Disorders - Psychosis Disorders
Frawley, E., Cowman, M., Lepage, M., Donohoe, G.
BACKGROUND: Psychosis, even in its early
stages, ranks highly among the causes of disability worldwide, resulting in an increased focus on improved recovery of social and occupational
functioning. This study aimed to provide an estimate of the effectiveness of psychosocial interventions for improving functioning in early psychosis.
We also sought evidence of superiority between intervention approaches.\rMETHODS: An electronic search was conducted using PubMed and PsycINFO to
identify original articles reporting on trials of psychosocial interventions in early-stage psychosis, published up to December 2020 and is reported
following PRISMA guidelines. Data were extracted on validated measures of functioning from included studies and pooled standardised mean difference
(SMD) was estimated.\rRESULTS: In total, 31 studies involving 2811 participants were included, focusing on: cognitive behavioural therapy for
psychosis (CBTp), family-based therapy, supported employment, cognitive remediation training (CRT) and multi-component psychosocial interventions.
Across interventions, improved function was observed (SMD = 0.239; 95% confidence interval 0.115-0.364, p < 0.001). Effect sizes varied by
intervention type, stage of illness, length and duration of treatment and outcome measure used. In particular, interventions based on CRT
significantly outperformed symptom-focused CBT interventions, while multi-component interventions were associated with largest gains.\rCONCLUSIONS:
Psychosocial interventions, particularly when provided as part of a multi-component intervention model and delivered in community-based settings are
associated with significant improvements in social and occupational function. This review underscores the value of sensitively tracking and targeting
psychosocial function as part of the standard provided by early intervention services.
Psychological medicine, 53(5) : 1787-1798
- Year: 2023
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Cognitive remediation
therapy, Individual placement and support (IPS), vocational
interventions
Engel, L, Alvarez-
Jimenez, M, Cagliarini, D, D'Alfonso, S, Faller, J, Valentine, L, Koval, P, Bendall, S, O'Sullivan, S, Rice, S, Miles, C, Penn,
D. L, Phillips, J, Russon, P, Lederman,
R, Killackey, E, Lal, S, Maree-Cotton, S, Gonzalez-Blanch, C, Herrman, H, McGorry, P. D, Gleeson, J. F.
M, Mihalopoulos, C.
BACKGROUND: Digital interventions have potential applications in promoting long-term recovery
and improving outcomes in first-episode psychosis (FEP). This study aimed to evaluate the cost-effectiveness of Horyzons, a novel online social
therapy to support young people aged 16-27 years following discharge from FEP services, compared with treatment as usual (TAU) from a healthcare
sector and a societal perspective.\rSTUDY DESIGN: A cost-effectiveness analysis (CEA), based on the change in social functioning, and a cost-utility
analysis (CUA) using quality-adjusted life years were undertaken alongside a randomized controlled trial. Intervention costs were determined from
study records; resources used by patients were collected from a resource-use questionnaire and administrative data. Mean costs and outcomes were
compared at 18 months and incremental cost-effectiveness ratios were calculated. Uncertainty analysis using bootstrapping and sensitivity analyses
was conducted.\rSTUDY RESULTS: The sample included 170 participants: Horyzons intervention group (n = 86) and TAU (n = 84). Total costs were
significantly lower in the Horyzons group compared with TAU from both the healthcare sector (-AU$4789.59; P < .001) and the societal perspective (-
AU$5131.14; P < .001). In the CEA, Horyzons was dominant, meaning it was less costly and resulted in better social functioning. In the CUA, the
Horyzons intervention resulted in fewer costs but also yielded fewer QALYs. However, group differences in outcomes were not statistically
significant. When young people engaged more with the platform, costs were shown to decrease and outcomes improved.\rCONCLUSIONS: The Horyzons
intervention offers a cost-effective approach for improving social functioning in young people with FEP after discharge from early intervention
services.
, 01 : 01
- Year: 2023
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational
interventions, Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement
interventions
Crump, C. J, Good, M. E, Abuelazm, H, El-Mallakh, R. S.
