05). However, for participants with low levels of well-being at baseline (Mental Health Continuum-Short Form score < 2.6), WBT was more effective than TAU in increasing ratings of well-being, γ = -0.41 (SE = 0.19) and posttraumatic growth, γ = -0.55 (SE = 0.24); this effect was most evident at T3 for posttraumatic growth, d = 1.23. Future research should assess clinically relevant individual characteristics that to optimize the effectiveness and utility of WBT.
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Affiliation(s)
- Mirjam Radstaak
- Department of Psychology, Health and TechnologyUniversity of TwenteEnschedeThe Netherlands
| | - Laura Hüning
- Mediant, Community Mental Health CenterEnschedeThe Netherlands
| | - Ernst T. Bohlmeijer
- Department of Psychology, Health and TechnologyUniversity of TwenteEnschedeThe Netherlands
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Turner DT, Reijnders M, van der Gaag M, Karyotaki E, Valmaggia LR, Moritz S, Lecomte T, Turkington D, Penadés R, Elkis H, Cather C, Shawyer F, O'Connor K, Li ZJ, de Paiva Barretto EM, Cuijpers P. Efficacy and Moderators of Cognitive Behavioural Therapy for Psychosis Versus Other Psychological Interventions: An Individual-Participant Data Meta-Analysis. Front Psychiatry 2020; 11:402. [PMID: 32431633 PMCID: PMC7214739 DOI: 10.3389/fpsyt.2020.00402] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/21/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Study-level meta-analyses have demonstrated the efficacy of cognitive-behavioural therapy for psychosis (CBTp). Limitations of conventional meta-analysis may be addressed using individual-participant-data (IPD). We aimed to determine a) whether results from IPD were consistent with study-level meta-analyses and b) whether demographic and clinical characteristics moderate treatment outcome. METHODS We systematically searched PubMed, Embase, PsychInfo and CENTRAL. Authors of RCTs comparing CBTp with other psychological interventions were contacted to obtain original databases. Hierarchical mixed effects models were used to examine efficacy for psychotic symptoms. Patient characteristics were investigated as moderators of symptoms at post-treatment. Sensitivity analyses were conducted for risk of bias, treatment format and study characteristics. RESULTS We included 14 of 23 eligible RCTs in IPD meta-analyses including 898 patients. Ten RCTs minimised risk of bias. There was no significant difference in efficacy between RCTs providing IPD and those not (p >0.05). CBTp was superior vs. other interventions for total psychotic symptoms and PANSS general symptoms. No demographic or clinical characteristics were robustly demonstrated as moderators of positive, negative, general or total psychotic symptoms at post-treatment. Sensitivity analyses demonstrated that number of sessions moderated the impact of treatment assignment (CBTp or other therapies) on total psychotic symptoms (p = 0.02). CONCLUSIONS IPD suggest that patient characteristics, including severity of psychotic symptoms, do not significantly influence treatment outcome in psychological interventions for psychosis while investing in sufficient dosage of CBTp is important. IPD provide roughly equivalent efficacy estimates to study-level data although significant benefit was not replicated for positive symptoms. We encourage authors to ensure IPD is accessible for future research.
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Affiliation(s)
- David T Turner
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands.,Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Lucia R Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Trust, London, United Kingdom
| | - Steffen Moritz
- Klinik für Psychiatrie und Psychotherapie, Arbeitsgruppe Klinische Neuropsychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Tania Lecomte
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada
| | - Douglas Turkington
- Wolfson Unit, Centre for Aging and Vitality, Newcastle-upon-Tyne, United Kingdom
| | - Rafael Penadés
- Hospital Clínic Barcelona, University of Barcelona, IDIBAPS-CIBERSAM, Barcelona, Spain
| | - Helio Elkis
- Department and Institute of Psychiatry, University de São Paulo Medical School, São Paulo, Brazil
| | - Corinne Cather
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Frances Shawyer
- Southern Synergy, Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Kieron O'Connor
- Department Psychiatrie, Université de Montréal, Montréal, QC, Canada
| | - Zhan-Jiang Li
- Department of Clinical Psychology, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
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Wong JPS, Ting KT, Wong AWS. Group cognitive behavioural therapy for psychosis in the Asian context: a review of the recent studies. Int Rev Psychiatry 2019; 31:460-470. [PMID: 31340692 DOI: 10.1080/09540261.2019.1634012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The cardinal symptoms of psychosis include hallucination and delusion, which can be both distressing and disabling. International guidelines recommend cognitive behavioural therapy for psychosis (CBTp) as an adjunctive intervention to medication management. Considering the difficulty in the widespread dissemination of the individual CBTp, group CBTp is an alternative in improving patients' access to psychological intervention. Although it has been found feasible and effective in various studies, systematic review on group CBTp, particularly in Asia, was not identified. Hence, this systematic review tried to examine the recent evidence of group CBTp in Asia in order to shed light on its implementation in routine psychiatric care. A relevant literature search was conducted in three databases (Pubmed, Web of Knowledge, and PsycINFO) during the period from January 2000 to December 2018. A total of 114 journal articles were identified. After a full-text review, four studies met our inclusion and exclusion criteria. Despite methodological shortcomings, positive results were found in terms of improvements on psychotic symptoms, functioning, and quality-of-life. These encouraging results indicate the need for future research studies with more rigorous methodology, leading to a better understanding on the applicability and effectiveness of group CBTp in the Asian context.
