We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
There is increasing evidence that cognitive–behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia.
To investigate the effects of cognitive–behavioural therapy on in-patients with treatment-refractory psychotic symptoms.
Manualised therapy was compared with supportive counselling in a randomised controlled study. Both interventions were delivered by experienced psychologists over 16 sessions of treatment. Therapy fidelity was assessed by two independent raters. Participants underwent masked assessment at baseline, after treatment and at 6 months' follow-up. Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale. The analysis was by intention to treat.
Participants receiving cognitive–behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up.
Cognitive–behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia.
To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.
To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.
Email your librarian or administrator to recommend adding this journal to your organisation's collection.
* Views captured on Cambridge Core between 2nd January 2018 - 12th June 2018. This data will be updated every 24 hours.
Mahesh Jayaram
21 April 2005
Valmaggia et al (2005) report an interesting randomised control trialevaluating Cognitive-behavioural therapy (CBT) for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication. The authors conclude that patients should not be excluded from psychological help on the grounds that they were too ill to benefit from therapy and cognitive behavioural therapy for psychotic symptoms should beavailable in in-patient facilities.
We feel the conclusions drawn by the authors do not truly reflect their results. The authors report that their primary hypothesis was that CBT would be more effective than supportive counselling in reducing auditory hallucinations and delusional beliefs. They have used the Positive and Negative syndrome scale (PANSS) and Psychotic symptom rating scale (PSYRATS) to measure the outcomes. From their own results, the post-treatment score on the PANSS positive subscale was not significantly different from the control group. On PSYRATS no significant effect was found on the delusions. CBT did benefit the physical characteristics of the auditory hallucination and cognitive interpretation but not on emotional characteristics. Even the benefits noticed were not sustained atfollow up. It would have been helpful if the authors had used an a priori definition of what constitutes a clinically meaningful improvement and provided the actual figures for the dichotomous outcome.
Also if one were to look at the NNT calculations, the authors have accurately reported the lack of statistical significance (PANSS positive symptom scale NNT 8, 95% CI 3 to ¡Þ, PSYRATS factor 2 NNT is 6, CI 2 to ¡Þand delusion scale factor 1, NNT is 4, CI 2 to ¡Þ and factor 2 NNT is 12, CI 3 to ¡Þ). The only finding with reasonable confidence intervals seems to be cognitive interpretation on the auditory hallucination scale of PSYRATS. (NNT 3, 95% CI 2-13). The authors also draw our attention to thefact that clozapine is effective in 32% of cases in producing a clinical improvement NNT 5, 95% CI 4 to 7 (Wahlbeck et al 1999). The authors seem to suggest that the figures from the current study are comparable to the effects of clozapine. However it has to be noted that this figure reported by Wahlbeck et al is for global improvement whereas in the current report the authors do not give any figures for global improvement and hence in our opinion these are not comparable. To conclude from these results that CBT could induce a change in psychotic symptoms seems to be overestimating the beneficial effects.
Patients with schizophrenia who are resistant to clozapine form one of the most difficult to treat client group. Cochrane review (Jones et al 2004) conclude that trial-based data supporting the wide use of CBT for people with schizophrenia or other psychotic illnesses are far from conclusive. This study evaluating interventions aimed at this population in a randomised control design is a welcome measure.
References:
Jones C, Cormac I, Silveira da Mota Neto JI., et al (2004) Cognitivebehaviour therapy for schizophrenia. The Cochrane Database of Systematic Reviews 2004, Issue 4.
Valmaggia, L.R., Gaag, Van der M., Tarrier, N., et al (2005) Cognitive¨Cbehavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication: Randomised controlled trial Br J Psychiatry 2005; 186: 324-330
Wahlbeck K, Cheine M, Essali MA. (1999) Clozapine versus typical neuroleptic medication for schizophrenia. The Cochrane Database of Systematic Reviews 1999, Issue 4. ... More
Conflict of interest: None Declared
Write a replyBack to top