Disorders - Psychosis Disorders
Vidarsdottir, O. G., Magnusdottir, B.
B., Roberts, D., Twamley, E. W., Sigurdsson, E., Gudmundsdottir, B.
Introduction: Cognitive remediation, combined with evidence based psychiatric rehabilitation programs, is effective
for improving cognitive deficits found in psychosis but generalization to everyday functioning remains a challenge. The objective of this study was
to integrate three cognitive remediation approaches: Neuropsychological Educational Approach to Remediation (NEAR), Compensatory Cognitive Training
(CCT), and Social Cognition and Interaction Training (SCIT), and evaluate the effects on cognition, functional outcome, and clinical symptoms.
Method(s): We conducted a randomized, wait-list control trial of an Integrative Cognitive Remediation (ICR) in 49 patients with primary psychotic
disorder seeking service at an early intervention center in Iceland (mean age: 24; 86% males). Participants were randomized to receive standard
treatment (N = 24) or standard treatment plus a 12-week group-based ICR (N = 25). Neurocognition (verbal memory, reasoning, working memory,
processing speed, cognitive flexibility, inhibition, planning), social cognition (theory of mind, emotion recognition and attributional style),
functional outcome, and clinical symptoms were assessed at baseline and post-treatment. Result(s): The ICR group showed significant improvements in
verbal memory, cognitive flexibility, theory of mind and a significant reduction in hostile attributional style, compared to those receiving standard
treatment alone. No significant ICR associated effects were seen in functional outcomes or clinical symptoms. Post-hoc analyses suggest a dose-
response effect. ICR was well tolerated and received high treatment satisfaction ratings. Conclusion(s): ICR is feasible and effective in improving
neurocognition and social cognition in psychosis. Findings will be discussed in context of continuing to improve comprehensive cognitive remediation
interventions for early psychosis with discussion on factors associated with treatment response.
Early Intervention in Psychiatry, 12 (Supplement
1) : 74
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Chien, W. T., Bressington, D., Chan, S. W. C.
Introduction: Recent
research in Western countries has indicated that family interventions in schizophrenia and other psychotic disorders can reduce patient relapse and
improve medication compliance. Few studies have addressed Chinese and Asian populations. This study tested the long-term effects of a 9-month
family-led mutual support group for Chinese people with schizophrenia in Hong Kong, compared with psycho-education and standard psychiatric care.
Methods: A randomized controlled trial of Chinese families of patients with recent-onset psychosis (<=5 years of illness) was conducted
between August 2012 and January 2017, with a 4-year follow-up. Two hundred and one Chinese families of adult outpatients with recent-onset psychosis
were randomly selected from the computerized patient lists and randomly assigned to either mutual support, psycho-education, or standard care group
(n = 70 per group). Family caregivers were mainly the parent, spouse, or child of the patients. Mutual support and psycho-education group consisted
of 16 two-hour group sessions and patients participated in three sessions. The standard care group and the two treatment groups received the routine
psychiatric outpatient care. Results: Patients and families in the mutual support group reported consistently greater improvements in overall
functioning [family functioning, F (2, 203) = 8.13, p = 0.003; patient functioning, F (2, 203) = 6.01, p = 0.008] and
reductions in duration of hospitalizations [F (2, 203) = 6.51, p = 0.005] over the 4-year follow-up. There were not any significant
increases of medication dosages or service use by both the family support and psycho-education groups over time. Conclusions: The peer-led
family support group can be an effective psychosocial intervention in early psychosis indicating long-term benefits on both patient and family
functioning and re-hospitalizations. Clinical Trial Registration: NCT00940394: https://register.clinicaltrials.gov.
Frontiers in psychiatry Frontiers
Research Foundation, 9 : 710
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Other Psychological Interventions
Puig, O.
