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Mayer SF, Corcoran C, Kennedy L, Leucht S, Bighelli I. Cognitive behavioural therapy added to standard care for first-episode and recent-onset psychosis. Cochrane Database Syst Rev 2024; 3:CD015331. [PMID: 38470162 PMCID: PMC10929366 DOI: 10.1002/14651858.cd015331.pub2] [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] [Indexed: 03/13/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) can be effective in the general population of people with schizophrenia. It is still unclear whether CBT can be effectively used in the population of people with a first-episode or recent-onset psychosis. OBJECTIVES To assess the effects of adding cognitive behavioural therapy to standard care for people with a first-episode or recent-onset psychosis. SEARCH METHODS We conducted a systematic search on 6 March 2022 in the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ClinicalTrials.gov, ISRCTN, and WHO ICTRP. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing CBT added to standard care vs standard care in first-episode or recent-onset psychosis, in patients of any age. DATA COLLECTION AND ANALYSIS Two review authors (amongst SFM, CC, LK and IB) independently screened references for inclusion, extracted data from eligible studies and assessed the risk of bias using RoB2. Study authors were contacted for missing data and additional information. Our primary outcome was general mental state measured on a validated rating scale. Secondary outcomes included other specific measures of mental state, global state, relapse, admission to hospital, functioning, leaving the study early, cognition, quality of life, satisfaction with care, self-injurious or aggressive behaviour, adverse events, and mortality. MAIN RESULTS We included 28 studies, of which 26 provided data on 2407 participants (average age 24 years). The mean sample size in the included studies was 92 participants (ranging from 19 to 444) and duration ranged between 26 and 52 weeks. When looking at the results at combined time points (mainly up to one year after start of the intervention), CBT added to standard care was associated with a greater reduction in overall symptoms of schizophrenia (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.47 to -0.08, 20 RCTs, n = 1508, I2 = 68%, substantial heterogeneity, low certainty of the evidence), and also with a greater reduction in positive (SMD -0.22, 95% CI -0.38 to -0.06, 22 RCTs, n = 1565, I² = 52%, moderate heterogeneity), negative (SMD -0.20, 95% CI -0.30 to -0.11, 22 RCTs, n = 1651, I² = 0%) and depressive symptoms (SMD -0.13, 95% CI -0.24 to -0.01, 18 RCTs, n = 1182, I² = 0%) than control. CBT added to standard care was also associated with a greater improvement in the global state (SMD -0.34, 95% CI -0.67 to -0.01, 4 RCTs, n = 329, I² = 47%, moderate heterogeneity) and in functioning (SMD -0.23, 95% CI -0.42 to -0.05, 18 RCTs, n = 1241, I² = 53%, moderate heterogeneity, moderate certainty of the evidence) than control. We did not find a difference between CBT added to standard care and control in terms of number of participants with relapse (relative risk (RR) 0.82, 95% CI 0.57 to 1.18, 7 RCTs, n = 693, I² = 48%, low certainty of the evidence), leaving the study early for any reason (RR 0.87, 95% CI 0.72 to 1.05, 25 RCTs, n = 2242, I² = 12%, moderate certainty of the evidence), adverse events (RR 1.29, 95% CI 0.85 to 1.97, 1 RCT, n = 43, very low certainty of the evidence) and the other investigated outcomes. AUTHORS' CONCLUSIONS This review synthesised the latest evidence on CBT added to standard care for people with a first-episode or recent-onset psychosis. The evidence identified by this review suggests that people with a first-episode or recent-onset psychosis may benefit from CBT additionally to standard care for multiple outcomes (overall, positive, negative and depressive symptoms of schizophrenia, global state and functioning). Future studies should better define this population, for which often heterogeneous definitions are used.
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Affiliation(s)
- Susanna Franziska Mayer
- Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, München, Germany
| | | | - Liam Kennedy
- Department of Old Age Psychiatry, Carew House, St Vincent's Hospital, Dublin, Ireland
| | - Stefan Leucht
- Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, München, Germany
- German Center for Mental Health (DZPG), Munich, Germany
| | - Irene Bighelli
- Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, München, Germany
- German Center for Mental Health (DZPG), Munich, Germany
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Cowman M, Godfrey E, Walsh T, Frawley E, Fowler D, Alvarez-Jimenez M, O’Connor K, Wykes T, Birchwood M, Donohoe G. Measures of Social and Occupational Function in Early Psychosis: A Systematic Review and Meta-analysis. Schizophr Bull 2024; 50:266-285. [PMID: 37173277 PMCID: PMC10919778 DOI: 10.1093/schbul/sbad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Deficits in social and occupational function are widely reported in psychosis, yet no one measure of function is currently agreed upon as a gold standard in psychosis research. The aim of this study was to carry out a systematic review and meta-analysis of functioning measures to determine what measures were associated with largest effect sizes when measuring between-group differences, changes over time, or response to treatment. Literature searches were conducted based on PsycINFO and PubMed to identify studies for inclusion. Cross-sectional and longitudinal observational and intervention studies of early psychosis (≤5 years since diagnosis) that included social and occupational functioning as an outcome measure were considered. A series of meta-analyses were conducted to determine effect size differences for between-group differences, changes over time, or response to treatment. Subgroup analyses and meta-regression were carried out to account for variability in study and participant characteristics. One hundred and sixteen studies were included, 46 studies provided data (N = 13 261) relevant to our meta-analysis. Smallest effect sizes for changes in function over time and in response to treatment were observed for global measures, while more specific measures of social and occupational function showed the largest effect sizes. Differences in effect sizes between functioning measures remained significant after variability in study and participant characteristics were accounted for. Findings suggest that more specific measures of social function are better able to detect changes in function over time and in response to treatment.
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Affiliation(s)
- Megan Cowman
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Emmet Godfrey
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Talissa Walsh
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Emma Frawley
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - David Fowler
- School of Psychology, University of Sussex, Falmer, UK
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Karen O’Connor
- RISE Early Intervention in Psychosis Service, South Lee Mental Health Service, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Til Wykes
- School of Mental Health & Psychological Sciences, King’s College London, London, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gary Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
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Morales-Pillado C, Fernández-Castilla B, Sánchez-Gutiérrez T, González-Fraile E, Barbeito S, Calvo A. Efficacy of technology-based interventions in psychosis: a systematic review and network meta-analysis. Psychol Med 2023; 53:6304-6315. [PMID: 36472150 PMCID: PMC10520607 DOI: 10.1017/s0033291722003610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/26/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis. METHODS Randomized controlled trials of outcomes of TBIs v. face-to-face interventions in psychosis were identified in a systematic search conducted in PubMed/Ovid MEDLINE. Data were extracted independently by two researchers, and standardized mean changes were pooled using a three-level model and network meta-analysis. RESULTS Fifty-eight studies were included. TBIs complementing treatment as usual (TAU) were generally superior to face-to-face interventions (g = 0.16, p ≤ 0.0001) and to specific outcomes, namely, neurocognition (g = 0.13, p ≤ 0.0001), functioning (g = 0.25, p = 0.006), and social cognition (g = 0.32, p ≤ 0.05). Based on the network meta-analysis, the effect of two TBIs differed significantly from zero; these were the TBIs cognitive training for the neurocognitive outcome [g = 0.16; 95% confidence interval (CI) 0.09-0.23] and cognitive behavioral therapy for quality of life (g = 1.27; 95% CI 0.46-2.08). The variables educational level, type of medication, frequency of the intervention, and contact during the intervention moderated the effectiveness of TBIs over face-to-face interventions in neurocognition and symptomatology. CONCLUSIONS TBIs are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis. The results of the network meta-analysis showed the efficacy of some TBIs for neurocognition, symptomatology, and quality of life. Therefore, TBIs should be considered a complement to TAU in patients with psychosis.
