Disorders - Psychosis Disorders
Gonzalez-Ortega, I., Vega, P., Echeburua, E., Alberich, S., Fernandez-Sevillano, J., Barbeito, S., Balanza-Martinez, V., Vieta, E., Lorente-Rovira, E., Luengo, A., Cerrillo, E., Crespo, J. M., Matute, C., Gonzalez-Pinto, A.
Introduction: There is evidence that early intervention
contributes to improving the prognosis and course of first-episode psychosis (FEP). However, further randomised treatment clinical trials are needed.
Objective(s): The aim of this study was to compare the efficacy of a combined clinical treatment involving Cognitive Behavioural Therapy (CBT) as an
adjunctive to treatment-as-usual (TAU) (CBT+TAU) versus TAU alone for FEP. Patients and Methods: In this multicentre, single-blind, randomised
controlled trial, 177 participants were randomly allocated to either CBT+TAU or TAU. The primary outcome was post-treatment patient functioning.
Result(s): The CBT+TAU group showed a greater improvement in functioning, which was measured using the Global Assessment Functioning (GAF) and
Functioning Assessment Short Test (FAST), compared to the TAU group post-treatment. The CBT+TAU participants exhibited a greater decline in
depressive, negative, and general psychotic symptoms; a better awareness of the disease and treatment adherence; and a greater increase in brain-
derived neurotrophic factor levels than TAU participants. Conclusion(s): Early intervention based on a combined clinical treatment involving CBT as
an adjunctive to standard treatment may improve clinical and functional outcomes in FEP. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.
International Journal of Environmental
Research and Public Health, 18(14) (no pagination) :
- Year: 2021
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Gleeson, J. F. M., Eleftheriadis, D., Santesteban-Echarri, O., Koval, P., Bastian,
B., Penn, D. L., Lim, M. H., Ryan, R.
M., Alvarez-Jimenez, M.
Background: First-episode psychosis typically has its onset during adolescence. Prolonged deficits in social
functioning are common in FEP and yet often variance in functioning remains unexplained. Developmental psychology frameworks may be useful for
understanding these deficits. Eudaimonic well-being (EWB), or positive self-development, is a developmental psychology construct that has been shown
to predict mental health outcomes across multiple populations but has not been systematically reviewed in FEP. Aim(s): Our aim was to systematically
review the evidence for: the predictors of EWB, the effectiveness of EWB interventions and to examine the quality of this research in FEP. Method(s):
Selected studies measured either composite or components of EWB. A systematic search produced 2876 abstracts and 122 articles were identified for
full screening which produced 17 final papers with 2459 participants. Result(s): Studies comprised six RCTs, eight prospective follow-up studies and
three case-controlled studies. Self-esteem and self-efficacy were the most commonly measured components. A meta-analysis of RCTs revealed no
statistically significant effect of interventions on self-esteem. The extant research indicates that character strengths may be associated with
higher EWB. Self-esteem may be lower in FEP compared with age matched controls but not different from ultra-high risk patients. Self-esteem appears
to be associated with poorer insight and improved therapeutic alliance. Significant problems with both external and internal validity of reviewed
studies were apparent. Conclusion(s): The hypotheses that lowered EWB is a risk factor for both onset of FEP and for poorer functional outcomes
warrant further investigation. There is currently no evidence for effective interventions for EWB in FEP. Copyright © 2020 John Wiley & Sons
Australia, Ltd
Early Intervention in Psychiatry, 15(5) : 1072-
1091
- Year: 2021
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any)
Gaughran, F., Stringer, D., Wojewodka, G., Landau, S., Smith, S., Gardner-Sood, P., Taylor, D., Jordan, H., Whiskey, E., Krivoy, A., Ciufolini, S., Stubbs, B., Casetta, C., Williams, J., Moore, S., Allen, L., Rathod, S., Boardman, A., Khalifa, R., Firdosi, M., McGuire, P., Berk, M., McGrath, J.