Early-onset schizophrenia (EOS), defined as the manifestation of psychotic symptoms prior to
18 years of age, is a less common and phenotypically more severe form of the disorder, and implies generalized neurocognitive impairment. Cognitive
remediation therapy (CRT) is a strategy-learning approach targeting cognitive deficits with the ultimate goal of improving functional outcome. The
height neural plasticity during childhood and adolescence suggests that they may be \"sensitive periods\" to treatment effects but it is also
possible that having EOS may confer damage that reduces the ability of the brain to benefit from CRT. Objective(s): To examine the efficacy of CRT in
improving cognition and functional outcomes in a sample of symptomatically stable but cognitively disabled adolescents with EOS. Method(s):
Randomized, controlled trial of individually delivered CRT plus treatment-as-usual (n = 25) compared with treatment-as-usual (TAU, n = 25). Clinical
symptoms and cognitive and functional performance were assessed before and after treatment in both groups and after 3 months in the CRT group.
Result(s): After CRT, significant improvements were found in verbal memory and executive functions. The derived cognitive composite score showed an
improvement after the treatment and this change was reliable in more than two-thirds of the treated patients. Improvements were also found after CRT
in daily living and adaptive functioning, and in family burden. Cognitive but not functional changes were maintained after 3 months. Conclusion(s):
Cognitive and functional improvements can be achieved through CRT in adolescents with EOS but additional strategies may be needed to enhance the
durability of functional gains.
Early Intervention in Psychiatry, 12
(Supplement 1) : 41
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Eack, S., Wojtalik, J., Keshavan, M.
Background: The purpose of this investigation was to examine the long-term
trajectories of cognitive, functional, and clinical outcomes following Cognitive Enhancement Therapy (CET) in early course schizophrenia. Method(s):
Schizophrenia outpatients from a 2-year randomized clinical trial of CET applied in the early course of the illness are completing a 10-year post-
treatment follow-up study. Participants from the original trial have completed a comprehensive battery of cognitive, functional, and clinical
assessments identical to those in the original trial. Composite indexes were calculated for processing speed, neurocognition, social cognition,
functioning, and symptomatology. Linear growth curve models were used to examine longitudinal durability differences in these five domains 10-years
following treatment with either CET or an Enriched Supportive Therapy (EST) comparison treatment. Result(s): Social-cognitive ability favoring CET
was stable across the 10-year follow-up period, with continued evidence of group separation and little evidence of erosion of efficacy. Some
reduction in functioning was observed in both groups after completing treatment (all p < .001), but after 10 years patients in CET retained a higher
level of functioning over the follow-up period. Finally, group separation favoring CET in symptomatology continued to persist relative to EST over
the course of 10-year follow-up. Conclusion(s): Although these data are considered preliminary, the results suggest that CET is an effective
treatment that contributes to long-term and stable improvements in cognition and functional outcome in people with schizophrenia treated in the early
course of the illness.
Early Intervention in Psychiatry, 12 (Supplement
1) : 33
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Supportive
therapy
Bhattacharyya,
S., Wilson, R., Allen, P., Bossong, M., Appiah-Kusi, E., McGuire, P.
Background: There has been growing
interest in the therapeutic potential of Cannabidiol (CBD) stemming from independent evidence that CBD has antipsychotic and anxiolytic properties in
patients with mental health disorders. CBD has been found to be non-inferior to antipsychotic medication in a 4-week clinical trial in acute
schizophrenia (Leweke et al 2012) and also has been found to reduce anxiety symptoms in social phobia and following public speaking. Human data also
suggest that it attenuates the cognitive impairments associated with use of the main psychoactive ingredient in cannabis. However, whether CBD may be
useful in relieving symptoms and distress in patients at clinical high-risk of psychosis (CHR) has never been tested. Furthermore, how the beneficial
