Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review and meta-analysis

Lutgens, Danyael; Gariépy, Geneviève; Malla, Ashok

doi:10.1192/bjp.bp.116.197103

Cited by 130 publications

(134 citation statements)

References 120 publications

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“…The impact of problems of occupation and activities requires further investigation. Given the outcomes for occupational therapy with people with psychosis (Lutgens, Gariepy, & Malla, ), and the NICE guideline () recommending that vocational/occupational support be provided routinely, this intervention might have the additional benefit of improving engagement if offered prior to CBT.…”

Section: Discussionmentioning

confidence: 99%

Predictors of disengagement from cognitive behavioural therapy for psychosis in a National Health Service setting: A retrospective evaluation

Richardson

Dasyam

Courtney

et al. 2019

British J Clinic Psychol

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Objectives. To evaluate whether demographic and clinical variables are related to disengagement rates in cognitive behavioural therapy (CBT) for psychosis in a clinical setting.Methods. The medical records and symptom severity data (from Health of the Nation Outcome Scales) were analysed retrospectively for 103 referrals for CBT for psychosis in a National Health Service secondary care and Early Intervention in Psychosis team.Results. Overall, 42.7% (n = 44) disengaged from CBT. There was no impact of gender or ethnicity, and no impact of clinical variables such as risk history and comorbid diagnosis. However, risk of disengagement was significantly higher for those who were younger, F = 6.89, partial g 2 = .064, p = <.05; those with greater total HoNOS scores, F = 4.22, partial g 2 = .04, p < .05; more severe symptoms on the HoNOS items of overactive, aggressive, disruptive, or agitated behaviour, v 2 = 6.13, p < .01; problem drinking or drug taking, v 2 = 7.65, p < .05; depressed mood, v 2 = 7.0, p < .01; and problems with occupation and activities: v 2 = 3.68, p < .05. There was a non-significant trend for shorter waiting times to be associated with greater levels of disengagement. Conclusions.These results indicate that it may not be psychosis per se that disrupts engagement in CBT, but linked behavioural and emotional factors. A more assertive approach to these factorsoveractive, aggressive, disruptive, or agitated behaviour, problem drinking or drug taking, depressed mood, and problems with occupation and activities, particularly in younger peoplemay be valuable prior to or early on in therapy as a means of increasing engagement in CBT for psychosis. Practitioner PointsRisk of disengagement from CBT for psychosis increases with overactive, aggressive, disruptive, or agitated behaviour (54.9% vs. 30.8%), problem drinking and drug taking (61.1% vs. 32.8%), depressed mood (56% vs. 30.2%), and problems with occupation and activities (53.3% vs. 34.5%), with a trend for younger age.An assertive and motivational approach to engagement and a focus on addressing low mood and problematic behaviours, prior to or early in therapy, may be warranted, particularly for younger people. This evaluation is limited by small sample size and being retrospective. These results speak to the question of whether psychosis itself renders people inappropriate for CBT for psychosis, or whether problems arise due to behavioural and emotional factors that might be addressed to increase access to CBT for psychosis. Disengagement in psychosis 441

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Section: Discussionmentioning

confidence: 99%

Predictors of disengagement from cognitive behavioural therapy for psychosis in a National Health Service setting: A retrospective evaluation

Richardson

Dasyam

Courtney

et al. 2019

British J Clinic Psychol

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Section: Epigenetic Perspective To An Integrated and Personalized Trementioning

confidence: 99%

“…Despite proof of effectiveness of psychotherapy alone or in combination with medication, the benefit of psychological or psychosocial interventions in treatment of severe psychiatric disorders appears sometimes underestimated and underused. 92 Undoubtedly, the ideal intervention would be to either prevent early trauma and/or to mitigate its long-term impact, as evidenced in rodents by the seminal work of Meaney. 93 Knowing that critical developmental windows are decisive for potentially long-lasting deleterious epigenetic effect, child psychiatry appears of high relevance to correct epigenetic insults in situ.…”