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Affiliation(s)
- Carla Morales-Pillado
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Universidad Complutense de Madrid, Madrid, Spain
- Faculty of Health Science, Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Belén Fernández-Castilla
- Department of Methodology of Behavioral and Health Sciences, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | | | | | - Sara Barbeito
- Faculty of Health Science, Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Ana Calvo
- Department of Personality, Assessment and Clinical Psychology, School of Psychology, Universidad Complutense de Madrid, Madrid, Spain
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Vita A, Barlati S, Ceraso A, Deste G, Nibbio G, Wykes T. Acceptability of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized controlled trials. Psychol Med 2023; 53:3661-3671. [PMID: 35257646 PMCID: PMC10277755 DOI: 10.1017/s0033291722000319] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acceptability is an important factor for predicting intervention use and potential treatment outcomes in psychosocial interventions. Cognitive remediation (CR) improves cognition and functioning in people with a diagnosis of schizophrenia, but its acceptability, and the impact of participants and treatment characteristics, remain to be investigated. Few studies provide a direct measure of acceptability, but treatment drop-out rates are often available and represent a valid surrogate. METHOD The systematic search conducted for the most comprehensive CR outcomes database for schizophrenia was updated in December 2020. Eligible studies were randomized clinical trials comparing CR with any other control condition in patients diagnosed with schizophrenia spectrum disorders and that also reported drop-out in treatment and control arms separately. Acceptability was measured as odd-ratios (OR) of drop-out. RESULTS Of 2119 identified reports, 151 studies, reporting 169 comparisons between CR and control interventions with 10 477 participants were included in the analyses. The overall rate of drop-out was 16.58% for CR programs and 15.21% for control conditions. In the meta-analysis, no difference emerged between CR interventions and controls [OR 1.10, 95% confidence interval (CI) 0.96-1.25, p = 0.177]. Factors improving acceptability were: inpatient only recruitment, participants with fewer years of education and lower premorbid IQ, the presence of all CR core elements, and the presence of techniques to transfer cognitive gains into real-world functioning. CONCLUSIONS CR for people diagnosed with schizophrenia is effective and has a good acceptability profile, similar to that of other evidence-based psychosocial interventions.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Anna Ceraso
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
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Petkari E, Martín-María N, Sánchez-Gutiérrez T, Fernández-Castilla B, Calvo A. A meta-analysis of cognitive interventions for patients with recent onset psychosis: are they effective for improving functioning? Psychol Med 2023; 53:3306-3321. [PMID: 37161705 DOI: 10.1017/s0033291723001198] [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] [Indexed: 05/11/2023]
Abstract
The increasing popularity of cognitive interventions for patients with psychosis calls for further exploration on how these interventions may benefit functional outcomes. We conducted a meta-analysis of randomized controlled trials (RCTs) to examine the effectiveness of cognitive interventions (i.e. Cognitive Remediation, Cognitive Training, Social Cognition, and their combination) on functioning of patients with recent onset psychosis, established as the period within the first five years from the first episode. The following databases were searched: Proquest, PUBMED/MEDLINE, PsycINFO, WOS, Scopus for research published until January 2022. In total, 12 studies were eligible. The total number of participants was 759, of which 32.2% in the intervention and 30.8% in the control group were female. We extracted data to calculate the standardized mean change from pre-test to post-test comparing the intervention with the control conditions. Overall, there was no effect of any of the cognitive intervention types on functioning. None of the examined factors (intervention type, length, and modality; control condition, follow-up time; cognitive functions; medication; symptoms) seemed to moderate these findings. Our results indicate that cognitive interventions as standalone interventions do not appear to improve functioning in patients with recent onset psychosis. Given the small number of eligible studies, further RCTs with larger and more refined samples are needed to test whether these interventions should be applied as single interventions with these patients.
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Affiliation(s)
- Eleni Petkari
- Faculty of Health Sciences, Universidad Internacional de La Rioja (UNIR), Logroño, Spain
| | - Natalia Martín-María
- Department of Biological and Health Psychology, School of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | - Belén Fernández-Castilla
- Department of Methodology of Behavioral and Health Sciences, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Ana Calvo
- Department of Personality, Assessment and Clinical Psychology. School of Psychology. Universidad Complutense de Madrid, Madrid, Spain
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Frawley E, Cowman M, Lepage M, Donohoe G. Social and occupational recovery in early psychosis: a systematic review and meta-analysis of psychosocial interventions. Psychol Med 2023; 53:1787-1798. [PMID: 34474696 PMCID: PMC10106304 DOI: 10.1017/s003329172100341x] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Psychosis, even in its early stages, ranks highly among the causes of disability worldwide, resulting in an increased focus on improved recovery of social and occupational functioning. This study aimed to provide an estimate of the effectiveness of psychosocial interventions for improving functioning in early psychosis. We also sought evidence of superiority between intervention approaches. METHODS An electronic search was conducted using PubMed and PsycINFO to identify original articles reporting on trials of psychosocial interventions in early-stage psychosis, published up to December 2020 and is reported following PRISMA guidelines. Data were extracted on validated measures of functioning from included studies and pooled standardised mean difference (SMD) was estimated. RESULTS In total, 31 studies involving 2811 participants were included, focusing on: cognitive behavioural therapy for psychosis (CBTp), family-based therapy, supported employment, cognitive remediation training (CRT) and multi-component psychosocial interventions. Across interventions, improved function was observed (SMD = 0.239; 95% confidence interval 0.115-0.364, p < 0.001). Effect sizes varied by intervention type, stage of illness, length and duration of treatment and outcome measure used. In particular, interventions based on CRT significantly outperformed symptom-focused CBT interventions, while multi-component interventions were associated with largest gains. CONCLUSIONS Psychosocial interventions, particularly when provided as part of a multi-component intervention model and delivered in community-based settings are associated with significant improvements in social and occupational function. This review underscores the value of sensitively tracking and targeting psychosocial function as part of the standard provided by early intervention services.
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Affiliation(s)
- E. Frawley
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - M. Cowman
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - M. Lepage
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - G. Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
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Haugen I, Stubberud J, Haug E, McGurk SR, Hovik KT, Ueland T, Øie MG. A randomized controlled trial of Goal Management Training for executive functioning in schizophrenia spectrum disorders or psychosis risk syndromes. BMC Psychiatry 2022; 22:575. [PMID: 36031616 PMCID: PMC9420179 DOI: 10.1186/s12888-022-04197-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Executive functioning is essential to daily life and severely impaired in schizophrenia and psychosis risk syndromes. Goal Management Training (GMT) is a theoretically founded, empirically supported, metacognitive strategy training program designed to improve executive functioning. METHODS A randomized controlled parallel group trial compared GMT with treatment as usual among 81 participants (GMT, n = 39 versus Wait List Controls, n = 42) recruited from an early intervention for psychosis setting. Computer generated random allocation was performed by someone independent from the study team and raters post-intervention were unaware of allocation. The primary objective was to assess the impact of GMT administered in small groups for 5 weeks on executive functioning. The secondary objective was to explore the potential of the intervention in influencing daily life functioning and clinical symptoms. RESULTS GMT improved self-reported executive functioning, measured with the Behavior Rating Inventory of Executive Function - Adult version (BRIEF-A), significantly more than treatment as usual. A linear mixed model for repeated measures, including all partial data according to the principle of intention to treat, showed a significant group x time interaction effect assessed immediately after intervention (post-test) and 6 months after intervention (follow-up), F = 8.40, p .005, r .37. Improvement occurred in both groups in objective executive functioning as measured by neuropsychological tests, functional capacity, daily life functioning and symptoms of psychosis rated by clinicians. Self-reported clinical symptoms measured with the Symptoms Check List (SCL-10) improved significantly more after GMT than after treatment as usual, F = 5.78, p .019, r .29. Two participants withdrew due to strenuous testing and one due to adverse effects. CONCLUSIONS GMT had clinically reliable and lasting effects on subjective executive function. The intervention is a valuable addition to available treatment with considerable gains at low cost. TRIAL REGISTRATION Registered at clinicaltrials.gov NCT03048695 09/02/2017.
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Affiliation(s)
- Ingvild Haugen
- Division of Mental Health Care, Innlandet Hospital Trust, P. O. Box 104, 2381 Brumunddal, Norway
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, P.O. Box 4970, Nydalen, 0440 Oslo, Norway
| | - Elisabeth Haug
- Division of Mental Health Care, Innlandet Hospital Trust, P. O. Box 104, 2381 Brumunddal, Norway
| | - Susan R. McGurk
- Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, 930 Commonwealth Avenue, Boston, MA 02215 USA
| | - Kjell Tore Hovik
- Division of Mental Health Care, Innlandet Hospital Trust, P. O. Box 104, 2381 Brumunddal, Norway
- Department of Psychology, Inland Norway University of Applied Sciences, P.O.Box 400, Elverum, Norway
| | - Torill Ueland
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Postboks 4956, Nydalen, 0424 Oslo, Norway
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
- Research Division, Innlandet Hospital Trust, P.O. Box 104, 2381 Brumunddal, Norway
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Gergov V, Milic B, Löffler-Stastka H, Ulberg R, Vousoura E, Poulsen S. Psychological Interventions for Young People With Psychotic Disorders: A Systematic Review. Front Psychiatry 2022; 13:859042. [PMID: 35401253 PMCID: PMC8987205 DOI: 10.3389/fpsyt.2022.859042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Psychotic disorders are commonly accompanied by intense psychological burden, and psychological interventions are usually needed in order to reduce the symptoms and help in maintaining or improving the level of psychological and social functioning after the onset of psychosis. The evidence-base for treating young people at risk for psychosis and adults with psychotic disorders is accumulating. Yet, pervasive systematic literature reviews that would include patients from the full age range being the most essential period for the risk of developing a psychotic disorder, a wide range of psychological interventions, and various types of clinical trials, have been lacking. The aim of this systematic review is to fill the gap by presenting the current research evidence from clinical trials on the effectiveness of psychological interventions for treating young people (12-30) with psychotic disorders. METHODS A systematic search was conducted in PubMed and PsycINFO followed by a 3-step screening process based on the PICOS strategy. Risk of bias of the included studies was assessed by the Mixed Methods Appraisal Tool (MMAT). Extracted data from the included studies is reported using a narrative synthesis. RESULTS Of the 1,449 publications screened, 40 from 25 studies were included in the review. Of these, 10 studies reported results from cognitive or behavioral therapy, nine from cognitive remediation therapy (CRT), and six from other types of therapies (i.e., integrative interventions combining psychoeducation and family/group interventions). All but one study found the target interventions to be effective, but the results mostly did not differ significantly from the control conditions in reducing symptoms and improving functioning, preventing relapses and hospitalization, or improving psychological or family variables. The most consistent findings were from CRT, showing more improvement in cognitive functioning compared to control conditions while not being superior in reducing symptom severity. Integrative interventions might be effective in treating young people suffering from psychotic disorders. CONCLUSION There is some evidence that psychological interventions are effective for young people with psychotic disorders. However, with regard to symptom severity, psychotherapy does not outperform control conditions, and the results do not strongly favor any specific type of treatment. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020166756], identifier [CRD42020166756].