effect of CBD on psychotic and anxiety symptoms may be mediated in the brain remains unclear. The aim of the present study was to investigate whether
short-term treatment with CBD was associated with preliminary evidence of therapeutic benefit and understand the neurocognitive mechanisms. Methods:
We investigated the effects of short-term (21 days) treatment with CBD on psychotic and anxiety symptoms in 33 CHR patients, using a
placebocontrolled, double-blind, parallel-arm design (CBD arm- 16; placebo arm- 17). In the subjects who received 21 days of treatment, we used fMRI
in conjunction with a verbal memory task to assess the effect of CBD relative to placebo treatment on medial temporal and striatal function. Results:
Of the 33 CHR patients recruited into the trial, 31 completed treatment for 21 days. Following 21-day treatment (intention-to-treat, last observation
carried forward analysis), CBD-treated (n=16) CHR patients showed a significantly greater reduction in anxiety (p=0.02) and in distress associated
with psychotic symptoms (p=0.03) and a trend (p=0.14) toward greater reduction in the severity of psychotic symptoms compared to those treated with
placebo (n=17) CHR patients (Figure 4). In addition, CBD was tolerated as well as placebo. Consistent with our predictions, treatment with CBD (n=15)
attenuated the engagement during verbal encoding of the parahippocampal cortex, but increased activation in the putamen in CHR patients. A similar
pattern of activation was evident during verbal recall, with CBD treatment associated with increased engagement in the putamen. Discussion: Results
from our proof-of-concept study suggest that 3-week treatment with CBD has beneficial effects on anxiety, attenuated psychotic symptoms and the
distress associated with psychotic symptoms. They also suggest that short-term treatment with CBD modulates both medial temporal and striatal
function in CHR patients, regions that are critically implicated in the CHR state. Coupled with the absence of significant adverse effects associated
with CBD, a particularly important issue in relation to the treatment of CHR individuals, not all of whom develop a full-blown psychotic disorder,
these data indicate that long-term treatment with CBD is likely to be efficacious in CHR patients.
Schizophrenia Bulletin, 44 (Supplement
1) : S28
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Breier, A., Liffick, E., Hummer, T. A., Vohs, J. L., Yang, Z., Mehdiyoun, N. F., Visco, A. C., Metzler, E., Zhang, Y., Francis, M. M.
BACKGROUND: Currently approved medications for schizophrenia are relatively ineffective for negative symptoms and cognitive impairment.
N-Acetyl Cysteine (NAC) is a neuroprotective agent that improved general symptoms, cognitive impairment and negative symptoms in some but not all
studies, but failed to improve positive symptoms in patients with schizophrenia. Progressive brain mass loss (PBML) has been consistently observed in
early phase schizophrenia. NAC mitigates the deleterious effects oxidative stress, inflammation and glutamatergic excitotoxicity and these three
pathological processes are hypothesized to contribute to PBML.\rMETHODS: In this study, we assessed the effects NAC (3600mg/day) in a 52-week,
double-blind, placebo controlled trial on symptoms, and cognition in early phase schizophrenia spectrum disorders (N=60). In the context of the
clinical trial, we explored the effects of NAC on brain morphology.\rRESULTS: NAC significantly improved (timexgroup) PANSS total (F=14.7, p<0.001),
negative (F=5.1, p=0.024) and disorganized thought (F=13.7, p<0.001) symptom scores. NAC failed to improve PANSS positive symptoms and BACS cognitive
scores. In preliminary analyses, baseline right (r=-0.48, p=0.041) and left (r=-0.45, p=0.018) total cortical thickness, and thickness in other
cortical regions, were associated with NAC related improvement in PANSS total scores, but NAC, as compared to placebo, did not significantly impact
brain morphology over the study treatment period.\rCONCLUSIONS: These results replicate some but not all previous findings of NAC efficacy.
Preliminary results suggest that NAC's symptom effects may be related to structural integrity, but NAC failed to demonstrate treatment effects on
longitudinal measures of brain morphology. ClinicalTrials.gov Identifier: NCT01339858.
Schizophrenia Research, 199 : 395-402
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Bucci,
S., Barrowclough, C., Ainsworth, J., Machin, M., Morris, R., Berry, K., Emsley, R., Lewis, S., Edge, D., Buchan, I., Haddock, G.