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Affiliation(s)
- Jade P S Wong
- Department of Psychiatry, The University of Hong Kong, HKSAR , Hong Kong , PR China
| | - Ka Tsun Ting
- Clinical Psychology Service, Kowloon Hospital, HKSAR , Hong Kong , PR China
| | - Agatha W S Wong
- Clinical Psychology Service, Kowloon Hospital, HKSAR , Hong Kong , PR China
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10
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Meng FQ, Han HY, Luo J, Liu J, Liu ZR, Tang Y, Hou X, Wei J, Shi LL, Tang MN, Yan YP, Huang YQ, Sun J, Li ZJ. Efficacy of cognitive behavioural therapy with medication for patients with obsessive-compulsive disorder: A multicentre randomised controlled trial in China. J Affect Disord 2019; 253:184-192. [PMID: 31108379 DOI: 10.1016/j.jad.2019.04.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/11/2019] [Accepted: 04/21/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Meta-analyses support the efficacy of cognitive behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) in Western cultures. However, there are no adequately powered multicentre studies in China. This study aimed to compare the effectiveness of treatment with CBT combined with medication and medication alone in OCD patients in China. METHODS OCD patients (N = 167) were recruited from outpatient clinics at three large tertiary psychiatric hospitals and one general hospital in China. Participants were randomly allocated to receive either CBT combined with medication (n = 92) or medication alone (n = 75) for a 24-week treatment period. Participants' symptoms and social functioning were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF) and Clinical Global Impression Scale for Severity (CGI-S) at 0, 4, 8, 12 and 24 weeks, and the effectiveness of the two treatments compared using linear mixed-effects models. RESULTS At 24 weeks, both groups showed large within-group effects in all measures. Significantly more patients receiving combined therapy than medication alone had a decrease in symptom severity of at least 35% (based on Y-BOCS total score). The CGI-S and GAF scores decreased in both groups, and significant differences were found between the groups. LIMITATIONS Study limitations included lack of consideration of medication types and dosages, and the absence of a CBT-only arm. CONCLUSIONS CBT combined with medication may be effective in alleviating symptoms and social functioning impairment associated with OCD, and is more effective than medication alone in China, particularly for the treatment of compulsive behaviours.
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Affiliation(s)
- Fan-Qiang Meng
- The Department of Clinical Psychology & National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, No. 5 Ankang Hutong Deshengmen, WaiXicheng District, 100088 Beijing, People's Republic of China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong Deshengmen, WaiXicheng District, 100088 Beijing, People's Republic of China
| | - Hai-Ying Han
- The Department of Clinical Psychology & National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, No. 5 Ankang Hutong Deshengmen, WaiXicheng District, 100088 Beijing, People's Republic of China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong Deshengmen, WaiXicheng District, 100088 Beijing, People's Republic of China
| | - Jia Luo
- The Department of Clinical Psychology & National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, No. 5 Ankang Hutong Deshengmen, WaiXicheng District, 100088 Beijing, People's Republic of China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong Deshengmen, WaiXicheng District, 100088 Beijing, People's Republic of China
| | - Jing Liu
- The Department of Clinical Psychology & National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, No. 5 Ankang Hutong Deshengmen, WaiXicheng District, 100088 Beijing, People's Republic of China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong Deshengmen, WaiXicheng District, 100088 Beijing, People's Republic of China
| | - Zhao-Rui Liu
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, People's Republic of China
| | - Yi Tang
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, People's Republic of China
| | - Xuan Hou
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, People's Republic of China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Li-Li Shi
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Mou-Ni Tang
- Department of Pediatrics, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou 510370, People's Republic of China
| | - Yong-Ping Yan
- Department of Epidemiology, Faculty of Preventive Medicine, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Yue-Qin Huang
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, People's Republic of China.
| | - Jing Sun
- School of Medicine, Griffith University, Queensland, Q4222 Australia.
| | - Zhan-Jiang Li
- The Department of Clinical Psychology & National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, No. 5 Ankang Hutong Deshengmen, WaiXicheng District, 100088 Beijing, People's Republic of China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong Deshengmen, WaiXicheng District, 100088 Beijing, People's Republic of China.
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11
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Cognitive therapy of psychosis: Research and implementation. Schizophr Res 2019; 203:62-65. [PMID: 29129504 DOI: 10.1016/j.schres.2017.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/10/2017] [Accepted: 09/19/2017] [Indexed: 12/31/2022]
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Jones C, Hacker D, Meaden A, Cormac I, Irving CB, Xia J, Zhao S, Shi C, Chen J. Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia. Cochrane Database Syst Rev 2018; 11:CD008712. [PMID: 30480760 PMCID: PMC6516879 DOI: 10.1002/14651858.cd008712.