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Affiliation(s)
- Vera Gergov
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- *Correspondence: Vera Gergov,
| | - Branka Milic
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Eleni Vousoura
- Department of Psychiatry, University of Athens, Athens, Greece
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Vita A, Gaebel W, Mucci A, Sachs G, Erfurth A, Barlati S, Zanca F, Giordano GM, Birkedal Glenthøj L, Nordentoft M, Galderisi S. European Psychiatric Association guidance on assessment of cognitive impairment in schizophrenia. Eur Psychiatry 2022; 65:e58. [PMID: 36059109 PMCID: PMC9532219 DOI: 10.1192/j.eurpsy.2022.2316] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Impairment in a wide range of cognitive abilities has been consistently reported in individuals with schizophrenia. Both neurocognitive and social cognitive deficits are thought to underlie severe functional disabilities associated with schizophrenia. Despite the key role in schizophrenia outcome, cognition is still poorly assessed in both research and clinical settings. Methods In this guidance paper, we provide a systematic review of the scientific literature and elaborate several recommendations for the assessment of cognitive functions in schizophrenia both in research settings and in real-world clinical practice. Results Expert consensus and systematic reviews provided guidance for the optimal assessment of cognitive functions in schizophrenia. Based on the reviewed evidence, we recommend a comprehensive and systematic assessment of neurocognitive and social cognitive domains in schizophrenia, in all phases of the disorder, as well as in subjects at risk to develop psychosis. This European Psychiatric Association guidance recommends not only the use of observer reports but also self-reports and interview-based cognitive assessment tools. The guidance also provides a systematic review of the state of the art of assessment in the first episode of psychosis patients and in individuals at risk for psychosis. Conclusion The comprehensive review of the evidence and the recommendations might contribute to advance the field, allowing a better cognitive assessment, and avoiding overlaps with other psychopathological dimensions. The dissemination of this guidance paper may promote the development of shared guidelines concerning the assessment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to obtain recovery.
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Miskowiak KW, Jespersen AE, Kessing LV, Aggestrup AS, Glenthøj LB, Nordentoft M, Ott CV, Lumbye A. Cognition Assessment in Virtual Reality: Validity and feasibility of a novel virtual reality test for real-life cognitive functions in mood disorders and psychosis spectrum disorders. J Psychiatr Res 2021; 145:182-189. [PMID: 34923359 DOI: 10.1016/j.jpsychires.2021.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/08/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
There is a pressing need for measures of real-life cognitive functioning in patients with mood or psychotic disorders in clinical settings and treatment trials targeting cognition. We developed the first immersive virtual reality cognition assessment tool, the Cognition Assessment in Virtual Reality (CAVIR), which assesses verbal memory, processing speed, attention, working memory and planning skills in an interactive virtual reality kitchen scenario. This study investigates the sensitivity and validity of the CAVIR for cognitive impairments in mood and psychotic disorders and its association with functioning and neuropsychological performance. Symptomatically stable patients with mood disorders (MD; n = 40) or psychosis spectrum disorders (PSD; n = 41) and healthy control participants (HC; n = 40) completed the CAVIR and standard neuropsychological tests and were rated for clinical symptoms and daily functioning. We found that the CAVIR was sensitive to cognitive impairments across MD and PSD with large effect sizes (MD: F(73) = 11.61, p < .01, ηp2 = 0.14; PSD: F(72) = 18.24, p < .001, ηp2 = 0.19). There was a moderate to strong positive correlation between performance on the CAVIR and on neuropsychological tests (r(121) = 0.58, p < .001), which prevailed after adjustment for age, years of education and verbal IQ (B = 0.67, p < .001). Lower CAVIR scores correlated moderately with more observer-rated and performance-based functional disability (r(121) = -0.30, p < .01 and r(68) = 0.44, p < .001, respectively), also after adjustment for age, years of education and verbal IQ (B = 0.03, p < .001). In conclusion, the CAVIR is a sensitive and valid instrument for measuring real-life cognitive impairments in mood and psychotic disorders. After further psychometric assessments, the CAVIR can be implemented in clinical settings and trials targeting cognition.
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Affiliation(s)
- Kamilla W Miskowiak
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Andreas E Jespersen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen, Denmark
| | - Anne Sofie Aggestrup
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Louise B Glenthøj
- Copenhagen Research Center for Mental Health (CORE) Copenhagen, Denmark
| | - Merete Nordentoft
- Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen, Denmark; Copenhagen Research Center for Mental Health (CORE) Copenhagen, Denmark
| | - Caroline V Ott
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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11
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Gleeson JFM, Eleftheriadis D, Santesteban-Echarri O, Koval P, Bastian B, Penn DL, Lim MH, Ryan RM, Alvarez-Jimenez M. Positive and meaningful lives: Systematic review and meta-analysis of eudaimonic well-being in first-episode psychosis. Early Interv Psychiatry 2021; 15:1072-1091. [PMID: 33037789 DOI: 10.1111/eip.13049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/13/2020] [Accepted: 09/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND First-episode psychosis typically has its onset during adolescence. Prolonged deficits in social functioning are common in FEP and yet often variance in functioning remains unexplained. Developmental psychology frameworks may be useful for understanding these deficits. Eudaimonic well-being (EWB), or positive self-development, is a developmental psychology construct that has been shown to predict mental health outcomes across multiple populations but has not been systematically reviewed in FEP. AIM Our aim was to systematically review the evidence for: the predictors of EWB, the effectiveness of EWB interventions and to examine the quality of this research in FEP. METHODS Selected studies measured either composite or components of EWB. A systematic search produced 2876 abstracts and 122 articles were identified for full screening which produced 17 final papers with 2459 participants. RESULTS Studies comprised six RCTs, eight prospective follow-up studies and three case-controlled studies. Self-esteem and self-efficacy were the most commonly measured components. A meta-analysis of RCTs revealed no statistically significant effect of interventions on self-esteem. The extant research indicates that character strengths may be associated with higher EWB. Self-esteem may be lower in FEP compared with age matched controls but not different from ultra-high risk patients. Self-esteem appears to be associated with poorer insight and improved therapeutic alliance. Significant problems with both external and internal validity of reviewed studies were apparent. CONCLUSIONS The hypotheses that lowered EWB is a risk factor for both onset of FEP and for poorer functional outcomes warrant further investigation. There is currently no evidence for effective interventions for EWB in FEP.
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Affiliation(s)
- John F M Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Dina Eleftheriadis
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia.,Orygen, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Olga Santesteban-Echarri
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Peter Koval
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brock Bastian
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - David L Penn
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michelle H Lim
- Centre for Mental Health & Iverson Health Research Innovation Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Richard M Ryan
- Department of Psychology, University of Rochester, Rochester, New York, USA.,Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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12
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Loewy R, Fisher M, Ma S, Carter C, Ragland JD, Niendam TA, Stuart B, Schlosser D, Amirfathi F, Yohannes S, Vinogradov S. Durable Cognitive Gains and Symptom Improvement Are Observed in Individuals With Recent-Onset Schizophrenia 6 Months After a Randomized Trial of Auditory Training Completed Remotely. Schizophr Bull 2021; 48:262-272. [PMID: 34510196 PMCID: PMC8781343 DOI: 10.1093/schbul/sbab102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Cognitive impairment in schizophrenia predicts functional outcomes and is largely unresponsive to pharmacology or psychotherapy; it is thus a critical unmet treatment need. This article presents the impact of remotely completed, intensive, targeted auditory training (AT) vs control condition computer games (CG) in a double-blind randomized trial in young adults with recent-onset schizophrenia. METHOD Participants (N = 147) were assessed for cognition, symptoms, and functioning at baseline, post-intervention, and at 6-month follow-up. All participants were provided with laptop computers and were instructed to complete 40 hours remotely of training or computer games. An intent-to-treat analysis (N = 145) was performed using linear mixed models with time modeled as a continuous variable. Planned contrasts tested the change from baseline to post-training, baseline to 6-month follow-up, and post-training to 6-month follow-up. RESULTS Global Cognition, which had improved in the AT group relative to the CG group at post-training, showed durable gains at 6-month follow-up in an omnibus group-by-time interaction test (F(1,179) = 4.80, P = .030), as did Problem-Solving (F(1,179) = 5.13, P = .025), and Speed of Processing improved at trend level significance (F(1,170) = 3.80, P = .053). Furthermore, the AT group showed significantly greater improvement than the CG group in positive symptoms (F(1,179) = 4.06, P = .045). CONCLUSIONS These results provide the first evidence of durable cognitive gains and symptom improvement at follow-up of cognitive training (CT) in early schizophrenia completed independently and remotely. While functioning did not show significant improvement, these findings suggest that intensive targeted CT of auditory processing is a promising component of early intervention to promote recovery from psychosis.