Section: Personalized Biopsychosocial Approach: a Model Of Enriched Ementioning

confidence: 99%

Epigenetics applied to psychiatry: Clinical opportunities and future challenges

Kular

2018

Psychiatry Clin Neurosci

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Psychiatric disorders are clinically heterogeneous and debilitating chronic diseases resulting from a complex interplay between gene variants and environmental factors. Epigenetic processes, such as DNA methylation and histone posttranslational modifications, instruct the cell/tissue to correctly interpret external signals and adjust its functions accordingly. Given that epigenetic modifications are sensitive to environment, stable, and reversible, epigenetic studies in psychiatry could represent a promising approach to better understanding and treating disease. In the present review, we aim to discuss the clinical opportunities and challenges arising from the epigenetic research in psychiatry. Using selected examples, we first recapitulate key findings supporting the role of adverse life events, alone or in combination with genetic risk, in epigenetic programming of neuropsychiatric systems. Epigenetic studies further report encouraging findings about the use of methylation changes as diagnostic markers of disease phenotype and predictive tools of progression and response to treatment. Then we discuss the potential of using targeted epigenetic pharmacotherapy, combined with psychosocial interventions, for future personalized medicine for patients. Finally, we review the methodological limitations that could hinder interpretation of epigenetic data in psychiatry. They mainly arise from heterogeneity at the individual and tissue level and require future strategies in order to reinforce the biological relevance of epigenetic data and its translational use in psychiatry. Overall, we suggest that epigenetics could provide new insights into a more comprehensive interpretation of mental illness and might eventually improve the nosology, treatment, and prevention of psychiatric disorders.

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“…Antipsychotics are effective in reducing the psychotic symptoms associated with schizophrenia, such as delusions and hallucinations, but have more limited effect on so‐called negative symptoms . Negative symptoms can be conceptualised as the absence or reduction in normal affective, behavioural and social functioning, and are one of the biggest predictors of quality of life for people with schizophrenia and social recovery . Whilst psychotic symptoms generally recede in older age, negative symptoms persist and older people are more likely to report problems with social functioning compared to both younger people with the condition and same age‐peers without the diagnosis, including those with other types of mental health problems …”

Section: Introductionmentioning

confidence: 99%

A systematic review of the effects of psychosocial interventions on social functioning for middle‐aged and older‐aged adults with severe mental illness

Smart

Brown

Palmier‐Claus

et al. 2020

Int J Geriat Psychiatry

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Objectives The number of older adults with severe mental health problems such as schizophrenia is likely to double in the next 20 years. The needs of this patient group change across the life course, but difficulties with social functioning persist into older age. Poorer social functioning is associated with poorer outcomes and has been identified as a priority for intervention by patients themselves. This paper systematically reviews studies examining the effectiveness of psychosocial interventions on social functioning for people with severe mental health problems in later life. Methods A systematic review of peer‐reviewed journal articles was conducted and databases were searched from inception to December 2017. The review was limited to psychosocial interventions, for mid to older aged adults (≥40 years of age) with severe mental illness that included a validated measure of social functioning. Results Fifteen studies (17 papers) met inclusion criteria. There was evidence to support skills training interventions that primarily focused on social skills training or integrated mental and physical health interventions. There was not sufficient evidence to recommend any other interventions. Conclusions The results highlight the limited nature of interventions designed specifically for older people with severe mental health problems that target social functioning and the need for more robust, large‐scale studies in the area. Current evidence suggests that cognitive behaviour therapy can be effective in targeting social functioning in younger age groups, but, as yet, there is insufficient evidence to recommend this intervention for an older population.

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Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review and meta-analysis

Cited by 130 publications

References 120 publications

Predictors of disengagement from cognitive behavioural therapy for psychosis in a National Health Service setting: A retrospective evaluation

Predictors of disengagement from cognitive behavioural therapy for psychosis in a National Health Service setting: A retrospective evaluation

Epigenetics applied to psychiatry: Clinical opportunities and future challenges

A systematic review of the effects of psychosocial interventions on social functioning for middle‐aged and older‐aged adults with severe mental illness

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