Disorders - Psychosis Disorders
Rinaldi, M., Craig, T., Singh, S., Smith, J., Shepherd, G.
Background: Supported employment (SE) has been shown in numerous controlled
trials to be the most effective intervention for helping patients return to paid employment but is poorly implemented in practice because of
scepticism and ambivalence of clinical staff. Objectives: To see whether a motivational intervention directed at clinical staff can improve
occupational outcomes for patients following a first episode of psychosis Methods: Two of four early intervention teams in the UK that offer
supported employment (SE) as part of their clinical service were randomised to receive additional motivational training (MT) for clinicians focused
on attitudinal barriers to employment. Occupational outcomes of patients in these teams were evaluated at 6 and 12 months. Results: 159/300 patients
in these teams consented to the research. Occupational outcomes were obtained for 149 (94%) at 6 months and 136 (85%) at 12-month follow-up. More
patients in the MT intervention teams than in the SE only teams achieved employment by 6 months (25/76 vs. 9/73). A random effects logistic
regression accounting for clustering by care coordinator and adjusted for the participant's sex, ethnicity, educational and employment history,
PANSS and GAF scores confirmed superiority of the MT + MI intervention (OR 4.5; 95% CI 2.2-12.4). Comparable results were obtained for 12-month
outcomes. Conclusions: Occupational outcomes of an SE programme were enhanced by addressing clinical ambivalence about supporting their patients back
into work.
Early Intervention in
Psychiatry, 8 : 121
- Year: 2014
- 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, Individual placement and support (IPS), vocational
interventions
Ritsner, M. S., Bawakny, H., Kreinin, A.
Aims: Management of recent-onset schizophrenia (SZ) and schizoaffective disorder (SA) is
challenging owing to frequent insufficient response to antipsychotic agents. This study aimed to test the efficacy and safety of the neurosteroid
pregnenolone in patients with recent-onset SZ/SA. Methods: Sixty out- and inpatients who met DSM-IV criteria for SZ/SA, with suboptimal response to
antipsychotics were recruited for an 8-week, double-blind, randomized, placebo-controlled, two-center add-on trial, that was conducted between 2008
and 2011. Participants were randomized to receive either pregnenolone (50 mg/day) or placebo added on to antipsychotic medications. The primary
outcome measures were the Positive and Negative Symptoms Scale and the Assessment of Negative Symptoms scores. Secondary outcomes included
assessments of functioning, and side-effects. Results: Analysis was by linear mixed model. Fifty-two participants (86.7%) completed the trial.
Compared to placebo, adjunctive pregnenolone significantly reduced Positive and Negative Symptoms Scale negative symptom scores with moderate effect
sizes (d = 0.79). Significant improvement was observed in weeks 6 and 8 of pregnenolone therapy among patients who were not treated with concomitant
mood stabilizers (arms x visit x mood stabilizers; P = 0.010). Likewise, pregnenolone significantly reduced Assessment of Negative Symptoms scores
compared to placebo (d = 0.57), especially on blunted affect, avolition and anhedonia domain scores. Other symptoms, functioning, and side-effects
were not significantly affected by adjunctive pregnenolone. Antipsychotic agents, benzodiazepines and sex did not associate with pregnenolone
augmentation. Pregnenolone was well tolerated. Conclusions: Thus, add-on pregnenolone reduces the severity of negative symptoms in recent-onset
schizophrenia and schizoaffective disorder, especially among patients who are not treated with concomitant mood stabilizers. Further studies are
warranted. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Psychiatry & Clinical Neurosciences, 68(6) : 432-
440
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Other biological interventions
Stain, H., Bucci, S., Halperin, S., Emsley, R., Shall, U., Lewin, T., Carr, V., Crittenden, K., Clark, V., Startup, M.
