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Zhou Z, Guan H, Xiu M, Wu F. Dance/movement therapy for improving metabolic parameters in long-term veterans with schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:23. [PMID: 38388554 PMCID: PMC10884034 DOI: 10.1038/s41537-024-00435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
Accumulating evidence has supported the implementation of dance/movement therapy (DMT) as a promising intervention for patients with schizophrenia (SCZ). However, its effect on body weight and metabolic profile in SCZ remains unclear. This study aimed to evaluate the outcome of a 12-week DMT session on weight and lipid profile in patients with SCZ using a randomized, single-blinded, controlled trial design. This study encompassed two groups of long-term hospitalized patients with SCZ, who were randomly assigned to the DMT intervention (n = 30) or the treatment as usual (TAU) group (n = 30). Metabolic markers, including weight, body mass index (BMI), fasting glucose, triglycerides, and total cholesterol were measured in both groups at two measurement points (at baseline and the end of the 12-week treatment). We found that DMT intervention significantly decreased body weight (F = 5.5, p = 0.02) and BMI (F = 5.7, p = 0.02) as compared to the TAU group. However, no significance was observed in other metabolic markers, including fasting glucose, triglycerides, and total cholesterol after treatment (all p > 0.05). Our study indicates that a 12-week, 24-session DMT program may be effective in decreasing body weight and BMI in long-term hospitalized patients with SCZ. DMT intervention may be a promising treatment strategy for long-term inpatients in the psychiatric department.
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Affiliation(s)
| | | | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China.
| | - Fengchun Wu
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
- Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China.
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2
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Guan H, Zhou Z, Li X, Pan Y, Zou Z, Meng X, Guan K, Zhang L, Li Z, Li X, Wei B, Zhang X, Li W, Han D, Li Z, Xiu M. Dance/movement therapy for improving balance ability and bone mineral density in long-term patients with schizophrenia: a randomized controlled trial. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:47. [PMID: 37524713 PMCID: PMC10390548 DOI: 10.1038/s41537-023-00373-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
Fractures are common accidents for long-term hospitalized patients with schizophrenia (SZ) in psychiatric hospitals, and once they occur, patients usually endure the pain of fractures for a long time. Accumulating evidence has supported the implementation of dance/movement therapy (DMT) as a promising intervention for patients with SZ. However, no research has been conducted to investigate its role in balance ability in SZ. This study was designed to investigate the efficacy of a 12-week DMT intervention in bone mineral density and balance ability in patients with SZ using a randomized, controlled trial design. A total of 58 veterans with SZ were randomly assigned to the DMT intervention group (n = 29) and the treatment-as-usual (TAU) group (n = 29). Bone mineral density (BMD) and balance ability were measured in both groups at two measurement points (at baseline and at the end of Week 12). We found that patients in the DMT intervention group had significant improvements in BMD and balance ability compared with the TAU group by using repeated measures analysis of variance. Treatment with DMT demonstrated a significant improvement in BMD from baseline to week 12 (0.03, 95% CI: 0.01-0.05). For the Berg total score and static and dynamic balance, the mean changes in the DMT group were 7.3 (95% CI: 5.6-9.0), 4.0 (95% CI: 0.9-7.1), and 3.7 (95% CI: 2.6-4.8), respectively. Regression analysis showed that baseline BMD was a significant predictor of improvement in BMD from baseline to week 12 in the DMT group (β = 0.58, p < 0.001). Our results suggest for the first time that DMT intervention may be effective in beneficially regulating BMD and balance ability in SZ patients.
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Affiliation(s)
| | | | - Xipo Li
- Hebei Province Veterans Hospital, Hebei, China
| | - Yanfen Pan
- Hebei Province Veterans Hospital, Hebei, China
| | - Zhenmin Zou
- Hebei Province Veterans Hospital, Hebei, China
| | | | - Kunya Guan
- Hebei Province Veterans Hospital, Hebei, China
| | - Lie Zhang
- Hebei Province Veterans Hospital, Hebei, China
| | - Zhanmin Li
- Hebei Province Veterans Hospital, Hebei, China
| | - Xueling Li
- Hebei Province Veterans Hospital, Hebei, China
| | - Baochun Wei
- Hebei Province Veterans Hospital, Hebei, China
| | - Xuan Zhang
- Hebei Province Veterans Hospital, Hebei, China
| | - Weiqing Li
- Hebei Province Veterans Hospital, Hebei, China
| | - Dongmei Han
- Hebei Province Veterans Hospital, Hebei, China
| | - Zezhi Li
- Department of Nutritional and Metabolic Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China Guangzhou Medical University, Guangzhou, China
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China.