Background: Timely access to intervention for psychosis is crucial yet
problematic. As such, health care providers are forming digital strategies for addressing mental health challenges. A theory-driven digital
intervention that monitors distressing experiences and provides real-time active management strategies could improve the speed and quality of
recovery in psychosis, over and above conventional treatments. This study assesses the feasibility and acceptability of Actissist, a digital health
intervention grounded in the cognitive model of psychosis that targets key early psychosis domains.\rMethods: A proof-of-concept, single, blind,
randomized controlled trial of Actissist, compared to a symptom-monitoring control. Thirty-six early psychosis patients were randomized on a 2:1
ratio to each arm of the trial. Actissist was delivered via a smartphone app over 12-weeks; clinical and functional assessment time-points were
baseline, post-treatment and 22-weeks. Assessors' blind to treatment condition conducted the assessments. Acceptability was examined using
qualitative methods.\rResults: Actissist was feasible (75% participants used Actissist at least once/day; uptake was high, 97% participants remained
in the trial; high follow-up rates), acceptable (90% participants recommend Actissist), and safe (0 serious adverse events), with high levels of user
satisfaction. Treatment effects were large on negative symptoms, general psychotic symptoms and mood. The addition of Actissist conferred benefit at
post-treatment assessment over routine symptom-monitoring and treatment as usual.\rConclusions: This is the first controlled proof-of-concept trial
of a theory-driven digital health intervention for early psychosis. Actissist is feasible and acceptable to early psychosis patients, with a strong
signal for treatment efficacy. Trial Registration: ISRCTN: 34966555.
Schizophrenia Bulletin, 44(5) : 1070-
1080
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Mindfulness based
therapy, Relaxation, Technology, interventions delivered using technology (e.g. online, SMS)
Burke, E., Wojcik, J., Seidman, L. J., Green, A., Woo, T. U. W.
Background: The overt
symptoms and deficits of schizophrenia (SZ) typically emerge during late adolescence and early adulthood, followed by a period of post-onset
functional deterioration. This peri-onset period temporally coincides with the final maturation of the prefrontal cortex (PFC), which is
characterized by a process of extensive pruning of synaptic connectivities. Developmental maturation of inhibitory neurotransmission may play a key
role in regulating the onset and duration of peri-adolescent synaptic pruning. We hypothesize that a deficit in the developmental increase in
inhibitory neurotransmission may disturb the PFC synaptic pruning process and hence contribute to the onset and the functional deterioration that is
characteristic of the early course of SZ. Enhancement of inhibitory neurotransmission may therefore restore the integrity of PFC neural circuitry,
which may then lead to lasting improvements in cognitive deficits and clinical symptoms. Methods: Here, we report preliminary data on the possible
efficacy of tiagabine (Gabitril), which is a selective uptake inhibitor of the GABA (gamma-aminobutyric acid) transporter GAT-1, in the treatment of
recentonset schizophrenia. Subjects were randomized to receive either tiagabine or placebo added on to their antipsychotic regimen. Results: Our data
suggest that treatment with tiagabine during the early course of the illness can modulate PFC activation, as demonstrated by functional magnetic
resonance imaging during working memory, and improve negative symptoms. Discussion: Taken together, the proposed treatment strategy represents an
effort to actively translate preclinical findings in SZ research into clinically testable hypotheses. This kind of translational approach, we
believe, will ultimately lead to breakthrough in the treatment and possible prevention of SZ.
Schizophrenia
Bulletin, 44 (Supplement 1) : S235-S236
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Anticonvulsants/mood stabilisers (excl. lithium)
Chang, W. C., Kwong, V. W. Y., Or-Chi-Fai, P., Lau, E. S.
K., Chan, G. H. K., Jim, O. T. T., Hui, C. L. M., Chan,
S. K. W., Lee, E. H. M., Chen, E. Y. H.
OBJECTIVE: Functional remission represents an
intermediate functional milestone toward recovery. Differential relationships of negative symptom sub-domains with functional remission in first-
episode psychosis are understudied. We aimed to examine rate and predictors of functional remission in people with first-episode psychosis in the
context of a 3-year follow-up of a randomized controlled trial comparing 1-year extension of early intervention (i.e. 3-year early intervention) with
step-down psychiatric care (i.e. 2-year early intervention).\rMETHOD: A total of 160 participants were recruited upon completion of a 2-year
specialized early intervention program for first-episode psychosis in Hong Kong and underwent a 1-year randomized controlled trial comparing 1-year
extended early intervention with step-down care. Participants were followed up and reassessed 3 years after inclusion to the trial (i.e. 3-year
follow-up). Functional remission was operationalized as simultaneous fulfillment of attaining adequate functioning (measured by Social and
Occupational Functioning Scale and Role Functioning Scale) at 3-year follow-up and sustained employment in the last 6 months of 3-year study period.