INTRODUCTION:
Schizophrenia usually begins with prodromal symptoms in adolescence. In 39% of patients, onset of psychotic symptoms occurs prior to age 19. Advances
in the treatment of psychosis with medications over the last decade are reviewed in this paper.\rAREAS COVERED: Understanding how to prescribe
antipsychotics early in schizophrenia requires an understanding of the pathophysiology of the disease. The current structure of the dopamine
hypothesis is reviewed. Risperidone, paliperidone, olanzapine, quetiapine, and aripiprazole have become established treatments prior to 2012. Since
2012, lurasidone (2017) and brexpiprazole (2022) have also been approved. Lurasidone was approved based on placebo-controlled studies, but
brexpiprazole has been approved on the bases of open safety trials. In comparative trials, aripiprazole was better tolerated and less likely to cause
hyperprolactinemia and metabolic abnormalities.\rEXPERT OPINION: Antipsychotics can induce adaptive changes in the brain that predispose patients to
future problems such as tardive dyskinesia and supersensitivity psychosis. When pathophysiology of schizophrenia, and a clear understanding of the
pharmacology of existing antipsychotics are included in the evidence-based analysis, use of partial agonists, which are less likely to induce
adaptive changes in the brain and less likely to induce metabolic and prolactin side effects, become the preferred agents.
Expert Opinion on Pharmacotherapy, 24(9) : 1039-1052
- Year: 2023
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Bremner, S, Greenwood, K.
Background: Early Intervention in Psychosis services improve outcomes for young people with psychosis but a significant proportion disengage
with potential costs to their mental health. Method(s): This study evaluated effectiveness and cost-effectiveness of the EYE-2 intervention, a
motivational engagement intervention, delivered by EIP clinicians, compared to standardized EIP (sEIP) in a cluster RCT in 20 EIP teams in 5 sites
across England. Participants were 1027 young people with first episode psychosis. The primary outcome was time to disengagement. Economic outcomes
were NHS mental health and wider societal costs, clinical and social outcomes and cost-effectiveness. Result(s): The adjusted hazard ratio for EYE-2
+ sEIP versus sEIP alone was 1.07, (95% CI 0.76 to 1.49; p = .713). Disengagement was 16% with no observed differences between arms for any secondary
outcomes. The health economic evaluation indicated lower average mental health costs [-543 (95% CI -2715 to 1628)] and marginally improved mental
health states, with a 63% probability of the EYE-2 intervention being dominant in cost-effectiveness compared to usual care. There were very
tentative indications of lower societal costs and better social outcomes with 30 more days per year spent in education and training (95% CI 1.52 to
53.68; probability positive outcome for the intervention: 99%) in a sub-sample of 22% of participants. Conclusion(s): Cost-effectiveness analyses
revealed estimates in the direction of dominance of EYE-2, but 95% confidence limits ruled out a reduction of more than 24% in the risk of
disengagement. Implementation, fidelity and COVID-19 impacts are discussed.
Early Intervention
in Psychiatry, 17(Supplement 1) : 109
- Year: 2023
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other service delivery and improvement
interventions
Bodoano-Sanchez, I., Mata-Agudo, A.: Guerrero-Jimenez, M.: Girela-
Serrano, B.: Alvarez-Gil, P., Carrillo-de-Albornoz-Calahorro, C. M., Gutierrez-Rojas, L.
BACKGROUND: Post-psychotic depression (PPD)
after a FEP (first-episode psychosis) differs from other depressive symptoms in chronic schizophrenia in its aetiology, symptomatology, and
prognostic implications. The objective was to search if any pharmacological or non-pharmacological interventions have proven to be effective on
depressive symptoms after a FEP.\rMETHODS: for this systematic review we systematically searched and screened PubMed for articles published from
August 1975 to October 15, 2020, with the terms: treatment AND first-episode psychosis OR post-psychotic OR post-schizophrenic AND depression.