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3
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Shukla A, Choudhari SG, Gaidhane AM, Quazi Syed Z. Role of Art Therapy in the Promotion of Mental Health: A Critical Review. Cureus 2022; 14:e28026. [PMID: 36134083 PMCID: PMC9472646 DOI: 10.7759/cureus.28026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/15/2022] [Indexed: 11/05/2022] Open
Abstract
Art therapy is used most commonly to treat mental illnesses and can aid in controlling manifestations correlated with psychosocially challenging behaviours, slowing cognitive decline, and enhancing the quality of life. Art therapy can help people express themselves more freely, improve their mental health, and improve interpersonal relationships. The basis of art therapy is established on the idea that people can recover and feel better via artistic expression. This review examines the current research on how active participation in the arts might improve mental health. A detailed literature search was carried out utilizing essential databases such as PubMed, the WHO's mental health database, and Google and Google Scholar. This review study looks into research done on art therapy and its potential advantages for adult mental health rehabilitation. It focuses on visual art therapy since it’s a key to reducing variation within the "creative arts" and defines the peculiar elements and effectiveness of art therapy used by mental health services. It was found that the use of art therapy as an adjunct treatment showed improved mental health in patients.
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4
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Gu S, He Z, Xu Q, Dong J, Xiao T, Liang F, Ma X, Wang F, Huang JH. The Relationship Between 5-Hydroxytryptamine and Its Metabolite Changes With Post-stroke Depression. Front Psychiatry 2022; 13:871754. [PMID: 35558423 PMCID: PMC9086784 DOI: 10.3389/fpsyt.2022.871754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 12/14/2022] Open
Abstract
Post-stroke depression (PSD) is the most common and serious sequelae of stroke. Approximately 33% of stroke survivors were affected by PSD. However, many issues (e.g., incidence, diagnostic marker, and risk factor) related to PSD remained unclear. The "monoamine hypothesis" is a significant hypothesis for depression, which suggests that three monoamines play a key role in depression. Therefore, most current antidepressants are developed to modulate the monoamines on PSD treatment, and these antidepressants have good effects on patients with PSD. However, the potential mechanisms of three monoamines in PSD are still unclear. Previously, we proposed "three primary emotions," which suggested a new model of basic emotions based on the three monoamines. It may provide a new way for PSD treatment. In addition, recent studies have found that monoamine-related emotional intervention also showed potential effects in the treatment and prevention of PSD. This study discusses these issues and attempts to provide a prospect for future research on PSD.
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Affiliation(s)
- Simeng Gu
- Department of Psychology, Jiangsu University Medical School, Zhenjiang, China.,Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Zhengming He
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Qiuyue Xu
- Department of Nurse, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jie Dong
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Tingwei Xiao
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Fei Liang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Xianjun Ma
- Section of Brain Diseases, Department of Neurology, Lianyungang Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Lianyungang, China
| | - Fushun Wang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, United States.,Department of Surgery, Texas A&M University College of Medicine, Temple, TX, United States
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5
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Riehle M, Böhl MC, Pillny M, Lincoln TM. Efficacy of Psychological Treatments for Patients With Schizophrenia and Relevant Negative Symptoms: A Meta-Analysis. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2899. [PMID: 36398145 PMCID: PMC9645476 DOI: 10.32872/cpe.v2i3.2899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background Recent meta-analyses on the efficacy of psychological treatments for the negative symptoms of schizophrenia included mostly trials that had not specifically targeted negative symptoms. To gauge the efficacy of such treatments in the target patient population - namely people with schizophrenia who experience negative symptoms - we conducted a meta-analysis of controlled trials that had established an inclusion criterion for relevant negative symptom severity. Method We conducted a systematic literature search and calculated random-effects meta-analyses for controlled post-treatment effects and for pre-post changes within treatment arms. Separate analyses were conducted for different therapeutic approaches. Our primary outcome was reduction in negative symptoms; secondary outcomes were amotivation, reduced expression, and functioning. Results Twelve studies matched our inclusion criteria, testing Cognitive Behavioral Therapy (CBT) vs. treatment-as-usual (k = 6), Cognitive Remediation (CR) vs. treatment-as-usual (k = 2), CBT vs. CR (k = 2), and Body-oriented Psychotherapy (BPT) vs. supportive group counseling and vs. Pilates (k = 1 each). Accordingly, meta-analyses were performed for CBT vs. treatment-as-usual, CR vs. treatment-as-usual, and CBT vs. CR. CBT and CR both outperformed treatment-as-usual in reducing negative symptoms (CBT: Hedges' g = -0.46; CR: g = -0.59). There was no difference between CBT and CR (g = 0.12). Significant pre-post changes were found for CBT, CR, and to a lesser extent for treatment-as-usual, but not for BPT. Conclusion Although effects for some approaches are promising, more high-quality trials testing psychological treatments for negative symptoms in their target population are needed to place treatment recommendations on a sufficiently firm foundation.
