Fowler D, Hodgekins J, Painter M, Reilly T, Crane C, Macmillan I, Mugford M, Croudace T, Jones P B
University of East Anglia, Norwich, UK.
Psychol Med. 2009 Oct;39(10):1627-36. doi: 10.1017/S0033291709005467. Epub 2009 Apr 1.
This study reports on a preliminary evaluation of a cognitive behavioural intervention to improve social recovery among young people in the early stages of psychosis showing persistent signs of poor social functioning and unemployment. The study was a single-blind randomized controlled trial (RCT) with two arms, 35 participants receiving cognitive behaviour therapy (CBT) plus treatment as usual (TAU), and 42 participants receiving TAU alone. Participants were assessed at baseline and post-treatment.
Seventy-seven participants were recruited from secondary mental health teams after presenting with a history of unemployment and poor social outcome. The cognitive behavioural intervention was delivered over a 9-month period with a mean of 12 sessions. The primary outcomes were weekly hours spent in constructive economic and structured activity. A range of secondary and tertiary outcomes were also assessed.
Intention-to-treat analysis on the combined affective and non-affective psychosis sample showed no significant impact of treatment on primary or secondary outcomes. However, analysis of interactions by diagnostic subgroup was significant for secondary symptomatic outcomes on the Positive and Negative Syndrome Scale (PANSS) [F(1, 69)=3.99, p=0.05]. Subsequent exploratory analyses within diagnostic subgroups revealed clinically important and significant improvements in weekly hours in constructive and structured activity and PANSS scores among people with non-affective psychosis.
The primary study comparison provided no clear evidence for the benefit of CBT in a combined sample of patients. However, planned analyses with diagnostic subgroups showed important benefits for CBT among people with non-affective psychosis who have social recovery problems. These promising results need to be independently replicated in a larger, multi-centre RCT.
本研究报告了一项认知行为干预的初步评估，该干预旨在改善处于精神病早期阶段的年轻人的社会康复情况，这些年轻人表现出持续的社交功能不佳和失业迹象。该研究是一项单盲随机对照试验（RCT），分为两组，35名参与者接受认知行为疗法（CBT）加常规治疗（TAU），42名参与者仅接受TAU。在基线和治疗后对参与者进行评估。
从二级心理健康团队招募了77名有失业史和不良社会结局的参与者。认知行为干预在9个月内进行，平均进行12次治疗。主要结局是每周花在建设性经济活动和结构化活动上的小时数。还评估了一系列次要和三级结局。
对情感性和非情感性精神病合并样本的意向性分析表明，治疗对主要或次要结局没有显著影响。然而，按诊断亚组进行的交互作用分析在阳性和阴性症状量表（PANSS）的次要症状结局方面具有显著性[F(1, 69)=3.99, p=0.05]。随后在诊断亚组内进行的探索性分析显示，非情感性精神病患者在建设性和结构化活动中的每周小时数以及PANSS评分有临床上重要且显著的改善。
主要研究比较未提供明确证据表明CBT对合并样本患者有益。然而，按诊断亚组进行的计划分析表明，CBT对有社会康复问题的非情感性精神病患者有重要益处。这些有前景的结果需要在更大规模的多中心RCT中独立重复验证。
