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July 09, 2007
Cognitive Therapy May Prevent High Risk Populations From Developing Psychosis
Read more... Schizophrenia Prevention
A 3-year follow up study on the ability of Cognitive Therapy (CT or CBT) to prevent psychosis in ultra high-risk populations was completed and the article featured in Schizophrenia Bulletin. The study utilized 58 participants considered ultra high risk of having an initial psychotic episode, and administered CT over a 6-month period. The participants were monitored monthly, and followed up over the 3 years.
This is a study of interest because its one of the first studies showing a possibility of preventing psychosis over several years using a psychotherapeutic method. It is also noteworthy that they found a psychological therapy alone to have an effect that seems to be:
as efficacious and enduring as that found in the study of combined pharmacological therapy and psychotherapy and that of a double blind placebo-controlled trial of pharmacotherapy alone (it is worth noting that all of these studies had very similar sample sizes).
The studies of medications alone only found differences at the end of the study, but not on any follow-ups; showing that the psychotherapeutic therapy (CT) might be the most long term, in helping maintain stability.
After controlling for age, gender, baseline PANSS scores, and family history, they found CT to significantly reduce the likelihood of being prescribed antipsychotic medications during the time of the study. CT did not however have an effect on transitioning to psychosis, which they measured using the Positive and Negative Syndrome Scale (PANSS) or probable Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis.
"There appear to be enduring benefits of CT over the long term, suggesting that it is an efficacious intervention for people at high risk of developing psychosis."
Some criticisms of this study are within the structure and the way in which they measured progression to psychosis. Although they did not find CT to help with the transition when measured by PANSS, PANSS may not have been a good measure based on the fact that it relays on clinical interviewing, and assumes a person has crossed a "somewhat arbitrary" threshold from non-psychotic to psychotic.
However, CT did significantly reduce the likelihood of transition to psychosis defined using the PANSS over the 3-year period, after controlling for beliefs that are targeted during therapy and baseline PANSS scores. The numbers in the analysis are small, however.) But measuring progress based on antipsychotic medication prescribing may also have limitations. "Prescription of antipsychotic medication cannot be considered a definitive indicator of transition because it is increasingly used in clinical practice for other disorders."
How can this be helpful to people or families at risk or with genetic vulnerabilities?
The researchers suggest that CT be encouraged as the initial treatment (prior to the use of anti-psychotic medications) of those from ultra high risk populations for psychosis, in the hopes that it help prevent progression to mental illness. They argue this since research is finding possibly equal benefit from CT as with medications (without the potential drug side-effects), and that CT's benefits seem to be long lasting. This appears to be a safer and possibly more acceptable option for those young children, adolescents, or adults who meet criteria for high risk. It needs to be highlighted that this is NOT suggesting people with already psychotic symptoms, or a diagnosis of a psychotic disorder can discontinue meds and only utilize CT. The researchers are focusing on those that are high risk for eventually developing the disorder, and that CT is a safer alternative than medications in preventing psychosis.
Posted by Michelle Roberts at July 9, 2007 07:27 AM
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