Steuwe Carolin, Carvalho Fernando Silvia, Runte Ingo, Bender Stefan, Heiler Wolfgang, Klein Fabian, Kronmüller Klaus, Volmert Kathrin, Norra Christine, Engelbrecht Stefan, Driessen Martin
Department of Psychiatry and Psychotherapy, Ev. Klinikum Bethel, Universität Bielefeld, Bielefeld, Germany.
Department of Psychiatry and Psychotherapy, LWL-Klinikum Marsberg, Marsberg, Germany.
Schizophr Bull. 2025 May 8;51(3):742-753. doi: 10.1093/schbul/sbae080.
Non-affective psychoses (NAP) are associated with severe consequences with regard to social functioning, physical health, employment, and suicidality. Treatment guidelines recommend cognitive behavioral therapy for psychosis (CBTp) as an effective additional treatment strategy to psychopharmacology. We hypothesized that outpatient CBTp has an add-on effect in individuals with NAP who already receive comprehensive outpatient care (COC) in Germany.
In a randomized-controlled effectiveness trial, 6 months of COC + CBTp were compared to COC. The primary outcomes were change of symptom severity as assessed by the Positive and Negative Symptom Scale (pre-/post-treatment and 6-month follow-up). Mixed linear models and effect sizes were used to compare changes across treatment groups. Additionally, the number of readmissions was compared.
N = 130 individuals with chronic NAP were recruited (COC + CBTp: n = 64, COC: n = 66). COC + CBTp participants significantly improved more regarding positive symptom severity (estimated mean difference at follow-up: -2.33, 95% CI: -4.04 to -0.61, P = .0083, d = 0.32) and general psychopathology (estimated mean difference at follow-up: -4.55, 95% CI: -7.30 to -1.81, P = .0013, d = 0.44) than the COC group. In both groups, negative symptom severity did not change significantly over time nor did groups differ regarding readmissions.
The results underline an add-on benefit of CBTp in chronically ill individuals with NAP. Superiority of CBTp was demonstrated in comparison with high-quality comprehensive care and may also be true in different comprehensive care settings.
DRKS00015627.
非情感性精神病（NAP）在社会功能、身体健康、就业及自杀倾向方面会产生严重后果。治疗指南推荐将精神病认知行为疗法（CBTp）作为精神药理学的一种有效的辅助治疗策略。我们假设，在德国已接受全面门诊护理（COC）的NAP患者中，门诊CBTp具有附加效应。
在一项随机对照有效性试验中，将6个月的COC + CBTp与COC进行比较。主要结局指标为采用阳性和阴性症状量表评估的症状严重程度变化（治疗前/后及6个月随访）。使用混合线性模型和效应量来比较各治疗组间的变化。此外，还比较了再入院次数。
招募了130例慢性NAP患者（COC + CBTp组：n = 64，COC组：n = 66）。COC + CBTp组患者在阳性症状严重程度（随访时估计平均差异：-2.33，95%CI：-4.04至-0.61，P = 0.0083，d = 0.32）和总体精神病理学（随访时估计平均差异：-4.55，95%CI：-7.30至-1.81，P = 0.0013，d = 0.44）方面的改善显著优于COC组。在两组中，阴性症状严重程度随时间均无显著变化，且两组在再入院次数方面也无差异。
结果强调了CBTp对慢性NAP患者的附加益处。与高质量的全面护理相比，CBTp显示出优越性，在不同的全面护理环境中可能也是如此。
DRKS00015627