Background: This will be the first presentation of the treatment outcomes for the Australian
DEPTh trial of cognitive behavioral therapy (CBT) for youth at ultra high risk (UHR) for psychosis. The DEPTh protocol is based on the EDIE model
(Morrison et al., 2004, 2012), but employed an active control condition, Non-Directive Refl ective Listening (NDRL). Method: This is a single blind
RCT of CBT compared to NDRL plus standard care conducted at two sites (urban-Newcastle, rural-Orange) with a 6-month treatment phase (weekly
sessions) and a 12-month follow-up from randomization in young people meeting UHR criteria. Assessments were conducted at baseline, 6 months and 12
months. Measurement domains included symptoms, substance use, functioning and quality of life. Intention-to-treat analysis was performed using
regression models. Results: There were 57 youth randomized to either treatment or active control (N = 30: CBT; N = 27: NDRL), with the majority of
participants female (60%) and an average age of 16.3 years. Attrition rates were high, with 40% and 53% of youth lost to follow-up at 6 months and 12
months respectively. At baseline and at 6 months the CBT group showed more distress associated with sub-clinical psychotic symptoms than the NDRL
group. This effect disappeared at 12 months. No other group differences were found at either 6 or 12 months. Discussion: High attrition rates at the
time of follow up assessments made analyses underpowered. We will discuss the rates of engagement in the intervention itself and the characteristics
of our sample in order to inform future treatment trials with young people.
Early Intervention in
Psychiatry, 8 : 15
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Wang, J., Hu, M. R., Guo, X.
F., Wu, R. R., Li, L. H., Zhao, J. P.
Cognitive impairment is a core feature of schizophrenia. The present randomized open study enrolled antipsychotic-naïve patients who were
experiencing their first episode of schizophrenia. After baseline neurocognitive tests and clinical assessment, subjects were randomly assigned to
olanzapine, risperidone and aripiprazole treatment groups. A battery of neurocognitive tests showed that risperidone produced cognitive benefits in
all five cognitive domains, including verbal learning and memory, visual learning and memory, working memory, processing speed, and selective
attention; olanzapine improved processing speed and selective attention; and aripiprazole improved visual learning and memory, and working memory.
However, the three atypical antipsychotic drugs failed to reveal any significant differences in the composite cognitive scores at the study endpoint.
In addition, the three drugs all significantly improved clinical measures without significant differences between the drugs after 6 months. These
results suggest that the atypical antipsychotics, olanzapine, risperidone and aripiprazole may improve specific cognitive domains with similar global
clinical efficacy. In clinical practice, it may be feasible to choose corresponding atypical antipsychotics according to impaired cognitive
domains.
Neural Regeneration Research, 8(3) : 277-286
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Velden-Hegelstad, W. T., Langeveld, J., Heitmann, L., Joa, I., Johannessen, J. O.
Background: In 60%-90% of cases, psychosis disrupts vocational or academic
engagement [1]. JobPrescription aims for employment/studies through Individual Placement and Support (IPS). Sixty-one participants (2010-2013) with
psychotic disorders entered the project, about half on the initiative of treating clinician. 41% attained regular paid employment, 20% were in
internships. The mean time from project inclusion to employment was 3.6 months (SD 0.7). However, these figures have not been compared to a control
group, and the group was a mix of chronic and first-episode patients. Objective: To evaluate the effect of this intervention using a randomised
controlled trial. Methods: First-episode psychosis (FEP) patients aged 15-65 are referred by TIPS early detection and randomised to treatment as
usual or Job- Prescription. Single blind assessments are carried out at baseline, 3 and 24 months. Primary outcome measures are employment/study
status. Secondary outcomes are quality of life and psychological well-being. Symptom levels and neuropsychological function are analysed as
covariates. Results: By April 2014, 20 patients were included. Four of 8 in the control and 9 of 12 in the experimental arm are engaged in employment
or studies. Preliminary results on symptoms, quality of life, and (neuro)psychological factors will be presented. Study inclusion continues until 60
participants. Discussion: Experiences from JobPrescription seem to indicate favourable results. However, threats to the RCT include a 50% refusal
rate, possibly due to the risk of randomisation to the wait-list condition; and treatment as usual increasingly making use of IPS methods and thus
contaminating the control arm.
Early Intervention in
Psychiatry, 8 : 122
- Year: 2014
- 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
Okuzawa, N., Kline, E., Fuertes, J., Negi, S., Reeves, G., Himelhoch,
S., Schiffman, J.
