Disorders - Psychosis Disorders
Van-Aubel, E., Vaessen, T., Van-Winkel, R., Lafit, G., Beijer-Klippel, A., Viechtbauer, W., Batink,
T., Van-Der-
Gaag, M., Van-Amelsvoort, T., Marcelis, M., Schirmbeck, F., De-Haan, L., Reininghaus, U., Myin-Germeys, I.
Background: We investigated treatment effects of Acceptance and Commitment Therapy in Daily
Life (ACT-DL) on psychological flexibility (PF) and the moderating role of the therapeutic working alliance on these effects in patients with early
psychosis. Method(s): ACT-DL is an ecological momentary intervention (EMI) combining face-to-face ACT with a smartphone app. In the multi-center
INTERACT randomized controlled trial, n=148 early psychosis individuals were randomized to either treatment as usual (TAU as the control condition,
n=77) or to ACT-DL in addition to TAU (ACT-DL + TAU as the experimental condition, n=71). We assessed global PF and the therapeutic alliance with
self-report questionnaires. In addition, we used the experience sampling methodology (ESM) to assess PF with a momentary (in-the-moment and since-
the-previous-beep openness) and an evening (daily PF) questionnaire. Assessments took place at baseline, post-intervention (POST), six (FU6), and
twelve months (FU12) follow-up. Result(s): Global (B=19.49 to 33.14; all P-values<.001) and daily PF (B=0.68; P-value<.001) improved equally in both
conditions at each time point. Individuals in the ACT-DL condition improved more than those in TAU on momentary openness (in-the-moment openness at
POST (B=0.32; P-value=0.007) and since-the-previous-beep openness at POST (B=0.33; P<.001) and FU6 (B=0.23; P-value=0.025). Client-perceived working
alliance moderated in-the-moment openness such that larger improvements in openness at POST (B=0.05; P-value<.001) were found in ACT-DL in
individuals with higher working alliance scores. Conclusion(s): Our results provide partial support for the capability of ACT-DL to improve daily
life measures of openness, and emphasize the importance of the therapeutic relationship in supporting processes of change. Copyright The copyright
holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a
CC-BY-NC-ND 4.0 International license.
medRxiv., 19 :
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Acceptance & commitment therapy
(ACT)
Tang, Y, Yu, L, Zhu, X, Lyu, J, Lyu, H, Yuan, Z.
BACKGROUND: The drug control of symptoms is for now the main clinical treatment of schizophrenia, but patients' varying condition and
poor compliance can also fluctuate the therapeutic effect. Personalized nursing with a quantitative evaluation strategy (PNQES) may help improve the
compliance and symptoms, but there are controversies over the outcomes reported in each specific study; the meta-analysis method aims to resolve the
controversies over studies, thus, we conducted this study to pooling the results of controlled clinical studies, and to systematically evaluate the
effects of this nursing model.\rMETHODS: The PubMed, Medline, Embase, China National Knowledge Infrastructure, and Wanfang databases were selected
and searched for relevant articles for PNQES comparing to usual care. The inclusion criteria were established according to the Participants,
Interventions, Comparisons, Outcomes, and Study (PICOS) framework. The Cochrane risk of bias 2.0 tool was used to evaluate the risk of bias of the
included articles. The symptom scores, treatment compliance rate, quality of life, and social function indicators of the patients after nursing were
quantitatively analyzed with effect sizes of mean difference (MD) or standard mean difference (SMD).\rRESULTS: The 11 included articles comprised a
total of 1,251 patients with experimental group 625 and control group 626. Of all the 11 articles, only 1 had a \"low\" risk of bias, while the other
articles had \"some concern of risk;\" none of the articles had a \"high\" risk of bias. The meta-analysis showed that patients who received PNQES
had a significantly lower Positive and Negative Syndrome Scale (PANSS) total score after care than patients who received routine care [MD =-9.95, 95%
confidence interval (CI): -14.35, -5.55; P<0.00001]. Further, the treatment compliance rate of patients who received PNQES was significantly higher
(odds ratio =4.44, 95% CI: 2.17, 9.09; P<0.0001), as was the quality of life (standard MD =2.40, 95% CI: 1.46, 3.34; P<0.00001). Further, the social
function deficit score was significantly lower (MD =-2.25, 95% CI: -3.75, -0.76; P=0.003). Subgroup and regression analyses showed that patient age,
initial PANSS score, and the quantitative method of disease severity were not the sources of heterogeneity. Different intervention approaches applied
may have been the source of heterogeneity.\rDISCUSSION: The application of PNQES is helpful for improving patients' symptoms and disease outcomes,
treatment compliance, social function, and quality of life. It is suggested to be generalized in clinical application.
