Disorders - psychosis disorders
Guimond, S, Ling, G, Drodge, J, Matheson, H, Wojtalik, J. A, Lopez, B, Collin, G, Brady, R, Mesholam-Gately, R. I, Thermenos, H, Eack, S. M, Keshavan, M. S.
BACKGROUND:
The ability to manage emotions is an important social-cognitive domain impaired in schizophrenia and linked to functional outcome. The goal of our
study was to examine the impact of cognitive enhancement therapy (CET) on the ability to manage emotions and brain functional connectivity in early-
course schizophrenia. METHOD(S): Participants were randomly assigned to CET (n = 55) or an enriched supportive therapy (EST) control group (n = 45).
The resting-state functional magnetic resonance imaging scans and measures of emotion management performances were collected at baseline, 9, and 18
months follow-up. The final sample consisted of 37 CET and 25 EST participants, including 19 CET and 12 EST participants with imaging data. Linear
mixed-effects models investigated the impact of treatment on emotion management and functional connectivity from the amygdala to ventrolateral and
dorsolateral prefrontal cortex (dlPFC). RESULT(S): The CET group showed significant improvement over time in emotion management compared to EST.
Neither functional connectivity changes nor main group differences were observed following treatment. However, a significant between-group
interaction showed that improved emotion management ability was associated with increased functional connectivity between the left amygdala and the
left dlPFC in the CET group exclusively. CONCLUSION(S): Our results replicate the previous work demonstrating that CET is effective at improving some
aspects of social cognition in schizophrenia. We found evidence that improvement in emotion management may be associated with a change in amygdala-
dlPFC connectivity. This fronto-limbic circuit may provide a mechanistic link between the biology of emotion management processes that can be
enhanced in individuals with schizophrenia.
Psychological medicine, 52(12) : 2245-
2254
- Year: 2022
- 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)
Gonzalez-Ortega, I., Echeburua,
E., Alberich, S., Bernardo, M., Vieta, E., Pablo, G. S., Gonzalez-Pinto, A.
Despite the negative influence of cannabis use on the development and prognosis of first-episode psychosis (FEP), there
is little evidence on effective specific interventions for cannabis use cessation in FEP. The aim of this study was to compare the efficacy of a
specific cognitive behavioral therapy (CBT) for cannabis cessation (CBT-CC) with treatment as usual (TAU) in FEP cannabis users. In this single-
blind, 1-year randomized controlled trial, 65 participants were randomly assigned to CBT-CC or TAU. The primary outcome was the reduction in cannabis
use severity. The CBT-CC group had a greater decrease in cannabis use severity and positive psychotic symptoms over time, and a greater improvement
in functioning at post-treatment than TAU. The treatment response was also faster in the CBT-CC group, reducing cannabis use, anxiety, positive and
general psychotic symptoms, and improving functioning earlier than TAU in the follow-up. Moreover, patients who stopped and/or reduced cannabis use
during the follow-up, decreased psychotic symptoms and increased awareness of disease compared to those who continued using cannabis. Early
intervention based on a specific CBT for cannabis cessation, may be effective in reducing cannabis use severity, in addition to improving clinical
and functional outcomes of FEP cannabis users. Copyright © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
International
Journal of Environmental Research and Public Health, 19(12) (no pagination) :
- Year: 2022
- Problem: Psychosis Disorders, Cannabis Use
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Garrido-Sanchez, L, Gomez-Revuelta, M, Ortiz-Garcia-de-la-Foz, V, Pelayo-Teran, J. M, Juncal-Ruiz, M, Ruiz-Veguilla, M, Mayoral-Van-Son, J, Ayesa-Arriola, R, Vazquez-Bourgon,
J, Crespo-Facorro, B.
