Disorders - psychosis disorders
Nuechterlein, K., McEwen, S., Ventura, J., Subotnik, K., Turner, L., Boucher, M., Casaus, L., Hayata, J.
Background: The search for treatments to remediate cognitive deficits and their functional outcome consequences
remains a critical frontier in schizophrenia. Cognitive training and aerobic exercise both show promising moderate impact on cognition and everyday
functioning. Aerobic exercise is hypothesized to increase brain-derived neurotrophic factor (BDNF) and thereby stimulate neurogenesis and synaptic
plasticity, leading to increased learning capacity. Systematic cognitive training should take advantage of increased learning capacity and be more
effective when combined with aerobic exercise. Methods: In a recently completed randomized controlled trial, we examined the impact of a 6-month
program of Cognitive Training & Exercise (CT&E) compared to Cognitive Training alone (CT) in 47 first-episode schizophrenia outpatients. All
participants were provided the same Posit Science computerized cognitive training, four hours/week, using BrainHQ and SocialVille programs. The CT&E
group also participated in total body circuit training exercises to enhance aerobic conditioning. The exercise intensity was in the 60-80% of aerobic
capacity range, combining clinic and home-based exercise for a target of 150 minutes per week. Results: Mixed model analyses demonstrate that the
MATRICS Consensus Cognitive Battery Overall Composite improves significantly more by 3 months with CT&E than with CT alone (6.6 vs. 2.2 T-score
points, p<.02). Work/school functioning improves substantially more with CT&E than with CT alone by 6 months (p<.001). BDNF is a promising mechanism
of action, improving even after 2 weeks and predicting the amount of cognitive gain at 3 months. The magnitude of cognitive gain by 3 months predicts
the amount of work/school functioning improvement at 6 months, suggesting a cascade of effects. Analyses by Dr. McEwen show differential increases in
cortical thickness in the left dorsal lateral prefrontal gyrus (p=.02) and right superior frontal gyrus (p=.02) over 6 months and increased
functional connectivity in the central executive network (p=.04) with CT&E compared to CT alone and correlations of these increases with cognitive
and functional outcome gains. Discussion: We conclude that aerobic exercise significantly enhances the impact of cognitive training on cognition,
functional outcome, and frontal cortical thickness in first-episode schizophrenia and that BDNF is a promising mechanism of action for these
effects.
Schizophrenia Bulletin, 44 (Supplement
1) : S18
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Cognitive remediation
therapy, Physical activity, exercise
Ochoa, S., Salas, M., Lopez-Carrilero, R., Pousa, E., Barajas, A., Grasa, E., Barrigon, M. L., Lorente, E., Cid, J., Gonzalez, F., Ruiz, I., Birules, I.
Background: The Meta-Cognitive Training (MCT) is a psychological intervention that combines psychoeducational
components and cognitive behavioural therapies with a meta-cognitive approach. The MCT (Moritz and Woodward, 2007) focuses on different cognitive
biases, theory of mind and attribution bias, as well as on the predictive value of depressed mood and low self-esteem on paranoid ideation. The MCT
has result effective for people with schizophrenia in order to improve symptoms, cognitive insight, jumping to conclusions, memory and quality of
life. However, less information is regarding the effectiveness of MCT in first episode psychosis. On the other hand, gender has an important role in
psychosis, nevertheless the effect of gender in the effectiveness of MCT has not been proved. The aim of the study is to assess the effectiveness of
MCT regarding symptoms and cognitive insight in people with first episode psychosis, considering the effect of gender. Methods: A multicenter,
randomized, controlled clinical trial was performed. A total of 122 patients were randomized to an MCT or a psychoeducational intervention. The
sample was composed of people with a recent onset of psychosis, recruited from 9 public centers in Spain. The treatment consisted of 8 weekly
sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at six months of follow-up. The evaluator was
blinded to the condition of the patient. Symptoms were assessed with the PANSS and cognitive insight with the BCIS. A regression model for repeated
measures was performed with the SPSS by gender. Results: The sample was composed by 85 men and 37 women, although 53 men and 21 women completed the
treatment and the follow-up. Both psychoeducational and MCT group improved in positive symptoms at post-treatment and follow-up (p<0.05-0.001) with
higher effect sizes in the MCT group (0.53 versus 0.38). Regarding negative symptoms the MCT group improved in the follow-up (p<0.001) and general
symptoms MCT improved in the post-treatment and follow-up (p<0.001). Cognitive insight was higher in people who attended the MCT, in self-certainty
in the posttreatment (p<0.05), self-reflectiveness in the follow-up (p<0.05) and the composite index in both assessments (p<0.05). Considering the
results by gender, men of both groups improve more in positive, negative and disorganized symptoms of the PANSS (p<0.001- 0.046) while women improve
in positive symptoms. A tendency of interaction between group and affective symptoms was found only in women (p=0.062), improving more women of the
MCT group. Regarding cognitive insight, women of the MCT group improve more in self certainty and total BCIS compared with the psychoeducational
group (p<0.001-0.022). Discussion: MCT could be an effective psychological intervention for people with a recent-onset of psychosis for the
improvement of cognitive insight and psychotic symptoms. It seems that women could benefit more from the MCT intervention than men in reduction of
affective symptoms and in the improvement of cognitive insight.
