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Cognitive–behavioural therapy in first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial

  • Nicholas Tarrier (a1), Shôn Lewis (a1), Gillian Haddock (a1), Richard Bentall (a2), Richard Drake (a1), Peter Kinderman (a3), David Kingdon (a4), Ronald Siddle (a1), Julie Everitt (a1), Karen Leadley (a1), Andy Benn (a1), Katy Grazebrook (a1), Cliff Haley (a1), Shahid Akhtar (a1), Lindad Avies (a1), Steve Palmer (a5) and Graham Dunn (a6)...

Abstract

Background

The initial phase of a trial of cognitive–behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery.

Aims

To test the hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period.

Method

This was an 18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation.

Results

There were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre–treatment interaction, reflecting centre differences in the effect of introducing either treatment, but not in the comparison of CBT and supportive counselling. Medication dosage and compliance did not explain group differences.

Conclusions

Adjunctive psychological treatments can have a beneficial longterm effect on symptom reduction.

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Copyright

Corresponding author

Correspondence: Professor Nicholas Tarrier, Education and Research Building (2nd Floor), Wythenshawe Hospital, Manchester M23 9LT, UK. Tel: 44 161 291 5883; fax: 44 161 275 5882; e-mail: nicholas.tarrier@man.ac. uk

Footnotes

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Declaration of interest

None.

Footnotes

References

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Cognitive–behavioural therapy in first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial

  • Nicholas Tarrier (a1), Shôn Lewis (a1), Gillian Haddock (a1), Richard Bentall (a2), Richard Drake (a1), Peter Kinderman (a3), David Kingdon (a4), Ronald Siddle (a1), Julie Everitt (a1), Karen Leadley (a1), Andy Benn (a1), Katy Grazebrook (a1), Cliff Haley (a1), Shahid Akhtar (a1), Lindad Avies (a1), Steve Palmer (a5) and Graham Dunn (a6)...
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eLetters

Why Are the Conclusions Different to the Results?

Alex J Mitchell, Consultant Liaison Psychiatrist
18 March 2004



Although this study appears to be methodologically more rigorous than the similar study of CBT in post-acute schizophrenia (Br. J. Psychiatry, Jun 2002; 180: 523 – 527), I am a little confused by the authors’ conclusions. After clearly demonstrating no superior effect for CBT over Supportive Counselling on measures of symptom reduction or relapse rates – the authors conclude their paper by stating “We suggest the optimum psychosocial management of early schizophrenia would include a combination of CBT and family intervention”. Would it be rude to suggest that the authors take into account their own findings before making such a statement? It is also more than a little frustrating that the authors refer to their sample as being diagnosed with “early schizophrenia” throughout the paper. Examining the inclusion criteria for this study shows that patients were included who suffered schizophreniform disorders, delusional disorders and unspecified psychoses. Regarding the criterion for “early” – most clinicians would define the duration of schizophrenia from symptom onset to commencement of treatment (hence the duration of untreated psychosis concept). Unless the authors specify illness duration – the criterion of early cannot be asserted. Thus this is appears to be a study of patients within 2 years of their first episode for non-affective psychoses and not those with early schizophrenia per se. Were these issues not picked up on peer review or were essential facts omitted in editing? ... More

Conflict of interest: None Declared

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