Importance: People with psychotic disorders have an increased risk of vitamin
D deficiency, which is evident during first-episode psychosis (FEP) and associated with unfavorable mental and physical health outcomes. Objective
(s): To examine whether vitamin D supplementation contributes to improved clinical outcomes in FEP. Design, Setting, and Participant(s): This
multisite, double-blind, placebo-controlled, parallel-group randomized clinical trial from the UK examined adults 18 to 65 years of age within 3
years of a first presentation with a functional psychotic disorder who had no contraindication to vitamin D supplementation. A total of 2136 patients
were assessed for eligibility, 835 were approached, 686 declined participation or were excluded, 149 were randomized, and 104 were followed up at 6
months. The study recruited participants from January 19, 2016, to June 14, 2019, with the final follow-up (after the last dose) completed on
December 20, 2019. Intervention(s): Monthly augmentation with 120000 IU of cholecalciferol or placebo. Main Outcomes and Measures: The primary
outcome measure was total Positive and Negative Syndrome Scale (PANSS) score at 6 months. Secondary outcomes included total PANSS score at 3 months;
PANSS positive, negative, and general psychopathology subscale scores at 3 and 6 months; Global Assessment of Function scores (for symptoms and
disability); Calgary Depression Scale score, waist circumference, body mass index, and glycated hemoglobin, total cholesterol, C-reactive protein,
and vitamin D concentrations at 6 months; and a planned sensitivity analysis in those with insufficient vitamin D levels at baseline. Result(s): A
total of 149 participants (mean [SD] age, 28.1 (8.5) years; 89 [59.7%] male; 65 [43.6%] Black or of other minoritized racial and ethnic group; 84
[56.4%] White [British, Irish, or of other White ethnicity]) were randomized. No differences were observed in the intention-to-treat analysis in the
primary outcome, total PANSS score at 6 months (mean difference, 3.57; 95% CI, -1.11 to 8.25; P =.13), or the secondary outcomes at 3 and 6 months
(PANSS positive subscore: mean difference, -0.98; 95% CI, -2.23 to 0.27 at 3 months; mean difference, 0.68; 95% CI, -0.69 to 1.99 at 6 months; PANSS
negative subscore: mean difference, 0.68; 95% CI, -1.39 to 2.76 at 3 months; mean difference, 1.56; 95% CI, -0.31 to 3.44 at 6 months; and general
psychopathology subscore: mean difference, -2.09; 95% CI, -4.36 to 0.18 at 3 months; mean difference, 1.31; 95% CI, -1.42 to 4.05 at 6 months). There
also were no significant differences in the Global Assessment of Function symptom score (mean difference, 0.02; 95% CI, -4.60 to 4.94); Global
Assessment of Function disability score (mean difference, -0.01; 95% CI, -5.25 to 5.23), or Calgary Depression Scale score (mean difference, -0.39;
95% CI, -2.05 to 1.26) at 6 months. Vitamin D levels were very low in the study group, especially in Black participants and those who identified as
another minoritized racial and ethnic group, 57 of 61 (93.4%) of whom had insufficient vitamin D. The treatment was safe and led to a significant
increase in 25-hydroxyvitamin D concentrations. Conclusions and Relevance: In this randomized clinical trial, no association was found between
vitamin D supplementation and mental health or metabolic outcomes at 6 months. Because so few patients with FEP were vitamin D replete, the results
of this study suggest that this group would benefit from active consideration in future population health strategies. Trial Registration: isrctn.org
Identifier: ISRCTN12424842. Copyright © 2021 American Medical Association. All rights reserved.
, 4(12) :
- Year: 2021
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Vitamins and supplements
Correll, C. U., Cortese, S., Croatto, G., Monaco, F., Krinitski, D., Arrondo, G., Ostinelli, E., Zangani, C., Fornaro, M., Estrade, A., Fusar-Poli, P., Carvalho, A. F., Solmi, M.