Negative symptom measure was delineated into amotivation (i.e. motivational impairment) and diminished expression (i.e. reduced affect and speech
output). Data analysis was based on 143 participants who completed follow-up functional assessments.\rRESULTS: A total of 31 (21.7%) participants
achieved functional remission status at 3-year follow-up. Multivariate regression analysis showed that lower levels of amotivation ( p = 0.010) and
better functioning at study intake ( p = 0.004) independently predicted functional remission (Final model: Nagelkerke R2 = 0.40,
chi2 = 42.9, p < 0.001). Extended early intervention, duration of untreated psychosis and diminished expression did not predict functional
remission.\rCONCLUSION: Only approximately one-fifths of early psychosis patients were found to achieve functional remission. Functional impairment
remains an unmet treatment need in the early stage of psychotic illness. Our results further suggest that amotivation may represent a critical
therapeutic target for functional remission attainment in early psychosis.
Australian & New Zealand Journal
of Psychiatry, : 4867418758918
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Case management, Other service delivery and improvement
interventions
Chen, E., Hui, C., Chang, W. C., Chan,
S., Lee, E., Honer, W.
Background: Clinical decision to dis/continue antipsychotics in patients remitted from first-episode
psychosis is important. Existing short-term evidence suggests that patients who discontinued antipsychotics had more relapses. Data on long-term
outcomes are lacking; with only one open-label study suggesting better long-term recovery outcome in patients who had early medication
discontinuation. We examined the long-term effect of early medication discontinuation in year 2 following first-episode remission for patients with
no residual psychotic symptoms. Methods: We followed-up 178 first-episode psychosis patients who participated in a 1-year randomized controlled trial
(RCT) on medication discontinuation. Patients were randomized into receiving either a medication maintenance group or a placebo discontinuation
group. After the RCT, all patients received usual psychiatric care. Poor long-term clinical outcome was defined as a composite of persistent
psychotic symptoms, a requirement for clozapine, or suicide. Results: There were no differences between patients who were included (n=142) and
excluded (n=36) from the study with regard to their baseline demographics, clinical and functioning. At 10 years, more patients in the early
discontinuation group (35/89, 39%) had poor clinical outcome than patients in the maintenance group (19/89, 21%) (P<0.01). Relapse during the RCT has
partly mediated the significant relationship between early medication discontinuation and poor outcome at 10-year. Discussion: Whether to discontinue
medication following successful treatment of first episode psychosis is a difficult clinical decision. In first episode psychosis with a full initial
response to antipsychotic treatment, continued need for medication is important for the first three years after starting treatment, to prevent
relapse, and decrease the risk for a poor long-term outcome.
Schizophrenia Bulletin, 44 (Supplement
1) : S97
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Medication dose
reduction/discontinuation
Conus, P., Seidman, L. J., Fournier, M., Xin, L., Cleusix, M., Baumann, P. S., Ferrari, C., Cousins, A., Alameda, L., Gholam-Rezaee, M., Golay, P., Jenni, R., Woo, T. U. W., Keshavan, M. S., Eap, C. B., Wojcik, J., Cuenod, M., Buclin, T., Gruetter, R., Do, K. Q.
Biomarker-guided treatments are needed in psychiatry, and previous data suggest oxidative stress may be a target in schizophrenia. A
previous add-on trial with the antioxidant N-acetylcysteine (NAC) led to negative symptom reductions in chronic patients. We aim to study NAC's
impact on symptoms and neurocognition in early psychosis (EP) and to explore whether glutathione (GSH)/redox markers could represent valid biomarkers
to guide treatment. In a double-blind, randomized, placebo-controlled trial in 63 EP patients, we assessed the effect of NAC supplementation (2700
mg/day, 6 months) on PANSS, neurocognition, and redox markers (brain GSH [GSHmPFC], blood cells GSH levels [GSHBC], GSH
peroxidase activity [GPxBC]). No changes in negative or positive symptoms or functional outcome were observed with NAC, but significant
improvements were found in favor of NAC on neurocognition (processing speed). NAC also led to increases of GSHmPFC by 23% (P = .005) and
GSHBC by 19% (P = .05). In patients with high-baseline GPxBC compared to low-baseline GPxBC, subgroup explorations
revealed a link between changes of positive symptoms and changes of redox status with NAC. In conclusion, NAC supplementation in a limited sample of
EP patients did not improve negative symptoms, which were at modest baseline levels. However, NAC led to some neurocognitive improvements and an
increase in brain GSH levels, indicating good target engagement. Blood GPx activity, a redox peripheral index associated with brain GSH levels, could
help identify a subgroup of patients who improve their positive symptoms with NAC. Thus, future trials with antioxidants in EP should consider
biomarker-guided treatment. Copyright © The Author(s) 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research
Center.