\rRESULTS: we identified 139 articles of which 20 met the inclusion criteria. These interventions were then categorized into four subgroups
(antipsychotics, antidepressants, psychological and miscellaneous).\rLIMITATIONS: this review has several limitations. The reviewed studies were
heterogeneous as to assessments, interventions, and samples; furthermore, only one study had PPD in FEP as its primary outcome.\rCONCLUSIONS: to our
knowledge, this is the first review of PPD in a FEP's treatment. PPD continues to be a diagnostic and therapeutic challenge. The available evidence
for the use of treatment whether pharmacological or non-pharmacological is limited. However, certain approaches such as online therapy and treatment
with n-3 polyunsaturated fatty acids (PUFA) show promising results. It could be of interest for future studies to focus not only on the treatment of
PPD but also on the diagnostic heterogeneity of the sample and the adaptation of the content of the intervention to the individual.
, 77(2) : 109-117
- Year: 2023
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any)
Bechdolf,
A, Muller, H, Hellmich, M, de-Millas, W, Falkai, P, Gaebel, W, Gallinat, J, Hasan, A, Heinz, A, Janssen, B, Juckel, G, Karow, A, Kruger-Ozgurdal,
S, Lambert, M, Maier, W, Meyer-Lindenberg, A, Putzfeld, V, Rausch,
F, Schneider, F, Stutzer, H, Wobrock, T, Wagner, M, Zink, M, Klosterkotter, J.
BACKGROUND: There is limited knowledge of whether cognitive-behavioral
therapy (CBT) or second-generation antipsychotics (SGAs) should be recommended as the first-line treatment in individuals at clinical high risk for
psychosis (CHRp).\rHYPOTHESIS: To examine whether individual treatment arms are superior to placebo and whether CBT is non-inferior to SGAs in
preventing psychosis over 12 months of treatment.\rSTUDY DESIGN: PREVENT was a blinded, 3-armed, randomized controlled trial comparing CBT to
clinical management plus aripiprazole (CM + ARI) or plus placebo (CM + PLC) at 11 CHRp services. The primary outcome was transition to psychosis at
12 months. Analyses were by intention-to-treat.\rSTUDY RESULTS: Two hundred eighty CHRp individuals were randomized: 129 in CBT, 96 in CM + ARI, and
55 in CM + PLC. In week 52, 21 patients in CBT, 19 in CM + ARI, and 7 in CM + PLC had transitioned to psychosis, with no significant differences
between treatment arms (P = .342). Psychopathology and psychosocial functioning levels improved in all treatment arms, with no significant
differences.\rCONCLUSIONS: The analysis of the primary outcome transition to psychosis at 12 months and secondary outcomes symptoms and functioning
did not demonstrate significant advantages of the active treatments over placebo. The conclusion is that within this trial, neither low-dose
aripiprazole nor CBT offered additional benefits over clinical management and placebo.
, 49(4) : 1055-
1066
- Year: 2023
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Bechard, L, Anderson, E, Desmeules, C, Huot-Lavoie, M, Corbeil, O, Brodeur, S, Essiambre, A. M, Fournier, E, Roy, M. A, Lauzier, S, Demers, M. F.
Aims: Determine the
effects of antipsychotic discontinuation in comparison to antipsychotic continuation on personal and functional recovery in remitted first-episode
psychosis (FEP) patients. Method(s): Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase, and PsycINFO were searched on
27 October 2022, with no date or language restrictions. The search strategy was elaborated using synonyms for 'first-episode psychosis',
'discontinuation' and 'antipsychotic' in both free-text terms and controlled vocabulary with the support of an information specialist. All
randomized controlled trials (RCTs) evaluating the effect of antipsychotic discontinuation in patients with remitted FEP were selected. Risk of bias
was evaluated with the Cochrane risk-of-bias tool 2 and the certainty of evidence was assessed with GRADE. A random-effect model with an inverse-
variance approach was used to conduct the meta-analysis. Result(s): 2185 studies were screened for eligibility and 10 studies were included
(including 2 ongoing studies with no results). No studies (published or ongoing) measured the effect of antipsychotic discontinuation on personal
recovery and two studies measured functional recovery. Patients in the discontinuation group were more likely to attain functional recovery (RR 2.36;
95% CIs: 1.24, 4.51; N = 128). Risk of bias for studies assessing functional recovery was high. Analysis of other secondary outcomes such as
employment is underway. Conclusion(s): Although personal recovery is the most important outcome for patients, no published or ongoing antipsychotic
discontinuation trial included personal recovery as an outcome. This information is currently lacking to help stakeholders in the decision to
discontinue or not antipsychotics following FEP remission.