Aim: Unlike medication treatment, which may confer an unfavourable risk-
benefit ratio, psychosocial intervention has been an emerging target of recent randomized controlled trials (RCTs) assessing its efficacy in delaying
or preventing the onset of psychosis in individuals identified at 'clinical high risk'. Literature comparing qualitative differences in these
psychotherapeutic interventions is scarce. The aim of the current study was to conduct a PRISMA systematic review evaluating the efficacy of
psychotherapeutic interventions in reducing the rates of conversion to psychosis in clinical high-risk individuals. Methods: RCTs were identified in
PubMed, Medline and PsycINFO databases up to 30 November 2013. Six studies (comprising 800 participants) met review inclusion criteria. Three
investigators performed data extraction independently by using a pre-structured selection form, and conducted risk of bias assessment employing the
Cochrane approach. Results: All six studies employed cognitive behaviour therapy as a core element. Three trials achieved a significant effect. The
two trials that employed cognitive behaviour therapy enhanced for the specialized needs of clinical high-risk patients maintained significant effects
at post-treatment follow up. Conclusion: Evidence from recent trials suggest that cognitive behaviour therapy may be beneficial in delaying or
preventing onset of psychosis in clinical high-risk individuals, although effect sizes to date appear small. Further research is needed in larger
samples to establish whether cognitive behaviour therapy is efficacious, and if additional intervention components can enhance established
psychotherapies. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Early Intervention in
Psychiatry, 8(4) : 307-322
- Year: 2014
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Puig, O., Penades, R., Baeza, I., De-la-Serna,
E., Sanchez-Gistau, V., Bernardo, M., Castro-Fornieles, J.
Objective:
Cognitive impairment is an enduring and functionally relevant feature of early-onset schizophrenia (EOS). Cognitive remediation therapy (CRT)
improves cognition and functional outcome in adults with schizophrenia, although data in adolescents with EOS remain scarce. The purpose of this
study is 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: We performed a randomized, controlled trial of individually delivered CRT plus treatment-as-usual compared with
treatment-as-usual (TAU). Fifty adolescents with EOS were randomly assigned to receive CRT (n = 25) or TAU (n = 25) and were included in an
intention-to-treat analysis. Clinical symptoms and cognitive and functional performance were assessed before and after treatment in both groups and
after 3 months in the CRT group. Cognitive domains were defined according to the Measurement and Treatment Research to Improve Cognition in
Schizophrenia (MATRICS) consensus battery and averaged in a global cognitive composite score. Results: After CRT, significant improvements were found
in verbal memory and executive functions, with medium-to-large effect sizes (ES). The derived cognitive composite score showed an improvement after
the treatment, with a large ES. This change was reliable in more than two-thirds of the treated patients. Medium-sized ES were found for improvements
after CRT in daily living and adaptive functioning, whereas large ES were observed for improvements in family burden. With the exception of
functional gains, these changes were maintained after 3 months. Conclusion: CRT appears to be a useful intervention strategy for adolescents with
EOS. Cognitive improvements can be achieved through CRT, although further research is warranted to determine the durability of functional gains.
(PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 53(8) : 859-
868
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Poulton,
R., Van-Ryzin, M. J., Harold, G. T., Chamberlain, P., Fowler, D., Cannon, M., Arseneault,
L., Leve, L. D.
Objective: Neurodevelopmental theories of psychosis highlight the potential benefits of early intervention, prevention, and/or
preemption. How early intervention should take place has not been established, nor whether interventions based on social learning principles can have
preemptive effects. The objective was to test whether a comprehensive psychosocial intervention can significantly alter psychotic symptom
trajectories during adolescence-a period of heightened risk for a wide range of psychopathology. Method: This study was a randomized controlled trial
(RCT) of Multidimensional Treatment Foster Care (MTFC) for delinquent adolescent girls. Assessment of psychotic symptoms took place at baseline and
then 6, 12, 18, and 24 months post-baseline using a standardized self-report instrument (Brief Symptom Inventory). A second source of information
about psychotic symptoms was obtained at baseline or 12 months, and again at 24 months using a structured diagnostic interview (the Diagnostic
Interview Schedule for Children [DISC]). Results: Significant benefits for MTFC over treatment as usual for psychosis symptoms were observed over a
24-month period. Findings were replicated across both measures. Effects were independent of substance use and initial symptom severity and persisted
beyond the initial intervention period. Conclusion: Ameliorating nonclinical psychotic symptoms trajectories beginning in mid-adolescence via a
multifaceted psychosocial intervention is possible. Developmental research on nonclinical psychotic symptoms and their prognostic value should be
complemented by more psychosocial intervention research aimed at modifying these symptom trajectories early in their natural history. Clinical trial
registration information-Juvenile Justice Girls Randomized Control Trial: Young Adult Follow-up; http://clinicaltrials.gov; NCT01341626. (PsycINFO
Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 53(12) : 1279-
1287
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Piskulic, D., Barbato, M., Liu, L., Addington, J.
