Are antipsychotic drugs or behavioral therapy beneficial for patients with psychosis? – Medical Information Bulletin

The researchers sought to determine whether antipsychotic drugs, cognitive-behavioral therapy, or a combination of both could

People with psychosis may meet the criteria of mental illness such as schizophrenia, schizoaffective disorder or delusional disorder.Some diagnostic criteria for schizophrenia may include feelings of persecution, delusions or hallucinations.

Previous clinical trials have has shown an advantage in treating some of these disorders with antipsychotic drugs and cognitive-behavioral therapy, but the benefits of each intervention vary from case to case: antipsychotic drugs and cognitive behavioral therapy (CBT), but side effects of antipsychotic drugs, such as increased mala-related deaths For the moment, the negative effects of CBT are not known

In a recent study published in The Lancet Psychiatry Morrison and his colleagues sought to further clarify the effects of CBT. effectiveness of cognitive-behavioral and antipsychotic therapy. pharmacotherapies, combined and individually. This British study was a blinded, controlled, randomized pilot trial of individuals aged 16 years or older who met the ICD-10 criteria for schizophrenia, schizoaffective disorder or delusional disorder among others. criteria.

26 received cognitive behavioral therapy alone, 24 received antipsychotics alone and 25 received both treatments. Most of the patients recruited received these interventions early at the first symptom, while two of them had previously been diagnosed previously.

Less Adverse Events in the TCC Group

The researchers used the PANSS score (Positive and Negative Syndrome Scale) to evaluate the effectiveness of treatments. They found a reduction in undesirable symptoms in all treatment groups. The combined treatment group showed a significant difference in scores compared to CBT alone, unlike the combined treatment group and the antipsychotic drug group. There was also no significant difference in scores between the TCC group and the group receiving antipsychotics.

In a 12-month observation, at the 6-month period, the greatest improvement (25% and 50% improvement) was seen in combination group treatment. However, this became indistinguishable from the other groups at the 12-month mark. There were fewer adverse events observed in the TCC group compared to the antipsychotic group and the combined treatment group. Between the combination treatment group and the antipsychotic group, adverse events were statistically similar.

Pilot trial can not provide definitive conclusions

Despite the significant effects of combined therapy on CBT alone (but not only with antipsychotics), the trial was still a pilot and feasibility trial . This type of test is not powerful enough to provide definitive conclusions about statistical differences observed between groups.

Although there were fewer side effects in the CBT group, this may be due to nonspecific symptoms, symptoms of another disorder, or another side effect. In addition, some patients from certain groups were admitted to the hospital. Reports of adverse events may have been biased by the level of exposure of some treatment groups to staff who reported these events.

The small number of participants in the study may also have affected the findings, and some participants eventually received another different treatment. from those that they were initially affected. There have also been instances of non-compliance for treatment in some patients. Finally, some data may be unexplained, as the use of other drugs

All treatments have shown benefits in the treatment of early psychosis

In conclusion, all treatment groups have shown some benefit in the treatment of early psychosis. However, it is important to note that this study should apply to patients eligible for early intervention services, and not to late schizophrenia.

The researchers point out that more tests of effectiveness and efficiency need to be done to support differences between treatment groups. seen in this study and that patient treatment decisions should be followed by national guidelines and an informed understanding of the patient.

Written by Olajumoke Marissa Ologundudu B.Sc. (Hons)

Reference: Morrison, PA and others Antipsychotic drugs for cognitive behavioral therapy versus a combination of both in individuals psychosis: a randomized controlled pilot and a feasibility study. Lancet Psychiatry (2018). doi: 10.1016 / S2215-0366 (18) 30096-8