Early Intervention in Psychiatry, 17(Supplement
1) : 274
- Year: 2023
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Allott, K, Yuen, H. P, Baldwin, L, O'Donoghue, B, Fornito, A., Chopra, S, Nelson, B, Graham, J, Kerr, M. J, Proffitt, T.
M, Ratheesh, A, Alvarez-Jimenez, M, Harrigan,
S, Brown, E, Thompson, A. D, Pantelis, C, Berk, M, McGorry, P. D, Francey, S. M, Wood, S. J.
The
drivers of cognitive change following first-episode psychosis remain poorly understood. Evidence regarding the role of antipsychotic medication is
primarily based on naturalistic studies or clinical trials without a placebo arm, making it difficult to disentangle illness from medication effects.
A secondary analysis of a randomised, triple-blind, placebo-controlled trial, where antipsychotic-naive patients with first-episode psychotic
disorder were allocated to receive risperidone/paliperidone or matched placebo plus intensive psychosocial therapy for 6 months was conducted. A
healthy control group was also recruited. A cognitive battery was administered at baseline and 6 months. Intention-to-treat analysis involved 76
patients (antipsychotic medication group: 37; 18.6Mage [2.9] years; 21 women; placebo group: 39; 18.3Mage [2.7]; 22 women); and
42 healthy controls (19.2Mage [3.0] years; 28 women). Cognitive performance predominantly remained stable (working memory, verbal fluency)
or improved (attention, processing speed, cognitive control), with no group-by-time interaction evident. However, a significant group-by-time
interaction was observed for immediate recall (p = 0.023), verbal learning (p = 0.024) and delayed recall (p = 0.005). The medication group declined
whereas the placebo group improved on each measure (immediate recall: p = 0.024; etap2 = 0.062; verbal learning: p = 0.015;
etap2 = 0.072 both medium effects; delayed recall: p = 0.001; etap2 = 0.123 large effect). The rate of
change for the placebo and healthy control groups was similar. Per protocol analysis (placebo n = 16, medication n = 11) produced similar findings.
Risperidone/paliperidone may worsen verbal learning and memory in the early months of psychosis treatment. Replication of this finding and
examination of various antipsychotic agents are needed in confirmatory trials. Antipsychotic effects should be considered in longitudinal studies of
cognition in psychosis.Trial registration: Australian New Zealand Clinical Trials Registry ( http://www.anzctr.org.au/ ; ACTRN12607000608460).
Transl
Psychiatry Psychiatry, 13(1) : 199
- Year: 2023
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Zhu, C., Guan, X., Wang, Y., Liu, J., Kosten, T. R., Xiu, M., Wu, F., Zhang,
X.