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Affiliation(s)
- Rachel Loewy
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA,To whom correspondence should be addressed; 401 Parnassus Ave, Box 0984-PAR, San Francisco, CA 94143-0984, USA; tel: 415-476-7659, fax: 415-502-6361, e-mail:
| | - Melissa Fisher
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Sisi Ma
- School of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA,Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Cameron Carter
- Department of Psychiatry, University of California, Davis, Davis, CA, USA
| | - J Daniel Ragland
- Department of Psychiatry, University of California, Davis, Davis, CA, USA
| | - Tara A Niendam
- Department of Psychiatry, University of California, Davis, Davis, CA, USA
| | - Barbara Stuart
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Danielle Schlosser
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA,Verily Life Sciences, South San Francisco, CA, USA
| | - Felix Amirfathi
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Seghel Yohannes
- Department of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Sophia Vinogradov
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
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13
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Lajoie MP, Gilbert E, Rouleau N. Effect of non-pharmacological interventions on source memory processes in the early course of psychosis: A systematic review. Early Interv Psychiatry 2021; 15:219-233. [PMID: 32141226 DOI: 10.1111/eip.12951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/20/2019] [Accepted: 01/27/2020] [Indexed: 12/29/2022]
Abstract
UNLABELLED People with a psychotic disorder suffer from major cognitive impairments which prevent their functional recovery. Source memory impairments have been shown to be associated with psychotic symptoms and even to precede their onset. Source memory has thus been hypothesized as a cognitive precursor of psychosis. However, few interventions targeting source memory are included in current therapeutic approaches for early psychosis. AIM This systematic review aimed to identify non-pharmacological interventions for early psychosis which have impacted source memory processes. METHODS Studies were selected from nine databases when they included: (a) a non-pharmacological intervention involving a sample of patients with early-onset psychotic disorder or subclinical psychotic symptoms; and (b) effects on source memory processes, measured directly or inferred through an episodic memory task. RESULTS Thirteen studies were identified, including two cognitive remediation programs and one repetitive transcranial magnetic stimulation treatment that reported beneficial effects on source memory. CONCLUSIONS Relevant intervention strategies for source memory impairments were identified. This review points up a need to further develop interventions targeting theoretically defined source memory concepts and assess their effects with specific and valid tasks. Recommendations regarding underlying mechanisms which could have a beneficial impact on source memory may provide guidance for the future development of early psychosis interventions.
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Affiliation(s)
- Marie-Pier Lajoie
- MANDALAB (Mindfulness AND Attention LAB), CERVO Brain Research Center, Quebec, Canada.,School of Psychology, Laval University, Quebec, Canada
| | - Elsa Gilbert
- Health Sciences Department, University of Quebec in Rimouski, Quebec, Canada
| | - Nancie Rouleau
- MANDALAB (Mindfulness AND Attention LAB), CERVO Brain Research Center, Quebec, Canada.,School of Psychology, Laval University, Quebec, Canada
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14
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Chong NIM, Maniam Y, Chua YC, Tang C. The Implementation and Review of Cognitive Remediation Training for First Episode Psychosis in Singapore. Front Psychiatry 2021; 12:784935. [PMID: 34916979 PMCID: PMC8669156 DOI: 10.3389/fpsyt.2021.784935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/08/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: Early intervention in patients with first episode psychosis (FEP) can improve cognitive abilities, with both short- and long-term benefits. In this paper, we describe the implementation and review of cognitive remediation training (CRT) in an Asian FEP population. The outcomes of the training are also evaluated and discussed. Methods: This naturalistic paper describes in detail the real-life implementation and conduct of CRT in an early psychosis intervention service. One hundred and nine patients with FEP underwent a 24-session CRT programme, using Cogpack and Neuropsychological Educational Approach to Remediation. The program is evaluated with pre- and post-CRT assessment scores which included Montreal Cognitive Assessment and Brief Assessment of Cognition in Schizophrenia. The rates of improvement on these cognitive assessments were evaluated using paired t-tests, with statistical significance set at p ≤ 0.05. Results: Of the 109 patients who underwent CRT, a total of 92 (84.4%) completed all 24 sessions. Paired t-tests between pre- and post-CRT assessments scores revealed that participants significantly improved on majority of the measures, including verbal memory, digit sequencing, and symbol coding. Conclusion: As with other cognitive remediation programmes, CRT has shown to improve cognitive functioning in patients with FEP. The results support the use of CRT in an Asian context and may serve as guidance for the implementation of similar training programmes in other Asian early psychosis intervention services.
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Affiliation(s)
- Nigel Ian Ming Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yogeswary Maniam
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore, Singapore
| | - Yi Chian Chua
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore, Singapore
| | - Charmaine Tang
- Early Psychosis Intervention Program, Institute of Mental Health, Singapore, Singapore
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15
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Thibaudeau E, Raucher-Chéné D, Lecardeur L, Cellard C, Lepage M, Lecomte T. Les interventions psychosociales destinées aux personnes composant avec un premier épisode psychotique : une revue narrative et critique. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088184ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Abstract
BACKGROUND Psychosis is an illness characterised by alterations in thoughts and perceptions resulting in delusions and hallucinations. Psychosis is rare in adolescents but can have serious consequences. Antipsychotic medications are the mainstay treatment, and have been shown to be effective. However, there is emerging evidence on psychological interventions such as cognitive remediation therapy, psycho-education, family therapy and group psychotherapy that may be useful for adolescents with psychosis. OBJECTIVES To assess the effects of various psychological interventions for adolescents with psychosis. SEARCH METHODS We searched the Cochrane Schizophrenia Group's study-based Register of Trials including clinical trials registries (latest, 8 March 2019). SELECTION CRITERIA All randomised controlled trials comparing various psychological interventions with treatment-as-usual or other psychological treatments for adolescents with psychosis. For analyses, we included trials meeting our inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We independently and reliably screened studies and we assessed risk of bias of the included studies. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous data, we used mean differences (MDs) and the 95% CIs. We used a random-effects model for analyses. We created a 'Summary of findings' table using GRADE. MAIN RESULTS The current review includes 7 studies (n = 319) assessing a heterogenous group of psychological interventions with variable risk of bias. Adverse events were not reported by any of the studies. None of the studies was sponsored by industry. Below, we summarise the main results from four of six comparisons, and the certainty of these results (based on GRADE). All scale scores are average endpoint scores. Cognitive Remediation Therapy (CRT) + Treatment-as-Usual (TAU) versus TAU Two studies compared adding CRT to participants' TAU with TAU alone. Global state (CGAS, high = good) was reported by one study. There was no clear difference between treatment groups (MD -4.90, 95% CI -11.05 to 1.25; participants = 50; studies = 1, very low-certainty). Mental state (PANSS, high = poor) was reported by one study. Scores were clearly lower in the TAU group (MD 8.30, 95% CI 0.46 to 16.14; participants = 50; studies = 1; very low-certainty). Clearly more participants in the CRT group showed improvement in cognitive functioning (Memory digit span test) compared to numbers showing improvement in the TAU group (1 study, n = 31, RR 0.58, 95% CI 0.37 to 0.89; very low-certainty). For global functioning (VABS, high = good), our analysis of reported scores showed no clear difference between treatment groups (MD 5.90, 95% CI -3.03 to 14.83; participants = 50; studies = 1; very low-certainty). The number of participants leaving the study early from each group was similar (RR 0.93, 95% CI 0.32 to 2.71; participants = 91; studies = 2; low-certainty). Group Psychosocial Therapy (GPT) + TAU versus TAU One study assessed the effects of adding GPT to participants' usual medication. Global state scores (CGAS, high = good) were clearly higher in the GPT group (MD 5.10, 95% CI 1.35 to 8.85; participants = 56; studies = 1; very low-certainty) but there was little or no clear difference between groups for mental state scores (PANSS, high = poor, MD -4.10, 95% CI -8.28 to 0.08; participants = 56; studies = 1, very low-certainty) and no clear difference between groups for numbers of participants leaving the study early (RR 0.43, 95% CI 0.15 to 1.28; participants = 56; studies = 1; very low-certainty). Cognitive Remediation Programme (CRP) + Psychoeducational Treatment Programme (PTP) versus PTP One study assessed the effects of combining two types psychological interventions (CRP + PTP) with PTP alone. Global state scores (GAS, high = good) were not clearly different (MD 1.60, 95% CI -6.48 to 9.68; participants = 25; studies = 1; very low-certainty), as were mental state scores (BPRS total, high = poor, MD -5.40, 95% CI -16.42 to 5.62; participants = 24; studies = 1; very low-certainty), and cognitive functioning scores (SPAN-12, high = good, MD 2.40, 95% CI -2.67 to 7.47; participants = 25; studies = 1; very low-certainty). Psychoeducational (PE) + Multifamily Treatment (MFT) Versus Nonstructured Group Therapy (NSGT, all long-term) One study compared (PE + MFT) with NSGT. Analysis of reported global state scores (CGAS, high = good, MD 3.38, 95% CI -4.87 to 11.63; participants = 49; studies = 1; very low-certainty) and mental state scores (PANSS total, high = poor, MD -8.23, 95% CI -17.51 to 1.05; participants = 49; studies = 1; very low-certainty) showed no clear differences. The number of participants needing hospital admission (RR 0.84, 95% CI 0.36 to 1.96; participants = 49; studies = 1) and the number of participants leaving the study early from each group were also similar (RR 0.52, 95% CI 0.10 to 2.60; participants = 55; studies = 1; low-certainty). AUTHORS' CONCLUSIONS Most of our estimates of effect for our main outcomes are equivocal. An effect is suggested for only four outcomes in the SOF tables presented. Compared to TAU, CRT may have a positive effect on cognitive functioning, however the same study reports data suggesting TAU may have positive effect on mental state. Another study comparing GPT with TAU reports data suggesting GPT may have a positive effect on global state. However, the estimate of effects for all the main outcomes in our review should be viewed with considerable caution as they are based on data from a small number of studies with variable risk of bias. Further data could change these results and larger and better quality studies are needed before any firm conclusions regarding the effects of psychological interventions for adolescents with psychosis can be made.