Schizophrenia Bulletin, 44 (Supplement 1) : S238
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage:
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Psychoeducation
ONeill, A., Wilson, R., Blest-Hopley, G., Annibale, L., Colizzi, M., Bhattacharyya,
S.
Background: Global neurocognitive impairments are a central feature of psychosis. Deficits in verbal memory in particular
are the most consistently reported of these impairments from the first-episode of psychosis (FEP). Neuroimaging studies in psychosis have largely
identified reductions in neural activation during various memory and learning related tasks, particularly in the medial temporal lobe, compared to
healthy controls. Tetrahydrocannabinol (THC) and cannabidiol (CBD), both components of the cannabis plant that act through the endocannabinoid (eCB)
system in the brain, have been found to induce direct and opposite neural effects during similar tasks in healthy samples, when compared to each
other. Additionally, CBD has been shown to have antipsychotic properties, and may suppress THC induced psychotic symptoms and their directly
associated functional abnormalities in healthy individuals. Thus far, the effects of CBD on the neural substrates implicated in memory and learning,
and those underlying psychotic symptoms in FEP cohorts is unknown. Methods: 17 FEP patients were initially recruited to the study. A double- blind,
randomized, placebo controlled, repeated measures, within subject cross over design, with at least a one-week washout period between scans was
employed. Participants were given identical capsules of either CBD (600mg), or placebo (PLB), then scanned using a block design fMRI paradigm, while
performing a verbal paired associate learning task. 13 participants completed scanning, and were included in the analysis of the data. An ROI mask of
the hippocampus, striatum, and parahippocampal gyrus was used in the data analysis, and all results were thresholded for less than one false positive
over the whole map. Results: A CBD related decrease in activity was observed in the left hippocampus (p = 0.0024) and the right parahippocampal gyrus
(p = 0.0024) during the recall condition, within the FEP group. No significant differences between PLB and CBD functional activity were observed
during the encoding condition. No significant differences were observed between FEP participant performances on the CBD and PLB study days.
Discussion: These findings provide robust evidence of the modulatory effect of an acute dose of CBD on the neural substrates underlying learning and
memory, supporting a role for the eCB system in the abnormalities observed in psychosis, and its potential as a target for treatment.
Schizophrenia Bulletin, 44 (Supplement
1) : S384
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Allott,
K., McGorry, P., Pan-Yuen, H., ODonnell, C.
Background: Vitamin B12, vitamin B6 and folic acid are homocysteinereducing agents. People with schizophrenia have been found to
have increased homocysteine levels. Elevated homocysteine has been associated with impaired cognition. Previous research in chronic schizophrenia has
shown that supplementation with folate plus vitamin B12 can improve cognition and clinical symptoms. Whether homocysteine lowering agents are
effective in first-episode psychosis is unknown. The aim of this study was to investigate if adjunctive vitamin B12, B6 and folic acid can lower
homocysteine and improve symptomatology and cognition in people with first-episode psychosis. Methods: This was a randomised, double-blind, placebo-
controlled trial conducted at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia. One hundred and twenty patients
aged 15-26 years with first-episode psychosis consented and were randomised to receive folic acid 5mg, vitamin B12 0.4mg, and vitamin B6 50mg or
placebo, each taken once-daily for 12 weeks as an adjunct to antipsychotic medication. Co-primary measures were change in cognition as measured by a
composite score from a battery of 11 tests and total symptomatology (PANSS) over 12 weeks. Secondary outcomes included additional cognitive, symptom,
functioning, tolerability and safety measures. Results: Of the 120 participants randomised in the study, 20 dropped out with no follow-up assessments
and were excluded from analysis. Of the remaining 100 participants, 52 were in the vitamins group and 48 the placebo group. At baseline, the two
treatment groups had lower levels of folate and vitamin B12 intake than healthy controls, but did not differ from each other. Vitamin B12, B6 and
folic acid reduced homocysteine levels in the vitamin group over 12 weeks. The homocysteine lowering effects of the vitamins did not confer a major
advantage over placebo therapy in improving the co-primary PANSS (p=.75) or composite cognition (p=0.79) outcomes over 12 weeks. There was a
significant difference between groups among females in the cognitive domain of speed of processing (p=.049) and attention/vigilance (p=0.002), in
which the mean performance of the placebo group declined over 12 weeks, whereas performance in the vitamin group remained showed improvement.
