459 research outputs found
Feasibility and efficacy of an acceptance and mindfulness-based group intervention for young people with early psychosis (Feel-Good group)
Background: Over the last decade, researchers have sought for alternative
interventions that have better treatment effects than Cognitive Behavioral
Therapy (CBT) when treating psychotic symptoms. Mindfulness-based
interventions have been a proposed alternative to CBT, yet research regarding
its feasibility, acceptance and effectiveness is lacking when treating individuals
with early psychosis in inpatient settings.
Objective: Before conducting a large-scale randomized-controlled trial
(RCT), this pilot study evaluated the feasibility and the potential efficacy
of a mindfulness-based inpatient group intervention that targets emotion
regulation in patients with early psychosis, and thus indirectly improving
psychotic symptoms.
Methods: A preâpost study was performed. Thirty-six patients with early
psychosis treated at the specialized inpatient treatment âFrĂŒhinterventionsund
Therapiezentrum; FRITZâ (early intervention and therapy center) received
eight group therapy sessions. Assessments were performed at baseline, after
8 weeks post treatment and at follow-up after 16 weeks.
Results: Rates of patients who participated in the study suggests that a
mindfulness-based group therapy is highly accepted and feasible for patients
with early psychosis being treated in an inpatient ward. Friedman analyses
revealed significant changes in the primary outcomes of emotional goal
attainment (Goal 1: W = 0.79; Goal 2: W = 0.71) and psychotic symptoms (PANSS-T: W = 0.74). Significant, albeit small, effect sizes were found in
patientsâ self-perception of emotion regulation skills (ERSQ: W = 0.23).
Discussion: We found favorable findings regarding the feasibility and
acceptance of the Feel-Good mindfulness-based intervention. Results of the
study provide a basis for an estimation of an adequate sample size for a
fully powered RCT that needs to be conducted to test whether Feel-Good
is effective in the inpatient treatment of psychotic symptoms for individuals
with early psychosis
Stage managing bipolar disorder.
OBJECTIVES: Clinical staging is widespread in medicine - it informs prognosis, clinical course, and treatment, and assists individualized care. Staging places an individual on a probabilistic continuum of increasing potential disease severity, ranging from clinically at-risk or latency stage through first threshold episode of illness or recurrence, and, finally, to late or end-stage disease. The aim of the present paper was to examine and update the evidence regarding staging in bipolar disorder, and how this might inform targeted and individualized intervention approaches.
METHODS: We provide a narrative review of the relevant information.
RESULTS: In bipolar disorder, the validity of staging is informed by a range of findings that accompany illness progression, including neuroimaging data suggesting incremental volume loss, cognitive changes, and a declining likelihood of response to pharmacological and psychosocial treatments. Staging informs the adoption of a number of approaches, including the active promotion of both indicated prevention for at-risk individuals and early intervention strategies for newly diagnosed individuals, and the tailored implementation of treatments according to the stage of illness.
CONCLUSIONS: The nature of bipolar disorder implies the presence of an active process of neuroprogression that is considered to be at least partly mediated by inflammation, oxidative stress, apoptosis, and changes in neurogenesis. It further supports the concept of neuroprotection, in that a diversity of agents have putative effects against these molecular targets. Clinically, staging suggests that the at-risk state or first episode is a period that requires particularly active and broad-based treatment, consistent with the hope that the temporal trajectory of the illness can be altered. Prompt treatment may be potentially neuroprotective and attenuate the neurostructural and neurocognitive changes that emerge with chronicity. Staging highlights the need for interventions at a service delivery level and implementing treatments at the earliest stage of illness possible
Early specific cognitive-behavioural psychotherapy in subjects at high risk for bipolar disorders: study protocol for a randomised controlled trial
Background: Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially developing BD, many adolescents and young adults seek help, and most of them suffer substantially from symptoms already leading to impairments in psychosocial functioning in school, training, at work and in their social relationships. We aimed to identify subjects at risk of developing BD and investigate the efficacy and safety of early specific cognitive-behavioural psychotherapy (CBT) in this subpopulation. Methods/Design: EarlyCBT is a randomised controlled multi-centre clinical trial to evaluate the efficacy and safety of early specific CBT, including stress management and problem solving strategies, with elements of mindfulness-based therapy (MBT) versus unstructured group meetings for 14 weeks each and follow-up until week 78. Participants are recruited at seven university hospitals throughout Germany, which provide in-and outpatient care (including early recognition centres) for psychiatric patients. Subjects at high risk must be 15 to 30 years old and meet the combination of specified affective symptomatology, reduction of psychosocial functioning, and family history for (schizo) affective disorders. Primary efficacy endpoints are differences in psychosocial functioning and defined affective symptomatology at 14 weeks between groups. Secondary endpoints include the above mentioned endpoints at 7, 24, 52 and 78 weeks and the change within groups compared to baseline; perception of, reaction to and coping with stress; and conversion to full BD. Discussion: To our knowledge, this is the first study to evaluate early specific CBT in subjects at high risk for BD. Structured diagnostic interviews are used to map the risk status and development of disease. With our study, the level of evidence for the treatment of those young patients will be significantly raised
Efficacy of Integrated Social Cognitive Remediation vs. Neurocognitive Remediation in Improving Functional Outcome in Schizophrenia: Concept and Design of a Multicenter, Single-Blind RCT (The ISST Study)
Background: Although clinically effective treatment is available for schizophrenia,
recovery often is still hampered by persistent poor psychosocial functioning, which
in turn is limited by impairments in neurocognition, social cognition, and social
behavioral skills. Although cognitive remediation has shown general efficacy in improving
cognition and social functioning, effects still need to be improved and replicated in
appropriately powered, methodologically rigorous randomized controlled trials (RCTs).