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Affiliation(s)
- Soumitra S Datta
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Rhea Daruvala
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Ajit Kumar
- Latrobe Regional Hospital, Victoria, Australia
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17
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Allott K, van-der-EL K, Bryce S, Parrish EM, McGurk SR, Hetrick S, Bowie CR, Kidd S, Hamilton M, Killackey E, Velligan D. Compensatory Interventions for Cognitive Impairments in Psychosis: A Systematic Review and Meta-Analysis. Schizophr Bull 2020; 46:869-883. [PMID: 32052837 PMCID: PMC7345816 DOI: 10.1093/schbul/sbz134] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Cognitive compensatory interventions aim to alleviate psychosocial disability by targeting functioning directly using aids and strategies, thereby minimizing the impact of cognitive impairment. The aim was to conduct a systematic review and meta-analysis of cognitive compensatory interventions for psychosis by examining the effects on functioning and symptoms, and exploring whether intervention factors, study design, and age influenced effect sizes. METHODS Electronic databases (Ovid Medline, PsychINFO) were searched up to October 2018. Records obtained through electronic and manual searches were screened independently by two reviewers according to selection criteria. Data were extracted to calculate estimated effects (Hedge's g) of treatment on functioning and symptoms at post-intervention and follow-up. Study quality was assessed using Cochrane Collaboration's risk of bias tool. RESULTS Twenty-six studies, from 25 independent randomized controlled trials (RCTs) were included in the meta-analysis (1654 participants, mean age = 38.9 years, 64% male). Meta-analysis revealed a medium effect of compensatory interventions on functioning compared to control conditions (Hedge's g = 0.46, 95% CI = 0.33, 0.60, P < .001), with evidence of relative durability at follow-up (Hedge's g = 0.36, 95% CI = 0.19, 0.54, P < .001). Analysis also revealed small significant effects of cognitive compensatory treatment on negative, positive, and general psychiatric symptoms, but not depressive symptoms. Estimated effects did not significantly vary according to treatment factors (ie, compensatory approach, dosage), delivery method (ie, individual/group), age, or risk of bias. Longer treatment length was associated with larger effect sizes for functioning outcomes. No evidence of publication bias was identified. CONCLUSION Cognitive compensatory interventions are associated with robust, durable improvements in functioning in people with psychotic illnesses.
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Affiliation(s)
- Kelly Allott
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia,To whom correspondence should be addressed; 35 Poplar Road, Parkville, VIC, 3052, Australia; tel: +3 9966 9423, e-mail:
| | - Kristi van-der-EL
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Shayden Bryce
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Emma M Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA
| | - Susan R McGurk
- Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, MA
| | - Sarah Hetrick
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia,Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | | | - Sean Kidd
- Department of Psychiatry, University of Toronto, Toronto, Ontario, ON, Canada
| | - Matthew Hamilton
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Eoin Killackey
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Dawn Velligan
- Department of Psychiatry, University of Texas Health Science Centre, San Antonio, TX
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18
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García-Fernández L, Cabot-Ivorra N, Rodríguez-García V, Pérez-Martín J, Dompablo M, Pérez-Gálvez B, Rodriguez-Jimenez R. Computerized cognitive remediation therapy, REHACOM, in first episode of schizophrenia: A randomized controlled trial. Psychiatry Res 2019; 281:112563. [PMID: 31525673 DOI: 10.1016/j.psychres.2019.112563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
Abstract
Patients with schizophrenia show cognitive impairments that have been linked to poor social functioning. Computerized cognitive remediation therapy has shown to be effective in improving both cognition and functioning in chronic schizophrenia, but relatively little is known about how these approaches improve cognition and functioning when applied to early stages of psychosis. Eighty-six participants with a first episode of psychosis, undergoing a specific program for early stages of schizophrenia, undertook either the REHACOM computerized cognitive remediation intervention (n = 36), or an active control condition (n = 50) consisting in 24 one-hour sessions addressed twice a week. Clinical features, cognition and functioning were assessed at baseline, post-treatment and six months after finishing the intervention. A significant progressive improvement in neurocognition and functioning was globally shown with no differences observed between the experimental and control group at post training or follow up. All cognitive domains but Social Cognition improved between 0.5 and 1 S.D. through the study period. The computerized cognitive remediation therapy REHACOM has not proved to be effective on improving cognition nor functioning compared to controls in outpatients with a first episode of schizophrenia.
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Affiliation(s)
- Lorena García-Fernández
- Department of Clinical Medicine, Universidad Miguel Hernández, Edificio Muhammad Al-Shafra, Campus de San Juan, Ctra. De Valencia, Km 87, 03550 San Juan, Alicante, Spain; Department of Psychiatry, Hospital Universitario de San Juan, Alicante, Ctra. Nacional. 332, s/n, 03550 San Juan, Alicante, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
| | - Nuria Cabot-Ivorra
- Doctoral School, Universidad Católica de Valencia San Vicente Mártir, C/Guillem de Castro, 65 bajo, 46008 Valencia, Spain
| | - Victoria Rodríguez-García
- Department of Psychiatry, Hospital Universitario de San Juan, Alicante, Ctra. Nacional. 332, s/n, 03550 San Juan, Alicante, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, KCL.16 De Crespigny Park, Camberwell, London SE5 8AF, UK
| | - Jorge Pérez-Martín
- Department of Psychiatry, Hospital Universitario de San Juan, Alicante, Ctra. Nacional. 332, s/n, 03550 San Juan, Alicante, Spain
| | - Mónica Dompablo
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas 12), Av. Córdoba s/n, 28041, Madrid, Spain
| | - Bartolomé Pérez-Gálvez
- Department of Clinical Medicine, Universidad Miguel Hernández, Edificio Muhammad Al-Shafra, Campus de San Juan, Ctra. De Valencia, Km 87, 03550 San Juan, Alicante, Spain
| | - Roberto Rodriguez-Jimenez
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas 12), Av. Córdoba s/n, 28041, Madrid, Spain; CogPsy-Group, Universidad Complutense (UCM), Madrid, Spain.
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19
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Miley K, Hadidi N, Kaas M, Yu F. Cognitive Training and Remediation in First-Episode Psychosis: A Literature Review. J Am Psychiatr Nurses Assoc 2019; 26:542-554. [PMID: 31578909 PMCID: PMC7863980 DOI: 10.1177/1078390319877952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Neurocognitive and social cognitive impairments are core characteristics of psychotic disorders, which are present in the first episode of psychosis (FEP) and strongly predict poor social functioning. Addressing cognitive impairments through cognitive training and remediation (CTR) may be a crucial component of recovery-oriented treatment. AIMS: The objectives of this review were to (1) evaluate the CTR theoretical basis and intervention components and (2) examine the effects of CTR on cognition and social functioning in FEP. METHOD: A combined search of Ovid Medline, Embase, and Psych Info databases was conducted using keywords. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quality and risk of bias were assessed using established instruments. RESULTS: Ten randomized controlled trials were included in this review and had an overall fair to poor quality. CTR interventions in FEP utilize a range of theoretical backgrounds, with most including a focus on higher order cognitive processes. Varied doses and intervention components are used. All but one study found improvements in at least one cognitive domain. Global cognition, verbal learning, and memory and executive function were most commonly improved. Three studies found an effect on a range of functional outcomes. CONCLUSIONS: A broad range of CTR interventions have promising effects for addressing cognitive impairments in FEP. Evidence of functional impact is less consistent. Further research is needed in FEP on CTR targeting sensory and perceptual processes, and to identify CTR intervention targets and treatment components that will lead to robust improvements in cognition and functioning.