Top-tier evidence on the safety/tolerability
of 80 medications in children/adolescents with mental disorders has recently been reviewed in this jour-nal. To guide clinical practice, such data
must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial inter-ventions and brain stimulation techniques are
treatment options for children/adolescents with mental disorders. For this umbrella review, we systematically searched network meta-analyses (NMAs)
and meta-analyses (MAs) of randomized controlled trials (RCTs) evaluating 48 medications, 20 psychosocial interventions, and four brain stimulation
techniques in children/adolescents with 52 different mental disorders or groups of mental disorders, reporting on 20 different efficacy/acceptability
outcomes. Co-primary outcomes were disease-specific symptom reduction and all-cause discontinuation (\"acceptability\"). We included 14 NMAs and 90
MAs, reporting on 15 mental disorders or groups of mental disorders. Overall, 21 medications outperformed placebo regarding the co-primary outcomes,
and three psychosocial interventions did so (while seven outperformed waiting list/no treatment). Based on the meta-analytic evidence, the most
convincing efficacy profile emerged for amphetamines, methylphenidate and, to a smaller extent, behavioral therapy in attention-deficit/hyperactivity
disorder; aripiprazole, risperidone and several psychosocial interventions in autism; risperidone and behavioral interventions in disruptive behavior
disorders; several antipsychotics in schizophrenia spectrum disorders; fluoxetine, the combination of fluoxetine and cognitive behavioral therapy
(CBT), and interpersonal therapy in depression; aripiprazole in mania; fluoxetine and group CBT in anxiety disorders; fluoxetine/selective serotonin
reuptake inhibitors, CBT, and behavioral therapy with exposure and response prevention in obsessive-compulsive disorder; CBT in post-traumatic stress
disorder; imipramine and alarm behavioral intervention in enuresis; behavioral therapy in encopresis; and family therapy in anorexia nervosa. Results
from this umbrella review of interventions for mental disorders in children/adolescents provide evidence-based information for clinical decision
making.Copyright © 2021 World Psychiatric Association
World Psychiatry, 20(2) : 244-
275
- Year: 2021
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Bipolar Disorders, Depressive Disorders, Anorexia Nervosa, Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Catalan, A., Salazar-de-Pablo, G., Vaquerizo-Serrano, J., Mosillo,
P., Baldwin, H., Fernandez-Rivas, A., Moreno, C., Arango, C., Correll, C. U., Bonoldi, I., Fusar-Poli, P.
BACKGROUND: The clinical high-risk state for psychosis (CHR-P) paradigm has facilitated the implementation of psychosis prevention into
clinical practice; however, advancements in adolescent CHR-P populations are less established. METHOD(S): We performed a PRISMA/MOOSE-compliant
systematic review of the Web of Science database, from inception until 7 October 2019, to identify original studies conducted in CHR-P children and
adolescents (mean age <18 years). Findings were systematically appraised around core themes: detection, prognosis and intervention. We performed
meta-analyses (employing Q statistics and I 2 test) regarding the proportion of CHR-P subgroups, the prevalence of baseline comorbid mental
disorders, the risk of psychosis onset and the type of interventions received at baseline. Quality assessment and publication bias were also
analysed. RESULT(S): Eighty-seven articles were included (n = 4,667 CHR-P individuals). Quality of studies ranged from 3.5 to 8 (median 5.5) on a
modified Newcastle-Ottawa scale. Detection: Individuals were aged 15.6 +/- 1.2 years (51.5% males), mostly (83%) presenting with attenuated positive
psychotic symptoms. CHR-P psychometric accuracy improved when caregivers served as additional informants. Comorbid mood (46.4%) and anxiety (31.4%)
disorders were highly prevalent. Functioning and cognition were impaired. Neurobiological studies were inconclusive. PROGNOSIS: Risk for psychosis
was 10.4% (95%CI: 5.8%-18.1%) at 6 months, 20% (95%CI: 15%-26%) at 12 months, 23% (95%CI: 18%-29%) at 24 months and 23.3% (95%CI: 17.3%-30.7%) at
>=36 months. INTERVENTIONS: There was not enough evidence to recommend one specific treatment (including cognitive behavioural therapy) over the
others (including control conditions) to prevent the transition to psychosis in this population. Randomised controlled trials suggested that family
interventions, cognitive remediation and fish oil supplementation may improve cognition, symptoms and functioning. At baseline, 30% of CHR-P
adolescents were prescribed antipsychotics and 60% received psychotherapy. CONCLUSION(S): It is possible to detect and formulate a group-level
prognosis in adolescents at risk for psychosis. Future interventional research is required. Copyright © 2020 The Authors. Journal of Child Psychology
and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
Journal of child psychology and psychiatry, and allied disciplines, 62(5) : 657-
673
- Year: 2021
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Cognitive remediation
therapy, Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil), Technology, interventions delivered using technology (e.g. online, SMS)
Alvarez-Jimenez, Mario, Koval, Peter, Schmaal, Lianne, Bendall, Sarah, O'Sullivan, Shaunagh, Cagliarini, Daniela, D'Alfonso, Simon, Rice, Simon, Valentine, Lee, Penn, David L., Miles, Chris, Russon, Penni, Phillips, Jessica, McEnery, Carla, Lederman, Reeva, Killackey, Eoin, Mihalopoulos, Cathrine, Gonzalez-Blanch, Cesar, Gilbertson, Tamsyn, Lal, Shalini, Cotton, Sue Maree, Herrman, Helen, McGorry, Patrick D., Gleeson, John F.
