Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany.
Department of Childhood and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany.
Eur Child Adolesc Psychiatry. 2020 Jul;29(7):1011-1022. doi: 10.1007/s00787-019-01415-4. Epub 2019 Oct 10.
Cognitive behavioral therapy for psychosis (CBT) is an effective treatment in adult patients with schizophrenia. However, no randomized controlled and blinded trial in adolescents with early-onset psychosis (EOP) has been conducted. Therefore, the present pilot study explores the acceptance, tolerability, feasibility, and safety of a modified CBT in adolescents with EOP. Twenty-five adolescents with EOP were randomized to either 9 months (20 sessions) of CBT + treatment as usual (TAU) or TAU alone. The primary endpoint was the PANSS-positive subscale (P1-7). Secondary endpoints included psychopathology, global functioning, and quality of life (QoL). Acceptance, tolerability, feasibility, and safety were assessed. Blinded assessments took place by the end of the treatment (9 months) and at 24-month follow-up. Despite improvements in both groups and lack of statistical significance between CBT + TAU and TAU regarding the primary endpoint, we observed between-group effect sizes of at least d = 0.39 in favor of CBT + TAU at post-treatment for delusions, negative symptoms, functioning and QoL after the intervention and effect sizes of at least d = 0.35 after 24 months. CBT in EOP was highly acceptable (73.5% agreed to randomization), well-tolerated (83.1% attendance rate, no drop-outs), and safe (one serious adverse event (SAE) in CBT + TAU in comparison with six SAEs in TAU). These findings suggest that CBT adapted to the needs of adolescents with EOP is a promising approach regarding negative symptoms, functioning, and QoL. CBT is a safe and tolerable treatment. However, due to the small sample size and the pilot character of the study, these conclusions are limited, and should be tested in a larger, adequately powered randomized controlled trial.
认知行为疗法（CBT）是治疗成人精神分裂症的有效方法。然而，目前还没有在青少年首发精神病（EOP）患者中进行的随机对照双盲试验。因此，本先导研究旨在探索改良 CBT 在青少年 EOP 中的接受度、耐受性、可行性和安全性。25 名 EOP 青少年被随机分为 CBT+常规治疗（TAU）组或 TAU 组，治疗期为 9 个月（20 次）。主要终点为阳性症状量表（P1-7）阳性亚量表。次要终点包括精神病理学、整体功能和生活质量（QoL）。评估了接受度、耐受性、可行性和安全性。盲法评估在治疗结束（9 个月）和 24 个月随访时进行。尽管两组均有改善，且 CBT+TAU 组与 TAU 组在主要终点上无统计学意义，但我们观察到治疗后 CBT+TAU 组在妄想、阴性症状、功能和 QoL 方面的组间效应大小至少为 d=0.39，干预后 24 个月的效应大小至少为 d=0.35。EOP 中的 CBT 具有较高的接受度（73.5%同意随机分组）、良好的耐受性（83.1%的出席率，无脱落）和安全性（CBT+TAU 组发生 1 例严重不良事件（SAE），TAU 组发生 6 例 SAE）。这些发现表明，针对青少年 EOP 需求进行调整的 CBT 可能是一种治疗阴性症状、功能和 QoL 的有前途的方法。CBT 是一种安全且可耐受的治疗方法。然而，由于样本量小且研究为先导性质，这些结论具有一定局限性，应在更大的、充分有力的随机对照试验中进行验证。
