Gumley Andrew, White Ross, Briggs Andy, Ford Ian, Barry Sarah, Stewart Corinna, Beedie Sara, McTaggart Jacqueline, Clarke Caoimhe, MacLeod Rachel, Lidstone Emma, Riveros Bruno Salgado, Young Robin, McLeod Hamish
Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, United Kingdom.
Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, United Kingdom; Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
Schizophr Res. 2017 May;183:143-150. doi: 10.1016/j.schres.2016.11.026. Epub 2016 Nov 25.
Depression is one of the major contributors to poorer quality of life amongst individuals with psychosis and schizophrenia. The study was designed as a Pilot Trial to determine the parameters of a larger, definitive pragmatic multi-centre randomised controlled trial of Acceptance and Commitment Therapy for depression after psychosis (ACTdp) for individuals with a diagnosis of schizophrenia who also meet diagnostic criteria for major depression.
Participants were required to meet criteria for schizophrenia and major depression. Blinded follow-ups were undertaken at 5-months (end of treatment) and at 10-months (5-months posttreatment). Primary outcomes were depression as measured by the Calgary Depression Scale for Schizophrenia (CDSS) and the Beck Depression Inventory (BDI).
A total of 29 participants were randomised to ACTdp + Standard Care (SC) (n=15) or SC alone (n=14). We did not observe significant differences between groups on the CDSS total score at 5-months (Coeff=-1.43, 95%CI -5.17, 2.32, p=0.45) or at 10-months (Coeff=1.8, 95%CI -2.10, 5.69, p=0.36). In terms of BDI, we noted a statistically significant effect in favour of ACTdp+SC at 5-months (Coeff=-8.38, 95%CI -15.49, -1.27, p=0.02) but not at 10-months (Coeff=-4.85, 95%CI -12.10, 2.39, p=0.18). We also observed significant effects on psychological flexibility at 5-months (Coeff=-8.83, 95%CI -14.94, -2.71, p<0.01) but not 10-months (Coeff=-4.92, 95%CI -11.09, 1.25, p=0.11).
In this first RCT of a psychological therapy with depression as the primary outcome, ACT is a promising intervention for depression in the context of psychosis. A further large-scale definitive randomised controlled trial is required to determine effectiveness.
ISRCTN: 33306437.
抑郁症是导致精神病和精神分裂症患者生活质量下降的主要因素之一。本研究设计为一项先导试验，旨在确定一项更大规模、权威性的实用性多中心随机对照试验的参数，该试验针对同时符合重度抑郁症诊断标准的精神分裂症患者，采用接纳与承诺疗法治疗精神病后抑郁症（ACTdp）。
参与者需符合精神分裂症和重度抑郁症的标准。在5个月（治疗结束时）和10个月（治疗后5个月）进行盲法随访。主要结局指标为用卡尔加里精神分裂症抑郁量表（CDSS）和贝克抑郁量表（BDI）测量的抑郁程度。
共有29名参与者被随机分为ACTdp+标准护理（SC）组（n=15）或单纯SC组（n=14）。我们未观察到两组在5个月时（系数=-1.43，95%CI -5.17，2.32，p=0.45）或10个月时（系数=1.8，95%CI -2.10，5.69，p=0.36）的CDSS总分存在显著差异。就BDI而言，我们注意到在5个月时有利于ACTdp+SC组有统计学显著效应（系数=-8.38，95%CI -15.49，-1.27，p=0.02），但在10个月时没有（系数=-4.85，95%CI -12.10，2.39，p=0.18）。我们还观察到在5个月时对心理灵活性有显著效应（系数=-8.83，95%CI -14.94，-2.71，p<0.01），但在10个月时没有（系数=-4.92，95%CI -11.09，1.25，p=0.11）。
在这项以抑郁症为主要结局指标的心理治疗的首次随机对照试验中，ACT是治疗精神病患者抑郁症的一种有前景的干预措施。需要进一步开展大规模权威性随机对照试验来确定其有效性。
ISRCTN：33306437。