Schizophrenia Bulletin, 44(2) : 317-
327
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Drake, R., Nordentoft, M., Haddock, G., Ainsworth, J., Lewis, S.
Background: We hypothesised that a multi-modal
psychosocial intervention (PSI) after first episodes of non-affective psychosis would increase antipsychotic adherence, improve functioning and
prevent readmission in a multicentre, blind-rated, randomised controlled trial. Methods: Following treatment of first episode non-affective psychosis
with amisulpride, olanzapine or clozapine (those remitting after phases 1-3 of the OPTIMISE program or dropping-out but willing to enter the
adherence trial) patients with DSM-IV schizophreniform disorder, schizophrenia, or schizoaffective disorder were eligible for allocation to PSI or
treatment as usual (TAU). PSI involved: i) e-learning via a psychoeducational website; ii) mHealth intervention with 3 months SMS medication
reminders configured by participants; iii) motivational interviewing targeting adherence over 6 weeks. Primary outcome measures at 3 and 12 month
follow-up were Compliance Rating Scale (score 1-7 worst to best), and Social and Occupational Function Assessment Scale (SOFAS; 0-100). Secondary
outcomes included remission, Drug Attitudes Inventory (DAI), and EuroQoL quality of life scale. We present interim analyses of 3 month data with
general linear and logistic regression models, clustered by centre and adjusted for baseline scores and demographics. Results: Recruitment time, now
finished, was extended to reach target sample size, so 12 month data are incomplete. 258 were allocated to PSI or TAU. 18 dropped-out before baseline
assessment: 240 entered the modified intention to treat analysis (PSI 121, TAU 119). After PSI, 71% were followed-up at 3 months; after TAU, 80%. No
baseline variable significantly predicted this attrition. Webpages covering illness and treatment had 244-290 hits each. Only 24% of the PSI group
set up SMS text reminders. At least 70% attended motivational interviewing, 77% of these for all sessions. Mean California Patient Alliance Scale
item score was 5.2 (95% Confidence Interval, CI, 5.0, 5.3; score 1-7 poor-good). Mean baseline SOFAS (SD) for the PSI group was 62 (14); for TAU 62
(15). General linear modelling of 12 week data included baseline CRS and drug attitudes: marginal mean SOFAS after PSI was 65.3 (CI 62.6, 68.0) and
after TAU 61.4 (CI 59.3, 63.4; p0.025; standardised effect size Glass' DELTA=0.41). Median (IQR) compliance score was 6 (5,7) at baseline for PSI
and 6 (6,7) for TAU; and 6 (5,7) at 3 months in both groups (ordinal logistic regression, p0.36). In secondary analyses 3 month DAI did not differ
significantly between PSI and TAU (marginal means 13.5 v 11.5, bootstrapped p0.164). EuroQoL wellbeing score was significantly better after PSI
(marginal means 76.0 v 69.1, bootstrapped p0.003) and remission was significantly commoner (72 v 54%, binary logistic regression p0.007). No analysis
result was sensitive to probability weighted adjustment for drop out. Discussion: Interim analyses indicate that immediately after PSI social
function and wellbeing improved significantly and remission was commoner. Adherence and DAI did not differ significantly. Either PSI's immediate
benefits were non-specific or adherence measures failed to capture its effect. Longer term effects are unclear until definitive analyses planned
before 2018.
Schizophrenia Bulletin, 44 (Supplement
1) : S50
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy, Technology, interventions delivered using technology (e.g. online, SMS)