Annals of Palliative Medicine, 11(7) : 2451-
2463
- Year: 2022
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Sturup, A. E, Hjorthoj, C, Albert,
N, Dolmer, S, Birk, M, Ebdrup, B. H, Eplov, L. F, Jensen, H, Vernal, D. L, Speyer, H, Mors,
O, Nordentoft, M.
Aim: Evidence is insufficient regarding the consequences of
discontinuing vs. maintaining antipsychotic medication in patients with first-episode schizophrenia. Our aim was to examine tapered discontinuation
vs. maintenance treatment regarding remission of psychotic symptoms and impact on other areas.\rMethods: Patients included had a diagnosis of
schizophrenia, were treated with antipsychotic medication, and were in remission of psychotic symptoms. Participants were randomized to tapered
discontinuation or maintenance treatment with antipsychotic medication. Assessments were undertaken at baseline and after 1-year. The primary outcome
was remission of psychotic symptoms without antipsychotic medication.\rResults: The trial was terminated due to insufficient recruitment. In total,
29 participants were included: 14 in the tapering/discontinuation group and 15 in the maintenance group. Adherence to maintenance treatment was poor.
At 1-year follow-up, remission of psychotic symptoms without antipsychotic medication for 3 months was observed in five participants in the
tapering/discontinuation group and two in the maintenance group.\rConclusion: Due to insufficient recruitment this study does not provide a
conclusion on whether unfavorable outcomes or advantages follow tapering of antipsychotic medication. Recruitment and adherence to maintenance
treatment encountered obstacles. Based on experiences from this trial, we discussed alternative study designs as consistent evidence is still needed
on whether to continue or discontinue antipsychotic medication in remitted patients with first-episode schizophrenia.\rClinical trial registration:
https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-000565-23/DK, EU Clinical Trials Register-EudraCT no. 2016-000565-23.
Frontiers in psychiatry Frontiers Research
Foundation, 13 : 910703
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation)
Srihari, V. H, Ferrara, M, Li, F, Kline, E, Guloksuz, S, Pollard, J. M, Cahill, J. D, Mathis, W. S, Yoviene-Sykes, L, Walsh, B. C, McDermott, G, Seidman, L. J, Gueorguieva, R, Woods, S. W, Tek, C, Keshavan, M. S.
Objective: Duration of Untreated Psychosis (DUP) remains unacceptably long and limits effectiveness of care. To determine whether an
early detection campaign (\"Mindmap\") can reduce DUP in a US community setting. Method(s): In this nonrandomized controlled trial, Mindmap targeted
the catchment of one specialty first-episode service or FES (STEP, Greater New Haven) from 2015 to 2019, while usual detection efforts continued at a
control FES (PREP, Greater Boston). Mindmap targeted diverse sources of delay through mass & social media messaging, professional outreach &
detailing, and rapid enrollment of referrals. Both FES recruited 16-35 years old with psychosis onset <=3 years. Outcome measures included DUP-Total
(onset of psychosis to FES enrollment), DUP-Demand (onset of psychosis to first antipsychotic medication), and DUP-Supply (first antipsychotic
medication to FES enrollment). Result(s): 171 subjects were recruited at STEP and 75 at PREP. Mindmap was associated with an increase in the number
of referrals and in efficiency of engagement at STEP. Pre-campaign DUP (2014-2015) was equivalent, while Mindmap was associated with DUP reductions
at STEP but not PREP. DUP-Total fell significantly in both the first and the second quartile (11.5 and 58.5 days reduction per campaign year,
respectively). DUP-Demand and DUP-Supply fell in the third quartiles only (46.3 and 70.3 days reduction per campaign year, respectively). No
reductions were detectable across all quartiles at PREP, but between site comparisons were not significant. Conclusion(s): This is the first
controlled demonstration of community DUP reduction in the US, and can inform future early detection efforts across diverse settings. Copyright ©
2022 The Author(s) 2022. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric
Research Center.