This study aimed to determine whether, following two years of specialized support for first-episode psychosis, the addition of a new
digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than 18 months of TAU alone. We conducted a single-blind
randomized controlled trial. Participants were people with first-episode psychosis (N = 170), aged 16-27 years, in clinical remission and nearing
discharge from a specialized service. They were randomly assigned (1:1) to receive Horyzons plus TAU (N = 86) or TAU alone (N = 84) between October
2013 and January 2017. Horyzons is a novel, comprehensive digital platform merging: peer-to-peer social networking; theory-driven and evidence-
informed therapeutic interventions targeting social functioning, vocational recovery and relapse prevention; expert clinician and vocational support;
and peer support and moderation. TAU involved transfer to primary or tertiary community mental health services. The primary outcome was social
functioning at 18 months as measured by the Personal and Social Performance Scale (PSP). Forty-seven participants (55.5%) in the Horyzons plus TAU
group logged on for at least 6 months, and 40 (47.0%) for at least 9 months. Social functioning remained high and stable in both groups from baseline
to 18-month follow-up, with no evidence of significant between-group differences (PSP mean difference: -0.29, 95% CI: -4.20 to 3.63, p = 0.77).
Participants in the Horyzons group had a 5.5 times greater increase in their odds to find employment or enroll in education compared with those in
TAU (odds ratio, OR = 5.55, 95% CI: 1.09-28.23, p = 0.04), with evidence of a dose-response effect. Moreover, participants in TAU were twice as
likely to visit emergency services compared to those in the Horyzons group (39% vs. 19%; OR = 0.31, 95% CI: 0.11-0.86, p = 0.03, number needed to
treat, NNT = 5). There was a non-significant trend for lower hospitalizations due to psychosis in the Horyzons group vs. TAU (13% vs. 27%; OR = 0.36,
95% CI: 0.11-1.08, p = 0.07, NNT = 7). So, although we did not find a significant effect of Horyzons on social functioning compared with TAU, the
intervention was effective in improving vocational or educational attainment, a core component of social recovery, and in reducing usage of hospital
emergency services, a key aim of specialized first-episode psychosis services. Horyzons holds significant promise as an engaging and sustainable
intervention to provide effective vocational and relapse prevention support for young people with first-episode psychosis beyond specialist services.
(PsycInfo Database Record (c) 2021 APA, all rights reserved)
World Psychiatry, 20(2) : 233-
243
- Year: 2021
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Technology, interventions delivered using technology (e.g. online, SMS)
Addington, J., Liu, L., Santesteban-Echarri, O., Brummitt, K., Braun, A., Cadenhead, K. S., Cornblatt, B. A., Holden, J. L., Granholm, E.
Aim: Poor
functioning has become a hallmark of many youth at clinical high-risk (CHR) of psychosis. Even for those who do not make the transition to psychosis
remain troubled by functional deficits and a decline in functioning increases the odds of transitioning to psychosis. There are very few treatment
studies that have attempted to improve social and role functioning. The aim of this paper is to describe the methods of a treatment study to address
social and role functioning in CHR. Method(s): This was a randomized controlled trial of cognitive-behavioural social skills training (CBSST) versus
a supportive therapy. CBSST combines elements of cognitive behaviour therapy (CBT) and social skills training (SST), two evidence-based treatments
for schizophrenia. By adding CBT to SST to target functioning outcomes, SST can be used to train new social skills, and thoughts that interfere with
skilled performance in the real world can be addressed using CBT. We developed an adapted version of CBSST, more appropriate for the age range and
illness severity of typical CHR individuals, to attempt to show improvements in social and role functioning for these young people. Result(s): Two
hundred and three participants were recruited for this study. Results include initial baseline data. Conclusion(s): This article describes the
baseline methodology of a CHR youth who have difficulties in social and/or role functioning. It is one of the first clinical trials to address this
significant problem. Copyright © 2021 John Wiley & Sons Australia, Ltd
Early Intervention in Psychiatry, 15(6) : 1626-
1636
- Year: 2021
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Skills training
Puntis, S., Minichino, A., De-
Crescenzo, F., Harrison, R., Cipriani, A., Lennox, B.