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Affiliation(s)
- Kathleen Miley
- Kathleen Miley, MSN, PMHNP-BC, University of Minnesota, Minneapolis, MN, USA
| | - Niloufar Hadidi
- Niloufar Hadidi, PhD, APRN, University of Minnesota, Minneapolis, MN, USA
| | - Merrie Kaas
- Merrie Kaas, PhD, PMHCNS-BC, University of Minnesota, Minneapolis, MN, USA
| | - Fang Yu
- Fang Yu, PhD, GNP-BC, University of Minnesota, Minneapolis, MN, USA
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20
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Rammou A, Fisher HL, Johnson S, Major B, Rahaman N, Chamberlain-Kent N, Stone JM. Negative symptoms in first-episode psychosis: Clinical correlates and 1-year follow-up outcomes in London Early Intervention Services. Early Interv Psychiatry 2019; 13:443-452. [PMID: 29148264 DOI: 10.1111/eip.12502] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
Abstract
AIM Negative symptoms (NS) have been associated with poor outcome and remain difficult to treat in patients with psychosis. This study examined the association of NS with clinical features at first presentation to mental health services for psychosis and with outcomes at 1-year follow-up. METHODS Clinical data were utilized from five London Early Intervention Services (EIS) included in the MiData audit database. The sample comprised 484 first-episode psychosis patients with complete Positive and Negative Syndrome Scale data at baseline and 1-year follow-up. Multiple imputation (N = 50) was conducted to account for missing follow-up data. RESULTS Baseline NS were associated with male gender (B = -1.63, P < .05), younger age at onset (B = -.15, P <. 05), a higher level of impairment on the Global Assessment of Functioning (disability) Scale at baseline (B = -.19, P <. 010), an absence of reported substance misuse prior to baseline assessment (B = -3.05, P <. 001) and unemployment at baseline (B = -.93, P <. 01). At 1-year follow-up, NS at presentation were associated with worse Global Assessment of Functioning Scale for symptom (B = -.28, P < .01) and disability (B = -.27, P <. 05) and with hospital admission (OR = 1.06, P < .01). CONCLUSIONS Negative symptoms at presentation to EIS were associated with worse functioning at entry and poorer outcomes 1 year later. Future research is required to better understand the aetiology and trajectories of NS in early psychosis and propose novel targeted interventions.
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Affiliation(s)
- Aikaterini Rammou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Helen L Fisher
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Barnaby Major
- EQUIP, Hackney, East London NHS Foundation Trust, London, UK.,Herefordshire Early Intervention Service, 2gether NHS Foundation Trust, Hereford, UK
| | - Nikola Rahaman
- Kensington, Chelsea, Westminster and Brent Early Intervention Service, Central & North West London NHS Foundation Trust, London, UK
| | - Nick Chamberlain-Kent
- Wandsworth Early Intervention Service, South West London & St Georges' Mental Health NHS Trust, London, UK
| | - James M Stone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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21
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Teigset CM, Mohn C, Brunborg C, Juuhl-Langseth M, Holmén A, Rund BR. Do clinical characteristics predict the cognitive course in early-onset schizophrenia-spectrum disorders? J Child Psychol Psychiatry 2018; 59:1012-1023. [PMID: 29573345 DOI: 10.1111/jcpp.12896] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Being in a period with extensive brain maturation, adolescents with early-onset schizophrenia-spectrum disorders (EOS) provide unique neurodevelopmental data that may contribute to a better understanding of schizophrenia at all ages. Cognitive dysfunction is a central feature of schizophrenia and is more pronounced in EOS than in later onset illness. However, there is limited research on both the long-term course of global cognition in EOS, and how cognition over time is influenced by clinical characteristics during the early illness period. METHODS Thirty-one EOS patients and 73 controls (age 12-18) were assessed on clinical variables at baseline (PANSS, duration of untreated psychosis [DUP], hospitalizations, suicide attempts, and remission). Neuropsychological assessments with the MATRICS Consensus Cognitive Battery (MCCB) were conducted at baseline and after both 1 and 2 years, and composite scores of total performances were calculated. The analyses were performed with a linear mixed model. RESULTS The present study found that global cognition followed a stable course over the first years of the disease in EOS, though at a significantly lower level in EOS compared with the controls. We did not detect a relationship between DUP, remission, positive/negative symptoms, and hospitalizations on one hand, and long-term cognition on the other hand, but PANSS-general and suicide attempt history at baseline were identified as risk factors of longitudinal cognitive function. CONCLUSIONS Though at different levels, the EOS group and the controls had a similar cognitive course over 2 years. Some baseline characteristics (psychotic symptoms, DUP, remission, and hospitalization) had no influence on cognition within the first 2 years of illness. In contrast, general symptoms and a history of suicide attempts at baseline were more potent risk factors of the cognitive course than the psychotic-specific symptoms, and should, therefore, be subject to specific attention in the evaluation and treatment of patients with early-onset psychosis.
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Affiliation(s)
| | - Christine Mohn
- Research Department, Vestre Viken Hospital Trust, Drammen, Norway
| | | | | | - Aina Holmén
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Bjørn Rishovd Rund
- Research Department, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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22
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Read H, Roush S, Downing D. Early Intervention in Mental Health for Adolescents and Young Adults: A Systematic Review. Am J Occup Ther 2018; 72:7205190040p1-7205190040p8. [DOI: 10.5014/ajot.2018.033118] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. The purpose of this systematic review was to describe the evidence for the effectiveness of early intervention to improve and maintain performance in occupations for youths with or at risk for serious mental illness (SMI).
METHOD. Titles and abstracts of 670 articles were reviewed, 234 were retrieved for full review, and 30 met inclusion criteria.
RESULTS. Moderate to strong evidence supports cognitive remediation (CR) and mixed evidence supports cognitive–behavioral therapy (CBT) as an adjunct modality to improve general functioning. Moderate to strong evidence supports use of supported employment and supported education (SE/E) to improve social and occupational outcomes in employment and academics. Strong evidence supports family psychoeducation (FPE) to prevent relapse and rehospitalization and improve problem-solving skills and general functioning.
CONCLUSION. Occupational therapy practitioners should integrate CR, SE/E, and FPE into early intervention with youth with or at risk for SMI. In addition, CBT is an effective modality for use with this population.
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Affiliation(s)
- Halley Read
- Halley Read, MOT, OTR/L, QMHP, is Clinical Assistant Professor, School of Occupational Therapy, Pacific University, Forest Grove, OR;
| | - Sean Roush
- Sean Roush, OTD, OTR/L, QMHP, is Associate Professor, School of Occupational Therapy, Pacific University, Forest Grove, OR
| | - Donna Downing
- Donna Downing, MS, OTR/L, is Family Psychoeducation Consultant, Maine Medical Center, Portland
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23
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Mohn C, Torgalsbøen AK. Details of attention and learning change in first-episode schizophrenia. Psychiatry Res 2018; 260:324-330. [PMID: 29227896 DOI: 10.1016/j.psychres.2017.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/11/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Abstract
Impaired attention and learning functions are common in schizophrenia. The details of this impairment, and how these change across time, are not well known. We aimed to compare the parameters of well-known attention and learning neuropsychological tests in first-episode schizophrenia (FES) patients and healthy controls in a 2-year follow-up period. The performance of 28-25 FES patients and pairwise matched healthy controls on the Continuous Performance Test-Identical Pairs, the revised Hopkins Verbal Learning Test, and the revised Brief Visuospatial Memory Test was compared at baseline and 2 years later. The attention dysfunction of the FES group was driven by slow reaction time and a comparative failure to identify correct hits. The reaction time was reduced somewhat across time in the patient group. Regarding the learning tasks, both groups increased their number of correct answers across trials. However, at each trial, the patient group exhibited lower scores, with a trend towards better visual learning performance across time. In summary, the FES patients were impaired in most of the parameters of the attention and learning tasks. Across time, modest improvements in reaction time and visual learning were displayed in the FES group. However, this group never caught up with the control group.
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Affiliation(s)
- Christine Mohn
- Research Department, Vestre Viken Hospital Trust, Wergelands gate 10, 3005 Drammen, Norway.
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24
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Cognitive remediation and occupational outcome in schizophrenia spectrum disorders: A 2year follow-up study. Schizophr Res 2017; 185:122-129. [PMID: 28041917 DOI: 10.1016/j.schres.2016.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 01/31/2023]
Abstract
Neurocognitive impairment is prominent in schizophrenia and a significant predictor of poor occupational outcomes. Vocational rehabilitation (VR) is frequently implemented to counteract high unemployment rates. Individuals with schizophrenia however face numerous challenges such as neurocognitive impairments and psychotic symptoms. Hence, augmenting VR to address illness-related factors may optimize occupational outcomes. The aim of this study was to examine the effects of Cognitive Remediation (CR) combined with VR(CR+VR) compared to techniques from Cognitive Behavioral Therapy (CBT) combined with VR(CBT+VR) on neurocognition and occupational functioning over a 2year period. A total of 131participants underwent assessment with the MATRICS Consensus Cognitive Battery (MCCB) at baseline, post treatment (after 10months) and follow-up (2years after randomization). Occupational status and number of hours worked were recorded at all assessment points. Both groups improved on several neurocognitive domains. All improvements were however in favor of the CR group. There was a significant increase in number of participants working and hours worked in both groups throughout the project period, with no between-group differences. Number of hours worked at follow-up was predicted by change in Working Memory and the Composite Score in the CR group. CR-augmented VR improved several domains, particularly Verbal Learning and Working Memory, which were central in the CR program. The combination of VR and CR or CBT thus enabled a significant proportion of participants to attain and maintain work.