Schizophrenia Bulletin Open, 3(1) (no
pagination) :
- Year: 2022
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Singappuli,
P., Sonuga-Barke, E., Kyriakopoulos, M.
Antipsychotic medications are used in a
wide range of mental health and neurodevelopmental conditions in children and adolescents. Their efficacy and tolerability with long-term use have
not been clearly established. We aimed to conduct a systematic review and meta-analysis to evaluate the long-term use of antipsychotics in children
and adolescents. All relevant double-blind randomized control trials (RCTs), on any antipsychotic used for 12 weeks or longer in any mental
health/neurodevelopmental condition in this age group, were included. We evaluated several efficacy and tolerability measures. Meta-analysis was
performed for adverse events. Seven RCTs were identified (n = 939, age = 5-17 years), four on aripiprazole and three on risperidone. All studies
reported symptomatic/functional improvements or more time before discontinuation with antipsychotics compared to placebo. Weight gain was identified
as a significant side effect with antipsychotics. Serum prolactin was reduced with aripiprazole and increased with risperidone, and abdominal
pain/discomfort, respiratory tract infections, were more common with Aripiprazole compared to placebo. Musculoskeletal pain may be more common with
aripiprazole compared to placebo. Use of antipsychotics for 12 weeks or longer may be associated with symptomatic/functional improvements, but may be
associated with additional side effects compared to short-term treatment. Further research in this population is needed. Copyright ©
CNS Spectrums, 27(5) : 570-
587
- Year: 2022
- Problem: Bipolar Disorders, Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Savaglio, M., O'Donnell, R., Hatzikiriakidis,
K., Vicary, D., Skouteris, H.
Australia has undergone significant youth mental health reform
over the past 10 years, leading to numerous studies examining the effects of community-based mental health care programs for Australian youth.
However, no synthesis of this literature currently exists. Therefore, this systematic review aimed to: (1) describe the types of community-based
mental health programs that have been delivered to Australian youth in the past 10 years; and (2) examine their impact in improving young people's
mental health symptomology and psychosocial functioning. A systematic search of the peer-reviewed literature was conducted. Studies were included if
they evaluated the extent to which such programs improved mental health symptomology (e.g., depression, anxiety, substance use) and/or psychosocial
outcomes (e.g., social functioning, school engagement, employment) for Australian youth aged 10-25 years. Thirty-seven studies were included. Four
types of community-based youth mental health care programs were identified: therapy (n=16), case management (n=9), integrated 'one-stop-shop' (n=6)
and lifestyle (n=6) programs. The majority of therapeutic programs were effective in reducing mental health symptomology. Case management and
integrated approaches consistently yielded significant improvements in both symptomology and psychosocial outcomes. Lifestyle programs were effective
in alleviating depressive symptoms, but inconclusive for other outcomes. This review provides support for youth-friendly, systemic, multidisciplinary
and integrated assertive outreach models of community mental health care to improve outcomes for young Australians experiencing mental health
concerns. Several recommendations for future research are provided to strengthen the local evidence-base supporting community mental health programs
to ultimately enhance young people's life trajectory. Copyright © 2022. The Author(s).
, 16 :
- Year: 2022
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders
(any), 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: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any)
Ruiz-Delgado, I, Moreno-Kustner, B, Garcia-Medina, M, Barrigon, M. L, Gonzalez-Higueras, F, Lopez-Carrilero, R, Barrios-Mellado, I, Barajas, A, Pousa, E, Lorente-Rovira, E, Grasa, E, Cid, J, Barrau-Sastre, P, Moritz, S, Ochoa, S.