BACKGROUND: Antipsychotic choice for the acute phase of a
first episode of psychosis (FEP) is of the utmost importance since it may influence long-term outcome. However, head-to-head comparisons between
second-generation antipsychotics remain scarce. The aim of this study was to compare the effectiveness in the short term of aripiprazole and
risperidone after FEP outbreak.\rMETHODS: From February 2011 to October 2018, a prospective, randomized, open-label study was undertaken. Two
hundred-sixty-six first-episode drug-naive patients were randomly assigned to aripiprazole (n = 136) or risperidone (n = 130) and followed-up for 12
weeks. The primary effectiveness measure was all-cause treatment discontinuation. In addition, an analysis based on intention-to-treat principle was
conducted to assess clinical efficacy.\rRESULTS: The overall dropout rate at 12 weeks was small (6.39%). Effectiveness measures were similar between
treatment arms as treatment discontinuation rates (chi 2 = 0,409; P = .522), and mean time to all-cause discontinuation (log rank chi 2 = -1.009; P =
.316) showed no statistically significant differences. Despite no statistically significant differences between groups regarding clinical efficacy,
aripiprazole required higher chlorpromazine equivalent dosage (chi 2 = 2.160; P = .032) and extended mean time (W = 8183.5; P = .008) to reach
clinical response. Sex-related adverse events and rigidity were more frequent in the risperidone group, whereas sialorrhea was on the aripiprazole
group.\rCONCLUSIONS: No differences regarding effectiveness were found between aripiprazole and risperidone for the short-phase treatment of FEP.
Despite the importance of efficacy during this phase, differences in side effect profiles and patient's preferences are essential factors that may
lead clinical decisions for these patients.\rCLINICALTRIALS.GOV: NCT02532491. Effectiveness of Second-Generation Antipsychotics in First Episode
Psychosis Patients: 1-year Follow-up (PAFIP3_1Y).
International Journal of Neuropsychopharmacology, 25(11) : 900-
911
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Friedman-Yakoobian, M. S., Parrish, E. M., Eack, S. M., Keshavan, M. S.
Background: Cognitive deficits are present in individuals at clinical high
risk for psychosis (CHR-P). We developed Cognition for Learning and for Understanding Everyday Social Situations (CLUES), an integrated social- and
neurocognitive remediation intervention for CHR-P, and examined its feasibility and efficacy compared to an active control intervention in a pilot
randomized controlled trial. Method(s): Thirty-eight individuals at CHR-P were randomized to CLUES or Enriched Acceptance and Commitment Therapy
(EnACT). Participants were assessed at baseline, end of treatment and 3-month follow-up for changes in social/role functioning, neuro- and social
cognition, and symptoms. Result(s): Social functioning significantly improved for participants in CLUES over EnACT, at end of treatment and 3-month
follow-up. CLUES participants also showed greater improvements in social cognition (theory of mind and managing emotions). Conclusion(s): The results
support feasibility of CLUES and suggest preliminary efficacy. Future randomized controlled trials of CLUES in a larger sample, with additional
treatment sites, could help determine efficacy of CLUES, and investigate whether CLUES can be effectively implemented in other settings. Copyright ©
2020 Elsevier B.V.
, 243 : 302-
306
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Flores, A. T., Hogarty, S. S., Mesholam-Gately, R.
I., Barrio, C., Keshavan, M. S., Eack, S. M.
Randomized-controlled trials of
Cognitive Enhancement Therapy (CET) reveal its impact on cognitive and functional improvements in schizophrenia and serve as an opportunity for
causal claims of potential mediational relationships. In order to examine cognitive gains during CET as a mechanism for improving functional
capacity, this secondary analysis included 86 outpatients in the early course of schizophrenia from an 18-month randomized-controlled trial of CET.
Functional capacity was measured using the Brief UCSD Performance-Based Skills Assessment (UPSA-B) and cognitive performance by the MATRICS Consensus
Cognitive Battery (MCCB) and additional measures of social cognition. Mixed-effects models were used to examine the effects of treatment on the
UPSA-B changes and mediation through cognitive improvements. Changes in overall cognition proved to be a significant mediator of CET-related gains in
functional capacity at mid-treatment and treatment completion. Exploratory models examining separable cognitive domains further found that
improvements in attention, theory of mind, and emotion processing significantly mediated CET effects on functional capacity. This study suggests that
CET has potential for improving functional capacity in individuals with schizophrenia, and that cognitive improvements partially mediate this
relationship. This evidence can be beneficial for guiding more targeted approaches for rehabilitation in this population. Copyright © 2022
Journal of Psychiatric Research, 151 : 554-
560
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
DeTore, N. R., Luther, L., Deng, W., Zimmerman, J., Leathem,
L., Burke, A. S., Nyer, M. B., Holt, D. J.
