Treatment Approaches for Early Psychosis

Study Objective

Researchers aimed to assess the effectiveness of antipsychotic drugs, cognitive behavioural therapy (CBT), and a combination of both in treating early psychosis. Individuals experiencing psychosis may qualify for diagnoses such as schizophrenia, schizoaffective disorder, or delusional disorder. Symptoms associated with schizophrenia include feelings of persecution, delusions, and hallucinations, which can also be observed in the other disorders.

Background and Previous Findings

Prior clinical trials have indicated that antipsychotic medications and CBT can be beneficial for treating these disorders. However, the effectiveness of each intervention can vary significantly among individuals. Meta-analyses have generally supported the advantages of both antipsychotic drugs and CBT, though concerns remain regarding the potential side effects of antipsychotic medications, including an increased risk of cardiovascular-related deaths. Currently, the adverse effects associated with CBT remain unclear.

Details of the Recent Study

A recent study published in The Lancet Psychiatry by Morrison and colleagues sought to further investigate the efficacy of CBT and antipsychotic drug therapies, both individually and in combination. This UK-based study was a single-blind, controlled, and randomized pilot trial involving participants aged 16 and older who met the ICD-10 criteria for schizophrenia, schizoaffective disorder, or delusional disorder, among other criteria.

Of the 75 participants, 26 received only CBT, 24 were treated with antipsychotic drugs, and 25 received both interventions. Most participants were treated early during their first onset of symptoms, while two had previously received a diagnosis.

Findings on Adverse Effects

The researchers utilized the Positive and Negative Syndrome Scale (PANSS) to evaluate treatment effectiveness. All treatment groups exhibited a reduction in adverse symptoms, with the combined treatment group demonstrating significant improvements compared to those receiving only CBT. However, no notable differences were found between the CBT group and those receiving antipsychotic drugs.

During the 12-month observation period, the combined treatment group showed the most improvement at the six-month mark, with 25% to 50% improvement, but this difference diminished by the 12-month evaluation. Additionally, the CBT group had fewer adverse effects compared to the antipsychotic and combined treatment groups, and adverse events were statistically similar between the combined and antipsychotic groups.

Limitations of the Pilot Trial

Despite the notable efficacy of combining therapies over CBT alone, the study’s pilot and feasibility nature limits its ability to draw definitive conclusions regarding the statistical differences between treatment groups. The reduced adverse effects in the CBT group could be attributed to non-specific symptoms or other underlying conditions. Some participants were hospitalized, and the reporting of adverse events may have been biased based on treatment group exposure.

The small sample size may have influenced the results, and some participants eventually received alternative treatments. Instances of non-compliance with prescribed therapies were also noted, and potential data gaps exist concerning the use of other medications.

Conclusion on Treatment Benefits

In summary, all treatment modalities demonstrated benefits in managing early psychosis. It is crucial to recognize that this study focused on patients eligible for early intervention services rather than those with advanced schizophrenia. The researchers advocate for further efficacy and effectiveness trials to clarify the differences observed among treatment groups, emphasizing that patient treatment decisions should adhere to national guidelines and incorporate informed consent from patients.

Written by Olajumoke Marissa Ologundudu B.Sc. (Hons)
Reference: Morrison, A. P. et al. Antipsychotic drugs versus cognitive behavioural therapy versus a combination of both in people with psychosis: a randomised controlled pilot and feasibility study. The Lancet Psychiatry (2018). doi:10.1016/S2215-0366(18)30096-8