Background: Psychosis is an illness characterised by
the presence of hallucinations and delusions that can cause distress or a marked change in an individual's behaviour (e.g. social withdrawal, flat
or blunted effect). A first episode of psychosis (FEP) is the first time someone experiences these symptoms that can occur at any age, but the
condition is most common in late adolescence and early adulthood. This review is concerned with first episode psychosis (FEP) and the early stages of
a psychosis, referred to throughout this review as 'recent-onset psychosis.'. Specialised early intervention (SEI) teams are community mental
health teams that specifically treat people who are experiencing, or have experienced a recent-onset psychosis. The purpose of SEI teams is to
intensively treat people with psychosis early in the course of the illness with the goal of increasing the likelihood of recovery and reducing the
need for longer-term mental health treatment. SEI teams provide a range of treatments including medication, psychotherapy, psychoeducation, and
occupational, educational and employment support, augmented by assertive contact with the service user and small caseloads. Treatment is time
limited, usually offered for two to three years, after which service users are either discharged to primary care or transferred to a standard adult
community mental health team. A previous Cochrane Review of SEI found preliminary evidence that SEI may be superior to standard community mental
health care (described as 'treatment as usual (TAU)' in this review) but these recommendations were based on data from only one trial. This review
updates the evidence for the use of SEI services. Objective(s): To compare specialised early intervention (SEI) teams to treatment as usual (TAU) for
people with recent-onset psychosis. Search Method(s): On 3 October 2018 and 22 October 2019, we searched Cochrane Schizophrenia's study-based
register of trials, including registries of clinical trials. Selection Criteria: We selected all randomised controlled trials (RCTs) comparing SEI
with TAU for people with recent-onset psychosis. We entered trials meeting these criteria and reporting useable data as included studies. Data
Collection and Analysis: We independently inspected citations, selected studies, extracted data and appraised study quality. For binary outcomes we
calculated the risk ratios (RRs) and their 95% confidence intervals (CIs). For continuous outcomes we calculated the mean difference (MD) and their
95% CIs, or if assessment measures differed for the same construct, we calculated the standardised mean difference (SMD) with 95% CIs. We assessed
risk of bias for included studies and created a 'Summary of findings' table using the GRADE approach. Main Result(s): We included three RCTs and
one cluster-RCT with a total of 1145 participants. The mean age in the trials was between 23.1 years (RAISE) and 26.6 years (OPUS). The included
participants were 405 females (35.4%) and 740 males (64.6%). All trials took place in community mental healthcare settings. Two trials reported on
recovery from psychosis at the end of treatment, with evidence that SEI team care may result in more participants in recovery than TAU at the end of
treatment (73% versus 52%; RR 1.41, 95% CI 1.01 to 1.97; 2 studies, 194 participants; low-certainty evidence). Three trials provided data on
disengagement from services at the end of treatment, with fewer participants probably being disengaged from mental health services in SEI (8%) in
comparison to TAU (15%) (RR 0.50, 95% CI 0.31 to 0.79; 3 studies, 630 participants; moderate-certainty evidence). There was low-certainty evidence
that SEI may result in fewer admissions to psychiatric hospital than TAU at the end of treatment (52% versus 57%; RR 0.91, 95% CI 0.82 to 1.00; 4
studies, 1145 participants) and low-certainty evidence that SEI may result in fewer psychiatric hospital days (MD -27.00 days, 95% CI -53.68 to -
0.32; 1 study, 547 participants). Two trials reported on general psychotic symptoms at the end of treatment, with no evidence of a difference between
SEI and TAU, although this evidence is very uncertain (SMD -0.41, 95% CI -4.58 to 3.75; 2 studies, 304 participants; very low-certainty evidence). A
different pattern was observed in assessment of general functioning with an end of trial difference that may favour SEI (SMD 0.37, 95% CI 0.07 to
0.66; 2 studies, 467 participants; low-certainty evidence). It was uncertain whether the use of SEI resulted in fewer deaths due to all-cause
mortality at end of treatment (RR 0.21, 95% CI 0.04 to 1.20; 3 studies, 741 participants; low-certainty evidence). There was low risk of bias for
random sequence generation and allocation concealment in three of the four included trials; the remaining trial had unclear risk of bias. Due to the
nature of the intervention, we considered all trials at high risk of bias for blinding of participants and personnel. Two trials had low risk of bias
and two trials had high risk of bias for blinding of outcomes assessments. Three trials had low risk of bias for incomplete outcome data, while one
trial had high risk of bias. Two trials had low risk of bias, one trial had high risk of bias, and one had unclear risk of bias for selective
reporting. Authors' conclusions: There is evidence that SEI may provide benefits to service users during treatment compared to TAU. These benefits
probably include fewer disengagements from mental health services (moderate-certainty evidence), and may include small reductions in psychiatric
hospitalisation (low-certainty evidence), and a small increase in global functioning (low-certainty evidence) and increased service satisfaction
(moderate-certainty evidence). The evidence regarding the effect of SEI over TAU after treatment has ended is uncertain. Further evidence
investigating the longer-term outcomes of SEI is needed. Furthermore, all the eligible trials included in this review were conducted in high-income
countries, and it is unclear whether these findings would translate to low- and middle-income countries, where both the intervention and the
comparison conditions may be different. Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cochrane Database of Systematic Reviews, 2020(11) (no
pagination) :
- Year: 2020
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
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
Puntis, S., Minichino, A., De-
Crescenzo, F., Harrison, R., Cipriani, A., Lennox, B.