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is a psychosocial treatment that aims to help individuals re-evaluate their appraisals of their experiences that can affect their level of distress and problematic behaviour. CBT is now recommended by the National Institute for Health and Care Excellence (NICE) as an add-on treatment for people with a diagnosis of schizophrenia. Other psychosocial therapies that are often less expensive are also available as an add-on treatment for people with schizophrenia. This review is also part of a family of Cochrane Reviews on CBT for people with schizophrenia. OBJECTIVES To assess the effects of CBT compared with other psychosocial therapies as add-on treatments for people with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study Based Register of Trials (latest 6 March, 2017). This register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register. SELECTION CRITERIA We selected randomised controlled trials (RCTs) involving people with schizophrenia who were randomly allocated to receive, in addition to their standard care, either CBT or any other psychosocial therapy. Outcomes of interest included relapse, global state, mental state, adverse events, social functioning, quality of life and satisfaction with treatment. We included trials meeting our inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We reliably screened references and selected trials. Review authors, working independently, assessed trials for methodological quality and extracted data from included studies. We analysed dichotomous data on an intention-to-treat basis and continuous data with 60% completion rate. Where possible, for binary data we calculated risk ratio (RR), for continuous data we calculated mean difference (MD), all with 95% confidence intervals (CIs). We used a fixed-effect model for analyses unless there was unexplained high heterogeneity. We assessed risk of bias for the included studies and used the GRADE approach to produce a 'Summary of findings' table for our main outcomes of interest. MAIN RESULTS The review now includes 36 trials with 3542 participants, comparing CBT with a range of other psychosocial therapies that we classified as either active (A) (n = 14) or non active (NA) (n = 14). Trials were often small and at high or unclear risk of bias. When CBT was compared with other psychosocial therapies, no difference in long-term relapse was observed (RR 1.05, 95% CI 0.85 to 1.29; participants = 375; studies = 5, low-quality evidence). Clinically important change in global state data were not available but data for rehospitalisation were reported. Results showed no clear difference in long term rehospitalisation (RR 0.96, 95% CI 0.82 to 1.14; participants = 943; studies = 8, low-quality evidence) nor in long term mental state (RR 0.82, 95% CI 0.67 to 1.01; participants = 249; studies = 4, low-quality evidence). No long-term differences were observed for death (RR 1.57, 95% CI 0.62 to 3.98; participants = 627; studies = 6, low-quality evidence). Only average endpoint scale scores were available for social functioning and quality of life. Social functioning scores were similar between groups (long term Social Functioning Scale (SFS): MD 8.80, 95% CI -4.07 to 21.67; participants = 65; studies = 1, very low-quality evidence), and quality of life scores were also similar (medium term Modular System for Quality of Life (MSQOL): MD -4.50, 95% CI -15.66 to 6.66; participants = 64; studies = 1, very low-quality evidence). There was a modest but clear difference favouring CBT for satisfaction with treatment - measured as leaving the study early (RR 0.86, 95% CI 0.75 to 0.99; participants = 2392; studies = 26, low quality evidence). AUTHORS' CONCLUSIONS Evidence based on data from randomised controlled trials indicates there is no clear and convincing advantage for cognitive behavioural therapy over other - and sometimes much less sophisticated and expensive - psychosocial therapies for people with schizophrenia. It should be noted that although much research has been carried out in this area, the quality of evidence available is mostly low or of very low quality. Good quality research is needed before firm conclusions can be made.
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Affiliation(s)
- Christopher Jones
- University of BirminghamSchool of PsychologyEdgbastonBirminghamUKB15 2TT
| | - David Hacker
- Birmingham and Solihull Mental Health Foundation NHS TrustBirminghamUK
| | - Alan Meaden
- Birmingham and Solihull Mental Health Foundation NHS TrustBirminghamUK
| | - Irene Cormac
- Rampton HospitalFleming HouseRetfordNottinghamshireUKDN22 0PD
| | - Claire B Irving
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph RoadNottinghamUKNG7 2TU
| | - Jun Xia
- The University of Nottingham NingboNottingham China Health Institute199 Taikang E RdYinzhou QuNingboZhejiang ShengChina315000
| | - Sai Zhao
- The Ingenuity Centre, The University of NottinghamSystematic Review Solutions LtdTriumph RoadNottinghamUKNG7 2TU
| | - Chunhu Shi
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthManchesterGreater ManchesterUKM13 9PL
| | - Jue Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineDepartment of Clinical Psychology600 Wan Ping Nan RoadShanghaiChina200030
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Bighelli I, Salanti G, Huhn M, Schneider‐Thoma J, Krause M, Reitmeir C, Wallis S, Schwermann F, Pitschel‐Walz G, Barbui C, Furukawa TA, Leucht S. Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta-analysis. World Psychiatry 2018; 17:316-329. [PMID: 30192101 PMCID: PMC6127754 DOI: 10.1002/wps.20577] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Psychological treatments are increasingly regarded as useful interventions for schizophrenia. However, a comprehensive evaluation of the available evidence is lacking and the benefit of psychological interventions for patients with current positive symptoms is still debated. The present study aimed to evaluate the efficacy, acceptability and tolerability of psychological treatments for positive symptoms of schizophrenia by applying a network meta-analysis approach, that can integrate direct and indirect comparisons. We searched EMBASE, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Library, World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov for randomized controlled trials of psychological treatments for positive symptoms of schizophrenia, published up to January 10, 2018. We included studies on adults with a diagnosis of schizophrenia or a related disorder presenting positive symptoms. The primary outcome was change in positive symptoms measured with validated rating scales. We included 53 randomized controlled trials of seven psychological interventions, for a total of 4,068 participants receiving the psychological treatment as add-on to antipsychotics. On average, patients were moderately ill at baseline. The network meta-analysis showed that cognitive behavioural therapy (40 studies) reduced positive symptoms more than inactive control (standardized mean difference, SMD=-0.29; 95% CI: -0.55 to -0.03), treatment as usual (SMD=-0.30; 95% CI: -0.45 to -0.14) and supportive therapy (SMD=-0.47; 95% CI: -0.91 to -0.03). Cognitive behavioural therapy was associated with a higher dropout rate compared with treatment as usual (risk ratio, RR=0.74; 95% CI: 0.58 to 0.95). Confidence in the estimates ranged from moderate to very low. The other treatments contributed to the network with a lower number of studies. Results were overall consistent in sensitivity analyses controlling for several factors, including the role of researchers' allegiance and blinding of outcome assessor. Cognitive behavior therapy seems to be effective on positive symptoms in moderately ill patients with schizophrenia, with effect sizes in the lower to medium range, depending on the control condition.