The aims are to assess improvements in memory, attention and executive function in first-
episode psychosis after Metacognitive Training (MCT). A multicenter randomized clinical trial was performed with two arms: MCT and psychoeducational
intervention. A total of 126 patients with a diagnosis of psychosis, less than 5 years from the onset of the disease, were included. Patients were
assessed two or three moments (baseline, post-treatment, 6 months follow-up) depending on the test, with a battery of neurocognitive tests (TAVEC,
TMTA-B, CPT, WCST, Stroop and premorbid IQ). General linear models for repeated measures were performed. A better improvement in the MCT was found by
an interaction between group and time in CPT Hit index, TMTB, Stroop, recent memory and number of perseverations of the TAVEC. Considering three
assessments, a better improvement was found in non-perseverative, perseverative and total errors of the WCST and TMTB. The MCT is an effective
psychological intervention to improve several cognitive functions.
Psychiatry
Research, 318 : 114941
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Robinson, D, Schooler, N, John, M, Marcy, P, Kane, J.
Background: Cognitive deficits are a well-established component of early phase psychosis. Cognition
has been found to moderate initial response to antipsychotic treatment with first episode patients. A next step question is whether cognition is also
associated with relapse. Studies examining relapse following response among recent onset patients have found variable results. Relapse studies
require long follow-up periods and long-term adherence to antipsychotic treatment is challenging for many recent onset patients. Variable long-term
antipsychotic adherence may be one factor that has limited the ability to detect possible relationships between cognition and relapse among recent
onset patients. Studies with long-acting injectable antipsychotic (LAI) formulations limit nonadherence effects and therefore may be particularly
useful for detecting cognition moderator effects on relapse risks. Method(s): The PRELAPSE trial was a large simple trial with cluster randomization
of 39 US clinics. Nineteen clinics provided participants the LAI aripiprazole monohydrate (AM) and 20 provided treatment as usual (TAU). The primary
outcome was time to first hospitalization; the observation period was 2 years. Inclusion criteria were: DSM-5 schizophrenia diagnosis; fewer than 5
years of lifetime antipsychotic treatment; age 18-35 years. Cognition was assessed with the Repeatable Battery for the Assessment of
Neuropsychological Status (RBANS) at baseline and then yearly. The RBANS had the advantage of easy administration for a large simple trial. The RBANS
consists of ten subtests that give five domain scores and a total score. For analysis of cognition as a moderator of hospitalization outcomes, the
sample was characterized as having poorer or better cognition based upon a median split of the baseline RBANS total score. Time to first
hospitalization was analyzed using a Cox Proportional Hazard model with shared random effects for sites (also known as a Shared Frailty model)
accounting for clustering effects. A lognormal distribution was assumed for the frailties. Result(s): The examination of baseline RBANS as a
moderator of time to first hospitalization included 457 of the 489 participants in the PRELAPSE trial. Mean age of the cognition sample (342 men and
115 women) was 25.2 years. Mean duration of prior antipsychotic treatment was 627 days. Poor and better cognition groups did not differ on age,
duration of prior antipsychotic treatment or on being at an AOM or TAU site. Women were more likely to be in the better cognition group than men (71
of 115 women versus 159 of 342 men). The Cox Proportional Hazard analyses revealed a treatment condition by baseline cognition interaction (Wald
Chi-Square = 3.3540, df =1, p = 0.0506). Subsequent analyses of participants in the poorer cognition group (N = 227) found no effect of treatment
condition (Wald Chi Square = 0.6792; df=1; p = 0.2367); the hazard ratio for AM versus TAU was 0.776 (95% CI = 0.424, 1.419). In contrast, among
participants with better cognition, there was a significant treatment effect (Wald Chi-Square=10.6210; df=1, p = 0.0006) favoring the AM versus the
TAU condition (hazard ratio for AM versus TAU was 0.304 (95% CI = 0.149, 0.622)). Conclusion(s): Our data suggest that patients with early phase
schizophrenia being treated with LAI antipsychotics who have better baseline cognition may have more reduction in relapse risk from treatment than
those with poorer baseline cognition. These results extend the findings of cognition moderating acute response to antipsychotic treatment to suggest
that cognition may also moderate antipsychotic treatment effects on relapse risk.
