Cognitive-behaviour therapy for medication-resistant positive symptoms in early psychosis: a case series.
BACKGROUND
Cognitive-behaviour therapy (CBT) for psychosis reduces the severity of medication-resistant positive symptoms in chronic schizophrenia, but its efficacy for early psychosis outpatients with a similar profile has not been established.


OBJECTIVE
This paper describes an uncontrolled evaluation of CBT, added to medication and comprehensive care in an early psychosis program, in a group of stable outpatients.


METHODS
The sample was drawn from 24 consecutive referrals. Fourteen were eligible, i.e. had positive symptom(s) and had been on the same medication regime for 3 months.


METHODS
Patients received an average of 16 individual sessions with a senior psychologist.


METHODS
Symptom severity was assessed both by an independent rater, and by patient self-report.


RESULTS
Eleven of 14 patients completed treatment. Both clinician and self-report post-treatment ratings of positive symptoms were significantly reduced following CBT. For positive symptom totals, effect sizes ranged from d = 1.0 to 1.3. Clinically significant changes were apparent in at least eight of 11 patients.


CONCLUSIONS
While case-series studies have significant limitations, the large effect sizes described here suggest that CBT shows promise for effectiveness with early psychosis patients. A randomized trial is needed to establish both the effect size over and above a control condition, and the durability of gains of CBT for medication-resistant symptoms in early psychosis.
Erickson
David H
DH
Fraser North Early Psychosis Program, New Westminster, British Columbia, Canada. David.Erickson@FraserHealth.ca
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011618:Psychotic Disorders / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D014150:Antipsychotic Agents