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Affiliation(s)
- Irene Bighelli
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of BernBernSwitzerland
| | - Maximilian Huhn
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Johannes Schneider‐Thoma
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Marc Krause
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Cornelia Reitmeir
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Sofia Wallis
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Felicitas Schwermann
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Gabi Pitschel‐Walz
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
| | - Corrado Barbui
- Department of NeuroscienceBiomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVeronaItaly
| | - Toshi A. Furukawa
- Department of Health Promotion and Human BehaviorKyoto University Graduate School of Medicine, Kyoto, Japan and School of Public HealthJapan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
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Edge D, Degnan A, Cotterill S, Berry K, Baker J, Drake R, Abel K. Culturally adapted Family Intervention (CaFI) for African-Caribbean people diagnosed with schizophrenia and their families: a mixed-methods feasibility study of development, implementation and acceptability. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06320] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BackgroundAfrican-Caribbean people in the UK experience the highest incidence of schizophrenia and the greatest inequity in mental health care. There is an urgent need to improve their access to evidence-based care and outcomes. Family intervention (FI) is a National Institute for Health and Care Excellence-approved psychosocial intervention. Although clinically effective and cost-effective for schizophrenia, it is rarely offered. Evidence for any research into FI is lacking for ethnic minority people generally and for African-Caribbean people specifically.Aims(1) To assess the feasibility of delivering a novel, culturally appropriate psychosocial intervention within a ‘high-risk’ population to improve engagement and access to evidence-based care. (2) To test the feasibility and acceptability of delivering FI via ‘proxy families’.DesignA mixed-methods, feasibility cohort study, incorporating focus groups and an expert consensus conference.SettingTwo mental health trusts in north-west England.ParticipantsWe recruited a convenience sample of 31 African-Caribbean service users. Twenty-six family units [service users, relatives/family support members (FSMs) or both] commenced therapy. Half of the service users (n = 13, 50%), who did not have access to their biological families, participated by working with FSMs.InterventionsAn extant FI model was culturally adapted with key stakeholders using a literature-derived framework [Culturally adapted Family Intervention (CaFI)]. Ten CaFI sessions were offered to each service user and associated family.Main outcome measuresRecruitment (number approached vs. number consented), attendance (number of sessions attended), attrition (number of dropouts at each time point), retention (proportion of participants who completed therapy sessions), and completeness of outcome measurement.ResultsOf 74 eligible service users, 31 (42%) consented to take part in the feasibility trial. The majority (n = 21, 67.7%) were recruited from community settings, seven (22.6%) were recruited from rehabilitation settings and three (9.7%) were recruited from acute wards. Twenty-four family units (92%) completed all 10 therapy sessions. The proportion who completed treatment was 77.42% (24/31). The mean number of sessions attended was 7.90 (standard deviation 3.96 sessions) out of 10. It proved feasible to collect a range of outcome data at baseline, post intervention and at the 3-month follow-up. The rating of sessions and the qualitative findings indicated that CaFI was acceptable to service users, families, FSMs and health-care professionals.LimitationsThe lack of a control group and the limited sample size mean that there is insufficient power to assess efficacy. The findings are not generalisable beyond this population.ConclusionsIt proved feasible to culturally adapt and test FI with a sample of African-Caribbean service users and their families. Our study yielded high rates of recruitment, attendance, retention and data completion. We delivered CaFI via FSMs in the absence of biological families. This novel aspect of the study has implications for other groups who do not have access to their biological families. We also demonstrated the feasibility of collecting a range of outcomes to inform future trials and confirmed CaFI’s acceptability to key stakeholders. These are important findings. If CaFI can be delivered to the group of service users with the most serious and persistent disparities in schizophrenia care, it has the potential to be modified for and delivered to other underserved groups.Future workA fully powered, multicentre trial, comparing CaFI with usual care, is planned.Trial registrationCurrent Controlled Trials ISRCTN94393315.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 32. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Dawn Edge
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Amy Degnan
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sarah Cotterill
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Baker
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Richard Drake
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn Abel
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Abstract
OBJECTIVE Over the past decade, cognitive behavioral therapy has been applied to an increasingly wider range of disorders and problems in Chinese societies. However, no meta-analysis has been conducted to synthesize the studies on cognitive behavioral therapy for Chinese clients. The purpose of this meta-analytic study was to examine the overall efficacy of cognitive behavioral therapy for Chinese people. METHOD A literature search was conducted using electronic databases, including Web of Science, PsycINFO and PubMed. Pooled mean effect sizes were calculated using the random-effects model. RESULTS The literature search identified 55 studies with 6763 Chinese participants. The overall short-term effect of cognitive behavioral therapy on the primary outcome was medium in size. Effect sizes were medium for anxiety, depression/well-being and caregiving stress and small for psychotic symptoms and addictive behaviors. The effects of cognitive behavioral therapy on process variables, dysfunctional thoughts and coping, were in the small range. The overall longer-term effect of cognitive behavioral therapy on the primary outcome was medium in size. Moderator analyses showed that the short-term effect was stronger for culturally adapted cognitive behavioral therapy than for unadapted cognitive behavioral therapy. Type of primary outcome, type of control group, recruitment method, study design, the format of delivery and region were found to moderate the efficacy of cognitive behavioral therapy. CONCLUSION The findings of this study provide evidence for the overall efficacy of cognitive behavioral therapy for Chinese people and the benefit of cultural adaptation of cognitive behavioral therapy to Chinese culture.