Discussion: Folic acid, B12 and B6 supplementation appears well tolerated and safe in first-episode psychosis and lowers homocysteine levels in this
population. However, supplementation may not offer extra benefits to all patients with first-episode psychosis, with the possible exception of speed
of processing and attention/vigilance. Although previous research suggests that males preferentially benefit, our findings suggest that there may be
a specific beneficial effect on cognition for females with first-episode psychosis.
Schizophrenia Bulletin, 44 (Supplement
1) : S130
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Vitamins and supplements
Anagnostopoulou, N., Kyriakopoulos, M., Alba, A.
BACKGROUND: Early onset psychosis (EOP), referring to
psychosis with onset before the age of 18 years, is a more severe form of psychosis associated with worse prognosis. While medication is the
treatment of choice, psychological interventions are also considered to have an important role in the management of symptoms and disability
associated with this condition. The present review aimed to explore the effectiveness of such interventions.\rMETHOD: An electronic search was
conducted on the Embase, Medline, and PsychInfo databases for papers of randomized controlled trials (RCTs) referring to psychological interventions
in EOP. References of identified papers were hand searched for additional studies. Identified studies were quality assessed.\rRESULTS: Eight studies
were included in the present review evaluating cognitive remediation therapy (CRT), cognitive behavioural therapy (CBT), a family intervention and
psychoeducation. CRT was associated with improvement in cognitive function and CBT and CRT seem to also have a positive effect in psychosocial
functioning. Symptom reduction appears to not be significantly affected by the proposed treatments.\rCONCLUSIONS: There is some evidence supporting
the effectiveness of psychological interventions in EOP. However, most research on adolescents is focused on CRT and its effects on cognitive
deficits. More studies on the effects of psychological interventions in EOP are needed.
European Child & Adolescent
Psychiatry, : 04
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any)
Correll, C. U., Galling, B., Pawar, A., Krivko, A., Bonetto, C., Ruggeri, M., Craig, T.
J., Nordentoft, M., Srihari, V. H., Guloksuz, S., Hui, C. L. M., Chen, E. Y. H., Valencia, M., Juarez, F., Robinson, D. G., Schooler, N. R., Brunette, M. F., Mueser, K. T., Rosenheck, R. A., Marcy, P., Addington, J., Estroff, S. E., Robinson, J., Penn, D., Severe, J.
B., Kane, J.
M.
Importance: The value of early intervention in psychosis and allocation of
public resources has long been debated because outcomes in people with schizophrenia spectrum disorders have remained suboptimal.\rObjective: To
compare early intervention services (EIS) with treatment as usual (TAU) for early-phase psychosis.\rData Sources: Systematic literature search of
PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov without language restrictions through June 6, 2017.\rStudy Selection: Randomized trials comparing
EIS vs TAU in first-episode psychosis or early-phase schizophrenia spectrum disorders.\rData Extraction and Synthesis: This systematic review was
conducted according to PRISMA guidelines. Three independent investigators extracted data for a random-effects meta-analysis and prespecified subgroup
and meta-regression analyses.\rMain Outcomes and Measures: The coprimary outcomes were all-cause treatment discontinuation and at least 1 psychiatric
hospitalization during the treatment period.\rResults: Across 10 randomized clinical trials (mean [SD] trial duration, 16.2 [7.4] months; range, 9-24
months) among 2176 patients (mean [SD] age, 27.5 [4.6] years; 1355 [62.3%] male), EIS was associated with better outcomes than TAU at the end of
treatment for all 13 meta-analyzable outcomes. These outcomes included the following: all-cause treatment discontinuation (risk ratio [RR], 0.70; 95%
CI, 0.61-0.80; P < .001), at least 1 psychiatric hospitalization (RR, 0.74; 95% CI, 0.61-0.90; P = .003), involvement in school or work (RR, 1.13;
95% CI, 1.03-1.24; P = .01), total symptom severity (standardized mean difference [SMD], -0.32; 95% CI, -0.47 to -0.17; P < .001), positive symptom
severity (SMD, -0.22; 95% CI, -0.32 to -0.11; P < .001), and negative symptom severity (SMD, -0.28; 95% CI, -0.42 to -0.14; P < .001). Superiority of
EIS regarding all outcomes was evident at 6, 9 to 12, and 18 to 24 months of treatment (except for general symptom severity and depressive symptom
severity at 18-24 months).\rConclusions and Relevance: In early-phase psychosis, EIS are superior to TAU across all meta-analyzable outcomes. These
results support the need for funding and use of EIS in patients with early-phase psychosis.