Individuals at clinical high risk
(CHR) of psychosis evidence cognitive deficits. Given suggestions that deficits in cognition are related to poor functional outcome, cognition is a
good treatment target. The aim of this study was to test the efficacy of cognitive remediation therapy (CRT) in improving cognition of CHR
individuals. Participants were randomised to either the BF treatment or a control treatment consisting of commercial computer games (CG). The 40
hours of BF intervention or computer game activity was expected to occur 4 days a week, for an hour each day, over a period of 10-12 weeks.
Participants were tested at baseline, immediately following CRT and 9 months post-baseline. The mixed effects modelling demonstrated no differences
in cognition between the experimental group and the control group at any time point. For the experimental group however, there was a trend towards
improvement in speed of processing between baseline and 9-month follow-up (t(29) = - 2.91, P = 0.06) and at post-CRT compared to 9-month follow-up
(t(29) = - 2.99, P < 0.05). In the control group, significant improvements in working memory were observed between post-CRT and 9-month follow-up (t
(29) = - 3.06, P < 0.05). Despite significant improvements in social functioning in the intervention group between baseline and 9-month follow-up (t
(28) = - 3.26, P < 0.05), these improvements were not correlated with cognition. There were trends towards improvement and no trends of decline in
the two groups. While CRT may be valuable for individuals at CHR, the type of intervention employed needs to be carefully considered.
Early Intervention in
Psychiatry, 8 : 86
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Piskulic, D., Barbato, M., Liu, L., Addington, J.
Background: Onset of psychotic disorders such as schizophrenia typically
occurs during late adolescence or early adulthood often resulting in chronic social and occupational disability. Deficits in cognition and functional
outcome (e.g. social and occupational functioning) often precede the onset of full-blown psychosis although to a lesser degree than observed in
schizophrenia. Progress in risk identification methodology has enabled reliable detection of persons thought to be putatively prodromal for psychosis
that is, at clinical high risk (CHR) of developing a psychotic disorder. Since CHR individuals evidence cognitive deficits, which increase around the
time of conversion, cognition is an excellent treatment target. There is evidence in schizophrenia and in CHR samples, that deficits in cognition are
related to poor functional outcome. Thus, treatments targeting cognition may consequently improve functional outcome. The primary aim of the project
was to reduce cognitive deterioration in CHR individuals using cognitive remediation training (CRT) and test the efficacy of the PositScience Brain
Fitness (BF) auditory training program in improving cognition of these individuals. Methods: This is a longitudinal, single blind, randomized
controlled pilot trial of CRT in 32 CHR persons between the ages of 14 and 35 years. Participants were randomised to either the BF treatment or a
control treatment consisting of commercial computer games (CG). The 40 hours of BF intervention or computer game activity was expected to occur 4
days a week, for an hour each day, over a period of 10-12 weeks. Participants were recruited from an ongoing longitudinal study of CHR individuals.
The primary outcome was cognitive function assessed using the MATRICS consensus cognitive battery. The secondary outcome was social and role
functioning assessed with Global Functioning: Social and Role scales. All clinical and cognitive assessments using symptom, functioning and cognitive
measures were performed at baseline, post-treatment (at 3 months) and at 6-month follow-up. Results: Half of all participants completed between 20-40
training sessions. There were no significant baseline differences between the two groups on demographics, functional outcome or attenuated symptoms.
Mixed effects modelling demonstrated no differences between the groups on cognitive domains at baseline or either follow up assessment. For the BF
group, there was a trend towards improvement in speed of processing at 6-months (LSM=46.59, SE=2.91) compared to baseline (LSM=39.88, SE=2.16; -2.91
(29), p=0.06) and post-training follow-up (LSM=40.6, SE=2.46; -2.99 (29) p=0.05). In the CG group, significant improvements in working memory were
observed between post-training (LSM=41.33, SE=3.14) and 6-month follow-up (47.48, SE=2.90; -6.14 (29), p<0.05). Additionally, there were significant
improvements in social functioning in the BF group at 6-month follow-up (LSM=7.32, SE=0.54) compared to baseline (LSM=5.80, SE=0.43; -1.51 (28),
p<0.05). Discussion: Although improvements in the BF group were on a trend level this finding is potentially significant from a clinical standpoint
as it suggest that cognitive remediation intervention may have some benefit after 20 training sessions. Similarly, working memory benefits noted in
the CG group indicate that there are some possible benefits to cognitive function from engaging in computer games that consisted of word puzzles and
strategy games. Despite improvements in social functioning in BF group this was not significantly associated with improvements in cognition. Lack of
significant findings may be due to underpowered study resulting from small sample size and high attrition rate.