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Affiliation(s)
- Marcel Riehle
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Mara Cristine Böhl
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Tania Marie Lincoln
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
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Millman LSM, Terhune DB, Hunter ECM, Orgs G. Towards a neurocognitive approach to dance movement therapy for mental health: A systematic review. Clin Psychol Psychother 2020; 28:24-38. [PMID: 32539160 DOI: 10.1002/cpp.2490] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/30/2020] [Accepted: 06/11/2020] [Indexed: 01/17/2023]
Abstract
Dance movement therapy (DMT) has become an increasingly recognized and used treatment, though primarily used to target psychological and physical well-being in individuals with physical, medical or neurological illnesses. To contribute to the relative lack of literature within the field of DMT for clinical mental health disorders, using a narrative synthesis, we review the scope of recent, controlled studies of DMT in samples with different psychiatric disorders including depression, schizophrenia, autism and somatoform disorder. A systematic search of electronic databases (PubMed, Science Direct, World of Science and Clinicaltrials.gov) was conducted to identify studies examining the effects of DMT in psychiatric populations. Fifteen studies were eligible for inclusion. After reviewing the principal results of the studies, we highlight strengths and weaknesses of this treatment approach and examine the potential efficacy of using bodily movements as a tool to reduce symptoms. We conclude by placing DMT within the context of contemporary cognitive neuroscience research, drawing out implications of such an orientation for future research and discussing potential mechanisms by which DMT might reduce psychiatric symptoms. DMT has clear potential as a treatment for a range of conditions and symptoms, and thus, further research on its utility is warranted.
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Affiliation(s)
| | - Devin B Terhune
- Department of Psychology, Goldsmiths, University of London, London, UK
| | | | - Guido Orgs
- Department of Psychology, Goldsmiths, University of London, London, UK
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7
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Morrison AP, Pyle M, Gumley A, Schwannauer M, Turkington D, MacLennan G, Norrie J, Hudson J, Bowe S, French P, Hutton P, Byrne R, Syrett S, Dudley R, McLeod HJ, Griffiths H, Barnes TR, Davies L, Shields G, Buck D, Tully S, Kingdon D. Cognitive-behavioural therapy for clozapine-resistant schizophrenia: the FOCUS RCT. Health Technol Assess 2020; 23:1-144. [PMID: 30806619 DOI: 10.3310/hta23070] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of cognitive-behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome. DESIGN The Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU). SETTING Secondary care mental health services in five cities in the UK. PARTICIPANTS People with CRS aged ≥ 16 years, with an International Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms. INTERVENTIONS Individual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services. MAIN OUTCOME MEASURES The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs. RESULTS Participants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) -3.32 to 1.55 points; p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (-2.40 points, 95% CI -4.79 to -0.02 points; p = 0.049). CBT was associated with a net cost of £5378 (95% CI -£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability < 50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46; p = 0.58). CONCLUSIONS Cognitive-behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained. TRIAL REGISTRATION Current Controlled Trials ISRCTN99672552. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Douglas Turkington
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Centre for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Clinical Trials Unit, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Suzy Syrett
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Griffiths
- Department of Clinical Psychology, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | | | - Linda Davies
- Division of Population Health, University of Manchester, Manchester, UK
| | - Gemma Shields
- Division of Population Health, University of Manchester, Manchester, UK
| | - Deborah Buck
- Division of Population Health, University of Manchester, Manchester, UK
| | - Sarah Tully
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - David Kingdon
- Department of Psychiatry, University of Southampton, Academic Centre, Southampton, UK
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8
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Bryl K, Bradt J, Cechnicki A, Fisher K, Sossin KM, Goodill S. The role of dance/movement therapy in the treatment of negative symptoms in schizophrenia: a mixed methods pilot study. J Ment Health 2020; 31:613-623. [DOI: 10.1080/09638237.2020.1757051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Karolina Bryl
- Creative Arts Therapies Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Joke Bradt
- Creative Arts Therapies Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Andrzej Cechnicki
