Talking (cognitive) therapy helps reduce severity of distress among psychotic patients

Posted on Friday 18th May 2012

Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial

Cognitive therapy (CT) reduces the severity of psychotic experiences in adults who are at risk of developing conditions such as schizophrenia, a study published on the BMJ website claims.

Authors from several UK universities, (Birmingham, Cambridge, Glasgow, Manchester and UAE) led by the University of Manchester, set out to determine whether cognitive therapy, combined with monitoring, is effective in preventing the worsening of psychotic symptoms which can lead to schizophrenia, in young adults who are actively seeking help. Monitoring was defined as aiming to provide warm, emphatic and supportive face-to-face contact.

All those involved in the study were between the ages of 14 and 35 and came from across the UK: Manchester, Birmingham, Worcestershire, Glasgow,Cambridge and Norfolk. The CT was provided by means of weekly meetings and all patients had access to a GP throughout the trial if they required.

Results show that although CT is not effective in preventing the development of first episode psychosis for those few that transition, it does significantly reduce the severity, frequency and intensity of psychotic symptoms in this help-seeking population. And although CT does not significantly affect distress, depression, anxiety and life satisfaction, these conditions did improve over time for all participants. This leads authors to believe that many patients recover naturalistically, or with minimal intervention. Based on these findings, the authors suggest that the proposed inclusion of an Attenuated Psychosis Syndrome as a new diagnostic category in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (due in May 2013) needs to be reconsidered.

The study found that the effect of monitoring sessions were greater than originally expected, mainly because they provided regular contact for the patients. This is consistent with earlier findings that brief, simple psychological interventions that target worry have significant effect on psychotic experiences.

The authors suggest that depression and anxiety among this age group, in conjunction with psychotic experiences, are common, and should be considered as suitable treatment targets. They conclude the importance of “future research [which] examines the developmental process in the transition to psychosis” and that anti-psychotic medication should not be offered as the first option to people at risk of developing schizophrenia, since more benign options appear equally effective.

Reference
Morrison, A. P. et al., (2012). Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. British Medical Journal. doi: 10.1136/bmj.e2233