Neuropsychopharmacology, 47(Supplement 1) : 344
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Robinson, D. G., Schooler, N. R., Marcy, P., Gibbons, R. D., Hendricks-Brown, C., John, M., Mueser, K. T., Penn, D. L., Rosenheck, R. A., Addington, J., Brunette, M. F., Correll, C. U., Estroff, S. E., Mayer-Kalos, P. S., Gottlieb, J. D., Glynn,
S. M., Lynde, D. W., Gingerich, S., Pipes, R., Miller, A. L., Severe, J. B., Kane, J. M.
To examine long-term effects of early intervention services (EIS)
for first-episode psychosis, we compared Heinrichs-Carpenter Quality of Life (QLS) and Positive and Negative Syndrome Scale (PANSS) scores and
inpatient hospitalization days over 5 years with data from the site-randomized RAISE-ETP trial that compared the EIS NAVIGATE (17 sites; 223
participants) and community care (CC) (17 sites; 181 participants). Inclusion criteria were: age 15-40 years; DSM-IV diagnoses of schizophrenia,
schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, or psychotic disorder not otherwise specified; first psychotic
episode; antipsychotic medication taken for <=6 months. NAVIGATE-randomized participants could receive NAVIGATE from their study entry date until
NAVIGATE ended when the last-enrolled NAVIGATE participant completed 2 years of treatment. Assessments occurred every 6 months. 61% of participants
had assessments conducted >=2 years; 31% at 5 years. Median follow-up length was CC 30 months and NAVIGATE 38 months. Primary analyses assumed data
were not-missing-at-random (NMAR); sensitivity analyses assumed data were missing-at-random (MAR). MAR analyses found no significant treatment-by-
time interactions for QLS or PANSS. NMAR analyses revealed that NAVIGATE was associated with a 13.14 (95%CI:6.92,19.37) unit QLS and 7.73
(95%CI:2.98,12.47) unit PANSS better improvement and 2.53 (95%CI:0.59,4.47) fewer inpatient days than CC (all comparisons significant). QLS and PANSS
effect sizes were 0.856 and 0.70. NAVIGATE opportunity length (mean 33.8 (SD = 5.1) months) was not associated (P = .72) with QLS outcome; duration
of untreated psychosis did not moderate (P = .32) differential QLS outcome. While conclusions are limited by the low rate of five-year follow-up, the
data support long-term benefit of NAVIGATE compared to community care.
, 48(5) : 1021-
1031
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Riccobene, T., Riesenberg, R., Yeung,
P. P., Earley, W. R., Hankinson, A. L.
Objective: Cariprazine is a dopamine D3-preferring D3/D2 and serotonin 5-HT1A receptor
partial agonist approved to treat adults with schizophrenia and manic/mixed or depressive episodes associated with bipolar I disorder. This
sequential-cohort, dose-escalation study was the first to evaluate the pharmacokinetic, safety, and tolerability profile of cariprazine and its two
major active metabolites, desmethyl-cariprazine (DCAR) and didesmethyl-cariprazine (DDCAR), in pediatric patients with schizophrenia or bipolar I
disorder. Method(s): This phase I open-label study enrolled patients with schizophrenia (13-17 years of age) or bipolar I disorder (10-17 years of
age). Patients met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for schizophrenia or bipolar I disorder
and had Positive and Negative Syndrome Scale (PANSS) total scores >=70 or Young Mania Rating Scale (YMRS) total scores >=20. Patients were assigned
to one of four treatment groups to receive 6 weeks of cariprazine treatment through slow titration to 1.5, 3, or 4.5 mg/d or fast titration to 4.5
mg/d. Pharmacokinetics, adverse events (AEs), and various safety parameters were analyzed. Efficacy was evaluated as an exploratory outcome. Result
(s): A total of 50 participants were enrolled. Based on mean trough levels, steady state appeared to be reached within 1-2 weeks for cariprazine and
DCAR and within 4-5 weeks for DDCAR. Systemic exposure of cariprazine, DCAR, and DDCAR generally increased approximately in proportion to the
increases in dose from 1.5 to 4.5 mg/d. The most frequent treatment-related, treatment-emergent AEs included sedation, parkinsonism, tremor,
dystonia, and blurred vision. Improvements from baseline on the PANSS and YMRS were observed throughout treatment. Conclusion(s): In this first
investigation of cariprazine in a pediatric population with schizophrenia or bipolar disorder, pharmacokinetic parameters were consistent with those
observed in adults. Cariprazine appeared to be safe and tolerable in children and adolescents. Copyright © 2022, Mary Ann Liebert, Inc.