- Community Psychiatry Department, Jagiellonian University, Cracow, Poland
| | - Kathleen Fisher
- Doctoral Nursing Programs, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - K. Mark Sossin
- Psychology Department, Dyson College of Arts and Sciences, Pace University, New York, NY, USA
| | - Sharon Goodill
- Creative Arts Therapies Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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9
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Shields GE, Buck D, Elvidge J, Hayhurst KP, Davies LM. Cost-Effectiveness Evaluations of Psychological Therapies for Schizophrenia and Bipolar Disorder: A Systematic Review. Int J Technol Assess Health Care 2019; 35:317-326. [PMID: 31328702 PMCID: PMC6707812 DOI: 10.1017/s0266462319000448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This review aims to assess the cost-effectiveness of psychological interventions for schizophrenia/bipolar disorder (BD), to determine the robustness of current evidence and identify gaps in the available evidence. METHODS Electronic searches (PsycINFO, MEDLINE, Embase) identified economic evaluations relating incremental cost to outcomes in the form of an incremental cost-effectiveness ratio published in English since 2000. Searches were concluded in November 2018. Inclusion criteria were: adults with schizophrenia/BD; any psychological/psychosocial intervention (e.g., psychological therapy and integrated/collaborative care); probability of cost-effectiveness at explicitly defined thresholds reported. Comparators could be routine practice, no intervention, or alternative psychological therapies. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms. Results were summarized qualitatively. The protocol was registered on the PROSPERO database (CRD42017056579). RESULTS Of 3,864 studies identified, 12 met the criteria for data extraction. All were integrated clinical and economic randomized controlled trials. The most common intervention was cognitive behavioral therapy (CBT, 6/12 studies). The most common measure of health benefit was the quality-adjusted life-year (6/12). Follow-up ranged from 6 months to 5 years. Interventions were found to be cost-effective in most studies (9/12): the probability of cost-effectiveness ranged from 35-99.5 percent. All studies had limitations and demonstrated uncertainty (particularly related to incremental costs). CONCLUSIONS Most studies concluded psychological interventions for schizophrenia/BD are cost-effective, including CBT, although there was notable uncertainty. Heterogeneity across studies makes it difficult to reach strong conclusions. There is a particular need for more evidence in the population with BD and for longer-term evidence across both populations.
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Affiliation(s)
| | - Deborah Buck
- Personal and Social Services Research Unit, University of Manchester
| | - Jamie Elvidge
- National Institute for Health and Care Excellence, United Kingdom
| | | | - Linda Mary Davies
- Centre for Health Economics, Division of Population Health, University of Manchester
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10
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Dilgul M, McNamee P, Orfanos S, Carr CE, Priebe S. Why do psychiatric patients attend or not attend treatment groups in the community: A qualitative study. PLoS One 2018; 13:e0208448. [PMID: 30543646 PMCID: PMC6292613 DOI: 10.1371/journal.pone.0208448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/16/2018] [Indexed: 12/24/2022] Open
Abstract
Background Non-attendance of treatment groups in the community has been a long-standing problem in mental health care. It has been found to have financial ramifications for services, worsen outcomes for those that do not attend and negatively impact on therapeutic group processes. There is a need to gain a better understanding of patients’ reasons for attending or not attending. This study aimed to explore patient views on facilitators and barriers to the attendance of treatment groups in the community. Methods The study used interview data collected as part of three studies that investigated treatment groups for psychiatric patients in the community. Sixty-seven interview transcripts were analysed using the framework method. Results Five themes relating to facilitators of group attendance were identified: opportunity for autonomy; self-acknowledging need and therapist encouragement; optimal group format and safe environment; interest in content and enjoyment; actual and expected benefits of attendance. Four themes related to barriers: not being sufficiently informed; concerns about social interactions and the unknown; limited accessibility; and negative group dynamics. Conclusion To facilitate attendance and reduce attrition to treatment groups in the community clinicians should address patient’s wishes for information, capture their interest in the group modality, and potentially offer a ‘trial’ session. Furthermore, they should make the group location and time as accessible as possible and create a moderately sized group of six to eight patients. In these groups, mutual respect, feelings of safety and encouragement appear essential to make patients feel they can benefit from attendance.