BACKGROUND: Prevention programs that are 'transdiagnostic' may be more cost-effective
and beneficial, in terms of reducing levels of psychopathology in the general population, than those focused on a specific disorder. This randomized
controlled study evaluated the efficacy of one such intervention program called Resilience Training (RT). METHOD(S): College students who reported
mildly elevated depressive or subclinical psychotic symptoms ('psychotic experiences' (PEs)) (n = 107) were randomized to receiving RT (n = 54) or
to a waitlist control condition (n = 53). RT consists of a four-session intervention focused on improving resilience through the acquisition of
mindfulness, self-compassion, and mentalization skills. Measures of symptoms and these resilience-enhancing skills were collected before and after
the 4-week RT/waitlist period, with a follow-up assessment 12-months later. RESULT(S): Compared to the waitlist control group, RT participants
reported significantly greater reductions in PEs, distress associated with PEs, depression, and anxiety, as well as significantly greater
improvements in resilience, mindfulness, self-compassion, and positive affect, following the 4-week RT/waitlist period (all p < 0.03). Moreover,
improvements in resilience-promoting skills were significantly correlated with symptom reductions (all p < 0.05). Lastly, the RT-related reductions
in PEs and associated distress were maintained at the 12-month follow-up assessment. CONCLUSION(S): RT is a brief, group-based intervention
associated with improved resilience and reduced symptoms of psychopathology, with sustained effects on PEs, in transdiagnostically at-risk young
adults. Follow-up studies can further assess the efficacy of RT relative to other interventions and test whether it can reduce the likelihood of
developing a serious mental illness.
Psychological medicine, : 1-
10
- Year: 2022
- Problem: Depressive Disorders, Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions, Mindfulness based
therapy
DeTore, N. R., Bain, K., Wright, A., Meyer-Kalos, P., Gingerich, S., Mueser, K. T.
BACKGROUND AND HYPOTHESIS: Impaired insight into one's illness is common in first episode psychosis (FEP), is associated with worse
symptoms and functioning, and predicts a worse course of illness. Despite its importance, little research has examined the effects of early
intervention services (EIS) on insight.\rDESIGNS: This paper evaluated the impact of EIS (NAVIGATE) on insight compared to usual community care (CC)
in a large cluster randomized controlled trial. Assessments were conducted at baseline and every 6 months for 2 years.\rRESULTS: A multilevel
regression model including all time points showed a significant time by treatment group interaction (P < .001), reflecting greater improvement in
insight for NAVIGATE than CC participants. Impaired insight was related to less severe depression but worse other symptoms and functioning at
baseline for the total sample. At 6 months, the same pattern was found within each group except insight was no longer associated with depression
among NAVIGATE participants. Impaired insight was more strongly associated with worse interpersonal relationships at 6 months in NAVIGATE than in CC,
and changes in insight from baseline to 6 months were more strongly correlated with changes in relationships in NAVIGATE than CC.\rCONCLUSIONS: The
NAVIGATE program improved insight significantly more than CC. Although greater awareness of illness has frequently been found to be associated with
higher depression in schizophrenia, these findings suggest EIS programs can improve insight without worsening depression in FEP. The increased
association between insight and social relationships in NAVIGATE suggests these 2 outcomes may synergistically interact to improve each other in
treatment.
, 48(6) : 1295-1305
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
De-Haan, L., Linszen, D., Wouters, L., Zwinderman, K., Dingemans,
P.
