A key target of early intervention is “indicated prevention” for individuals at high risk of psychosis who have been identified with early signs of the disorder, but do not meet any diagnostic criteria. There are two key approaches for identifying people with early signs. The first approach is based on Huber’s Basic Symptoms, which focuses on a detailed way of describing phenomenological (subjective) disturbances in the domains of perception, cognition, language, motor function, will, initiative and level of energy, and stress tolerance. Because the basic symptoms refer only to subtle subjectively experienced abnormalities, they may reflect an earlier phase in the disease process than the second approach. The second approach identifies at-risk mental states as a combination of a family history of psychosis plus non-specific symptoms and recent decline in functioning, recent onset attenuated psychotic symptoms with a decline in functioning, and brief, limited, intermittent psychotic symptoms.

Early intervention treatments for people identified at a high risk of psychosis often comprise both pharmaceutical and psychosocial therapies, consequently this table presents the evidence for both.

What is the evidence for treatments for high-risk groups?

Moderate quality evidence suggests cognitive behavioural therapy (CBT) may reduce the risk of transition to psychosis for up to two years when compared to various control conditions, with no differences in symptoms, functioning, study retention or quality of life. There were some advantages of ziprasidone plus needs-based interventions for improving attenuated psychotic symptoms when compared to needs-based interventions alone, CBT plus needs-based interventions, or risperidone plus CBT and needs-based interventions.

There were no differences in rates of transitioning to psychosis between needs-based interventions with versus without additional components (aripiprazole, olanzapine, ziprasidone, risperidone, glycine or D-serine, omega-3, CBT, integrated therapies, or family therapies). There were no differences between CBT, omega-3, or cognitive remediation and various control conditions for social functioning, and no differences between NMDAR (glutamate) modulators, CBT, omega-3, risperidone, family therapies, or cognitive remediation and control conditions for negative symptoms.

May 2022

Image: ©gstockstudio – stock.adobe.com

The post Therapies and medications for high-risk groups appeared first on NeuRA Library.

Childhood-onset schizophrenia is defined as schizophrenia with onset prior to the age of 13 years, and early-onset schizophrenia describes schizophrenia between the ages of 13 and 17 years.

What is the evidence for psychosocial treatments for childhood and early-onset schizophrenia?

Moderate quality evidence finds supportive therapy is better than cognitive behavioural therapy for improving symptoms, however cognitive behavioural therapy is better than supportive therapy for improving insight in children with early-onset schizophrenia. Education about the illness may be beneficial for improving symptoms and functioning.

Moderate to low quality evidence finds cognitive remediation can improve verbal memory, executive cognitive functioning (e.g. problem solving), daily living, and general functioning.

September 2020

Image: ©Brian Jackson – Fotolia – stock.adobe.com

The post Therapies for childhood onset and early onset schizophrenia appeared first on NeuRA Library.

Cognitive impairment is a significant problem for many people with schizophrenia, effecting domains such as executive functioning, attention, memory and social cognition. These deficits interfere considerably with day-to-day function. Cognitive remediation or rehabilitation interventions usually take the form of repetitive exercises with or without computers and sometimes augmented by group sessions, strategy coaching and homework exercises, which serve as training for cognitive processes as well as social skills and communication. Strategy learning focuses on providing alternative strategies to compensate for the observed difficulties with cognition; in contrast, rehearsal learning is aimed at restitution of lost skills. This type of intervention is specifically targeted to particular cognitive domains which are known to be deficient in people with schizophrenia, with the intention of compensating or improving functional outcome.

What is the evidence for cognitive rehabilitation interventions?

Moderate to high quality evidence finds a medium-sized benefit of computerised or non-computerised cognitive remediation over control interventions for improving attention, memory, processing speed, problem solving, cognitive flexibility and social functioning. There was also a small benefit for improving symptoms. Moderate to low quality evidence finds similar effectiveness for short (<15 sessions) and long duration of training (>15 sessions), and that strategy learning is more effective than rehearsal learning.

For computerised cognitive drill and practice training, moderate to high quality evidence finds small to medium-sized improvements in attention and positive symptoms when compared to mixed control conditions. There was also a small improvement in functioning. Moderate quality evidence finds medium-sized improvements in working memory and depressive symptoms, and small improvements in psychomotor speed. There were also small improvements in verbal fluency, verbal and visual learning and memory., and negative and total symptoms.

For observation and imitation of social emotions interventions, moderate to high quality evidence finds a medium-sized benefit of improved theory of mind.

September 2020

Image: ©freshidea – stock.adobe.com

The post Therapies for cognition appeared first on NeuRA Library.

Dual diagnosis is a term that refers to having both a mental illness and a substance abuse problem. Studies of dual diagnosis investigate the effectiveness and availability of treatments for improving outcomes relating to either diagnosis, such as symptoms, functioning, quality of life, substance use, or cognitive problems.

What is the evidence for the effectiveness of therapy for dual diagnosis?

Moderate quality evidence suggests a medium-sized benefit of motivational interviewing with or without cognitive behavioural therapy for reducing the amount of cannabis used, but no benefit for reducing frequency of cannabis use. There may also be a small benefit for positive, but not negative symptoms.