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Affiliation(s)
- Merve Dilgul
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
- * E-mail:
| | - Philip McNamee
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Stavros Orfanos
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Catherine Elizabeth Carr
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Blizard Institute, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
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11
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Galbusera L, Fellin L, Fuchs T. Towards the recovery of a sense of self: An interpretative phenomenological analysis of patients' experience of body-oriented psychotherapy for schizophrenia. Psychother Res 2017; 29:234-250. [PMID: 28532254 DOI: 10.1080/10503307.2017.1321805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Increasing evidence supports the efficacy of body-oriented psychotherapy (BPT) for schizophrenia. Yet, so far no research has investigated outcome in relation to therapy process: Why and how BPT is effective. In this study, we qualitatively explore participants' experience of a manualized BPT for schizophrenia to shed light on the process of therapeutic change. METHOD We conducted in-depth interviews with 6 participants who completed a 10-week BPT group intervention. Interviews explored participants' experience of change and helpful aspects of therapy and were analysed using interpretative phenomenological analysis. FINDINGS We identified six master themes across the interviews: (i) Being a whole: body-mind connection; (ii) Being agentic and being able; (iii) Being unique and worthy: Being accepted for who one is; (iv) Changing interactions: Engaging in authentic interpersonal contact; (v) Being part of a group: Feeling integrated; and (vi) Hope and investing in the future. CONCLUSION We discuss the clinical implications for each theme and bring the findings together by describing therapeutic change in schizophrenia as a recovery of sense of self at different but interlocked levels. Moreover, we put forward recommendations for both specific and common factors for schizophrenia therapy. Clinical or methodological significance of this article: The clinical significance of this study is twofold. On the one hand, the findings of this analysis might inform the theory and practice of BPT and might directly feedback into a further development of the manual guidelines. On the other hand, common helpful factors have been identified thatmight also be relevant for the more general clinical practice concerning patients with schizophrenia. Here, we summarize our key messages for the clinical practitioner emerging from the findings: The inclusion of bodily aspects and a focus on pre-reflective experience in psychotherapy can help persons with schizophrenia recover the sense of being a body-mind unity. Empowering persons with schizophrenia, instead of instructing them, seems to foster a sense of agency and self-confidence, which are crucial to the recovery process. A twofold therapeutic stance characterized by openness towards the other and authenticity was experienced by patients as facilitating the rapport building. This might help persons with schizophrenia engage in the relation. Social inclusion might enhance therapeutic change and recovery in schizophrenia. Group therapy might be helpful for fostering a feeling of social belonging, but the inclusion in the wider social and community context remains a critical issue. The experience of joyful moments in psychotherapy might positively contribute to therapeutic change in that it fosters a sense of hope for the future. Overall our paper contributes to the literature aiming at expanding the range of therapeutic modalities, focussing on the creation and use of mixed models of therapy within and beyond talking practices.
