Tayside-Fife clinical trial of cognitive-behavioural therapy for medication-resistant psychotic symptoms. Results to 3-month follow-up.
BACKGROUND
Evidence for the efficacy of cognitive-behavioural therapy for schizophrenia is promising but evidence for clinical effectiveness is limited.


OBJECTIVE
To test the effectiveness of cognitive-behavioural therapy delivered by clinical nurse specialists in routine practice.


METHODS
Of 274 referrals, 66 were allocated randomly to 9 months of treatment as usual (TAU), cognitive-behavioural therapy plus TAU (CBT) or supportive psychotherapy plus TAU (SPT) and followed up for 3 months.


RESULTS
Treatment effects were modest but the CBT condition gave significantly greater improvement in overall symptom severity than the SPT or TAU conditions combined (F (1,53)=4.14; P=0.05). Both the CBT and SPT conditions combined gave significantly greater improvement in severity of delusions than did the TAU condition (F (1,53)=4.83; P=0.03). Clinically significant improvements were achieved by 7/21 in the CBT condition (33%), 3/19 in the SPT condition (16%) and 2/17 in the TAU condition (12%).


CONCLUSIONS
Cognitive-behavioural therapy delivered by clinical nurse specialists is a helpful adjunct to routine care for some people with chronic psychosis.
Durham
Robert C
RC
Department of Psychiatry, University of Dundee, Scotland, UK. r.c.durham@dundee.ac.uk
Guthrie
Moyra
M
Morton
R Victor
RV
Reid
David A
DA
Treliving
Linda R
LR
Fowler
David
D
Macdonald
Ranald R
RR
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001294:Attitude to Health; D002746:Chlorpromazine / Q000627:therapeutic use; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009732:Nursing Care / Q000379:methods; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods; D011618:Psychotic Disorders / Q000188:drug therapy / Q000628:therapy*; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy; D012563:Schizophrenia, Paranoid / Q000188:drug therapy / Q000628:therapy; D012720:Severity of Illness Index
D014150:Antipsychotic Agents; D002746:Chlorpromazine