Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms.
BACKGROUND
The application of cognitive therapy (CT) to psychosis is currently being developed in the UK. This paper reports a trial of CT in acute psychosis with the objective of hastening the resolution of positive symptoms and reducing residual symptoms.


METHODS
Of 117 patients with acute non-affective psychosis, 69 satisfied inclusion criteria and 40 proceeded to stratified randomisation. The experimental intervention involving individual and group CT was compared with a group receiving matched hours of therapist input providing structured activities and informal support; routine pharmacotherapy was provided by clinicians blind to group allocation. Patients were monitored weekly using self-report and mental state assessments during admission and over the subsequent nine months.


RESULTS
Both groups showed a decline in positive symptoms but this was more marked in the CT group (P < 0.001). At 9 months 5% of the CT group, v.56% of the control group, showed moderate or severe residual symptoms.


CONCLUSIONS
CT appears to be a potent adjunct to pharmacotherapy and standard care for acute psychosis. Issues concerning internal and external validity of the study and opportunities for further research are discussed.
Drury
V
V
Archer Centre, All Saints Hospital, Birmingham.
Birchwood
M
M
Cochrane
R
R
Macmillan
F
F
D000208:Acute Disease; D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D015203:Reproducibility of Results; D016896:Treatment Outcome