Author:
Garety Philippa A.,Fowler David G.,Freeman Daniel,Bebbington Paul,Dunn Graham,Kuipers Elizabeth
Abstract
BackgroundFamily intervention reduces relapse rates in psychosis.
Cognitive-behavioural therapy (CBT) improves positive symptoms but
effects on relapse rates are not established.AimsTo test the effectiveness of CBT and family intervention in reducing
relapse, and in improving symptoms and functioning in patients who had
recently relapsed with non-affective psychosis.MethodA multicentre randomised controlled trial (ISRCTN83557988) with two
pathways: those without carers were allocated to treatment as usual or
CBT plus treatment as usual, those with carers to treatment as usual, CBT
plus treatment as usual or family intervention plus treatment as usual.
The CBT and family intervention were focused on relapse prevention for 20
sessions over 9 months.ResultsA total of 301 patients and 83 carers participated. Primary outcome data
were available on 96% of the total sample. The CBT and family
intervention had no effects on rates of remission and relapse or on days
in hospital at 12 or 24 months. For secondary outcomes, CBT showed a
beneficial effect on depression at 24 months and there were no effects
for family intervention. In people with carers, CBT significantly
improved delusional distress and social functioning. Therapy did not
change key psychological processes.ConclusionsGeneric CBT for psychosis is not indicated for routine relapse prevention
in people recovering from a recent relapse of psychosis and should
currently be reserved for those with distressing medication-unresponsive
positive symptoms. Any CBT targeted at this acute population requires
development. The lack of effect of family intervention on relapse may be
attributable to the low overall relapse rate in those with carers.
Publisher
Royal College of Psychiatrists
Subject
Psychiatry and Mental health
Cited by
232 articles.
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