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Affiliation(s)
- Ting Kin Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Daniel Fu Keung Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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Abstract
PURPOSE OF REVIEW The aim was to synthesize recent evidence on schizophrenia illness experience and outcomes and models of care in low and middle-income countries (LMICs). RECENT FINDINGS There is a plurality of explanatory models for psychosis and increasing evidence that context influences experiences of stigma. People with schizophrenia in LMICs are vulnerable to food insecurity, violence and physical health problems, in addition to unmet needs for mental healthcare. Family support may help to improve outcomes if present, but caregivers may be overwhelmed by the challenges faced. Despite efforts to increase availability, evidence-based care remains inaccessible to many people with schizophrenia. Non-randomized evaluations in South Africa and Mexico indicate that psychosocial support groups for people with schizophrenia and caregivers may be acceptable and useful. Randomized controlled trials in Pakistan and China show that culturally adapted cognitive-behavioural therapy can reduce symptom severity. There is emerging evidence that alternative medicine, such as Tai Chi, may be beneficial, but to date most studies are of low quality. The challenges of biomedical-traditional provider collaborations have been highlighted. Evaluations of integrated mental healthcare in primary care are underway and promise to provide vital information about how to scale-up quality care. SUMMARY Acceptable and effective responses to schizophrenia in LMICs should be cognisant of both cultural context and universal concerns. Efforts to enhance the quality of family support should be central to models of care.
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Li J, Huang YG, Ran MS, Fan Y, Chen W, Evans-Lacko S, Thornicroft G. Community-based comprehensive intervention for people with schizophrenia in Guangzhou, China: Effects on clinical symptoms, social functioning, internalized stigma and discrimination. Asian J Psychiatr 2018; 34:21-30. [PMID: 29627721 DOI: 10.1016/j.ajp.2018.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/24/2018] [Accepted: 04/01/2018] [Indexed: 02/04/2023]
Abstract
Comprehensive interventions including components of stigma and discrimination reduction in schizophrenia in low- and middle-income countries (LMICs) are lacking. We developed a community-based comprehensive intervention to evaluate its effects on clinical symptoms, social functioning, internalized stigma and discrimination among patients with schizophrenia. A randomized controlled trial including an intervention group (n = 169) and a control group (n = 158) was performed. The intervention group received comprehensive intervention (strategies against stigma and discrimination, psycho-education, social skills training and cognitive behavioral therapy) and the control group received face to face interview. Both lasted for nine months. Participants were measured at baseline, 6 months and 9 months using the Internalized Stigma of Mental Illness scale (ISMI), Discrimination and Stigma Scale (DISC-12), Global Assessment of Functioning (GAF), Schizophrenia Quality of Life Scale (SQLS), Self-Esteem Scale (SES), Brief Psychiatric Rating Scale (BPRS) and PANSS negative scale (PANSS-N). Insight and medication compliance were evaluated by senior psychiatrists. Data were analyzed by descriptive statistics, t-test, chi-square test or Fisher's exact test. Linear Mixed Models were used to show intervention effectiveness on scales. General Linear Mixed Models with multinomial logistic link function were used to assess the effectiveness on medication compliance and insight. We found a significant reduction on anticipated discrimination, BPRS and PANSS-N total scores, and an elevation on overcoming stigma and GAF in the intervention group after 9 months. These suggested the intervention may be effective in reducing anticipated discrimination, increasing skills overcoming stigma as well as improving clinical symptoms and social functioning in Chinese patients with schizophrenia.
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Affiliation(s)
- Jie Li
- Guangzhou Huiai Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Yuan-Guang Huang
- Guangzhou Huiai Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong.
| | - Yu Fan
- Guangzhou Huiai Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Sun Yat-sen Center for Migrant Health Policy, Guangzhou, China.
| | - Sara Evans-Lacko
- Personal Social Services Research Unit, London School of Economics and Political Science, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
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18
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Lysaker PH, Pattison ML, Leonhardt BL, Phelps S, Vohs JL. Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments. World Psychiatry 2018; 17:12-23. [PMID: 29352540 PMCID: PMC5775127 DOI: 10.1002/wps.20508] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle L Pattison
- College of Applied Behavioral Sciences, University of Indianapolis, Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Indiana University School of Medicine, Eskenazi Health-Midtown Community Mental Health, Indianapolis, IN, USA
| | | | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA
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Rathod S, Gega L, Degnan A, Pikard J, Khan T, Husain N, Munshi T, Naeem F. The current status of culturally adapted mental health interventions: a practice-focused review of meta-analyses. Neuropsychiatr Dis Treat 2018; 14:165-178. [PMID: 29379289 PMCID: PMC5757988 DOI: 10.2147/ndt.s138430] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In recent years, there has been a steadily increasing recognition of the need to improve the cultural competence of services and cultural adaptation of interventions so that every individual can benefit from evidence-based care. There have been attempts at culturally adapting evidence-based interventions for mental health problems, and a few meta-analyses have been published in this area. This is, however, a much debated subject. Furthermore, there is a lack of a comprehensive review of meta-analyses and literature reviews that provide guidance to policy makers and clinicians. This review summarizes the current meta-analysis literature on culturally adapted interventions for mental health disorders to provide a succinct account of the current state of knowledge in this area, limitations, and guidance for the future research.
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Affiliation(s)
| | - Lina Gega
- Department of Health Sciences, University of York, York, UK
| | - Amy Degnan
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Jennifer Pikard
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Tasneem Khan
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Tariq Munshi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Farooq Naeem
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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20
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Howells FM, Kingdon DG, Baldwin DS. Current and potential pharmacological and psychosocial interventions for anxiety symptoms and disorders in patients with schizophrenia: structured review. Hum Psychopharmacol 2017; 32. [PMID: 28812313 DOI: 10.1002/hup.2628] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Between 30% and 62% of patients with schizophrenia present with co-morbid anxiety disorders that are associated with increased overall burden. Our aim was to summarize current and potential interventions for anxiety in schizophrenia. DESIGN Structured review, summarizing pharmacological and psychosocial interventions used to reduce anxiety in schizophrenia and psychosis. RESULTS Antipsychotics have been shown to reduce anxiety, increase anxiety, or have no effect. These may be augmented with another antipsychotic, anxiolytic, or antidepressant. Novel agents, such as L-theanine, pregabalin, and cycloserine, show promise in attenuating anxiety in schizophrenia. Psychosocial therapies have been developed to reduce the distress of schizophrenia. Cognitive behavioural therapy (CBT) has shown that benefit and refinements in the therapy have been successful, for example, for managing worry in schizophrenia. CBT usually involves more than 16 sessions, as short courses of CBT do not attenuate the presentation of anxiety in schizophrenia. To address time and cost, the development of manualized CBT to address anxiety in schizophrenia is being developed. CONCLUSIONS The presence of coexisting anxiety symptoms and co-morbid anxiety disorders should be ascertained when assessing patients with schizophrenia or other psychoses as a range of pharmacological and psychosocial treatments are available.