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25
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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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26
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Cella M, Preti A, Edwards C, Dow T, Wykes T. Cognitive remediation for negative symptoms of schizophrenia: A network meta-analysis. Clin Psychol Rev 2016; 52:43-51. [PMID: 27930934 DOI: 10.1016/j.cpr.2016.11.009] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/01/2016] [Accepted: 11/22/2016] [Indexed: 01/15/2023]
Abstract
Cognitive remediation (CR) is a treatment targeting cognitive difficulties in people with schizophrenia. Recent research suggested that CR may also have a positive effect on negative symptoms. This meta-analysis investigates the effect of CR on negative symptoms. A systematic search was used to identify all randomized-controlled trials of CR in people with schizophrenia reporting negative symptoms outcomes. Levels of negative symptoms at baseline, post-therapy and follow-up, sample demographics and treatment length were extracted. Study methodological quality and heterogeneity were addressed. Negative symptoms standardized mean change was calculated using Hedges's g and used as the main outcome. The search identified 45 studies reporting results for 2511 participants; 15 studies reported follow-up outcomes. CR was associated with a reduction of negative symptoms (most conservative model g=-0.30; 95% CI: -0.36, -0.22) at post-therapy compared with treatment as usual and this effect was larger at follow-up (g=-0.36; 95% CI: -0.51, -0.21). Drop-out rate was comparable between conditions. Network meta-analysis confirmed CR was superior to TAU and TAU plus active control or adjunctive treatment. No evidence of publication bias was found. Studies with more rigorous methodology were associated with larger negative symptom reduction (g=-0.40; 95% CI: -0.51 to -0.30). Although negative symptoms have not been considered a primary target for CR, this intervention can have small to moderate beneficial effects on this symptom cluster. Future research should explore in detail the active mechanisms responsible for negative symptom reduction and the relationship between cognitive and negative symptoms in schizophrenia.
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Affiliation(s)
- Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | - Antonio Preti
- Genneruxi Medical Center, Cagliari, Italy; Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy
| | - Clementine Edwards
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Tabitha Dow
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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27
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Balon R. Clinical factor 2014. PSYCHOTHERAPY AND PSYCHOSOMATICS 2016; 84:330-8. [PMID: 26398921 DOI: 10.1159/000439224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/06/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Richard Balon
- Departments of Psychiatry and Behavioral Neurosciences and of Anesthesiology, Wayne State University School of Medicine, Detroit, Mich., USA
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28
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Abstract
The development of cognitive remediation programs has been a key step toward the creation of a treatment approach to address the cognitive-symptom domain in psychosis. Studies support the efficacy of cognitive remediation in producing moderate effects on cognition at the group level in patients with schizophrenia. Cognitive remediation may harness neuroplasticity in relevant systems that underpin the cognitive functions being addressed. Since neuroplasticity may be greater in people who (1) are younger and (2) have not yet experienced the consequences of long-term psychosis, cognitive remediation may be particularly effective in people in the early course of illness or in the prodrome, prior to the onset of frank symptoms. The present article reviews the evidence for implementing cognitive remediation in patients with recent-onset psychosis and people identified as being at high risk for developing schizophrenia, and also the evidence for cognitive remediation to modify neural targets. Promising findings suggest that cognitive remediation may be useful in addressing cognitive deficits in early-course and prodromal participants. Additionally, a growing literature using neuroimaging techniques demonstrates the ability of cognitive remediation paradigms to engage neural targets.
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29
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Roche E, Segurado R, Renwick L, McClenaghan A, Sexton S, Frawley T, Chan CK, Bonar M, Clarke M. Language disturbance and functioning in first episode psychosis. Psychiatry Res 2016; 235:29-37. [PMID: 26699880 DOI: 10.1016/j.psychres.2015.12.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/19/2015] [Accepted: 12/08/2015] [Indexed: 12/11/2022]
Abstract
Language disturbance has a central role in the presentation of psychotic disorders however its relationship with functioning requires further clarification, particularly in first episode psychosis (FEP). Both language disturbance and functioning can be evaluated with clinician-rated and performance-based measures. We aimed to investigate the concurrent association between clinician-rated and performance-based measures of language disturbance and functioning in FEP. We assessed 108 individuals presenting to an Early Intervention in Psychosis Service in Ireland. Formal thought disorder (FTD) dimensions and bizarre idiosyncratic thinking (BIT) were rated with structured assessment tools. Functioning was evaluated with a performance-based instrument, a clinician-rated measure and indicators of real-world functioning. The disorganisation dimension of FTD was significantly associated with clinician-rated measures of occupational and social functioning (Beta=-0.19, P<0.05 and Beta=-0.31, P<0.01, respectively). BIT was significantly associated with the performance-based measure of functioning (Beta=-0.22, P<0.05). Language disturbance was of less value in predicting real-world measures of functioning. Clinician-rated and performance-based assessments of language disturbance are complementary and each has differential associations with functioning. Communication disorders should be considered as a potential target for intervention in FEP, although further evaluation of the longitudinal relationship between language disturbance and functioning should be undertaken.
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Affiliation(s)
- Eric Roche
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland.
| | - Ricardo Segurado
- UCD CSTAR, School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin, Ireland.
| | - Laoise Renwick
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland; School of Nursing, Midwifery and Social Work, University of Manchester, UK.
| | - Aisling McClenaghan
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland.
| | - Sarah Sexton
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland.
| | - Timothy Frawley
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland.
| | - Carol K Chan
- School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland.
| | - Maurice Bonar
- School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland.
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland.
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30
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Maniam Y, Kumaran P, Lee YP, Koh J, Subramaniam M. The journey of young people in an early psychosis program involved in participatory photography. Br J Occup Ther 2016. [DOI: 10.1177/0308022615621567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The purpose of this study was to examine the experiences and perceptions of young people in an early psychosis program towards participating in a 10-week photovoice and exhibition project and the themes that had emerged from their photographs. Method Photographs create meanings and participants are able to tell their stories in a meaningful way. Eleven clients who had gone through a prior 10-week photovoice project and exhibition consented to being interviewed for this study. Clients chose and brought to the interview photos of theirs that had been exhibited. Structured questions were asked to generate discussions. Findings Findings illustrated that participants were keen to educate the general public on mental health issues. They craved acceptance and were keen to make connections and build relationships. They were their own agents of change. Supportive networks create hope, which in turn helps people with mental health issues to reframe their outlook. Conclusion The results of this study are important and provide occupational therapists with another tool for intervention and advocacy. As both photovoice and occupational therapy focus on the process rather than the product, occupational therapists can utilize photography in groups creatively to generate more client- and peer-led discussions.
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Affiliation(s)
- Yogeswary Maniam
- Senior Occupational Therapist, Early Psychosis Intervention Program, Institute of Mental Health, Singapore
| | - Pushpa Kumaran
- Senior Case Manager and Team Leader, Early Psychosis Intervention Program, Institute of Mental Health, Singapore
| | - Yi Ping Lee
- Senior Case Manager, Early Psychosis Intervention Program, Institute of Mental Health, Singapore
| | - Jennifer Koh
- Co-founder and Executive Director of Photovoice SG, Singapore
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31
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Rund BR, Barder HE, Evensen J, Haahr U, Hegelstad WTV, Joa I, Johannessen JO, Langeveld J, Larsen TK, Melle I, Opjordsmoen S, Røssberg JI, Simonsen E, Sundet K, Vaglum P, McGlashan T, Friis S. Neurocognition and Duration of Psychosis: A 10-year Follow-up of First-Episode Patients. Schizophr Bull 2016; 42:87-95. [PMID: 26101305 PMCID: PMC4681546 DOI: 10.1093/schbul/sbv083] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A substantial proportion of schizophrenia-spectrum patients exhibit a cognitive impairment at illness onset. However, the long-term course of neurocognition and a possible neurotoxic effect of time spent in active psychosis, is a topic of controversy. Furthermore, it is of importance to find out what predicts the long-term course of neurocognition. Duration of untreated psychosis (DUP), accumulated time in psychosis the first year after start of treatment, relapse rates and symptoms are potential predictors of the long-term course. In this study, 261 first-episode psychosis patients were assessed neuropsychologically on one or more occasions. Patients were tested after remission of psychotic symptoms and reassessed 1, 2, 5, and 10 years after inclusion. The neurocognitive battery consisted of California Verbal Learning Test, Wisconsin Card Sorting Test, Controlled Oral Word Association Task, Trail Making A and B, and Finger Tapping. We calculated a composite score by adding the z-scores of 4 tests that were only moderately inter-correlated, not including Finger Tapping. Data were analyzed by a linear mixed model. The composite score was stable over 10 years. No significant relationship between psychosis before (DUP) or after start of treatment and the composite score was found, providing no support for the neurotoxicity hypothesis, and indicating that psychosis before start of treatment has no significant impact on the course and outcome in psychosis. We found no association between symptoms and the neurocognitive trajectory. Stable remission during the first year predicted neurocognitive functioning, suggesting that the early clinical course is a good predictor for the long-term course.