JAMA Psychiatry, 75(6) : 555-
565
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Davies, C., Cipriani, A., Ioannidis, J. P. A., Radua, J., Stahl, D., Provenzani,
U., McGuire, P., Fusar-Poli, P.
Preventing psychosis in patients at clinical high risk may be a promising avenue for pre-emptively ameliorating
outcomes of the most severe psychiatric disorder. However, information on how each preventive intervention fares against other currently available
treatment options remains unavailable. The aim of the current study was to quantify the consistency and magnitude of effects of specific preventive
interventions for psychosis, comparing different treatments in a network meta-analysis. PsycINFO, Web of Science, Cochrane Central Register of
Controlled Trials, and unpublished/grey literature were searched up to July 18, 2017, to identify randomized controlled trials conducted in
individuals at clinical high risk for psychosis, comparing different types of intervention and reporting transition to psychosis. Two reviewers
independently extracted data. Data were synthesized using network meta-analyses. The primary outcome was transition to psychosis at different time
points and the secondary outcome was treatment acceptability (dropout due to any cause). Effect sizes were reported as odds ratios and 95% confidence
intervals (CIs). Sixteen studies (2,035 patients, 57% male, mean age 20.1 years) reported on risk of transition. The treatments tested were needs-
based interventions (NBI); omega-3 + NBI; ziprasidone + NBI; olanzapine + NBI; aripiprazole + NBI; integrated psychological interventions; family
therapy + NBI; D-serine + NBI; cognitive behavioural therapy, French & Morrison protocol (CBT-F) + NBI; CBT-F + risperidone + NBI; and cognitive
behavioural therapy, van der Gaag protocol (CBT-V) + CBT-F + NBI. The network meta-analysis showed no evidence of significantly superior efficacy of
any one intervention over the others at 6 and 12 months (insufficient data were available after 12 months). Similarly, there was no evidence for
intervention differences in acceptability at either time point. Tests for inconsistency were non-significant and sensitivity analyses controlling for
different clustering of interventions and biases did not materially affect the interpretation of the results. In summary, this study indicates that,
to date, there is no evidence that any specific intervention is particularly effective over the others in preventing transition to psychosis. Further
experimental research is needed. Copyright © 2018 World Psychiatric Association
World Psychiatry, 17(2) : 196-209
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Davies, C., Radua, J., Cipriani, A., Stahl, D., Provenzani, U., McGuire, P., Fusar-Poli, P.