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Affiliation(s)
- Fleur M Howells
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - David G Kingdon
- Department of Psychiatry Faculty of Medicine, University of Southampton, Southampton, UK
| | - David S Baldwin
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry Faculty of Medicine, University of Southampton, Southampton, UK
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Szymczynska P, Walsh S, Greenberg L, Priebe S. Attrition in trials evaluating complex interventions for schizophrenia: Systematic review and meta-analysis. J Psychiatr Res 2017; 90:67-77. [PMID: 28231496 DOI: 10.1016/j.jpsychires.2017.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/27/2017] [Accepted: 02/08/2017] [Indexed: 11/18/2022]
Abstract
Essential criteria for the methodological quality and validity of randomized controlled trials are the drop-out rates from both the experimental intervention and the study as a whole. This systematic review and meta-analysis assessed these drop-out rates in non-pharmacological schizophrenia trials. A systematic literature search was used to identify relevant trials with ≥100 sample size and to extract the drop-out data. The rates of drop-out from the experimental intervention and study were calculated with meta-analysis of proportions. Meta-regression was applied to explore the association between the study and sample characteristics and the drop-out rates. 43 RCTs were found, with drop-out from intervention ranging from 0% to 63% and study drop-out ranging from 4% to 71%. Meta-analyses of proportions showed an overall drop-out rate of 14% (95% CI: 13-15%) at the experimental intervention level and 20% (95% CI: 17-24%) at the study level. Meta-regression showed that the active intervention drop-out rates were predicted by the number of intervention sessions. In non-pharmacological schizophrenia trials, drop-out rates of less than 20% can be achieved for both the study and the experimental intervention. A high heterogeneity of drop-out rates across studies shows that even lower rates are achievable.
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Affiliation(s)
- P Szymczynska
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, UK.
| | - S Walsh
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, UK
| | - L Greenberg
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK
| | - S Priebe
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, UK
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22
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Lutgens D, Gariepy G, Malla A. Psychological and psychosocial interventions for negative symptoms in psychosis: systematic review and meta-analysis. Br J Psychiatry 2017; 210:324-332. [PMID: 28302699 DOI: 10.1192/bjp.bp.116.197103] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/10/2016] [Accepted: 01/27/2017] [Indexed: 01/15/2023]
Abstract
BackgroundNegative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination.AimsTo conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders.MethodWe searched for randomised controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure.ResultsA total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive-behavioural therapy (pooled SMD -0.34, 95% CI -0.55 to -0.12), skills-based training (pooled SMD -0.44, 95% CI -0.77 to -0.10), exercise (pooled SMD -0.36, 95% CI -0.71 to -0.01), and music treatments (pooled SMD -0.58, 95% CI -0.82 to -0.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD -0.38, 95% CI -0.53 to -0.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity.ConclusionsSpecific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed.
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Affiliation(s)
- Danyael Lutgens
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Genevieve Gariepy
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Ashok Malla
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
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Li W, Zhang L, Luo X, Liu B, Liu Z, Lin F, Liu Z, Xie Y, Hudson M, Rathod S, Kingdon D, Husain N, Liu X, Ayub M, Naeem F. A qualitative study to explore views of patients', carers' and mental health professionals' to inform cultural adaptation of CBT for psychosis (CBTp) in China. BMC Psychiatry 2017; 17:131. [PMID: 28390407 PMCID: PMC5385068 DOI: 10.1186/s12888-017-1290-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/29/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The evidence for effectiveness of Cognitive Behaviour Therapy (CBT) is robust and the national organizations in the United Kingdom and the United States recommend its use. It is not utilized to its full potential in low and middle-income countries. Adaptation of CBT treatment to the target culture may facilitate its uptake. This study explored views of patients with schizophrenia, their caregivers, and mental health professionals for the purpose of cultural adaptation of CBT. METHOD The project was conducted in a teaching hospital in China. Systematic content and question analysis were the techniques we used to analyse the data generated in a series of qualitative interviews (N 45) in China. After identification of emerging themes and categories we compared and contrasted the themes across different interviews recursively. Triangulation of themes and concepts was undertaken to compare further and contrast the data from the different participating groups. RESULTS This work highlighted the barriers in therapy as well as opportunities for use of CBT in that environment. Patients and their carers in China use a bio-psycho-spiritual-social model of illness. CBT is not commonly used to help those with schizophrenia in China. CONCLUSIONS This study will facilitate the therapists using CBT for people with psychosis in China. These results require to be tested in clinical trials.