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Affiliation(s)
- Laura Galbusera
- a Clinic for General Psychiatry , University of Heidelberg , Heidelberg , Germany
| | - Lisa Fellin
- b School of Psychology , University of East London , London , UK
| | - Thomas Fuchs
- a Clinic for General Psychiatry , University of Heidelberg , Heidelberg , Germany
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Wang J, Zhou Y, Gan H, Pang J, Li H, Wang J, Li C. Efficacy Towards Negative Symptoms and Safety of Repetitive Transcranial Magnetic Stimulation Treatment for Patients with Schizophrenia: A Systematic Review. SHANGHAI ARCHIVES OF PSYCHIATRY 2017; 29:61-76. [PMID: 28765677 PMCID: PMC5518263 DOI: 10.11919/j.issn.1002-0829.217024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Negative symptoms are one of the most difficult areas in the treatment of schizophrenia because antipsychotics are often less effective towards them. Repetitive transcranial magnetic stimulation (rTMS) is a new technique for cerebral cortex stimulation and is believed to be a safe and promising method for the treatment of mental disorders. As the clinical research and new treatment models have increased in recent years, the efficacy towards negative symptoms and safety evaluation of rTMS treatment should also be updated. Aims To explore the efficacy and safety of rTMS in the treatment of negative symptoms for patients with schizophrenia. Methods We searched for relevant controlled clinical trials from the following databases: PubMed, EMBASE, the Cochrane Library, EBSCO, Web of Science, China National Knowledge Infrastructure (CNKI), VIP, Wanfang Data, SINOMED, and Airiti Library. The retrieval time went up to January 2, 2017. The research literature was screened according to the predefined inclusion and exclusion criteria. After data extraction, statistical analysis was conducted by using RevMan 5.3 and Stata 14. Quality evaluation was done on the included research articles. The Cochrane risk of bias assessment tool was adopted for assessing risk of bias. The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system recommendation grading method was used as the reference standard. Results A total of 3500 articles were retrieved. In the end, there were 29 articles included in the metaanalysis with a total sample size of 1440. After the meta-analysis, it was found that the use of antipsychotic treatment combined with rTMS could improve the negative symptoms of patients (SMD=-0.40, 95% CI= -0.62~-0.18). Based on the bias of the efficacy evaluation assessed by the Cochrane risk of bias assessment tool, there were 6 studies rated as having “high risk of bias” and the rest were rated as “unable to determine”. According to the assessment, development and evaluation criteria of the GRADE classification, the evidence quality for the efficacy evaluation index was “moderate”. The acceptability of rTMS treatment was better (RR= 0.75, 95% CI= 0.49~1.15, based on the 1492 samples from the 28 studies), however, the patients who received the rTMS treatment had a higher rate of mild adverse effects (RR= 2.20, 95% CI= 1.53~ 3.18, based on the 1296 samples from the 23 studies). Conclusions The use of the antipsychotic treatment incorporated with rTMS treatment can slightly improve the negative symptoms of patients with schizophrenia and has better acceptability and fewer adverse effects. Nevertheless, there is publication bias in this study and the heterogeneity of the study is relatively high. Therefore, we need to be cautious when interpreting the results
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Affiliation(s)
- Junjie Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingqun Zhou
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Gan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoyan Pang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Savill M, Orfanos S, Bentall R, Reininghaus U, Wykes T, Priebe S. The impact of gender on treatment effectiveness of body psychotherapy for negative symptoms of schizophrenia: A secondary analysis of the NESS trial data. Psychiatry Res 2017; 247:73-78. [PMID: 27871030 PMCID: PMC5191935 DOI: 10.1016/j.psychres.2016.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/14/2016] [Indexed: 11/25/2022]
Abstract
Despite promising findings from small-scale studies suggesting that body psychotherapy may be an effective treatment for negative symptoms, these results were not replicated in a recent multisite trial. In this trial a far smaller proportion of women were recruited relative to earlier studies, which may be an issue given the gender mix of the sample evaluated has been found to affect trial outcomes in schizophrenia. Using data from our multisite trial, the interaction between gender and treatment allocation as a predictor of outcomes was examined in 275 participants (72 women and 203 men) randomised to either a body psychotherapy or Pilates group. Negative symptoms were found to significantly reduce in women randomised to the body psychotherapy condition in comparison to Pilates, while no such effect was detected in men. Consistent with the smaller trials, this improvement was found to relate predominantly to expressive deficits. These findings suggest that body psychotherapy may be an effective treatment for negative symptoms in women. These findings emphasise the importance of sample characteristics in determining trial outcome in psychological treatment studies.
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Affiliation(s)
- Mark Savill
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, Box 0984 266, 401 Parnassus Avenue, LP-255, San Francisco, CA 94143, USA.
| | - Stavros Orfanos
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, UK
| | | | - Ulrich Reininghaus
- MHeNS School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, UK
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