Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada.
Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
BMC Psychiatry. 2024 Oct 14;24(1):684. doi: 10.1186/s12888-024-06050-1.
Several adversity-focused treatment trials have reported improvements to adversity sequelae (e.g., PTSD symptoms) and decreases in psychotic symptoms among individuals with psychotic disorders. Yet, no trials have examined the impact of adversity-focused treatment on substance use or examined the outcomes among an early phase psychosis population. These gaps in both the research literature and clinical practice have resulted in less knowledge about the outcomes of adversity-focused treatment at this stage of illness, including the impact on substance use.
The outcomes of an adapted prolonged exposure protocol (PE+) among an early phase psychosis population were examined using a multiple-baseline design. Nineteen adults with a psychotic disorder, current substance misuse, and a history of adversity were recruited from an early psychosis program. Participants were randomized to treatment start time and participated in a 15-session course of PE + therapy. Ten assessments were completed focusing on primary outcomes (i.e., adversity sequelae, negative psychotic symptoms, substance misuse) and secondary outcomes (i.e., functioning, hopelessness, experiential avoidance). The Reliable Change Index (RCI) was used to establish whether there were clinically significant changes to primary or secondary outcomes.
Half or more of treatment completers experienced clinically significant changes to most domains of adversity sequelae, no participants experienced improvements in negative psychotic symptoms, and substance misuse increased for several participants. In terms of secondary outcomes, functioning and experiential avoidance were improved for a number of participants, while hopelessness decreased for only one participant. Participants reported high satisfaction with the PE + treatment, and exposure and coping skills were rated as the most helpful elements of treatment.
Reductions in adversity sequelae were observed following PE + treatment, suggesting that adversity-focused treatment may be beneficial for an early psychosis population. Yet, few positive changes to psychotic symptoms or substance use were observed. Further integrating treatment strategies for psychosis and substance use into PE + may be required to effectively treat the links between psychosis, adversity sequelae, and substance use. Future studies should make efforts to integrate substance use strategies into adversity treatment trials for people with psychotic disorders.
Clinicaltrials.gov, NCT04546178; registration posted 11/09/2020, https://clinicaltrials.gov/ct2/show/NCT04546178?term=NCT04546178&draw=2&rank=1 .
几项以逆境为重点的治疗试验报告称，在患有精神障碍的个体中，逆境后遗症（例如创伤后应激障碍症状）得到改善，精神病症状减少。然而，没有试验研究过以逆境为重点的治疗对物质使用的影响，也没有研究过早期精神病患者人群的结果。这些在研究文献和临床实践中的差距导致人们对该疾病阶段以逆境为重点的治疗结果了解较少，包括对物质使用的影响。
采用多基线设计，检查早期精神病患者人群中适应性延长暴露方案（PE+）的结果。从早期精神病计划中招募了 19 名患有精神障碍、当前物质滥用和逆境史的成年人。参与者随机分配到治疗开始时间，并参加了 15 节 PE+治疗课程。完成了 10 次评估，重点关注主要结果（即逆境后遗症、负性精神病症状、物质滥用）和次要结果（即功能、绝望、体验回避）。使用可靠变化指数（RCI）确定主要或次要结果是否存在临床显著变化。
一半或更多的治疗完成者在大多数逆境后遗症领域经历了临床显著的变化，没有参与者经历了负性精神病症状的改善，并且一些参与者的物质滥用增加。就次要结果而言，许多参与者的功能和体验回避得到改善，而只有一名参与者的绝望感下降。参与者对 PE+治疗的满意度很高，暴露和应对技能被评为治疗中最有帮助的元素。
在接受 PE+治疗后，逆境后遗症减少，表明以逆境为重点的治疗可能对早期精神病患者人群有益。然而，观察到精神病症状或物质使用的积极变化很少。可能需要进一步将精神病和物质使用的治疗策略整合到 PE+中，以有效治疗精神病、逆境后遗症和物质使用之间的联系。未来的研究应努力将物质使用策略纳入精神障碍患者的逆境治疗试验中。
Clinicaltrials.gov，NCT04546178；注册日期：2020 年 11 月 9 日，https://clinicaltrials.gov/ct2/show/NCT04546178?term=NCT04546178&draw=2&rank=1。