Existing evidence indicates that effects can most likely be optimized by combining
treatment approaches to simultaneously address both social cognitive and social
behavioral processes.
Objectives: To assess whether Integrated Social Cognitive and Behavioral Skill Therapy
(ISST) ismore efficacious in improving functional outcome in schizophrenia than the active
control treatment Neurocognitive Remediation Therapy (NCRT).
Methods: The present study is a multicenter, prospective, rater-blinded, two-arm RCT
being conducted at six academic study sites in Germany. A sample of 180 at least partly
remitted patients with schizophrenia are randomly assigned to either ISST or NCRT. ISST
is a compensatory, strategy-based program that targets social cognitive processes and
social behavioral skills. NCRT comprisesmainly drill and practice-oriented neurocognitive
training. Both treatments consist of 18 sessions over 6 months, and participants are subsequently followed up for another 6 months. The primary outcome is all-cause
discontinuation over the 12-month study period; psychosocial functioning, quality of life,
neurocognitive and social cognitive performance, and clinical symptoms are assessed as
secondary outcomes at baseline before randomization (V1), at the end of the six-month
treatment period (V6), and at the six-month follow-up (V12).
Discussion: This RCT is part of the German Enhancing Schizophrenia Prevention and
Recovery through Innovative Treatments (ESPRIT) research network, which aims at using
innovative treatments to enhance prevention and recovery in patients with schizophrenia.
Because this study is one of the largest and methodologically most rigorous RCTs on
the efficacy of cognitive remediation approaches in schizophrenia, it will not only help
to identify the optimal treatment options for improving psychosocial functioning and thus
recovery in patients but also allow conclusions to be drawn about factors influencing and
mediating the effects of cognitive remediation in these patients
DAOA/G72 predicts the progression of prodromal syndromes to first episode psychosis
The genetic factors determining the progression of prodromal syndromes to first episode schizophrenia have remained enigmatic to date. In a unique prospective multicentre trial, we assessed whether variants at the d-amino acid oxidase activator (DAOA)/G72 locus influence progression to psychosis. Young subjects with a prodromal syndrome were observed prospectively for up to 2 years to assess the incidence of progression to schizophrenia or first episode psychosis. Of the 82 probands with a prodromal syndrome, 21 probands experienced progression to psychosis within the observation period. Assessment of nine common variants in the DAOA/G72 locus yielded two variants with the predictive value for symptom progression: all four probands with the rs1341402 CC genotype developed psychosis compared with 17 out of 78 probands with the TT or CT genotypes (Ï2 = 12.348; df = 2; p = 0.002). The relative risk for progression to psychosis was significantly increased in the CC genotype: RR = 4.588 (95% CI = 2.175â4.588). Similarly, for rs778294, 50% of probands with the AA genotype, but only 22% of probands with a GG or GA genotype progressed to psychosis (Ï2 = 7.027; df = 2; p = 0.030). Moreover, haplotype analysis revealed a susceptibility haplotype for progression to psychosis. This is one of the first studies to identify a specific genetic factor for the progression of prodromal syndromes to schizophrenia, and further underscores the importance of the DAOA/G72 gene for schizophrenia
Abnormal P300 in people with high risk of developing psychosis
Background
Individuals with an âat-risk mental stateâ (or âprodromalâ symptoms) have a 20â40% chance of developing psychosis; however it is difficult to predict which of them will become ill on the basis of their clinical symptoms alone. We examined whether neurophysiological markers could help to identify those who are particularly vulnerable.
Method
35 cases meeting PACE criteria for the at-risk mental state (ARMS) and 57 controls performed an auditory oddball task whilst their electroencephalogram was recorded. The latency and amplitude of the P300 and N100 waves were compared between groups using linear regression.
Results
The P300 amplitude was significantly reduced in the ARMS group [8.6 ± 6.4 microvolt] compared to controls [12.7 ± 5.8 microvolt] (p < 0.01). There were no group differences in P300 latency or in the amplitude and latency of the N100. Of the at-risk subjects that were followed up, seven (21%) developed psychosis.
Conclusion
Reduction in the amplitude of the P300 is associated with an increased vulnerability to psychosis. Neurophysiological and other biological markers may be of use to predict clinical outcomes in populations at high risk
Bipolar at-risk criteria: an examination of which clinical features have optimal utility for identifying youth at risk of early transition from depression to bipolar disorders
Background: A clinical and research challenge is to identify which depressed youth are at risk of âearly transition to bipolar disorders (ET-BD).â This 2-part study (1) examines the clinical utility of previously reported BD at-risk (BAR) criteria in differentiating ET-BD cases from unipolar depression (UP) controls; and (2) estimates the Number Needed to Screen (NNS) for research and general psychiatry settings.
Methods: Fifty cases with reliably ascertained, ET-BD IÂ and II cases were matched for gender and birth year with 50 UP controls who did not develop BD over 2 years. We estimated the clinical utility for finding true cases and screening out non-cases for selected risk factors and their NNS. Using a convenience sample (NÂ =Â 80), we estimated the NNS when adjustments were made to account for data missing from clinical case notes.
Results: Sub-threshold mania, cyclothymia, family history of BD, atypical depression symptoms and probable antidepressant-emergent elation, occurred significantly more frequently in ET-BD youth. Each of these âBARDepressionâ criteria demonstrated clinical utility for screening out non-cases. Only cyclothymia demonstrated good utility for case finding in research settings; sub-threshold mania showed moderate utility. In the convenience sample, the NNS for each criterion ranged from ~4 to 7.Â
Conclusions: Cyclothymia showed the optimum profile for case finding, screening and NNS in research settings. However, its presence or absence was only reported in 50% of case notes. Future studies of ET-BD instruments should distinguish which criteria have clinical utility for case finding vs screening
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