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Affiliation(s)
- Bjørn Rishovd Rund
- Vestre Viken Hospital Trust, Drammen, Norway; Department of Psychology, University of Oslo, Oslo, Norway;
| | | | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ulrik Haahr
- Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Roskilde, Denmark;,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Wenche ten Velden Hegelstad
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Science,University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Science,University of Stavanger, Stavanger, Norway
| | - Johannes Langeveld
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway
| | - Tor Ketil Larsen
- Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway;,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Institute of Clinical Medicine, University of Oslo, Oslo, Norway;,NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | | | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Simonsen
- Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Roskilde, Denmark;,Psychiatric Research Unit, Psychiatry Region Zealand, Roskilde, Denmark
| | - Kjetil Sundet
- Department of Psychology, University of Oslo, Oslo, Norway;,NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Thomas McGlashan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Svein Friis
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Cognitive course in first-episode psychosis and clinical correlates: A 4 year longitudinal study using the MATRICS Consensus Cognitive Battery. Schizophr Res 2015; 169:101-108. [PMID: 26416442 DOI: 10.1016/j.schres.2015.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/13/2015] [Accepted: 09/04/2015] [Indexed: 11/22/2022]
Abstract
While cognitive impairments are prevalent in first-episode psychosis, the course of these deficits is not fully understood. Most deficits appear to remain stable, however there is uncertainty regarding the trajectory of specific cognitive domains after illness onset. This study investigates the longitudinal course of cognitive deficits four years after a first-episode of psychosis and the relationship of performance with clinical course and response to treatment. Twenty three individuals with psychotic illness, matched with 21 healthy volunteers, were assessed using the MATRICS Consensus Cognitive Battery at illness onset and 4 years later. We also investigated the relationship between cognitive deficits and quality of life and clinical indices. Verbal learning and two measures of processing speed had marked poorer trajectory over four years compared to the remaining cognitive domains. Processing speed performance was found to contribute to the cognitive deficits in psychosis. Poorer clinical outcome was associated with greater deficits at illness onset in reasoning and problem solving and social cognition. Cognitive deficits did not predict quality of life at follow-up, nor did diagnosis subtype differentiate cognitive performance. In conclusion, an initial psychotic episode may be associated with an additional cost on verbal learning and two measures of processing speed over a time spanning at least four years. Moreover, processing speed, which has been manipulated through intervention in previous studies, may represent a viable therapeutic target. Finally, cognition at illness onset may have a predictive capability of illness course.
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Revell ER, Neill JC, Harte M, Khan Z, Drake RJ. A systematic review and meta-analysis of cognitive remediation in early schizophrenia. Schizophr Res 2015; 168:213-22. [PMID: 26305063 DOI: 10.1016/j.schres.2015.08.017] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 07/06/2015] [Accepted: 08/12/2015] [Indexed: 12/14/2022]
Abstract
Neurocognitive impairment predicts disability in schizophrenia, making intervention theoretically attractive as a means to minimise chronic disability. Many trials confirm that cognitive remediation (CR) produces meaningful, durable improvements in cognition and functioning but fewer focus on the early stages. We systematically reviewed CR trials in early schizophrenia to determine its efficacy on global cognition, functioning and symptoms. Two reviewers independently searched electronic databases to identify randomised controlled trials investigating CR following a first episode of psychosis. Eleven trials with 615 participants were identified. Random effect models revealed a non-significant effect of CR on global cognition (effect size=0.13, 95% CI -0.04, 0.31; p0.14), p<0.05 in sensitivity analysis (effect size 0.19; CI 0.00, 0.38). One of seven neurocognitive domains showed a significant positive effect (verbal learning and memory) and five others showed borderline significant benefits. There was a significant effect on functioning (0.18; CI 0.01, 0.36; p<0.05) and symptoms (0.19; CI 0.02, 0.36; p<0.05). CR's effect on functioning and symptoms was larger in trials with adjunctive psychiatric rehabilitation and small group interventions. CR's effect sizes in early illness were smaller than those in chronic schizophrenia, perhaps because of participants' reduced scope for improvement, though trials' small number and size produces uncertain estimates of effect. However, significant benefits were seen in functioning and symptoms and moderator analyses indicate factors that may increase CR's effect. Findings here, theoretical considerations and trials in chronic schizophrenia suggest that targeting social cognition might also enhance its efficacy.
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Affiliation(s)
- Emily R Revell
- School of Pharmacy, University of Manchester, M13 9PT, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK
| | - Jo C Neill
- School of Pharmacy, University of Manchester, M13 9PT, UK
| | - Michael Harte
- School of Pharmacy, University of Manchester, M13 9PT, UK
| | - Zarshed Khan
- Manchester Mental Health & Social Care NHS Trust, Manchester, M21 9UN, UK
| | - Richard J Drake
- Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK; Manchester Mental Health & Social Care NHS Trust, Manchester, M21 9UN, UK.
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Ahmed AO, Hunter KM, Goodrum NM, Batten NJ, Birgenheir D, Hardison E, Dixon T, Buckley PF. A randomized study of cognitive remediation for forensic and mental health patients with schizophrenia. J Psychiatr Res 2015; 68:8-18. [PMID: 26228394 DOI: 10.1016/j.jpsychires.2015.05.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/14/2015] [Accepted: 05/21/2015] [Indexed: 01/07/2023]
Abstract
Cognitive remediation has proven efficacy for improving neurocognition in people with schizophrenia. The current study evaluated the benefits of cognitive remediation on neurocognition, functioning, psychotic symptoms, and aggression in a sample of forensic and mental health patients. Care recipients with schizophrenia or schizoaffective disorder (N = 78) receiving services in the forensic and mental health units of a state hospital were randomized to participate in cognitive remediation versus computer games control activities. Participants' neurocognition, functional capacity, experiential recovery, psychotic symptoms, and aggression incidents were assessed at baseline and posttreatment. Cognitive remediation was associated with improvements in several neurocognitive domains and circumscribed domains of functional capacity. People assigned to cognitive remediation experiences greater reductions in negative symptoms, agitation/excitement, and verbal and physical aggression. In addition to improving neurocognition in long-term hospitalized forensic and mental health patients, cognitive remediation may enhance efforts at reducing negative symptoms, emotion dysregulation, and aggression incidents. Forensic settings may represent a new frontier for the clinical dissemination of cognitive remediation.
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Affiliation(s)
- Anthony O Ahmed
- Department of Psychiatry, Weill Cornell Medical College, USA; Department of Psychiatry and Health Behavior, Georgia Regents University, USA.
| | - Kristin M Hunter
- Department of Counseling and Human Development Services, University of Georgia, USA
| | | | | | | | | | - Thaddeus Dixon
- School of Nursing, Emory University, USA; Department of Psychology, East Central Regional Hospital, USA
| | - Peter F Buckley
- Department of Psychiatry and Health Behavior, Georgia Regents University, USA
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35
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Cognitive intervention in early psychosis — preserving abilities versus remediating deficits. Curr Opin Behav Sci 2015. [DOI: 10.1016/j.cobeha.2015.02.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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36
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Ciufolini S, Morgan C, Morgan K, Fearon P, Boydell J, Hutchinson G, Demjaha A, Girardi P, Doody GA, Jones PB, Murray R, Dazzan P. Self esteem and self agency in first episode psychosis: Ethnic variation and relationship with clinical presentation. Psychiatry Res 2015; 227:213-8. [PMID: 25868868 DOI: 10.1016/j.psychres.2015.03.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 02/28/2015] [Accepted: 03/03/2015] [Indexed: 11/15/2022]
Abstract
The impact of self esteem and Locus of Control (LoC) on clinical presentation across different ethnic groups of patients at their first psychotic episode (FEP) remains unknown. We explored these constructs in 257 FEP patients (Black n=95; White British n=119) and 341 controls (Black n=70; White British n=226), and examined their relationship with symptom dimensions and pathways to care. FEP patients presented lower self-esteem and a more external LoC than controls. Lower self esteem was associated with a specific symptoms profile (more manic and less negative symptoms), and with factors predictive of poorer outcome (longer duration of untreated psychosis (DUP) and compulsory mode of admission). A more external LoC was associated with more negative symptoms and an insidious onset. When we explored these constructs across different ethnic groups, we found that Black patients had significantly higher self esteem than White British. This was again associated with specific symptom profiles. While British patients with lower self esteem were more likely to report delusions, hallucinations and negative symptoms, Black patients with a lower self esteem showed less disorganization symptoms. These findings suggest that self esteem and LoC may represent one way in which social experiences and contexts differentially influence vulnerable individuals along the pathway to psychosis.
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Affiliation(s)
- Simone Ciufolini
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King׳s College London, London, UK.
| | - Craig Morgan
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Kevin Morgan
- University of Westminster, Department of Psychology, London, UK
| | - Paul Fearon
- Trinity College Dublin, Department of Psychiatry, Dublin, Ireland
| | - Jane Boydell
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Gerard Hutchinson
- University of West Indies, Department of Psychiatry, St. Augustine, Trinidad and Tobago
| | - Arsjme Demjaha
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Paolo Girardi
- University of La Sapienza, Department of Psychiatry, Rome, Italy
| | - Gill A Doody
- University of Nottingham, Department of Psychiatry, Nottingham, UK
| | - Peter B Jones
- University of Cambridge, Department of Psychiatry, Addenbrooke׳s Hospital, Cambridge, UK
| | - Robin Murray
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Paola Dazzan
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King׳s College London, London, UK
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