Journal of Child and Adolescent
Psychopharmacology, 32(8) : 434-443
- Year: 2022
- Problem: Bipolar Disorders, Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Pine, J. G., Moe, A. M., Wastler, H. M., Breitborde, N. J.
K.
Aim: Metacognitive remediation
therapy (MCR) has been shown to help individuals with first-episode psychosis experience improvements in cognition, social functioning,
vocational/educational functioning and quality of life. The theoretical model underlying MCR has yet to be empirically validated. Method(s):
Seventy-three individuals with first-episode psychosis completed measures of metacognition and cognition at enrollment and after 6-months of care at
a specialized clinical program for individuals with first-episode psychosis. Among this group, we compared changes in these variables between the 21
individuals who opted to participate in MCR and the 52 individuals who did not participate in MCR. Result(s): Improvements in metacognition were
moderated by MCR treatment participation. Consistent with the MCR theoretical model of change, increases in metacognition mediated the relationship
between treatment and longitudinal changes in cognition. Conclusion(s): Our findings suggest that the benefits of MCR on cognitive functioning may
stem, in part, from the ability of MCR to produce improvements in metacognitive functioning. Copyright © 2021 John Wiley & Sons Australia, Ltd.
Early Intervention in Psychiatry, 16(6) : 683-
686
- Year: 2022
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Other Psychological Interventions
Nuechterlein, K. H, Ventura, J, Subotnik, K.
L, Gretchen-Doorly, D, Turner, L. R, Casaus, L. R, Luo, J, Boucher, M. L, Hayata, J. N, Bell, M. D, Medalia, A.
BACKGROUND: Cognitive deficits
at the first episode of schizophrenia are predictive of functional outcome. Interventions that improve cognitive functioning early in schizophrenia
are critical if we hope to prevent or limit long-term disability in this disorder. METHOD(S): We completed a 12-month randomized controlled trial of
cognitive remediation and of long-acting injectable (LAI) risperidone with 60 patients with a recent first episode of schizophrenia. Cognitive
remediation involved programs focused on basic cognitive processes as well as more complex, life-like situations. Healthy behavior training of equal
treatment time was the comparison group for cognitive remediation, while oral risperidone was the comparator for LAI risperidone in a 2 x 2 design.
All patients were provided supported employment/education to encourage return to work or school. RESULT(S): Both antipsychotic medication adherence
and cognitive remediation contributed to cognitive improvement. Cognitive remediation was superior to healthy behavior training in the LAI medication
condition but not the oral medication condition. Cognitive remediation was also superior when medication adherence and protocol completion were
covaried. Both LAI antipsychotic medication and cognitive remediation led to significantly greater improvement in work/school functioning. Effect
sizes were larger than in most prior studies of first-episode patients. In addition, cognitive improvement was significantly correlated with
work/school functional improvement. CONCLUSION(S): These results indicate that consistent antipsychotic medication adherence and cognitive
remediation can significantly improve core cognitive deficits in the initial period of schizophrenia. When combined with supported
employment/education, cognitive remediation and LAI antipsychotic medication show separate significant impact on improving work/school
functioning.
Psychological medicine, 52(8) : 1517-
1526
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Psychological Interventions
(any), Cognitive remediation
therapy, Other service delivery and improvement
interventions