Background:
Attenuated positive psychotic symptoms represent the defining features of the clinical high-risk for psychosis (CHR-P) criteria. The effectiveness of
each available treatment for reducing attenuated positive psychotic symptoms remains undetermined. This network meta-analysis (NMA) investigates the
consistency and magnitude of the effects of treatments on attenuated positive psychotic symptoms in CHR-P individuals, weighting the findings for
acceptability. Methods: Web of Science (MEDLINE), PsycInfo, CENTRAL and unpublished/gray literature were searched up to July 18, 2017. Randomized
controlled trials in CHR-P individuals, comparing at least two interventions and reporting on attenuated positive psychotic symptoms at follow-up
were included, following PRISMA guidelines. The primary outcome (efficacy) was level of attenuated positive psychotic symptoms at 6 and 12 months;
effect sizes reported as standardized mean difference (SMD) and 95% CIs in mean follow-up scores between two compared interventions. The secondary
outcome was treatment acceptability [reported as odds ratio (OR)]. NMAs were conducted for both primary and secondary outcomes. Treatments were
cluster-ranked by surface under the cumulative ranking curve values for efficacy and acceptability. Assessments of biases, assumptions, sensitivity
analyses and complementary pairwise meta-analyses for the primary outcome were also conducted. Results: Overall, 1,707 patients from 14 studies (57%
male, mean age = 20) were included, representing the largest evidence synthesis of the effect of preventive treatments on attenuated positive
psychotic symptoms to date. In the NMA for efficacy, ziprasidone + Needs-Based Intervention (NBI) was found to be superior to NBI (SMD = -1.10, 95%
CI -2.04 to -0.15), Cognitive Behavioral Therapy-French and Morrison protocol (CBT-F) + NBI (SMD = -1.03, 95% CI -2.05 to -0.01), and risperidone +
CBT-F + NBI (SMD = -1.18, 95% CI -2.29 to -0.07) at 6 months. However, these findings did not survive sensitivity analyses. For acceptability,
aripiprazole + NBI was significantly more acceptable than olanzapine + NBI (OR = 3.73; 95% CI 1.01 to 13.81) at 12 months only. No further
significant NMA effects were observed at 6 or 12 months. The results were not affected by inconsistency or evident small-study effects, but only two
studies had an overall low risk of bias. Conclusion: On the basis of the current literature, there is no robust evidence to favor any specific
intervention for improving attenuated positive psychotic symptoms in CHR-P individuals. Copyright © 2018 Davies, Radua, Cipriani, Stahl, Provenzani,
McGuire and Fusar-Poli.
Frontiers in
Psychiatry, 9 (JUN) (no pagination)(187) :
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Galling, B., Correll, C.
Background: The value of early intervention in psychosis and allocation of public resources has long been debated since outcomes in people
with schizophrenia-spectrum disorders have remained suboptimal. Several research programs for early psychosis yielded promising results for
teambased, multi-element coordinated specialty care (CSC). Methods: Systematic literature search of PubMed/PsycInfo/Embase/clinicaltrials. gov
without language restrictions until 06/06/2017. Random effects meta-analysis of randomized trials comparing CSC versus Treatment as Usual (TAU) in in
first episode psychosis or early-phase schizophreniaspectrum disorders (schizophrenia, psychotic disorder not otherwise specified, schizoaffective
disorder, schizophreniform disorder, delusional disorder), calculating standardized mean differences (SMDs) and risk ratios (RRs) for continuous and
categorical outcomes as well as prespecified subgroup and meta-regression analyses. Co-primary outcomes were all-cause treatment discontinuation and
>=1 psychiatric hospitalization during the treatment period. Key secondary outcomes were total symptom improvement, functioning, and work or school
involvement. Results: Across 10 trials (n=2,176; age=27.5 +/- 4.6 years; male=62.3%; trial duration=16.2 +/- 7.4 (range=9-24) months), CSC
outperformed TAU at the end of treatment regarding all meta-analyzable outcomes. This included all-cause discontinuation (studies=10, n=2,173,
RR=0.70, 95% confidence interval (CI)=0.61-0.80, p<0.001; number-needed-to-treat (NNT)=12.4), >=1 hospitalization (studies=10, n=2,105, RR=0.74,
95%CI=0.61-0.90, p=0.003; NNT=10.1), total symptom severity (studies=8, n=1,179, SMD=- 0.32, 95%CI=-0.47, -0.17, p<0.001), positive symptoms
(studies=10, n=1,532, SMD=-0.22, 95%CI=-0.32, -0.13, p<0.001), negative symptoms (studies=10, n=1,432, SMD=-0.28, 95%CI=-0.42, -0.14, p<0.001),
general symptoms (studies=8, n=1,118, SMD=-0.30, 95%CI=-0.47, -0.13, p=0.001), depressive symptoms (studies=5, n=874, SMD=-0.19, 95%CI=- 0.35, -0.03,
p=0.017), functioning (studies=7, n=1,005, SMD=0.21, 95%CI=0.09-0.34, p=0.001), involvement in school/work (studies=6, n=1,743, RR=1.13, 95%CI=1.03-
1.24, p=0.012; NNT=17.8), and quality of life (studies=4, n=505, SMD=0.23, 95%CI=0.004-0.456, p=0.046). Superiority of CSC regarding all outcomes was
also evident at 6, 9-12, and 18-24 months of treatment (except general symptoms and depression at 18-24 months). Discussion: In early psychosis, CSC
is superior to TAU across all meta-analyzable, highly relevant outcomes with small-to-medium effect sizes. These results support the need for funding
and utilization of CSC in patients with early-phase psychosis.