BACKGROUND: The long-term outcome of first-episode schizophrenia needs improvement. Here, we evaluate the effectiveness of 5 years sustained
specialist treatment (ST), ST including Parent groups (ST + P) or treatment as usual (TAU) on psychotic relapse and social functioning. METHOD(S): A
three condition randomized, parallel assigned, single-blind efficacy trial, in which 198 first-episode psychosis (FEP) patients aged 15-28 years were
included. The effect on time to first relapse, first relapse rates, mean number of relapses per patient, and time to the improvement of social
functioning were analyzed using Cox regression or ANOVA. RESULT(S): We found no significant differences between treatment conditions in the ITT
analysis concerning time to first relapse, nor first relapse rate. Mean number of relapses per patient differed at a trend level between ST, ST + P
or TAU conditions, respectively: 0.72; 0.62 or 1.02 (p = 0.069). No evidence was found for differential effect of treatment conditions on social
functioning. CONCLUSION(S): Five years sustained ST of FEP nor addition of parent groups increased time to first relapse or reduced first relapse
rate, compared to sustained TAU. Indications for favorable effects of parent groups were found on relapses per patient.
Psychological medicine, : 1-8
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other service delivery and improvement
interventions
Damme, K. S. F., Gupta, T., Ristanovic, I., Kimhy, D., Bryan, A. D., Mittal, V. A.
BACKGROUND AND HYPOTHESIS: Individuals at clinical high risk for psychosis (CHR-p) are less fit than
nonclinical peers and show hippocampal abnormalities that relate to clinical symptoms. Exercise generates hippocampal neurogenesis that may
ameliorate these hippocampal abnormalities and related cognitive/clinical symptoms. This study examines the impact of exercise on deficits in
fitness, cognitive deficits, attenuated psychotic symptoms, hippocampal volumes, and hippocampal connectivity in individuals at CHR-p.\rSTUDY DESIGN:
In a randomized controlled trial, 32 individuals at CHR-p participated in either an exercise (n = 17) or waitlist (no exercise) (n = 15) condition.
All participants were sedentary at use and absent of current antipsychotic medication, psychosis diagnoses, or a substance use disorder. The
participants completed a series of fitness, cognitive tasks, clinical assessments, and an MRI session preintervention and postintervention. The
exercise intervention included a high-intensity interval exercise (80% of VO2max) with 1-minute high-intensity intervals (95% of VO2max) every 10
minutes) protocol twice a week over 3 months.\rSTUDY RESULTS: The exercise intervention was well tolerated (83.78% retention; 81.25% completion). The
exercising CHR-p group showed that improved fitness (pre/post-d = 0.53), increased in cognitive performance (pre/post-d = 0.49), decrease in positive
symptoms (pre/post-d = 1.12) compared with the waitlist group. Exercising individuals showed stable hippocampal volumes; waitlist CHR-p individuals
showed 3.57% decreased hippocampal subfield volume. Exercising individuals showed that increased exercise-related hippocampal connectivity compared
to the waitlist individuals.\rCONCLUSIONS: The exercise intervention had excellent adherence, and there were clear signs of mechanism engagement.
Taken together, evidence suggests that high-intensity exercise can be a beneficial therapeutic tool in the psychosis risk period.
, 48(6) : 1394-
1405
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Chien, W. T, Ho, L. K, Gray, R, Bressington, D.
Early patient-centered interventions can improve mental health and prevent psychotic relapse in people with recent-onset
psychosis (ROP). However, limited effective peer-facilitated early interventions are found worldwide. We aimed to test the effects of a four-month
peer-facilitated self-management intervention (PFSMI) for Chinese patients with ROP compared with a psychoeducation group (PEG) and treatment-as-
usual (TAU) group. A randomized controlled trial was conducted at six Integrated Community Centers for Mental Wellness in Hong Kong. The primary
outcome was level of recovery. Secondary outcomes were improvement of problem-solving ability, insight into illness/treatment, and functioning, and
reducing psychotic symptoms and re-hospitalization rates. Overall, 180 ROP patients were randomly selected, and after collecting baseline data,
randomly assigned to the PFSMI, PEG or TAU (60 per group). Their outcomes were measured at 1-week and 6-month post-intervention. One hundred and
sixty-one patients (89.4 %) completed their interventions, with an overall attrition rate of 7.8 % (n = 14). Based on intention-to-treat principle,
results of generalized estimating equation test indicated that the PFSMI group reported significantly greater improvements in levels of recovery,
functioning and insight into illness/treatment and reductions in psychotic symptoms and duration of re-hospitalizations (p = 0.0007-0.02, with
moderate to large effect sizes) than the TAU group at 1-week post-intervention, and both the TAU and PEG at 6-month post-intervention. Significantly
fewer PFSMI participants were hospitalized than the TAU and PEG over 6-month follow-up (p = 0.003). The findings support that PFSMI can produce
medium-term positive effects on the mental health and functioning of patients with ROP.