Many patients with schizophrenia (SCZ) discontinue
antipsychotics, frequently due to dose-related multiple and severe adverse effects. We hypothesized that a low-dose ziprasidone plus sertraline would
reduce serious side effects without affecting treatment efficacy. Therefore, this clinical trial was designed to investigate the efficacy, safety,
and tolerability of adding sertraline to ziprasidone in order to substantially reduce ziprasidone dose and potential side effects in first-episode
and drug-naive (FEDN) patients with SCZ. This 24-week randomized, double-blinded, controlled clinical trial randomly allocated 452 FEDN SCZ patients
to receive a usual dose of ziprasidone (control group) or half the dose of ziprasidone in combination with sertraline (ZS group). Treatment outcome
included the Positive and Negative Syndrome Scale (PANSS), the Hamilton Depression Rating Scale (HAMD), CGI-Severity (CGI-S) and the Personal and
Social Performance Scale (PSP) at baseline and weeks 2, 4, 8, 12, and 24. Repeated measures ANCOVA showed significant treatment by time interactions
on the PANSS general psychopathology and total scores, as well as CGI-S, HAMD, and PSP scores (all p < 0.05). Furthermore, the ZS group had greater
reductions in PANSS general psychopathology, total scores, HAMD, and CGI-S (all p < 0.05) and greater increases in the PSP total score (p < 0.01)
than the control group. Importantly, adverse effects were lower in the ZS than control group. The reduction in PANSS, CGI-S, or HAMD scores was not
correlated with the increase in PSP. Sex and duration of disease predicted PSP improvement from baseline to week 24 in the ZS group. Our FEDN
patients with SCZ were effectively treated for their psychotic and depressive symptoms while experiencing significantly fewer adverse effects using
half the usual ziprasidone dose when combined with sertraline. ClinicalTrials.gov, NCT04076371. Copyright © 2022, The American Society for
Experimental NeuroTherapeutics, Inc.
Neurotherapeutics, 19(3) : 1037-1046
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any), Atypical Antipsychotics (second
generation)
Zheng, Y., Xu, T., Zhu, Y., Li, C., Wang, J., Livingstone, S., Zhang, T.
Objective: This study aimed to provide insight into the efficacy of cognitive-behavioral therapy for
psychosis (CBTp) in patients with \"clinical high risk of psychosis (CHR-P)\". Method(s): Major scientific databases were searched up to April 17,
2020. Randomized controlled trials in CHR-P individuals, comparing CBTp with needs-based interventions (NBI, including treatment as usual or
nonspecific control treatment) were included, following PRISMA guidelines. The primary outcome (efficacy) was transition to psychosis by 6 months, 12
months, 24 months, and over 24 months. Secondary outcomes were change in attenuated psychotic symptoms, depression, distress, improvements in
functioning, and quality of life. Result(s): Ten randomized controlled studies met inclusion criteria. The comparisons included 1128 participants.
CBTp was significantly more efficacious in reducing rate of transition to psychosis by 6 months (after post-hoc sensitivity analysis) (relative risk
[RR] = 0.44, 95% confidence interval [CI]: 0.26, 0.73), 12 months (RR = 0.44, 95% CI: 0.30, 0.64), 12 months (RR = 0.46, 95%CI: 0.30, 0.69), and over
24 months (RR = 0.58, 95% CI: 0.35, 0.95) after treatment, compared with those receiving NBI. CBTp was also associated with more reduced attenuated
psychotic symptoms by 12 months (SMD = -0.17, 95% CI: -0.33, -0.02) and by 24 months (SMD = -0.24, 95% CI: -0.43, -0.06). No beneficial effects on
functioning, depression, quality of life, or distress were observed favoring CBTp. Conclusion(s): CBTp is effective in reducing both psychosis
transition rates and attenuated psychotic symptoms for the prodromal stage of psychosis. It is a promising intervention at the preventative stage.
Copyright © 2021 The Author(s). Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.
, 48(1) : 8-19
- Year: 2022
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Wojtalik, J. A., Mesholam-Gately, R. I., Hogarty, S. S., Greenwald, D. P., Litschge, M. Y., Sandoval, L. R., Shashidhar, G., Guimond, S., Keshavan, M. S., Eack, S. M.
OBJECTIVE: Cognitive enhancement therapy (CET)
is an 18-month comprehensive cognitive remediation intervention designed to improve cognition and functioning among patients with schizophrenia. The
current study sought to confirm previously observed benefits of CET on cognitive and behavioral outcomes in the early course of the condition in a
large multisite trial.\rMETHODS: Overall, 102 outpatients with early-course schizophrenia were randomly assigned to 18 months of CET (N=58) or
enriched supportive therapy (EST; N=44). Participants completed cognitive, social adjustment, and symptom assessments at baseline and at 9 and 18
months. Composite indices were calculated for these outcomes. Mixed-effects models investigated differential changes in outcomes between CET and EST.