Schizophrenia
Bulletin, 44 (Supplement
1) : S108
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Case management, Other service delivery and improvement
interventions
Oliver, D., Davies, C., Crossland, G., Lim, S., Gifford, G., McGuire, P., Fusar-Poli, P.
Background: Reduction of duration of untreated psychosis (DUP) is the key strategy of early
interventions for improving the outcomes of first episode psychosis. Although several controlled interventional studies have been conducted with the
aim of reducing DUP, the results are highly inconsistent and conflicting. Methods: The current study systematically searched Web of Science and Ovid
for English original articles investigating interventions adopted to reduce DUP, compared to a control intervention, up to 6th April 2017. 16
controlled interventional studies were retrieved, including 1964 patients in the intervention arm and 1358 in the control arm. The controlled
interventions studies were characterised by: standalone first episode psychosis services, standalone clinical high risk services, community
interventions, healthcare professional training and multifocus interventions. Random effects meta-analyses were conducted. Results: There was no
summary evidence that available interventions are successful in reducing DUP during the first episode of psychosis (Hedges' g = -0.12, 95%CIs -0.25
to 0.01). Subgroup analyses showed no differences within each subgroup, with the exception of clinical high risk services (Hedges' g = -0.386, 95%CI
-0.726 to -0.045). . There was substantial heterogeneity (I2 = 66.4%), most of which was accounted by different definitions of DUP onset (R2=0.88).
Discussion: These negative findings may reflect a parcelled research base in the area, lack of prospective randomized controlled trials (only two
randomised cluster designed studies were present) and small sample sizes. Psychometric standardisation of DUP definition, improvement of study design
and implementation of preventative strategies seem the most promising avenues for reducing DUP and improving outcomes of first-episode psychosis.
Schizophrenia Bulletin, 44 (6) : 1362-
1372
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Vijverberg, R., Ferdinand, R., Beekman, A., van-Meijel, B.
Background: During the past
decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries
implement Assertive Community Treatment (ACT) as an alternative for inpatient care for \"difficult to reach\" children and adolescents with severe
mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are
undertaken to strengthen the patient's motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions,
enhance cost-effectiveness, stimulate social participation and support, and reduce stigma. ACT has been extensively investigated in adults with
severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding
the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-
ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions. Method: A systematic literature search was
conducted in PubMed, Cochrane Library, PsychINFO and CINAHL published up to March 2017. To assess methodological quality of the included studies, the
Oxford Centre of Evidence-Based Medicine grading system was used. Results: Thirteen studies were included in this review. There are indications that
youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of
psychiatric hospital admissions. Conclusions: The current literature on youth-ACT is limited but promising. There are indications that youth-ACT is
effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital
admissions. The effect of youth-ACT may be comparable with the effect of ACT in adults. Similar as in adult ACT, the studies on youth-ACT found
effects that vary from small to large. Randomized experimental research designs are needed to further corroborate effectiveness. Copyright © 2017 The
Author(s).
BMC Psychiatry, 17 (1) (no
pagination)(284) :
- Year: 2017
- Problem: Psychosis Disorders, Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Case management, Other service delivery and improvement
interventions
Breitborde, N. J. K., Woolverton, C., Dawson, S. C., Bismark, A., Bell, E. K., Bathgate, C. J., Norman, K.
Aim: Meta-cognitive skills training (MST) is a frequent component of cognitive remediation programmes for individuals
with psychosis. However, no study has investigated whether incorporating such activities produces increased clinical benefits compared with
computerized cognitive remediation alone. Methods: Individuals with first-episode psychosis who completed computerized cognitive remediation with
concurrent meta-cognitive skills training (CCR + MST) were compared with a historical control group who received computerized cognitive remediation
alone (CCR) and did not differ from the CCR + MST group with regard to pre-intervention cognition, diagnosis, age, duration of psychotic illness or
sex. Participants completed assessments of cognition and real-world functioning before and after 6 months of treatment. Results: Individual receiving
CCR + MST experience greater gains in cognition and real-world functioning than individuals who received CCR. Conclusions: MST may be an important
component within cognitive remediation programmes for first-episode psychosis. Copyright © 2015 Wiley Publishing Asia Pty Ltd
Early
Intervention in Psychiatry, 11(3) : 244-249
- Year: 2017
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Other Psychological Interventions