Background: Psychosis is an illness
characterised by the presence of hallucinations and delusions that can cause distress or a marked change in an individual's behaviour (e.g. social
withdrawal, flat or blunted effect). A first episode of psychosis (FEP) is the first time someone experiences these symptoms that can occur at any
age, but the condition is most common in late adolescence and early adulthood. This review is concerned with FEP and the early stages of a psychosis,
referred to throughout this review as 'recent-onset psychosis.'. Specialised early intervention (SEI) teams are community mental health teams that
specifically treat people who are experiencing, or have experienced, a recent-onset psychosis. SEI teams provide a range of treatments including
medication, psychotherapy, psychoeducation, educational and employment support, augmented by assertive contact with the service user and small
caseloads. Treatment is time limited, usually offered for two to three years, after which service users are either discharged to primary care or
transferred to a standard adult community mental health team. Evidence suggests that once SEI treatment ends, improvements may not be sustained,
bringing uncertainty about the optimal duration of SEI to ensure the best long-term outcomes. Extending SEI has been proposed as a way of providing
continued intensive treatment and continuity of care, of usually up to five years, in order to a) sustain the positive initial outcomes of SEI; and
b) improve the long-term trajectory of the illness. Objective(s): To compare extended SEI teams with treatment as usual (TAU) for people with
recent-onset psychosis.To compare extended SEI teams with standard SEI teams followed by TAU (standard SEI + TAU) for people with recent-onset
psychosis. Search Method(s): On 3 October 2018 and 22 October 2019, we searched Cochrane Schizophrenia's study-based register of trials, including
registries of clinical trials. Selection Criteria: We selected all randomised controlled trials (RCTs) comparing extended SEI with TAU for people
with recent-onset psychosis and all RCTs comparing extended SEI with standard SEI + TAU for people with recent-onset psychosis. We entered trials
meeting these criteria and reporting usable data as included studies. Data Collection and Analysis: We independently inspected citations, selected
studies, extracted data and appraised study quality. For binary outcomes we calculated the risk ratios (RRs) and their 95% confidence intervals
(CIs). For continuous outcomes we calculated the mean difference (MD) and their 95% CIs, or if assessment measures differed for the same construct,
we calculated the standardised mean difference (SMD) with 95% CIs. We assessed risk of bias for included studies and created a 'Summary of
findings' table using the GRADE approach. Main Result(s): We included three RCTs, with a total 780 participants, aged 16 to 35 years. All
participants met the criteria for schizophrenia spectrum disorders or affective psychoses. No trials compared extended SEI with TAU. All three trials
randomly allocated people approximately two years into standard SEI to either extended SEI or standard SEI + TAU. The certainty of evidence for
outcomes varied from low to very low. Our primary outcomes were recovery and disengagement from mental health services. No trials reported on
recovery, and we used remission as a proxy. Three trials reported on remission, with the point estimate suggesting a 13% increase in remission in
favour of extended SEI, but this included wide confidence intervals (CIs) and a very uncertain estimate of no benefit (RR 1.13, 95% CI 0.97 to 1.31;
3 trials, 780 participants; very low-certainty evidence). Two trials provided data on disengagement from services with evidence that extended SEI
care may result in fewer disengagements from mental health treatment (15%) in comparison to standard SEI + TAU (34%) (RR 0.45, 95% CI 0.27 to 0.75; 2
trials, 380 participants; low-certainty evidence). There may be no evidence of a difference in rates of psychiatric hospital admission (RR 1.55, 95%
CI 0.68 to 3.52; 1 trial, 160 participants; low-certainty evidence), or the number of days spent in a psychiatric hospital (MD -2.70, 95% CI -8.30 to
2.90; 1 trial, 400 participants; low-certainty evidence). One trial found uncertain evidence regarding lower global psychotic symptoms in extended
SEI in comparison to standard SEI + TAU (MD -1.90, 95% CI -3.28 to -0.52; 1 trial, 156 participants; very low-certainty evidence). It was uncertain
whether the use of extended SEI over standard SEI + TAU resulted in fewer deaths due to all-cause mortality, as so few deaths were recorded in trials
(RR 0.38, 95% CI 0.09 to 1.64; 3 trials, 780 participants; low-certainty evidence). Very uncertain evidence suggests that using extended SEI instead
of standard SEI + TAU may not improve global functioning (SMD 0.23, 95% CI -0.29 to 0.76; 2 trials, 560 participants; very low-certainty evidence).