Because of a high attrition rate, sensitivity analyses of data from treatment completers (N=49) were conducted.\rRESULTS: The effects of CET on
improved overall cognition were confirmed and tentatively confirmed for social cognition in both intent-to-treat and completer analyses, and
beneficial effects on attention/vigilance were also observed. An effect of CET on social adjustment was not confirmed in the analyses, because both
CET and EST groups had considerably improved social adjustment. Although not statistically significant, the between-group effect size for CET's
effect on social adjustment doubled from the intent-to-treat (Cohen's d=0.23) to completer analyses (Cohen's d=0.51) (p=0.057). Both groups
displayed similar symptom improvements.\rCONCLUSIONS: CET effectively improved cognition among patients with early-course schizophrenia. The
functional benefits of CET appeared to increase with treatment retention. Further research is needed to understand predictors of attrition and
mechanisms of change during CET for this population.
Psychiatric Services, 73(5) : 501-509
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Supportive
therapy
Vitger, T, Hjorthoj, C, Austin, S. F, Petersen, L, Tonder, E. S, Nordentoft, M, Korsbek, L.
BACKGROUND:
Shared decision-making (SDM) is a process aimed at facilitating patient-centered care by ensuring that the patient and provider are actively involved
in treatment decisions. In mental health care, SDM has been advocated as a means for the patient to gain or regain control and responsibility over
their life and recovery process. To support the process of patient-centered care and SDM, digital tools may have advantages in terms of
accessibility, structure, and reminders.\rOBJECTIVE: In this randomized controlled trial, we aimed to investigate the effect of a digital tool to
support patient activation and SDM.\rMETHODS: The trial was designed as a randomized, assessor-blinded, 2-armed, parallel-group multicenter trial
investigating the use of a digital SDM intervention for 6 months compared with treatment as usual. Participants with a diagnosis of schizophrenia,
schizotypal or delusional disorder were recruited from 9 outpatient treatment sites in the Capital Region of Denmark. The primary outcome was the
self-reported level of activation at the postintervention time point. The secondary outcomes included self-efficacy, hope, working alliance,
satisfaction, preparedness for treatment consultation, symptom severity, and level of functioning. Explorative outcomes on the effect of the
intervention at the midintervention time point along with objective data on the use of the digital tool were collected.\rRESULTS: In total, 194
participants were included. The intention-to-treat analysis revealed a statistically significant effect favoring the intervention group on patient
activation (mean difference 4.39, 95% CI 0.99-7.79; Cohen d=0.33; P=.01), confidence in communicating with one's provider (mean difference 1.85, 95%
CI 0.01-3.69; Cohen d=0.24; P=.05), and feeling prepared for decision-making (mean difference 5.12, 95% CI 0.16-10.08; Cohen d=0.27; P=.04). We found
no effect of the digital SDM tool on treatment satisfaction, hope, self-efficacy, working alliance, severity of symptoms, level of functioning, use
of antipsychotic medicine, and number or length of psychiatric hospital admissions.\rCONCLUSIONS: This trial showed a significant effect of a digital
SDM tool on the subjective level of patient activation, confidence in communicating with one's provider, and feeling prepared for decision-making at
the postintervention time point. The effect size was smaller than the 0.42 effect size that we had anticipated and sampled for. The trial contributes
to the evidence on how digital tools may support patient-centered care and SDM in mental health care.\rTRIAL REGISTRATION: ClinicalTrials.gov
NCT03554655; https://clinicaltrials.gov/ct2/show/NCT03554655.\rINTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-doi: 10.1186/s12888-019-2143-
2.
Journal of Medical Internet Research, 24(10) : e40292
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement
interventions