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Affiliation(s)
- Weihui Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Li Zhang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xuerong Luo
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Bangshan Liu
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Zhipeng Liu
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
- Jiangxi mental health center, Changsha, China
| | - Fang Lin
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
- Xiangyang Anding Hospital, Changsha, China
| | - Zhiling Liu
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011 China
- National Clinical Research Center for Mental Disorders, Changsha, China
- National Technology Institute on Mental Disorders, Changsha, China
- Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
- Chuxiong Prefecture’s Mental Hospital, Changsha, China
| | - Yuhuan Xie
- Department of Psychiatry, Queens University, 191 Portsmouth Avenue, Kingston, ON K7M 8A6 Canada
| | - Melissa Hudson
- Department of Psychiatry, Queens University, 191 Portsmouth Avenue, Kingston, ON K7M 8A6 Canada
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Clinical Trials Facility, Tom Rudd Unit, Moorgreen Hospital, Southampton, SO30 3JB UK
| | | | | | - Xudong Liu
- Department of Psychiatry, Queens University, 191 Portsmouth Avenue, Kingston, ON K7M 8A6 Canada
| | - Muhammad Ayub
- Department of Psychiatry, Queens University, 191 Portsmouth Avenue, Kingston, ON K7M 8A6 Canada
| | - Farooq Naeem
- Department of Psychiatry, Queens University, 191 Portsmouth Avenue, Kingston, ON K7M 8A6 Canada
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Guo ZH, Li ZJ, Ma Y, Sun J, Guo JH, Li WX, Wang ZQ, Xu HL, Ng RMK, Turkington D, Kingdon D. Brief cognitive-behavioural therapy for patients in the community with schizophrenia: randomised controlled trial in Beijing, China. Br J Psychiatry 2017; 210:223-229. [PMID: 28069563 DOI: 10.1192/bjp.bp.116.183285] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/17/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022]
Abstract
BackgroundBrief cognitive-behavioural therapy (CBT) is an emerging treatment for schizophrenia in community settings; however, further trials are needed, especially in non-Western countries.AimsTo test the effects of brief CBT for Chinese patients with schizophrenia in the community (trial registration: ChiCTR-TRC-13003709).MethodA total of 220 patients with schizophrenia from four districts of Beijing were randomly assigned to either brief CBT plus treatment as usual (TAU) or TAU alone. Patients were assessed at baseline, post-treatment and at 6- and 12-month follow-ups by raters masked to group allocation.ResultsAt the post-treatment assessment and the 12-month follow-up, patients who received brief CBT showed greater improvement in overall symptoms, general psychopathology, insight and social functioning. In total, 37.3% of those in the brief CBT plus TAU group experienced a clinically significant response, compared with only 19.1% of those in the TAU alone group (P = 0.003).ConclusionsBrief CBT has a positive effect on Chinese patients with schizophrenia in the community.
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Affiliation(s)
- Zhi-Hua Guo
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Zhan-Jiang Li
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Yun Ma
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Jing Sun
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Jun-Hua Guo
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Wen-Xiu Li
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Zhi-Qiang Wang
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Hui-Li Xu
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Roger M K Ng
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - Douglas Turkington
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
| | - David Kingdon
- Zhi-Hua Guo, MD, Zhan-Jiang Li, MD, PhD, Yun Ma, MSc, Department of Clinical Psychology & Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Centre of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Jing Sun, PhD, Menzies Health Institute Queensland and School of Medicine, Griffith University, Queensland, Australia; Jun-Hua Guo, MD, Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Wen-Xiu Li, MD, Mental Health Prevention Hospital of Haidian District, Beijing, People's Republic of China; Zhi-Qiang Wang, MD, Dongcheng District Stadium Road Community Health Care Centre, Beijing, People's Republic of China; Hui-Li Xu, MD, Chaoyang District Centre for Mental Disease Control and Prevention, Beijing, People's Republic of China; Roger M. K. Ng, MD, PhD, Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China; Douglas Turkington, MD, MRCPsych, Newcastle University, Newcastle-on-Tyne, UK; David Kingdon, MD, MRCPsych, Department of Psychiatry, University of Southampton, Southampton, UK
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25
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Psychotherapy Services in China: Current Provisions and Future Development. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9345-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Adjunctive selective estrogen receptor modulator increases neural activity in the hippocampus and inferior frontal gyrus during emotional face recognition in schizophrenia. Transl Psychiatry 2016; 6:e795. [PMID: 27138794 PMCID: PMC5070055 DOI: 10.1038/tp.2016.59] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/29/2016] [Accepted: 03/05/2016] [Indexed: 12/18/2022] Open
Abstract
Estrogen has been implicated in the development and course of schizophrenia with most evidence suggesting a neuroprotective effect. Treatment with raloxifene, a selective estrogen receptor modulator, can reduce symptom severity, improve cognition and normalize brain activity during learning in schizophrenia. People with schizophrenia are especially impaired in the identification of negative facial emotions. The present study was designed to determine the extent to which adjunctive raloxifene treatment would alter abnormal neural activity during angry facial emotion recognition in schizophrenia. Twenty people with schizophrenia (12 men, 8 women) participated in a 13-week, randomized, double-blind, placebo-controlled, crossover trial of adjunctive raloxifene treatment (120 mg per day orally) and performed a facial emotion recognition task during functional magnetic resonance imaging after each treatment phase. Two-sample t-tests in regions of interest selected a priori were performed to assess activation differences between raloxifene and placebo conditions during the recognition of angry faces. Adjunctive raloxifene significantly increased activation in the right hippocampus and left inferior frontal gyrus compared with the placebo condition (family-wise error, P<0.05). There was no significant difference in performance accuracy or reaction time between active and placebo conditions. To the best of our knowledge, this study provides the first evidence suggesting that adjunctive raloxifene treatment changes neural activity in brain regions associated with facial emotion recognition in schizophrenia. These findings support the hypothesis that estrogen plays a modifying role in schizophrenia and shows that adjunctive raloxifene treatment may reverse abnormal neural activity during facial emotion recognition, which is relevant to impaired social functioning in men and women with schizophrenia.
