North East London NHS Foundation Trust, Acute and Rehabilitation Directorate, Goodmayes Hospital, Barley Lane, Ilford, Essex IG3 8XJ, United Kingdom of Great Britain and Northern Ireland; University College London, Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland.
North East London NHS Foundation Trust, Acute and Rehabilitation Directorate, Goodmayes Hospital, Barley Lane, Ilford, Essex IG3 8XJ, United Kingdom of Great Britain and Northern Ireland.
Schizophr Res. 2020 Aug;222:133-144. doi: 10.1016/j.schres.2020.03.041. Epub 2020 Jun 22.
Psychological interventions such as Cognitive Behavioural Therapy for psychosis (CBTp) are recommended by the National Institute of Health and Care Excellence (NICE) for delivery in the acute phase of people's mental health difficulties. However, the effectiveness of cognitive behavioural informed psychological therapies for psychiatric inpatients is unknown. The aim of this review is to examine the type, quality and efficacy of cognitive behavioural informed psychological interventions for psychiatric inpatients experiencing psychosis. A systematic review and meta-analysis was conducted of randomised controlled trials examining the efficacy of cognitive behavioural informed psychological interventions offered to acute psychiatric inpatients with psychosis on primary (positive symptoms) and secondary outcomes of interest. A total of 23 studies were identified reporting on 18 trials of interventions such as CBTp, Acceptance and Commitment Therapy (ACT) and Metacognitive Therapy (MCT). Cognitive behavioural informed psychological interventions were found not be effective in reducing positive symptoms (primary outcome) at post-therapy and at follow-up but when a one study removed analysis was conducted a positive effect was found at both time points. In regard to secondary outcomes, cognitive behavioural informed psychological interventions demonstrated a significant favourable effect on negative symptoms (post-therapy), total symptoms (post-therapy and follow-up), functioning (post-therapy and follow-up) and readmission (follow-up). These psychological interventions may have potential to be effective for those admitted to psychiatric inpatient care and in acute crisis. However, findings are equivocal with evidence that these interventions have effect on some symptom measures but not others. Further examination of inpatient adapted cognitive behavioural informed psychological interventions is required.
心理干预，如针对精神病的认知行为疗法（CBTp），被英国国家卫生与保健优化研究所（NICE）推荐在精神健康困难患者的急性期提供。然而，针对精神病住院患者的认知行为导向心理治疗的有效性尚不清楚。本综述旨在考察针对精神病住院患者的精神病体验认知行为导向心理干预的类型、质量和疗效。对急性精神病住院患者接受认知行为导向心理干预的随机对照试验进行了系统评价和荟萃分析，以评估主要（阳性症状）和次要疗效指标。共确定了 23 项研究，其中 18 项试验报告了 CBTp、接受与承诺疗法（ACT）和元认知疗法（MCT）等干预措施。认知行为导向心理干预并未在治疗后和随访时减少阳性症状（主要结局），但在去除一项研究后进行分析时，在这两个时间点都发现了积极效果。关于次要结局，认知行为导向心理干预对阴性症状（治疗后）、总症状（治疗后和随访）、功能（治疗后和随访）和再入院（随访）有显著的有利影响。这些心理干预措施可能对那些被收入精神病住院治疗和急性危机的患者有效。然而，结果存在争议，有证据表明这些干预措施对某些症状测量有效果，而对其他症状测量则没有效果。需要进一步研究适合住院患者的认知行为导向心理干预措施。