There was low risk of bias in all three trials for random sequence generation, allocation concealment and other biases. All three trials had high
risk of bias for blinding of participants and personnel due to the nature of the intervention. For the risk of bias for blinding of outcome
assessments and incomplete outcome data there was at least one trial with high or unclear risk of bias. Authors' conclusions: There may be
preliminary evidence of benefit from extending SEI team care for treating people experiencing psychosis, with fewer people disengaging from mental
health services. Evidence regarding other outcomes was uncertain. The certainty of evidence for the measured outcomes was low or very low. Further,
suitably powered studies that use a consistent approach to outcome selection are needed, but with only one further ongoing trial, there is unlikely
to be any definitive conclusion for the effectiveness of extended SEI for at least the next few years. Copyright © 2020 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.
Cochrane Database of Systematic
Reviews, 2020(11) (no pagination) :
- Year: 2020
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
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
Melbye, S., Kessing, L. V., Bardram, J. E., Faurholt-Jepsen, M.
Background: Psychiatric
disorders often have an onset at an early age, and early identification and intervention help improve prognosis. A fine-grained, unobtrusive, and
effective way to monitor symptoms and level of function could help distinguish severe psychiatric health problems from normal behavior and
potentially lead to a more efficient use of clinical resources in the current health care system. The use of smartphones to monitor and treat
children, adolescents, and young adults with psychiatric disorders has been widely investigated. However, no systematic review concerning
smartphone-based monitoring and treatment in this population has been published. Objective(s): This systematic review aims at describing the
following 4 features of the eligible studies: (1) monitoring features such as self-assessment and automatically generated data, (2) treatment
delivered by the app, (3) adherence to self-monitoring, and (4) results of the individual studies. Method(s): We conducted a systematic literature
search of the PubMed, Embase, and PsycInfo databases. We searched for studies that (1) included a smartphone app to collect self-monitoring data, a
smartphone app to collect automatically generated smartphone-based data, or a smartphone-based system for treatment; (2) had participants who were
diagnosed with psychiatric disorders or received treatment for a psychiatric disorder, which was verified by an external clinician; (3) had
participants who were younger than 25 years; and (4) were published in a peer-reviewed journal. This systematic review was reported in accordance
with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias in each individual study was systematically
assessed. Result(s): A total of 2546 unique studies were identified through literature search; 15 of these fulfilled the criteria for inclusion.
These studies covered 8 different diagnostic groups: psychosis, eating disorders, depression, autism, self-harm, anxiety, substance abuse, and
suicidal behavior. Smartphone-based self-monitoring was used in all but 1 study, and 11 of them reported on the participants' adherence to self-
monitoring. Most studies were feasibility/pilot studies, and all studies on feasibility reported positive attitudes toward the use of smartphones for
self-monitoring. In 2 studies, automatically generated data were collected. Three studies were randomized controlled trials investigating the
effectiveness of smartphone-based monitoring and treatment, with 2 of these showing a positive treatment effect. In 2 randomized controlled trials,
the researchers were blinded for randomization, but the participants were not blinded in any of the studies. All studies were determined to be at
high risk of bias in several areas. Conclusion(s): Smartphones hold great potential as a modern, widely available technology platform to help
diagnose, monitor, and treat psychiatric disorders in children and adolescents. However, a higher level of homogeneity and rigor among studies
regarding their methodology and reporting of adherence would facilitate future reviews and meta-analyses. Copyright © Sigurd Melbye, Lars Vedel
Kessing, Jakob Eyvind Bardram, Maria Faurholt-Jepsen. Originally published in JMIR Mental Health (http://mental.jmir.org), 29.10.2020. This is an
open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is
properly cited. The complete bibliographic information, a link to the original publication on http://mental.jmir.org/, as well as this copyright and
license information must be included.