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Hazell CM, Hayward M, Cavanagh K, Strauss C. A systematic review and meta-analysis of low intensity CBT for psychosis. Clin Psychol Rev 2016; 45:183-92. [PMID: 27048980 DOI: 10.1016/j.cpr.2016.03.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 01/29/2016] [Accepted: 03/19/2016] [Indexed: 11/19/2022]
Abstract
Sixteen sessions of individual cognitive behavior therapy for people with psychosis (CBTp) is recommended. However, access to CBTp is poor, so the potential of low intensity CBTp (fewer than 16 sessions of face-to-face contact) is being explored. A systematic review and meta-analysis was conducted of 10 controlled trials evaluating low intensity CBTp. Significant between-group effects were found on the primary outcome, symptoms of psychosis, at post-intervention (d=-0.46, 95% CI: -0.06, -0.86) and follow-up (d=-0.40, 95% CI: -0.06, -0.74). Study quality did not moderate post-intervention psychosis outcomes, nor did contact time/number of sessions or therapy format (individual versus group). Between-group effects on secondary outcomes (depression, anxiety and functioning) were not significant at post-intervention, but became significant at follow-up for depression and functioning outcomes (but not for anxiety). Overall, findings suggest that low intensity CBTp shows promise with effect sizes comparable to those found in meta-analyses of CBTp more broadly. We suggest that low intensity CBTp could help widen access. Future research is called for to identify mechanisms of change and to ascertain moderators of outcome so that low intensity CBTp targets key mechanisms (so that scarce therapy time is used effectively) and so that interventions offered are matched to patient need.
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Affiliation(s)
- Cassie M Hazell
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK.
| | - Mark Hayward
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove BN3 7HZ, UK.
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK.
| | - Clara Strauss
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove BN3 7HZ, UK.
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Freeman D, Waite F, Emsley R, Kingdon D, Davies L, Fitzpatrick R, Dunn G. The efficacy of a new translational treatment for persecutory delusions: study protocol for a randomised controlled trial (The Feeling Safe Study). Trials 2016; 17:134. [PMID: 26969128 PMCID: PMC4788840 DOI: 10.1186/s13063-016-1245-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/19/2016] [Indexed: 12/11/2022] Open
Abstract
Background Persecutory delusions (strong unfounded fears that others intend harm to the person) occur in more than 70 % of the patients diagnosed with schizophrenia. This major psychotic experience is a key clinical target, for which substantial improvement in treatment is needed. Our aim is to use advances in theoretical understanding to develop a much more efficacious treatment that leads to recovery in at least 50 % of people with persistent persecutory delusions. Our cognitive conceptualisation is that persecutory delusions are threat beliefs, developed in the context of genetic and environmental risk, maintained by a number of psychological processes including excessive worry, low self-confidence, intolerance of anxious affect and other internal anomalous experiences, reasoning biases, and safety-seeking strategies. The clinical implication is that safety has to be relearned, by entering the feared situations after reduction of the influence of the maintenance factors. We have been individually evaluating modules targeting causal factors. These will now be tested together as a full treatment, called The Feeling Safe Programme. The treatment is modular, personalised, and includes patient preference. We will test whether the new treatment leads to greater recovery in persistent persecutory delusions, psychological well-being, and activity levels compared to befriending (that is, controlling for therapist attention). Methods/design The Feeling Safe Study is a parallel group randomised controlled trial for 150 patients who have persecutory delusions despite previous treatment in mental health services. Patients will be randomised (1:1 ratio) to The Feeling Safe Programme or befriending (both provided in 20 sessions over 6 months). Standard care will continue as usual. Online randomisation will use a permuted blocks algorithm, with randomly varying block size, stratified by therapist. Assessments, by a rater blind to allocation, will be conducted at 0, 6 (post treatment), and 12 months. The primary outcome is the level of delusional conviction at 6 months. Secondary outcomes include levels of psychological well-being, suicidal ideation, and activity. All main analyses will be intention-to-treat. The trial is funded by the NHS National Institute for Health Research. Discussion The Feeling Safe study will provide a Phase II evaluation of a new targeted translational psychological treatment for persecutory delusions. Trial registration Current Controlled Trials ISRCTN18705064 (registered 11 November 2015).
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, Manchester University, Manchester Academic Health Centre, Manchester, UK
| | - David Kingdon
- Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Linda Davies
- Centre for Health Economics, Institute of Population Health, Manchester University, Manchester Academic Health Centre, Manchester, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, Manchester University, Manchester Academic Health Centre, Manchester, UK
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Sarris J, Nishi D, Xiang YT, Su KP, Bannatyne A, Oliver G, Kua EH, Ng CH. Implementation of psychiatric-focused lifestyle medicine programs in Asia. Asia Pac Psychiatry 2015; 7:345-54. [PMID: 26403310 DOI: 10.1111/appy.12212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/23/2015] [Indexed: 12/11/2022]
Abstract
Lifestyle-focused health programs are growing in interest throughout Western society, and a range of lifestyle factors are known to enhance both physical and mental health. However, it remains largely unknown as to whether this approach is salient for the Asian context. The major components of integrative lifestyle-focused health programs to enhance mental and physical health are considered to include the evidence-based adoption of physical activity and exercise, dietary modification, general psychoeducation, adequate relaxation/sleep and social interaction, use of mindfulness techniques, the reduction of substance use, attention of intersecting environmental factors, and the potential use of motivation and goal-setting techniques. This paper outlines an overview of the evidence underpinning these elements, and discusses potential barriers and challenges, and what logistical considerations may need to be addressed in the implementation of such programs within the context of Asian cultures.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Daisuke Nishi
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan
| | - Amy Bannatyne
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgina Oliver
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ee-Heok Kua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chee Hong Ng
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
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