, 250 : 22-30
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Psychoeducation, Other service delivery and improvement
interventions
Cheng, N., McLaverty, A., Nelson, B., Markulev, C., Schafer, M. R., Berger, M., Mossaheb, N., Schlogelhofer, M., Smesny, S., Hickie, I. B., Berger, G. E., Chen, E. Y. H., De-Haan, L., Nieman, D. H., Nordentoft, M., Riecher-Rossler,
A., Verma,
S., Street, R., Thompson, A., Yuen, H. P., Hester, R., Yung, A. R., McGorry, P. D., Allott, K., Amminger, G. P.
Background Cognitive impairments are well-established features of psychotic disorders and are present
when individuals are at ultra-high risk for psychosis. However, few interventions target cognitive functioning in this population. Aims To
investigate whether omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation improves cognitive functioning among individuals at ultra-high risk
for psychosis. Method Data (N = 225) from an international, multi-site, randomised controlled trial (NEURAPRO) were analysed. Participants were given
omega-3 supplementation (eicosapentaenoic acid and docosahexaenoic acid) or placebo over 6 months. Cognitive functioning was assessed with the Brief
Assessment of Cognition in Schizophrenia (BACS). Mixed two-way analyses of variance were computed to compare the change in cognitive performance
between omega-3 supplementation and placebo over 6 months. An additional biomarker analysis explored whether change in erythrocyte n-3 PUFA levels
predicted change in cognitive performance. Results The placebo group showed a modest greater improvement over time than the omega-3 supplementation
group for motor speed (etap2 = 0.09) and BACS composite score (etap2 = 0.21). After repeating the analyses without individuals who transitioned,
motor speed was no longer significant (etap2 = 0.02), but the composite score remained significant (etap2 = 0.02). Change in erythrocyte n-3 PUFA
levels did not predict change in cognitive performance over 6 months. Conclusions We found no evidence to support the use of omega-3 supplementation
to improve cognitive functioning in ultra-high risk individuals. The biomarker analysis suggests that this finding is unlikely to be attributed to
poor adherence or consumption of non-trial n-3 PUFAs. Copyright © 2022 The Author(s). Published by Cambridge University Press on behalf of the Royal
College of Psychiatrists.
BJPsych Open, 8(5) : ArtID
e165
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Berry, C., Hodgekins, J., French, P., Clarke, T., Shepstone, L., Barton, G., Banerjee, R., Byrne, R., Fraser, R., Grant, K., Greenwood, K., Notley, C., Parker, S., Wilson, J., Yung, A. R., Fowler, D.
Background: Young people with social disability and severe and complex mental health problems have poor outcomes,
frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or
psychosocial intervention. Aims: We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would
improve social recovery compared with ESC alone. Method: A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was
conducted in three UK centres. Participants (n = 270) were aged 16-25 years, with persistent social disability, defined as under 30 hours of
structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to
ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured
activity 15 months post-randomisation. Results: We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured
activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no
significant difference between arms; treatment effect was -4.44 (95% CI -10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC
alone arm. Conclusions: We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically
significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing
specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes. (PsycInfo Database
Record (c) 2022 APA, all rights reserved)
, 220(3) : 154-
162
- Year: 2022
- Problem: Anxiety Disorders (any), Depressive Disorders, Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions