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Preventing relapse of psychosis and deterioration of physical health
Date: 15 May 2015
Schizophrenia represents a substantial cost to the NHS and society because it is common and begins in adolescence or early adulthood, and often causes lifelong impairment. The first three years are a “critical period” in which the course of the illness is determined. Emerging evidence has shown that it is vital to avoid relapse and prevent deterioration in physical health in the critical period, as both can drastically reduce the chances of full recovery.
Professor Max Marshall and his research team developed three linked phase-specific interventions to prevent relapse of psychosis and/or deterioration in physical health (weight gain from taking medication is often a side effect) in people who have experienced a first episode of psychosis.
They found that Cognitive Remediation (CR) delivered by relatively unskilled workers can improve the efficiency of subsequent Cognitive-Behavioural Therapy (CBT), enabling participants and therapists to achieve the same progress in therapy in approximately half the number of sessions. A substantial increase in CBT’s efficiency implies that the same number of CBT therapists could treat many more patients.
Support workers can be trained to deliver a healthy living intervention, but the effect of the intervention in reducing weight or controlling weight gain was small and not significant. The effect of the intervention was larger in the subgroup taking antipsychotic medicine, suggesting that future work should focus attention on this subgroup of service users.
Motivational Interviewing CBT (MI-CBT) intervention was acceptable to young cannabis users in early psychosis but it is not yet known whether MI-CBT improved outcome in terms of reducing cannabis use or improving clinical outcome. The results, when available, will be a significant addition to the evidence base and will be of considerable interest to academics and clinicians in the field.
Professor Marshall said: “There is increasing awareness of the need to begin psychological and medical treatment of first episode psychosis as soon as possible after onset. In this context it is vital that we continue to extend our understanding of which treatments work best. I believe that this NIHR Programme Grant has made a significant contribution to our knowledge base, and I would like to thank all the service users, clinicians and researchers who participated.”