Moderate to low quality evidence finds less hospitalisations with contingency management (positive rewards), but more loss to treatment compared to treatment as usual.

Low quality evidence is unclear of the benefits of skills training, group therapy, family therapy, or residential treatments for reducing substance use or improving symptoms.

September 2020

The post Therapies for dual diagnosis appeared first on NeuRA Library.

Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively, we will endeavour to conduct our own review to fill this gap in the Library.

September 2020

The post Therapies for fathers with schizophrenia appeared first on NeuRA Library.

What is the evidence for treatments for first-episode psychosis?

High quality evidence suggests multi-element first-episode psychosis programs involving both antipsychotic medication and psychosocial treatments provide a small reduction in the risk of relapse and symptom severity after a first episode of psychosis compared to treatment as usual. Moderate quality evidence suggests these programs may also improve social function, quality of life, treatment adherence, and treatment satisfaction. The addition of Cognitive Behavioural Therapy or Relapse Prevention Therapy does not further reduce the rate of relapse or suicide, but may further improve negative symptoms, social function and quality of life.

Moderate to high quality evidence suggests early intervention programs using assertive case management can reduce the number of hospital bed days compared to treatment as usual. Moderate quality evidence finds they may also reduce the number of hospitalisations.

Moderate to high quality evidence suggests no differences in long-term outcomes when medication is delayed for a short period of time and psychosocial treatments are provided in a research setting when compared to immediate commencement of medication without psychosocial treatment.

Moderate to low quality evidence suggests no significant benefit of group therapy over individual therapy for negative symptoms, functioning and quality of life, but some benefit for improving psychotic symptoms, treatment adherence and treatment satisfaction.

September 2020

The post Therapies for first-episode psychosis appeared first on NeuRA Library.

Insight, in the context of mental illness, refers to the ability to recognise that the observed features and symptoms of an illness are abnormal. A lack of insight into one’s illness is a feature of many psychiatric disorders, particularly psychosis. This can prevent effective medication adherence and has been associated with poorer long-term outcomes.

What is the evidence for treatments to improve insight?

Moderate to low quality evidence is unclear as to the benefit of cognitive behavioural therapy, psychoanalytical therapy, video self-observation or antipsychotics for improving insight into psychosis. There may be some benefit from individualised psychoeducation.

September 2020

The post Therapies for insight appeared first on NeuRA Library.

Internalised stigma occurs within an individual, such that a person’s attitude may reinforce a negative self-perception of mental disorders, resulting in reduced sense of self-worth, anticipation of social rejection, and a desire for social distance. Stigma can be an important barrier for people with schizophrenia to seek out proper treatment.

What is the evidence for treatments for internalised stigma?

Moderate to high quality evidence suggests a small effect of reduced internalised stigma with targeted interventions comprising psychoeducation and peer-led group discussion.

September 2020

The post Therapies for internalised stigma appeared first on NeuRA Library.

Mothers who have been diagnosed with schizophrenia face challenges in accessing and maintaining treatment programs, particularly when inpatient care is required. Mothers with dependent children may be less likely to seek treatments for their illness due to a fear of losing custody of their children, or due to difficulties in finding alternative care should hospitalisation be required. They may also find it difficult to properly adhere to any treatment programs due to the demands of childcare. Mothers have been shown to be particularly at risk of relapse in the months immediately following child birth and specialised programs could help to support them and their babies during this time.

What is the evidence for treatments tailored to mothers with schizophrenia?

Moderate to low quality evidence is unclear as to the benefits of specialised programs tailored to mothers with schizophrenia who have dependent children. Review authors conclude that such interventions are lacking and that flexible treatment approaches that incorporate support networks including childcare and family involvement are highly recommended.

September 2020

The post Therapies for mothers with schizophrenia appeared first on NeuRA Library.

The negative symptoms of schizophrenia refer to an absence of normal functions. This may include (but is not limited to); blunted affect, which is a scarcity of facial expressions of emotion, reduced frequency and range of gestures and voice modulation, and restricted eye contact; alogia (poverty of speech); asociality (reduced social interaction); avolition (reduced motivation and often poor hygiene) and anhedonia, which is reduced experience of pleasure, often manifesting as scarcity of recreation, inability to experience closeness, and reduced interest in sexual activity.

Psychosocial therapies may provide a clinical adjunct to pharmacological therapy, and include cognitive behavioural therapy (CBT), hallucination focused integrative treatment, acceptance and commitment therapy, experience focused counselling, family intervention, metacognitive training, mindfulness, social skills training, and supportive therapy.

What is the evidence for psychosocial treatments for negative symptoms?

Moderate to high quality evidence shows a small to medium-sized benefit of CBT for greater improvement in negative symptoms than treatment as usual. Moderate quality evidence finds skills training, occupational therapy, music therapy, and exercise also provided small to medium-sized benefits for negative symptoms when compared to treatment as usual. The factors associated with the most benefit were skill enhancement, behavioural activation, social engagement and neurocognitive factors.

February 2022

Image: ©Igor Stevanovic – stock.adobe.com

The post Therapies for negative symptoms appeared first on NeuRA Library.