Schizophrenia Research, 153 : S218
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
O'Brien, M. P., Miklowitz, D.
J., Candan, K. A., Marshall, C., Domingues, I., Walsh, B. C., Zinberg, J. L., De-Silva, S. D., Woodberry, K. A., Cannon, T. D.
Objective: This study investigated whether family focused therapy (FFT-CHR), an 18-session intervention that consisted
of psychoeducation and training in communication and problem solving, brought about greater improvements in family communication than enhanced care
(EC), a 3-session psychoeducational intervention, among individuals at clinical high risk for developing psychosis. Method: This study was conducted
within a randomized controlled trial across 8 sites. We examined 10-min problem-solving discussions at baseline and 6-month reassessment among 66
adolescents and young adults and their parents. Trained coders who were blind to treatment and time of assessment achieved high levels of interrater
reliability when evaluating family discussions on categories of calm-constructive and critical-conflictual behavior. Results: Individuals at high
risk and their family members who participated in FFT-CHR demonstrated greater improvement from baseline to 6-month reassessment in constructive
communication and decreases in conflictual behaviors during family interactions than those in EC. Participants in FFT-CHR showed greater increases
from baseline to 6 months in active listening and calm communication and greater decreases in irritability and anger, complaints and criticism, and
off-task comments compared to participants in EC. These changes occurred equally in high-risk participants and their family members. Conclusions: A
6-month family skills training treatment can bring about significant improvement in family communication among individuals at high risk for psychosis
and their parents. Future studies should examine the association between enhancements in family communication and reduced risk for the onset of
psychosis among individuals at high risk. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Journal of Consulting &
Clinical Psychology, 82(1) : 90-101
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Nuechterlein, K. H., Ventura, J., Subotnik, K. L., Gretchen-Doorly, D., Turner, L., Casaus, L., Luo, J., Bell, M. D., Medalia, A.
Background: Work/school functioning is often the outcome domain with the greatest continuing impairment after a first episode of
schizophrenia. The level of cognitive deficit during this period is a strong rate-limiting factor in work recovery. Interventions that can improve
cognitive functioning early in the course of schizophrenia are essential if we hope to prevent or limit long-term disability in this disorder.
Methods: We completed a 12-month randomized controlled trial of cognitive remediation with 67 patients with a recent first episode of schizophrenia
using healthy behavior training as an active comparison group. The cognitive remediation approach combined computer programs emphasizing repeated
practice with elementary cognitive processes (processing speed, attention, immediate memory) and more complex, life-like situations (higher-order
memory and problem solving). Two hours/week of computerized cognitive training at the clinic was supplemented with a weekly bridging group to
encourage transfer of learning to work and school situations. Patients assigned to healthy behavior training had an equal amount of treatment time
that involved instruction and practice in good nutrition habits, light physical exercise, and stress reduction. Supported education/ employment was
provided to both treatment groups to encourage return to competitive work or schooling. Results: Consistent antipsychotic medication adherence was
found to increase cognitive improvement in this period after a first psychotic episode so medication adherence and protocol completion were covaried
to examine cognitive remediation effects. Compared to healthy behavior training cognitive remediation produced significant improvement in the Overall
Composite score and the Attention/Vigilance domain from the MATRICS Consensus Cognitive Battery. Cognitive remediation also produced significantly
greater improvement in work/school functioning than healthy behavior training. The amount of cognitive improvement was also significantly correlated
with the degree of work/school functional improvement suggesting that the cognitive gains were a notable factor in this functional improvement.
Discussion: Our results indicate that cognitive remediation can significantly improve cognitive deficits after a first episode of schizophrenia. When
combined with supported education/employment, cognitive remediation shows an impact on work/school functioning that goes beyond the facilitating
effect of that compensatory work rehabilitation approach. Additional research should focus on treatment conditions that can produce even larger gains
in cognition in this initial period of schizophrenia and that facilitate further generalization of learning from cognitive training sessions to
everyday functioning.
Schizophrenia Research, 153 : S224
- Year: 2014
- 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), Cognitive remediation
therapy, Physical activity, exercise, Technology, interventions delivered using technology (e.g. online, SMS)