JMIR Mental
Health, 7(10) :
- Year: 2020
- Problem: Anorexia Nervosa, Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Li, Yichen, Sun, Ke, Liu, Denghua, Chen, Mo-Xian, Li, Guo, Ma, Jun, Zhang,
Xiaofan
Background\rThe
limitations associated with antipsychotics in early-onset schizophrenia patients have stimulated more interest in psychological interventions in this
population. Nevertheless, the isolated psychosocial interventions are unrealistic in a treatment success covering the complex array of symptoms, and
the psychosocial interventions could be an adjunct treatment to the pharmacological treatment. It is necessary to find the benefits of psychological
interventions with limited and targeted use of antipsychotics. Social cognition and interaction training (SCIT) was a program for social cognitive
rehabilitation in adult schizophrenia. However, it is unclear how generalizable this is to early-onset patients.\rMethods\rThe current study tested
this hypothesis that combined SCIT and paliperidone was superior to paliperidone alone in treating early-onset schizophrenia patients on cognitive,
functional, and symptom outcomes. Two hundred eight inpatients with schizophrenia aged 13 to 17 years old participated in a 24-week work intervention
program. Patients completed a battery of measures administered at a pre-SCIT intervention baseline, 4, 8, 12, and 24 weeks post-SCIT, respectively.
\rResults\rSCIT had significant added benefits above paliperidone for the speed of processing, attention/vigilance, and social cognition of the
Chinese version of MATRICS consensus cognitive battery (MCCB) domains (p<0.05). The following logistic regression analysis on the exploration of the
influential factors also confirmed the effects of SCIT. However, combined SCIT and paliperidone intervention had a null impact on social functioning
and symptomatology.\rConclusions\rThe present study provides the first evidence that combined SCIT and paliperidone intervention has the potential to
improve cognitive functions for the early-onset schizophrenia patients. The findings in the current study are suggestive of the extreme importance of
SCIT as an adjunctive treatment in early-onset schizophrenia patients.
Frontiers in Psychiatry Vol 11 2020, ArtID
525492, 11 :
- Year: 2020
- 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
Estrada, Francesc, Crosas, Josep Maria, Ahuir,
Maribel, Perez-Munoz,
Sara, Zabala, Wanda, Aguayo, Raquel, Barbero, Juan David, Montalvo, Itziar, Tost, Meritxell, Llaurado, Laura, Guardia, Armand, Palao, Diego, Monreal, Jose Antonio, Labad,
Javier
Introduction: Cognitive deficits are a cause of functional disability in psychotic disorders.
\rCognitive remediation therapy (CRT) might be applied to improve these deficits. We\rconducted a pilot study to explore whether thyroid hormones
might predict the response to CRT in patients with recent-onset psychosis (ROP).\rMethods: Twenty-eight stable ROP outpatients (9 women) were
randomized to receive\rcomputerized CRT (N=14) or treatment as usual (TAU) (N=14), over three months. Both\rcognitive and thyroid functions were
assessed at the baseline and after those three\rmonths to all patients. A full cognitive battery (CANTAB) was administered before and after the
treatment. Serum levels of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured. FT4 concentrations were recoded into a
dichotomic variable (FT4 group) based on the median of the sample (1.2 ng/dL). Data were analyzed on an intention-totreat basis with linear mixed
models. Afterwards, we offered CRT to all participants from the TAU group and seven enrolled CRT, reassessing them when finished. Secondary analyses
were repeated in a sample of 14 participants who completed the CRT (either from the beginning or after the TAU period) and attended at least one
third of the sessions.\rResults: The linear mixed models showed a significant time x CRT x FT4 group effect in\rtwo cognitive tasks dealing with
executive functions and sustained attention (participants\rwith higher FT4 concentrations worsened executive functions but improved sustained
\rattention after CRT). In the secondary analysis including all patients assigned to CRT,\rhigher FT4 concentrations were associated with a poorer
response in verbal memory but\ra better response in spatial working memory.\rConclusions: Free thyroxine concentrations moderate the response to a
CRT in patients\rwith early psychosis.
Frontiers in Psychiatry Vol 11 2020, ArtID
636, 11 :
- Year: 2020
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive remediation
therapy, Technology, interventions delivered using technology (e.g. online, SMS)