Feasibility randomised controlled trial of a one-day CBT workshop (“DISCOVER”) for 15-18 year olds with anxiety and/or depression in clinic settings

Background: “DISCOVER” one-day cognitive behavioural therapy (CBT) workshops have been developed to provide accessible, developmentally-sensitive psychological support for older adolescents experiencing emotional difficulties. Previous school-based evaluations of the DISCOVER model have shown positive outcomes. Aims: The current study aimed to test the model for clinically-referred adolescents, in real-world settings. Method: A randomised controlled trial (RCT) assessed feasibility, acceptability and preliminary outcomes of the DISCOVER intervention, in comparison with usual care, for 15-18-year-olds with emotional difficulties. Participants were recruited from outpatient clinic waiting lists in UK child and adolescent mental health services (CAMHS). Research feasibility indicators included rates of recruitment, randomisation, intervention participation (group workshops and individualised follow-up telephone calls), and data collection (at baseline and 8-week follow-up). Intervention acceptability was assessed using a structured service satisfaction questionnaire and semi-structured qualitative interviews with intervention participants. Preliminary clinical outcomes were explored using adolescent-reported validated measures of depression, anxiety and well-being. Results: N=24 participants were randomised to intervention and usual care groups. Workshop attendance was good and high levels of treatment satisfaction were reported, although feasibility challenges emerged in recruitment and randomisation. Trends were found towards potential improvements in anxiety and well-being for the intervention group, but the effect estimate for depression was imprecise; interpretability was also limited due to the small sample size. Conclusions: DISCOVER appears to be a feasible and acceptable intervention model for clinically-referred 15-18-year-olds with emotional difficulties. A full-scale RCT is warranted to evaluate effectiveness; protocol modifications may be necessary to ensure feasible recruitment and randomisation procedures

E-therapy in the treatment and prevention of eating disorders: A systematic review and meta-analysis

AbstractThe widespread availability of the Internet and mobile-device applications (apps) is changing the treatment of mental health problems. The aim of the present study was to review the research on the effectiveness of e-therapy for eating disorders, using the methodology employed by the UK's National Institute for Health and Care Excellence (NICE). Electronic databases were searched for published randomised controlled trials of e-therapies, designed to prevent or treat any eating disorder in all age groups. Studies were meta-analysed where possible, and effect sizes with confidence intervals were calculated. The GRADE approach was used to determine the confidence in the effect estimates. Twenty trials met the inclusion criteria. For prevention, a CBT-based e-intervention was associated with small reductions in eating disorder psychopathology, weight concern and drive for thinness, with moderate confidence in the effect estimates. For treatment and relapse prevention, various e-therapies showed some beneficial effects, but for most outcomes, evidence came from single studies and confidence in the effect estimates was low. Overall, although some positive findings were identified, the value of e-therapy for eating disorders must be viewed as uncertain. Further research, with improved methods, is needed to establish the effectiveness of e-therapy for people with eating disorders

Efficacy and safety of pharmacological and psychological interventions for the treatment of psychosis and schizophrenia in children, adolescents and young adults : a systematic review and meta-analysis

Background Studies report contrasting results regarding the efficacy and safety of pharmacological, psychological, and combined interventions in psychosis and schizophrenia in children, adolescents and young adults. Methods Systematic review and meta-analysis. Embase, Medline, PreMedline, PsycINFO, and CENTRAL were searched to July 2013 without restriction to publication status. Randomised trials comparing any pharmacological, psychological, or combined intervention for psychosis and schizophrenia in children, adolescents and young adults were included. Studies were assessed for bias, and GRADE criteria were used to describe the quality of the results. Results Twenty-seven trials including 3067 participants were identified. Meta-analyses were performed for 12 comparisons: symptoms, relapse, global state, psychosocial functioning, depression, weight and discontinuation. Low quality evidence demonstrated that antipsychotics have small beneficial effects on psychotic symptoms (SMD = -0.42, 95% CI -0.58 to -0.26), and a medium adverse effect on weight gain (WMD = 1.61, 95% CI 0.61 to 2.60) and discontinuation due to side effects (RR = 2.44, 95% CI, 1.12 to 5.31). There were no trials of psychological treatments in under-18 year olds. There was no evidence of an effect of psychological interventions on psychotic symptoms in an acute episode, or relapse rate, but low quality evidence of a large effect for family plus individual CBT on the number of days to relapse (WMD = 32.25, 95% CI -36.52 to -27.98). Conclusions For children, adolescents and young adults, the balance of risk and benefit of antipsychotics appears less favourable than in adults. Research is needed to establish the potential for psychological treatments, alone and in combination with antipsychotics, in this population

Antipsychotic medication compared with placebo at post-treatment—weight.

<p>Antipsychotic medication compared with placebo at post-treatment—weight.</p

Antipsychotic medication compared with placebo at post-treatment—total symptoms.

<p>Antipsychotic medication compared with placebo at post-treatment—total symptoms.</p

Family plus individual CBT compared with TAU at EPPIC—Time to relapse at post-treatment.

<p>Family plus individual CBT compared with TAU at EPPIC—Time to relapse at post-treatment.</p

PRISMA flowchart.

<p>PRISMA flowchart.</p

Study characteristics for pharmacological interventions.

<p><i>Note</i>.</p><p>* Data not reported in sufficient detail to include in analysis</p><p>¹ Molindone was the third arm of this trial (n = 40), however as it was discontinued by its sole supplier, Endo Pharmaceuticals, on January 13, 2010, only data for risperidone and olanzapine are used in this review</p><p>² The study design consisted of an 8 week ‘acute phase’ and a blind ‘maintenance phase’ up to 52 weeks post randomization. During the maintenance phase participants continued to be administered treatment within their randomised groups and at same dose range.</p><p>³ Loxapine was the third arm of this trial (n = 26), however it was not included in this guideline as it was discontinued in the UK in 2003.</p><p>⁴This trial included a fourth arm of paliperidone 6–12mg/day. The 3–6mg/day arm was selected as the ‘higher dose’ antipsychotic medication in accordance with POMH-UK Topic 10 benchmarking exercise and therefore the 6–12mg/day arm was not included in the current work.</p><p>N = number randomised; nr = not reported; na = not applicable; mg = milligrams; DU = duration of treatment; PT = post-treatment data collection; FU = follow-up data collection</p><p>Study characteristics for pharmacological interventions.</p