title: Brief culturally adapted CBT for psychosis (CaCBTp): A randomized controlled trial from a low income country.
abstract: Evidence for the effectiveness of Culturally adapted CBT for psychosis in Low And Middle Income Countries (LAMIC) is limited. Therefore, brief Culturally adapted CBT for psychosis (CaCBTp) targeted at symptoms of schizophrenia for outpatients plus treatment as usual (TAU) is compared with TAU. A total of 116 participants with schizophrenia were recruited from 2 hospitals in Karachi, Pakistan, and randomized into two groups with 1:1 allocation (CaCBTp plus TAU=59, TAU=57). A brief version of CaCBTp (6 individual sessions with the involvement of main carer, plus one session for the family) was provided over 4months. Psychopathology was measured using Positive and Negative Syndrome Scale of Schizophrenia (PANSS), Psychotic Symptom Rating Scales (PSYRATS), and the Schedule for Assessment of Insight (SAI) at baseline and end of therapy. Participants in treatment group, showed statistically significant improvement in all measures of psychopathology at the end of the study compared with control group. Participants in treatment group showed statistically significant improvement in Positive Symptoms (PANSS, Positive Symptoms Subscale; p=0.000), Negative Symptoms (PANSS, Negative Symptoms subscales; p=0.000), Delusions (PSYRATS, Delusions Subscale; p=0.000), Hallucinations (PSYRATS, Hallucination Subscale; p=0.000) and Insight (SAI; p=0.007). The results suggest that brief, Culturally adapted CBT for psychosis can be an effective treatment when provided in combination with TAU, for patients with schizophrenia in a LAMIC setting. This is the first trial of CBT for psychosis from outside the western world. These findings need replicating in other low and middle income countries.
authors.affiliation: Department of Psychiatry, Queens University, Kingston, Canada. Electronic address: farooqnaeem@yahoo.com.
authors.forename: Farooq
authors.initials: F
authors.lastname: Naeem
authors.affiliation: Pakistan Association of Cognitive Therapists, Karachi, Pakistan.
authors.forename: Sofiya
authors.initials: S
authors.lastname: Saeed
authors.affiliation: Department of Psychiatry and Behavioural Sciences, Peshawar Medical College, Peshawar, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Irfan
authors.affiliation: Pakistan Institute of Living and Learning, Karachi, Pakistan.
authors.forename: Tayyeba
authors.initials: T
authors.lastname: Kiran
authors.affiliation: Pakistan Institute of Living and Learning, Karachi, Pakistan.
authors.forename: Nasir
authors.initials: N
authors.lastname: Mehmood
authors.affiliation: Sir Ganga Ram Hospital, Lahore, Pakistan.
authors.forename: Mirrat
authors.initials: M
authors.lastname: Gul
authors.affiliation: Department of Psychiatry, Queens University, Kingston, Canada.
authors.forename: Tariq
authors.initials: T
authors.lastname: Munshi
authors.affiliation: Department of Psychiatry, Abbasi Shaheed Hospital, Karachi, Pakistan.
authors.forename: Sohail
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Department of Psychiatry, Karwan e Hayat Hospital, Karachi, Pakistan.
authors.forename: Ajmal
authors.initials: A
authors.lastname: Kazmi
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Nusrat
authors.initials: N
authors.lastname: Husain
authors.affiliation: Department of Psychiatry, PGMI Lady Reading Hospital Peshawar, Pakistan; Staffordshire University, UK.
authors.forename: Saeed
authors.initials: S
authors.lastname: Farooq
authors.affiliation: Department of Psychiatry, Queens University, Kingston, Canada.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ayub
authors.affiliation: Mental Health Care Delivery, University of Southampton, UK; Southern Health NHS Trust, UK.
authors.forename: David
authors.initials: D
authors.lastname: Kingdon
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D065246:Culturally Competent Care; D003702:Delusions / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D006212:Hallucinations / Q000209:etiology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011203:Poverty / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: Insight; Positive and negative symptoms; Psychopathology; Schizophrenia